Planned medical treatment abroad due to excessive waiting period in Slovenia
To obtain the right to medical treatment abroad due to excessive waiting period in Slovenia you have to meet the following conditions:
- have health insurance in Slovenia,
- be placed on a waiting list at a healthcare provider in Slovenia,
- have a set appointment at a healthcare provider in Slovenia,
- have an authorisation from the ZZZS to receive medical treatment abroad due to exceeding the maximum allowed waiting period or a reasonable time frame at all healthcare providers in Slovenia (before or after receiving treatment) and
- undergo treatment in another EU Member State, EEA Member State or Switzerland,
- the selected healthcare provider in the EU Member State, EEA Member State or Switzerland is part of the public healthcare network in this country.
Waiting periods
Review of waiting periods in Slovenia
The terms waiting time, maximum permissible waiting time, waiting period, waiting list and reasonable time frame are defined in detail in the regulations governing patients’ rights.
Authorisation procedure of planned medical treatment abroad due to excessive waiting period in Slovenia
Fill out the Application for authorisation of planned medical treatment abroad due to excessive waiting period in Slovenia with the following data:
- personal data and data on your supplementary insurance (insurance company, insurance policy number),
- data on the representative or proxy holder, if any,
- data on the medical referral (name of the selected healthcare provider abroad which is part of the public healthcare network, the country in which you intend to undertake the treatment and a short explanation regarding the medical referral).
Submit the following with the application:
- supporting documents showing you are registered on a waiting list at a healthcare provider in Slovenia,
- supporting documents showing a treatment date in Slovenia and at which healthcare provider,
- medical records on your medical treatment in Slovenia to date.
Submit the signed application for authorisation, together with all annexes, to the ZZZS, Regional unit Ljubljana.
Possible ways of submitting the application:
- by mail: Miklošičeva cesta 24, 1000 Ljubljana or
- by email: OELJ@zzzs.si or
- in person: Mala ulica 3, 1000 Ljubljana.
As part of the authorisation procedure of medical treatments abroad, the ZZZS shall determine whether the maximum permissible waiting period for a specific service is exceeded and whether there is no other healthcare provider in Slovenia where this waiting period would not be exceeded.
If the ZZZS determines that the maximum allowed waiting period is exceeded at all healthcare providers in Slovenia, it shall authorise your treatment in another country in the EU, EEA or Switzerland.
Prior to authorising the treatment, the ZZZS shall seek an opinion of the clinic or institute on the estimated duration of the treatment, examination or test, the need for an escort, the need for and type of transport and the closest healthcare provider that could provide the suggested treatment, examination or test abroad.
After obtaining the opinion of the relevant clinic or institute, the ZZZS shall decide on the merit of a treatment abroad (it issues a decision on the authorisation of a planned medical treatment abroad).
If the ZZZS determines that the maximum allowed waiting period is not exceeded and that there is at least one healthcare provider in Slovenia which can provide treatment within the maximum allowed waiting period, the ZZZS shall determine whether the reasonable time frame period is exceeded.
In order to determine whether the reasonable time frame is exceeded, the ZZZS shall request a written opinion of the clinic or institute on the matter, whether in view of your position on the waiting list the expected waiting time exceeds the reasonable time frame.
After obtaining an opinion of the relevant clinic or institute, the ZZZS shall decide on the merit of a treatment abroad (it issues a decision on the authorisation of a planned medical treatment abroad).
Coverage of costs of the planned medical treatment abroad due to excessive waiting period in Slovenia
If the ZZZS authorises your medical treatment in an EU Member State, EEA Member State or Switzerland due to excessive waiting period in Slovenia, it will issue you a form S2 for assuming the costs and you submit the form to the healthcare provider abroad.
The selected healthcare provider in an EU Member State, EEA Member State or Switzerland must be part of the relevant country’s public healthcare network.
Travel, food, accommodation and escort costs
If the ZZZS authorises your treatment abroad, it will also decide on your right to reimbursement of travel, food, accommodation and escort costs.
After your treatment abroad, fill out the Application for reimbursement of costs of your planned medical treatment abroad due to excessive waiting period in Slovenia with the following data:
- personal data and data on your supplementary insurance (insurance company, insurance policy number),
- information on your bank account, to which the funds shall be transferred,
- data on the representative or proxy holder, if any,
- data on the previously issued decision of the ZZZS,
- data on the medical referral.
Submit the following with the application:
- original invoice and proof of payment of the medical and other services rendered (accommodation),
- supporting documents on the medical treatment abroad,
- travel itinerary (departure time and date, arrival time and date, kilometres travelled etc.),
- tickets or other supporting documents showing that the transport was paid for.
Submit the signed application for reimbursement of costs together with all annexes:
Reimbursement of costs of a medical treatment received if you had no prior authorisation of the ZZZS
Fill out the Application for the coverage of costs of planned medical treatment abroad due to excessive waiting period in Slovenia with the following data:
- personal data and data on your supplementary insurance (insurance company, insurance policy number),
- information on your bank account, to which the funds shall be transferred,
- data on the representative or proxy holder, if any,
- data on the medical treatment you received abroad.
Submit the following with the application:
- medical records on your medical treatment in Slovenia to date,
- medical records on the medical treatment you received abroad,
- supporting documents showing you are registered on a waiting list at a healthcare provider in Slovenia,
- supporting documents showing a treatment date in Slovenia and at which healthcare provider,
- original invoice and proof of payment of the invoice for the medical treatment you received abroad,
- original invoice and proof of payment for other services (accommodation),
- travel itinerary (departure time and date, arrival time and date, kilometres travelled etc.),
- tickets or other supporting documents showing that the transport was paid for.
Submit the signed application for reimbursement of costs together with all annexes to the ZZZS, Regional unit Ljubljana.
Possible ways of submitting the application:
- by mail: Miklošičeva cesta 24, 1000 Ljubljana or
- by email: OELJ@zzzs.si or
- in person: Mala ulica 3, 1000 Ljubljana.
Based on the submitted application and relevant supporting documents, the ZZZS retroactively determines whether you have gotten a date when registering on the waiting list at a healthcare provider in Slovenia that exceeds the maximum aloowed waiting period or reasonable time frame and there is no other healthcare provider in Slovenia where this time period would not be exceeded.
If the ZZZS authorises your medical treatment abroad, it will also decide on your right to reimbursement of the treatment costs and eventual travel, accommodation and escort costs.
Amount of reimbursement of costs of planned medical treatment abroad due to excessive waiting period in Slovenia
The ZZZS shall reimburse costs of medical services to the amount the service in question costs in the public healthcare network in the country where you received the treatment. The ZZZS shall obtain information on the amount of the reimbursement from the foreign insurance institution.
The ZZZS shall reimburse transportation, food, escort and accommodation costs in accordance with its decision on the authorisation of the treatment and regulations on health insurance.
Legal basis
Competent authority
Health Insurance Institute of Slovenia (ZZZS)
Applications
Before going for medical treatment abroad:
Application for authorisation of planned medical treatment abroad due to excessive waiting period in Slovenia
After having received medical treatment abroad:
Application for reimbursement of costs of the planned medical treatment abroad due to excessive waiting period in Slovenia
