To the extent specified by the Health Care and Health Insurance Act, compulsory health insurance in the Republic of Slovenia provides the following to insured persons:
Rights to health care services cover the services of primary health care, dental care, specialist outpatient care, hospital and tertiary activity, health resort treatment, ambulance services, treatment abroad, the right to prescription medicines, the right to medical and technical devices, the right to services in nursing homes, special social security institutions and education institutions, the right to follow-up rehabilitation for the disabled, participation in organised groups for education and vacationing for children and pupils, the right to escort and the right to health care services during travel and staying abroad.
With compulsory health insurance, insured individuals are provided with full (100%) payment of health care services, without additional payment, in the following cases:
- systematic and other preventive medical examinations of children, pupils, secondary-school students and university students in regular schooling; medical examinations of women in connection with pregnancy, and other adultspursuant to the specific programme, with the exception of preventive medical examinations provided by employers on the basis of the Act;
- early detection and prevention of diseases in line with the programme;
- treatment and rehabilitation of children, pupils and students in regular schooling, and children and adolescents with physical and mental disorders;
- health security of women linked to counselling on family planning, contraception, pregnancy, and labour,
- prevention, detection and treatment of HIV and contagious diseases with legally determined steps taken to prevent further spreading of disease;
- compulsory vaccinations, immunoprophylaxis, and chemoprophylaxis pursuant to the programme;
- treatment and rehabilitation of malignant diseases, muscular and neuromuscular diseases, paraplegia, tetraplegia, cerebral palsy, epilepsy, haemophilia, mental illnesses, developed types of diabetes, multiple sclerosis and psoriasis,
- treatment and rehabilitation for professional diseases and injuries at work;
- health care regarding the donation and exchange of tissues and organs for transplantation to other persons;
- emergency medical assistance, including emergency transportation;
- home-care visits, treatment and care at home and in social security institutions;
- prescription medicines in line with the classification of medicinal products, orthopaedic and other devices related to treatment of individuals and conditions referred to in the above indents;
- prescription medicines from the positive and interim list for children, pupils, high-school students, apprentices and university students and children with mental and physical disorders.
The extent of other rights to health care services is specified in a certain percentage of the value of the service, which was defined based on the Act by the HIIS Assembly
. This means that compulsory health insurance only covers services to a certain percentage of their price, which varies according to the group of conditions or reasons for treatment (e.g. injuries at work, outside work etc.). The difference to the full value must be covered by insured individuals from their own resources, or they may obtain supplementary health insurance to cover the additional payment. In this case, the additional payment is covered by the insurance company with which the insured individual concluded such insurance.
The rights deriving from the compulsory health insurance do not include:
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- aesthetic surgery services, except when needed due to the consequences of injuries, defects or diseases and when also associated with the elimination of functional impairment;
- services related to recuperation after acute alcohol intoxication;
- non-mandatory vaccination services;
- services of establishing health status enforced by the insured persons due to the requirements or regulations in other fields or with other bodies (with insurance companies, in criminal proceedings, issuing certificates for drivers of motor vehicles, measures related to occupational safety etc.);
- services needed to enforce rights from pension and disability insurance exceeding the extent of services defined in the list of compulsory medical documentation to enforce rights based on disability and remaining working ability, and services required by the disability committee;
- services of alternative diagnostics, treatment or rehabilitation not approved by the minister responsible for health;
- services performed at the request of the insured individual which are, according to their personal or referring physician, not necessary with respect to their health status.
Individuals who pay the cost of medicinal products or food products for special medical purposes (hereinafter: medicinal products) in the Republic of Slovenia which is a right derived from compulsory health insurance can file a claim for reimbursement of costs of medicinal products with their insurance company when they return to their country. They are advised to discuss with their national contact points as to which documentation must be attached to the application.
The main reasons for payment of medicinal products in the Republic of Slovenia are as follows:
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- the insured person enforced the right to the medicinal products without having adequate documentation (European Health Insurance Cards …),
- the medicinal products are not a right from the compulsory health insurance system in the Republic of Slovenia,
- additional payment to the full price of certain medicinal products,
Individuals who buy medical devices in the Republic of Slovenia which is a right derived from compulsory health insurance in their homeland can file a claim for reimbursement of costs of medical devices with their insurance company when they return to their country. They are advised to discuss with their national contact points as to which documentation must be attached to the application. More about it