Application forms

European Health Insurance Card

• Application to receive european health insurance card (EHIC)
• Application for a replacement EVAK certificate

E104 Form 

Exemption from patient co-payments 

• Application for exemption from patient co-payments

Application for a refund of a health insurance contribution

• Application for a refund of a health insurance contribution

Reimbursement of medicines on an individual basis

• Application for reimbursement of medicines on an individual basis

S Forms 

• Application for S1/E106 Form (for employed/self-employed person at the place of residence)
• Application for S1/E106 Form (for a business trip with a valid A1 certificate)
• Application for S1/E121 Form (for recipient of pension)
• Application for S1/E106 Form (for an unemployment benefit recipient with a valid U2 Form)
• S2 (E112) Form
• S1 Annex A on the child

Reimbursement of expenses for healthcare services received in another EU country, EEA country or Switzerland

• Application for reimbursement for healthcare services received and paid for in another EU country, European Economic Area country or Switzerland

Inclusion in the database of beneficiaries of healthcare services

• Application for inclusion in the database of beneficiaries of healthcare services

Unlocking patient registration with a general practitioner

• Application for unblocking patient registration with a general practitioner

Reimbursement of expenses for persons of low income

• Application for reimbursement of expenses incurred during the period of being recognised as a person of low income when covering the patient co-payment from one’s own pocket
• Application for reimbursement of expenses incurred during the period of being recognised as a person of low income when purchasing medicines and medical devices from one’s own pocket

Authorising another person to carry out activities on the eHealth portal, such as purchasing e-prescription medicines

• Application for authorisation to operate the single electronic health information system
• Application for a contact person in the single electronic health information system

Application to recognize vaccination performed outside European countries

• Application to recognize vaccination performed outside European countries

Application for other services

• Free-form application

List of reimbursable medicines 

• Application for inclusion of medicines in the list of reimbursable medicines
• Application for inclusion of medical devices in the list of reimbursable medicines
• Application for review of the conditions for reimbursement of medicines
• Application for review of the conditions for reimbursement of a medical device
• Application for revision of the reference reimbursement price for medicines
• Application for revision of the reference reimbursement price for medical devices
• Application for temporary reduction of the reference price of medicines
• Application for temporary reduction of the reference price of medical devices