Dla Pacjenta

As the National Health Fund (NFZ) we cannot pay for your treatment directly to the facility that treated you. The foreign healthcare provider (that is, for example, a hospital or clinic) should settle the costs of your treatment with the insurance institution of your home country.

Some costs may have to be borne by you. This is because, according to the coordination regulations¹, as a patient you have the same rights and obligations as those insured in the country of treatment. This means that if patients insured in that country pay for a service, you have to pay too - even if it would be free of charge under the NFZ treatment regime in Poland.

What you can do not to pay for treatment

You can ask the provider to cancel the bill and settle the costs of the services with the relevant institution in the country, e.g. the local insurance company. To do this, you must provide the provider with the relevant document confirming that you are eligible for treatment.

Send to the billing provider:

• a copy of the bill
• a copy of one of the two documents that was valid on the date of the services provided:

• European Health Insurance Card (EHIC) - only if your card was issued prior to the date you were provided with services
• Provisional Replacement Certificate (PRC) - only if your card was not issued prior to the date on which the benefits were provided to you; you can obtain the certificate retroactively from any branch of the National Health Fund.

If benefits were provided to you in Germany, please also enclose:

• a completed form 81 - you will receive this at the facility where you were provided with services 
• a copy of your identity document, e.g. identity card or passport.

Check the rules in the individual EU/EFTA countries.

What if the service provider does not cancel the bill

If the healthcare provider does not settle the costs of the services according to this procedure, pay the bill. This can happen, for example, if the provider:

• did not consider the benefits necessary
• operates only in the private sector
• has closed the billing period and can no longer cancel the bill.

Once you have paid the bill, you can apply to the NFZ for reimbursement of the treatment costs incurred.

 

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¹ Provisions on the coordination of social security systems with regard to the healthcare benefits in kind, set out in the Regulations of the European Parliament and of the Council No 883 of 29 April 2004 (OJ L 166) and No 987 of 16 September 2009 (OJ L 284)

You can apply for reimbursement if:

• you are entitled to healthcare benefits in Poland,
• you received treatment during a stay in an EU or EFTA Member State,
• you were treated under the public healthcare system,
• you have paid bills issued by a foreign healthcare provider.

In Poland, the following persons are entitled to healthcare benefits:

• insured persons (e.g. employed, retired) and their family members who are registered for insurance,
• non-insured persons under special entitlements (e.g. children under 18 who cannot be declared insured by a parent or grandparent).

When can you apply for reimbursement?

You can apply for reimbursement if:

• the treatment was necessary and unplanned,
• the treatment was planned, but you were granted authorisation by the National Health Fund,
• you have not been reimbursed for treatment under a private insurance policy.

Where to apply for reimbursement?

You can apply for reimbursement:

1. in the country where you obtained treatment – this is possible in countries such as Belgium, France and Switzerland;
2. in a dedicated branch of the National Health Fund, i.e. in the Shared Services Centre (Centrum Usług Wspólnych, CUW) in the Lubuskie Province Branch of the National Health Fund.

Are you a pensioner or a person insured as a family member and have received planned treatment?

You cannot apply to the National Health Fund for reimbursement of the costs of planned treatment if we have issued the S1 document for you (formerly forms E109/E121) and you have registered it in one of the following countries where the benefits are reimbursed on the basis of fixed amounts:

• Cyprus,
• Ireland,
• Spain,
• Portugal,
• Sweden,
• the United Kingdom.

You can then only apply for reimbursement in the country where you were treated.

1. Download, print, complete and sign the Application for reimbursement of medical costs incurred in another Member State of the European Union or the European Free Trade Association from our website.

Model application for reimbursement (DOC)

Model application for reimbursement (PDF)

Model authorization to submit an application

2. Attach to your application:

• original bills or invoices for your treatment,
• proof of payment for them,
• copies of prescriptions,
• other documents issued in connection with your treatment.

Your bills can be paid by anyone – you do not have to do it yourself. It is important that the payment slip clearly states that it relates to the costs of your treatment.

Please note. The amount of reimbursement for your treatment is determined by the insurance institution of the country where you received treatment. If you do not attach the required documents, it will refuse to determine the amount to be reimbursed. In that case, we will not reimburse you for the costs of your treatment.

Send the application together with the attachments to the mailing address of the Shared Services Centre (Centrum Usług Wspólnych, CUW) in the Lubuskie Province Branch of the National Health Fund.

CUW w Gorzowie Wielkopolskim – Lubuski Oddział Wojewódzki NFZ

ul. Pionierów 8

66-400 Gorzów Wielkopolski

An application sent to the address of the Head Office or another regional branch of the National Health Fund will be sent to the above-mentioned Shared Services Centre (CUW) in the Lubuskie Province Branch of the National Health Fund, which may prolong the application examination process.

You can find out the status of your application:

• by writing to: cuwgorzow@nfz-zielonagora.pl
• or by calling: 95 7336320

How to apply for reimbursement for private treatment?

You cannot exercise your entitlement to reimbursement for treatment under EU legislation if:

• you have been treated abroad in a private facility or by a private doctor,
• you have been treated abroad under the public healthcare system but the treatment was not considered necessary.

However, you can apply for reimbursement for such treatment under national legislation if you meet the requirements set out in the Act, e.g:

• you will apply for reimbursement within 6 months from the date of issue of the bill,
• you attach a referral or prescription to your application.

The amount of the reimbursement will be determined according to the rates applicable in Poland. We only reimburse the cost of benefits that are guaranteed benefits in Poland.

For information on reimbursement based on national legislation, see www.kpk.nfz.gov.pl

In this case, submit your application to your local branch of the National Health Fund. The Shared Services Centre (CUW) in the Lubuskie Province Branch of the National Health Fund only handles reimbursement requests under EU legislation.

