Application forms

European Health Insurance Card

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

E104 Form 

• Information on the preparation of the application for the E104 Form (includes information on the person's periods of insurance in the country where the form is issued)

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