Source: http://www.cleiss.fr/particuliers/partir/soins/ue/soins-programmes-ue-eee_en.html
Timestamp: 2017-10-19 07:04:46
Document Index: 512432072

Matched Legal Cases: ['Art. 20', '§1', '§2', '§3', 'Art. 27', '§3', 'Art. 26', '§1']

If you travel to another EU or European Economic Area (Iceland, Liechtenstein, and Norway) member State to receive health care
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If you are a member* (or the beneficiary of a member) of a French social security scheme, you may qualify for coverage of your healthcare expenses when you go to another EU or European Economic Area (Iceland, Liechtenstein, and Norway) member state in order to receive medical treatment.
In order to be covered for certain types of scheduled care (particularly extensive treatment) in another EU or European Economic Area (Iceland, Liechtenstein, and Norway) member State, prior authorization from the French health insurance fund is required.
* salaried or self-employed worker, unemployment benefits recipient, resident, pensioner, etc.)
Scheduled treatment subject to prior authorization
Scheduled treatment not subject to prior authorization
On the European Commission website
Video : "Before you leave"
Brochure : "Seeking treatment in another EU member State : your rights" "
1. Scheduled treatment subject to prior authorization
art. R-160-2 of the Social Security Code
decree of May 27, 2014
(JORF of 08.06.2014)
Before you leave, you must apply for prior authorization of coverage for care requiring at least a one-night hospital stay or the use of highly specialized and costly medical equipment or facilities.
Treatments subject to prior authorization are as follows:
Care requiring the use of major medical equipment : scintillation camera with or without a positron coincidence detection system, positron emission tomography, positron camera, clinical nuclear magnetic resonance imaging or spectroscopy, CT scanner, hyperbaric chamber, medical cyclotron,
Ambulatory carpal tunnel and other superficial nerve release procedures, as well as other surgical hand procedures,
Clinical and biological assisted reproductive technology procedures and biological prenatal diagnostics activities.
If approved, you will be issued a portable S2 certificate for coverage in the country you are visiting. If you pay all or part of your expenses upfront, you will be able to apply to your French health insurance fund for a reimbursement when you come back to France.
The portable S2 certificate
Art. 20 §1, §2 and §3 of (EC) Regulation No. 883/04
Art. 27 §3 of (EC) Regulation No. 883/04
Art. 26 §1 of (EC) Regulation No. 987/09
The portable S2 certificate, « Entitlement to scheduled treatment », authorizes you to travel to another EU or European Economic Area (Iceland, Liechtenstein, and Norway) member state to receive medical care. It means that your care will be covered as provided by local law and according to local rates. Indeed, you will receive the same care as members of the local social security system.
You will need to request this document from your French health insurance fund. Your application must specify the type of care you are planning to receive and list the medical reasons behind your request to receive care abroad, including a doctor's opinion if necessary.
Your authorization will not be granted automatically. Indeed, the following conditions apply:
The care or treatments you plan to receive abroad must be covered by the French social security system;
This care or treatment must be appropriate to your condition;
This care must not be available in France, within a medically acceptable time frame, in light of your current state of health and the expected course of your illness.
In the member State you are visiting, you will need to show your S2 certificate either to one of the local health insurance fund or directly to your health care provider so that your care is covered locally pursuant to local law.
Requesting reimbursement when you return to France
If you paid your medical expenses upfront, you can submit your paid invoices to your health insurance fund to request reimbursement.
The fund will examine your request for reimbursement. In particular, it will check whether prior authorization was granted and whether the conditions for reimbursement provided by French law, such as the requirement for a prior agreement or a medical prescription, were met.
Where applicable, the fund will reimburse you for your care based on Social Security rates in the country where the care was provided or, if you so request, based on French Social Security rates up to a maximum of actual expenses. A supplement can be considered if the foreign rates are lower than the French rates for the same treatment: the French health insurance fund will issue a supplementary reimbursement, up to a maximum of your upfront expenses.
For example, for a procedure billed 150 euros, if you were issued a 100-euro reimbursement in the foreign country and the French social security rate is 150 euros, you may receive a 50-euro supplement from your French fund.
2. Scheduled treatment not subject to prior authorization
art. L315-1 & L315-2 of the Social Security Code
Coverage of other scheduled care, particularly standard ambulatory care, is not subject to prior authorization from your local French health insurance fund. However, certain types of care or treatment may be subject to prior authorization from the French system:
Certain cholesterol-lowering drugs,
Before you leave, ask your health professional in France if prior authorization is required. If so, it is also required if the care is provided outside France.
If you have paid for your treatment upfront in the foreign country, you can apply for reimbursement.
•	The fund will examine your request for reimbursement. In particular, it will check whether prior authorization was granted and whether the conditions for reimbursement provided by French law, such as the requirement for a prior agreement or a medical prescription, were met.
Where applicable, the fund will reimburse you for your care only based on French Social Security rates up to a maximum of actual expenses.