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Legal basis

Articles 42b and 42d of the Act on publicly funded healthcare benefits

The process of determining the amount of reimbursement involves an exchange of information between the Shared Services Centre (CUW) in the Lubuskie Province Branch of the National Health Fund and the insurance institution of the country in which you were treated. Correspondence between these institutions is carried out using special documents: E126 or S067.

Process steps:

1. Based on your application, we check whether:

• you were entitled to benefits at the time of treatment,
• you have attached the required documents to your application, in particular all bills and proofs of payment.

2. If so, we initiate an EU procedure to determine the amount to be reimbursed. We describe it in the following paragraphs. If not, we send you a notice stating that you have been refused reimbursement of medical costs.
3. We send a request to the insurance institution of the country where you have been treated to determine the amount of reimbursement to which you are entitled. We do this on one of the following documents:

• E126 – for traditional, paper-based correspondence; we attach bills and proofs of payment to it,
• S067 – for electronic correspondence; we attach scans of the bills and proofs of payment to it,

4. The institution determines the amount of the reimbursement and enters it in document E126 or S068 (depending on which one it has received) and then sends it back to us.
   The processing time of our application by the foreign institution is beyond our control. We send a reminder if we do not receive a reply within 4 months.
5. We convert the reimbursement amount into the Polish zloty.
6. We pay you the reimbursement for the treatment as you indicated in your application:

• into your bank account,
• by postal transfer to your address.

Please note. We have no influence on the amount of the reimbursement. This is decided by the insurance institution of the country where you received treatment. The amount of the reimbursement may not be higher than the costs you actually incurred, as evidenced by the bills attached to your application.

Patient’s own contribution (down payment, co-payment, co-funding amount) – this is the mandatory payment for treatment charged by the foreign healthcare provider directly to the patient. It applies in most EU or EFTA Member States. The amount is set by the legislation of the relevant country – usually as a percentage of the total cost of the benefit or as a fixed fee. It is not reimbursable.

Reimbursement – this is the process of determining the amount to be reimbursed by the insurance institution of an EU or EFTA State Member in respect of the costs of treatment incurred by an insured person in another country, provided under the provisions on coordination in the EU.

Form E126 – this is an EU document for the paper exchange of information between insurance institutions about the amount of reimbursement to an insured person who has incurred costs for treatment provided under the provisions on coordination.

Document S067/S068 – these are EU documents for the electronic exchange of information between insurance institutions about the amount of reimbursement to an insured person who has incurred costs for treatment provided under the provisions on coordination.

 

What conditions do I have to meet to be reimbursed for medical costs?

You will be reimbursed for medical costs if:

• you are covered by health insurance from the National Health Fund,
• you have been treated in another EU or EFTA Member State,
• the treatment was necessary and urgent or planned but you had prior authorisation,
• you have paid bills for the treatment issued by a foreign healthcare provider,
• you will submit an application for reimbursement of medical costs, together with the attachments.

You can apply for reimbursement even if you do not have the EHIC.

Am I entitled to reimbursement if my treatment was planned?

Yes, provided you have been granted authorisation for the treatment. Authorisation is issued on E112 or S2 documents. With S2 or E112 documents, you should not incur any costs.

Legal basis

Article 42b of the Act on publicly funded healthcare benefits

Who determines the amount of the reimbursement?

The country where you received treatment.

How does it work?

1. We will issue an E126 or S067 document (electronic document) based on your application for reimbursement and the bills and proof that you have paid them.
2. We forward them to the insurance institution in the country where you were treated, together with a request concerning the amount of reimbursement to which you are entitled.
3. The institution determines the amount of the reimbursement and enters it in document E126 or S068 and then sends it back to us.
4. We convert the reimbursement amount into the Polish zloty.
5. We reimburse you for your treatment.

Why is the amount of my reimbursement for medical costs much lower than my bills say?

In most EU and EFTA Member States, there is an obligation to co-pay for treatment (patient’s own contribution). If you are being treated in such a country, you are treated in the same way as its citizens, so you also pay these costs. We do not reimburse them. We also do not reimburse the costs of treatment in private facilities or treatment that is not covered in the country in question (i.e. not covered by public insurance).

When will I be reimbursed for my treatment costs?

This depends on how long it takes for the insurance institution of the country where you were treated to respond. It determines the amount of the reimbursement and passes it on to us on document E126 or S068. We will send a reminder if we do not receive a reply within 4 months.

ow to avoid paying for treatment in other EU and EFTA Member States?

1. Emergency and essential treatment – apply for the EHIC and take it with you when you travel. However, in most EU and EFTA Member States, there is an obligation to co-pay for medical treatment and you have to pay these costs yourself.

If you want to reduce your co-payment risk, consider taking out additional commercial insurance.

2. Planned treatment – obtain prior authorisation from the National Health Fund

I am retired and live outside Poland. Where do I send my application for reimbursement of medical costs?

It depends on your situation. If:

• you have the S1 document (formerly E121) – send the application for reimbursement of medical costs to the branch of the National Health Fund indicated on your health insurance application, i.e. to the branch in the province where you lived in Poland,
• you have the S1 document (formerly E121), but it was registered in one of the countries where the benefits are reimbursed on the basis of fixed amounts* listed below and you paid for planned treatment – send the application for reimbursement of medical costs of such planned treatment to the insurance institution of the country where you are treated.

 

*Countries where the benefits are reimbursed on the basis of fixed amounts:

• Cyprus,
• Ireland,
• Spain,
• Norway,
• Portugal,
• Sweden,
• the United Kingdom.

Legal basis

Article 26(1) of Regulation 987/2009