Provision of Services in the EU and Prior Authorizations

18.08.2017.  |   Print

The Cross-border Healthcare Directive envisages reimbursement for the expenses for scheduled healthcare services received in another EU member state, Norway, Iceland, Switzerland and Liechtenstein (the inhabitants of Latvia may apply for a reimbursement in accordance with the tariffs for the healthcare services effective in Latvia).

  • When receiving a healthcare service in another member state, the patient shall receive from their country the amount fixed for the service in the home country of the patient (here – in Latvia), but not exceeding the amount the patient has actually paid for such service.
  • Only the healthcare services covered from the national budget in the home country (here – Latvia) can be reimbursed. The patient shall arrange and pay for the transportation and accommodation as well as pay to the provider of the healthcare services in advance. 
  • A special permission is required for some services in other EU member states, Norway, Liechtenstein, Iceland and Switzerland.

Procedure for Obtaining the Prior Authorization

The National Health Service shall decide on the issue of the prior authorization for the following scheduled healthcare services in another EU, EEA (Norway, Iceland, Liechtenstein) member state or in Switzerland:

  • endoprosthesis replacement of the large joints in an in-patient facility;
  • cardiac surgery treatment in an in-patient facility (e.g., myocardial revascularisation; coronary artery bypass surgery, mamaro-coronary bypass surgery; cardiac tumour surgery; valve plastic surgery; correction of congenital cardiac conditions, a.o.);
  • medical rehabilitation in an in-patient facility;
  • surgical services in ophthalmology (such as cataract, glaucoma surgeries);
  • medical fertilisation.

The National Health Service shall refuse to issue the prior authorization:

  • for healthcare services provided within clinical studies or involving the use of an experimental medical technology;
  • in cases when the healthcare service can be received in the territory of the Republic of Latvia within the following timelines:

- endoprosthesis replacement of the large joints in an in-patient facility and medical fertilisation – 5 years;

- cardiac surgery treatment in an in-patient facility and medical rehabilitation in an in-patient facility - 12 months;

- surgical services in ophthalmology – 24 months.

The waiting list shall not be taken into account when waiting is not possible due to the health condition of the patient and the expected progression of the disease, and this is specified in the medical documentation submitted by the patient (for in-patient facility services, this shall be specified in the conclusion of a panel of doctors; for outpatient services, this shall be specified in the referral).


Use of Prescriptions in Other EU Member States

According to the Cross-border Healthcare Directive, patients may purchase medicinal products against the issued prescription not only in their home country, but also in another EU member state, Norway, Iceland, Switzerland and Liechtenstein (except for narcotic or psychotropic medicines or narcotic analgesics).

Important!

1) The patient shall notify the doctor if they plan to purchase any medicinal products in another EU member state, Norway, Iceland, Switzerland or Liechtenstein.

2) If the patient has informed that they intend to use the prescription in another European Union member state, Norway, Iceland, Switzerland or Liechtenstein, the doctor shall additional specify the following in the prescription:

- the date of birth of the patient in the patient data part;

- additional details in the healthcare professional data part (e-mail address and telephone or fax number (including the country code)).

- include the following in the name of the medicinal product:

- the international non-proprietary name of the medicinal product or, in case there is no such name, the approved common name of the medicinal product, or

- the trade name given by the manufacturer in case the medicinal product must not be replaced (sentence "Zāles atļauts aizvietot" (The medicinal product can be replaced) shall be crossed out and the reason for the prohibition shall be given), or

- the trade name given by the manufacturer of the medicinal product if a medicinal product of biological origin is prescribed.

The National Health Service will continue to issue the prescription forms printed before 25 October 2013 till 1 July 2014 to assure gradual transition to the new prescription forms.

Important!                                                                                                                                                             

In case a patient has purchased medicinal products reimbursed in Latvia in another EU member state, they may be reimbursed for the price of such medicinal products in the amount they are reimbursable in Latvia.


APPLICATIONS

Prior authorization

To obtain a prior authorization for an EU, EEA member state or Switzerland and in order to be reimbursed for the treatment expenses, the following documents shall be submitted to the Central Office of the National Health Service:

  • the application containing the name, surname, identity number, address, telephone number or e-mail address of the individual, the healthcare service for which the advance permission is requested, the state in which the individual plans to receive the healthcare service;
  • the referral issued by the family doctor (GP) or specialist;
  • in case it is planned to receive a healthcare service in an in-patient facility, the conclusion of the panel of doctors of the respective medical institution with information about the healthcare service to be provided to the individual;
  • the statement issued by the medical institution regarding inclusion of the individual into the waiting list for the respective healthcare service (with specified time when the individual would be able to receive the necessary healthcare services in Latvia).

Reimbursement for Expenses

To be reimbursed for the expenses for healthcare services in an EU, EEA member state or in Switzerland (covered from the personal resources), the following documents shall be submitted to the Central Office of the National Health Service:

  • the application containing the name, surname, identity number, address, telephone number or e-mail address of the individual, the individual’s bank account details; the state in which the healthcare services have been received; the name, registration number and address of the healthcare service provider; a description of the reasons for the receipt of the healthcare services in the other EU, EEA member state or in Switzerland. If the individual requests that they be reimbursed for their expenses for healthcare services received based on the prior authorization issued by the National Health Service, the date and number of the decision shall be provided;
  • the documents confirming the payments (where the payer can be identified);
  • the documents issued by the healthcare service provider and containing the healthcare services provided to the individual; the time of provision of the healthcare services; the prices of each of the healthcare services provided to the individual, the proof of payment for the provided healthcare services, and a notarised translation of these documents;
  • the prescription or the referral issued by the family doctor (general practitioner) or specialist (no referral is necessary if the patient has turned to a directly accessible specialists) if the individual has received scheduled healthcare services (including those according to the special permission);
  • a confirmation that the individual is not insured under another social insurance plan.

Use of the EHIC

Like until now, the residents of Latvia may receive the European Health Insurance Card (EHIC) to be able to travel to other EU member states, Liechtenstein, Norway, Iceland or Switzerland and, if necessary, produce the EHIC in order to receive emergency and necessary medical care on the same conditions as such care is provided to the residents of the respective state.