Planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia
To obtain the right to medical treatment abroad on the basis of a medical referral from a doctor in Slovenia you have to meet the following conditions:
- have health insurance in Slovenia,
- have a medical referral from a doctor in Slovenia before going abroad for treatment,
- receive medical services abroad which you are entitled to under the compulsory health insurance in Slovenia,
- undergo treatment in another EU Member State,
- have prior authorisation of the ZZZS, if you will also claim coverage of healthcare services that demand spending a night at the hospital,
- have prior authorisation of the ZZZS, if you will claim coverage of healthcare services abroad which are on the list for prior authorisation.
Authorisation procedure of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia
You require prior authorisation of the ZZZS if you will receive the following in an EU Member State:
Fill out the Application for authorisation of planned medical treatment abroad on the basis of a medical referral from a doctor 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 in an EU Member State, 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 application for approval, 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.
Prior authorisation shall not be granted if:
- the medical service can be provided within the maximum allowed waiting period from at least one healthcare provider in Slovenia,
- you will be, with reasonable certainty, exposed to risk that cannot be deemed acceptable,
- on account of the medical service that is the subject of prior authorisation, the general public will be exposed to risk with reasonable certainty.
As part of the authorisation procedure of the medical treatment abroad, the ZZZS shall determine whether the maximum allowed 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.
If the ZZZS determines that the maximum allowed waiting period is not exceeded and that there is at least one healthcare provider in Slovenia that can provide treatment within the maximum allowed waiting period, the ZZZS shall determine whether a reasonable time frame is exceeded.
In order to determine whether a 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 a reasonable time frame.
After obtaining an opinion from the relevant clinic or institute, the ZZZS shall decide on the merit of a treatment abroad (it issues a decision on the authorisation of the planned medical treatment abroad).
Cost coverage of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia
You pay for treatment in an EU Member State yourself and afterwards claim reimbursement of the costs. This also applies if you had prior authorisation of the ZZZS.
Fill out the Application for reimbursement of costs of planned medical treatment abroad on the basis of a medical referral from a doctor 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,
- if you had prior authorisation of the ZZZS, data on the authorisation,
- data on the medical treatment you received abroad.
Submit the following with the application:
- original invoice and proof of payment of medical and other services rendered (accommodation),
- medical records on the medical treatment you received abroad,
- proof that you had a medical referral from your doctor in Slovenia (if you had prior authorisation of the ZZZS you do not need to submit any such proof).
Submit the signed application for reimbursement of costs together with all annexes:
You are not entitled to reimbursement of medical costs abroad in case of:
- medical services in a basic medical practice (services of a chosen personal physician, dentist, gynaecologist etc.),
- medical services in the field of long-term care, including non-emergency hospital treatments and care in social security institutions,
- medical services in the field of obtaining and transplanting parts of the human body,
- medical services in the field of screening programmes,
- cohabitation of one of the parents in a healthcare institution with a sick child up to 5 years of age,
- medical devices that you rent as accessories for treatment, care and rehabilitation at home,
- training a guide dog, to which a blind person in entitled to,
- travel costs and escort costs.
Amount of reimbursed costs of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia
The ZZZS shall reimburse costs in the amount of the average price of such services in Slovenia, but not exceeding the actual costs.
If the price of the service is higher in Slovenia, the actual cost of the service in another EU Member State shall be reimbursed.
The ZZZS shall reimburse part of the average price covered by compulsory health insurance, the rest you claim from your insurance company with which you have concluded a contract for supplementary health insurance.
You can check the average prices of medical services in Slovenia using the Informative calculator.
The displayed prices are given merely for information and include the part covered by compulsory health insurance as well as the part covered by supplementary health insurance.
The ZZZS shall not reimburse you any travel and accommodation costs.
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 on the basis of a medical referral from a doctor in Slovenia
After having received medical treatment abroad:
Application for reimbursement of costs of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia
