natgillin/translations-raw huggingface dataset:
Država članica zdravstvenega zavarovanja v skladu z določbami iz členov 8 in 9 zagotovi, da se stroški, ki jih ima zavarovana oseba, ki prejme čezmejno zdravstveno varstvo, povrnejo, če zadevno zdravstveno varstvo sodi med storitve, zagotovljene z zakonodajo, upravnimi predpisi, smernicami ter kodeksi ravnanja v zdravstvenih poklicih, do katerih je zavarovana oseba upravičena v državi članici svojega zdravstvenega zavarovanja.
Subject to the provisions of Articles 8 and 9, the Member State of affiliation shall ensure the costs incurred by an insured person who receives cross-border healthcare are reimbursed, if the healthcare in question is among the benefits provided for by legislation, administrative regulations, or guidelines or codes of conduct of the medical professions, to which the insured person is entitled in the Member State of affiliation or is equally effective to healthcare that is among those benefits .
Države članice se lahko odločijo, da povrnejo stroške samo za metode zdravljenja, ki so v mednarodni medicini zadostno preskušene in testirane.
Member States may choose to only reimburse such methods of treatment that are sufficiently tried and tested by international medical science. .
Država članica zdravstvenega zavarovanja, brez poseganja v Uredbo (ES) št. 883/2004, državi članici zdravljenja ali zavarovani osebi povrne stroške, ki bi bili plačani iz obveznega sistema socialne varnosti za enako učinkovito zdravstveno varstvo na njenem ozemlju.
Without prejudice to Regulation (EC) No 883/2004, the Member State of affiliation shall reimburse the costs to the Member State of treatment or the insured person which would have been paid for by its statutory social security system had equally effective healthcare been provided o n its territory.
Če država članica zdravstvenega zavarovanja zavrne povračilo stroškov tovrstnega zdravljenja, svojo odločitev strokovno utemelji.
If the Member State of affiliation refuses to reimburse this treatment, that Member State shall give a medical justification for its decision.
Katere storitve zdravstvenega varstva so plačane ne glede na kraj izvajanja, v vsakem primeru določi država članica pacientovega zdravstvenega zavarovanja.
In any event, it is for the Member State of affiliation to determine the healthcare that is paid for regardless of where it is provided.
Ne glede na Uredbo (ES) št. 883/2004 bi morali pacienti z redkimi boleznimi na podlagi predhodne objektivne klinične ocene po členu 9(3) imeti pravico dostopa do zdravstvenega varstva v drugi državi članici, četudi zadevno zdravljenje ni med storitvami, ki jih zagotavljajo zakonodaja, upravni predpisi, smernice ter kodeksi ravnanja v zdravstvenih poklicih države članice pacientovega zdravstvenega zavarovanja.
Without prejudice to Regulation (EC) No 883/2004, on the basis of a prior objective clinical examination subject to A rticle 9 (3) , patients affected or suspected to be affected by rare diseases shall have the right to access healthcare in another Member State and to receive reimbursement even if the diagnosis or treatment in question is not among the benefits provided for by legislation, administrative regulations, or guidelines or codes of conduct of the medical professions, of the Member State of affiliation.
Za takšno zdravljenje se zahteva predhodna odobritev.
Such treatment shall be subject to prior authorisation.
Ker je diagnosticiranje redkih bolezni že prva težava, s katero se srečajo pacienti, bi klinična ocena pomagala pri določanju suma na redko bolezen ter v takih primerih omogočila dostop do čezmejnega zdravstvenega varstva in povračil, četudi država članica zdravstvenega zavarovanja ne krije zadevnih metod zdravljenja.
As diagnosis of rare diseases is the first difficulty met by patients, a clinical examination would enable to determine also the suspicion of rare diseases and then should open the possibility for such cases to have access to cross border healthcare and reimbursement even if the treatment methods are not among the benefits provided by the Member State of affiliation.
Člen 7 – odstavek 1a (novo)
Article 7 – paragraph 1 a (new)
Zavarovana oseba stroške, ki presegajo raven stroškov, ki jih povrne država članica njenega zdravstvenega zavarovanja, krije sama, razen če država članica zavarovanja odloči, da ji povrne tudi stroške, ki to raven presegajo.
Any costs incurred by the insured person over and above the level reimbursed by the Member State of affiliation shall be borne solely by the insured person, unless the Member State of affiliation decides also to reimburse the insured person for the costs incurred in excess of that level.
Veljavne omejitve za povračilo stroškov zavarovanim osebam s strani držav članic njihovega zavarovanja so jasno navedene v odstavku 4 tega člena.
The limits applying to the reimbursement of insured persons by the Member State of affiliation are clearly indicated in paragraph 4 of this Article.
Vendar bi bilo v skladu s ciljem (izraženim v členih 5 in 6), da je treba pacientom zagotoviti jasne informacije, dobro pojasniti, da če stroški zavarovane osebe presegajo raven stroškov, ki jih povrne država članica njenega zavarovanja, mora razliko kriti zavarovana oseba.
However, in accordance with the aim – expressed in Articles 5 and 6 – of providing patients with clear information, it would be well to clarify that, if the costs incurred by the insured person exceed the level reimbursed by the Member State of affiliation, the difference in cost must be borne by the insured person.
Ta določba seveda državi članici zavarovanja ne sme onemogočiti, da bi zavarovanim osebam povrnila vse stroške ali v večjem obsegu.
Naturally, this provision must not preclude the Member State of affiliation from reimbursing the insured person in full, or to a greater extent.
Stroške čezmejnega zdravstvenega varstva povrne država članica zdravstvenega zavarovanja do višine stroškov, ki bi jih prevzela država članica zdravstvenega zavarovanja, če bi bilo zdravstveno varstvo zagotovljeno na njenem ozemlju, ne da bi prekoračili dejanske stroške prejetega zdravstvenega varstva.
The costs of cross-border healthcare shall be reimbursed by the Member State of affiliation up to the level of costs that would have been assumed by the Member State of affiliation, had this healthcare been provided in its territory without exceeding the actual costs of healthcare received.
Stroške čezmejnega zdravstvenega varstva v skladu z določbami te direktive povrne ali neposredno plača država članica zdravstvenega zavarovanja do višine stroškov, ki bi jih prevzela, če bi bilo zdravstveno varstvo zagotovljeno na njenem ozemlju, ne da bi pri tem prekoračili dejanske stroške prejetega zdravstvenega varstva.
The costs of cross-border healthcare shall be reimbursed or paid directly by the Member State of affiliation in accordance with the provisions of this Directive up to the level of costs that would have been assumed by the Member State of affiliation, had this healthcare been provided in its territory without exceeding the actual costs of healthcare received.
Države članice se lahko odločijo, da krijejo druge, s tem povezane stroške, na primer stroške terapevtskega zdravljenja in nastanitve ter potne stroške.
Member States may decide to cover other related costs, such as therapeutic treatment and accommodation and travel costs.
Dodatne stroške, ki lahko nastanejo zaradi ene ali večplastne invalidnosti, kadar je čezmejnega zdravstvenega varstva deležna invalidna oseba, povrne država članica zdravstvenega zavarovanja v skladu z nacionalno zakonodajo in pod pogojem, da za te stroške obstaja zadostna dokumentacija.
The extra costs which persons with disabilities might incur when receiving cross-border healthcare due to one or more disabilities shall be reimbursed by the Member State of affiliation in accordance with national legislation and on the condition that sufficient documentation setting out these costs exists.
PS 68 iz prve obravnave
am 68 of first reading
Države članice za namene odstavka 4 določijo mehanizem za izračun stroškov čezmejnega zdravstvenega varstva , ki jih mora država članica zdravstvenega zavarovanja povrniti zavarovani osebi .
For the purposes of paragraph 4 , Member States shall have a mechanism for calculation of costs of cross-border healthcare that are to be reimbursed to the insured person by the Member State of affiliation .
Ta mehanizem temelji na vnaprej znanih objektivnih, nediskriminatornih merilih.
This mechanism shall be based on objective, non-discriminatory criteria known in advance.
Države članice za namene tega odstavka določijo pregleden mehanizem za izračun stroškov čezmejnega zdravstvenega varstva.
For the purposes of this Article , Member States shall have a transparent mechanism for the calculation of costs of cross-border healthcare.
Ta mehanizem temelji na vnaprej znanih objektivnih, nediskriminatornih merilih in se uporablja na ustrezni (lokalni, regionalni ali nacionalni) upravni ravni.
The mechanism shall be based on objective, non-discriminatory criteria known in advance and applied at the relevant (local, regional or national) administrative level.
Država članica zdravstvenega zavarovanja lahko za zavarovano osebo, ki želi povračilo stroškov čezmejnega zdravstvenega varstva , vključno s storitvami zdravstvenega varstva prek telemedicine, uporabi enake pogoje, merila o izpolnjevanju pogojev ter regulativne in upravne formalnosti, bodisi na lokalni, regionalni ali nacionalni ravni, ki bi jih naložila, če bi bilo zdravstveno varstvo zagotovljeno na njenem ozemlju.
The Member State of affiliation may impose on an insured person seeking reimbursement of the costs of cross-border healthcare, including healthcare received through means of telemedicine, the same conditions, criteria of eligibility and regulatory and administrative formalities, whether set at a local, regional or national level, as it would impose if this healthcare were provided in its territory.
Vendar pa pogoji, merila o izpolnjevanju pogojev ter regulativne in upravne formalnosti, naložene v skladu s tem odstavkom, ne smejo biti diskriminatorne oziroma ne smejo predstavljati neutemeljene ovire za prosti pretok blaga , oseb ali storitev .
However, no conditions, criteria of eligibility and regulatory and administrative formalities imposed according to this paragraph may be discriminatory or constitute an unjustified obstacle to the free movement of goods, persons or services .
Država članica zdravstvenega zavarovanja lahko za zavarovano osebo, ki želi uporabiti čezmejno zdravstveno varstvo , vključno s storitvami zdravstvenega varstva prek telemedicine, ter za prejetje zdravstvenega varstva in povračilo stroškov zanj uporabi enake pogoje, merila o izpolnjevanju pogojev ter regulativne in upravne formalnosti, bodisi na lokalni, regionalni ali nacionalni ravni, ki bi jih naložila, če bi bilo zdravstveno varstvo zagotovljeno na njenem ozemlju.
The Member State of affiliation may impose on an insured person seeking cross-border healthcare, including healthcare through means of telemedicine, the same conditions, criteria of eligibility and regulatory and administrative formalities, whether set at a local, national or regional level, for receiving healthcare and reimbursement of healthcare costs as it would impose if that healthcare were provided in its territory.
Vendar pa pogoji, merila o izpolnjevanju pogojev ter regulativne in upravne formalnosti, naložene v skladu s tem odstavkom, ne smejo biti diskriminatorne oziroma ne smejo predstavljati ovire za prosti pretok pacientov ali blaga, na primer zdravil in medicinskih pripomočkov, poleg tega morajo biti ti pogoji in merila vnaprej javno znani .
However, no conditions, criteria of eligibility and regulatory and administrative formalities imposed according to this paragraph may be discriminatory or constitute an obstacle to the free movement of patientsor goods, such as medicinal products and medical devices , and such conditions, criteria and formalities shall be made publicly available in advance .
Država članica zdravstvenega zavarovanja lahko omeji uporabo pravil o povračilu stroškov čezmejnega zdravstvenega varstva v skladu s tem členom:
The Member State of affiliation may limit the application of the rules on reimbursement for cross-border healthcare according to this Article:
a) na podlagi nujnih razlogov v splošnem interesu, kot je tveganje resne ogrozitve finančnega ravnotežja sistema socialne varnosti ali cilj ohranitve uravnotežene in vsem dostopne bolnišnične storitve; ter
a) based on overriding reasons of general interest such as the risk of seriously undermining the financial balance of a social security system, or the objective of maintaining a balanced hospital service open to all, and
b) izvajalcem, ki so vključeni v sistem zavarovanja poklicne odgovornosti ali jamstev ali v podobno ureditev, kot je opredeljena v državi članici zdravljenja v skladu s členom 4(2)(d).
b) to providers that are affiliated to a system of professional liability insurance , a guarantee or a similar arrangement as established by the Member State of treatment according to Article 4(2)(d).
Člen 7 – odstavek 10
Article 7 – paragraph 10
Odločitev o omejitvi uporabe tega člena v skladu z odstavkom 9(a) in (b) je omejena na to, kar je potrebno in sorazmerno, in ne bi smela predstavljati sredstva za samovoljno diskriminacijo ali neutemeljene ovire za prosti pretok blaga, oseb ali storitev.
The decision to limit the application of this Article pursuant to paragraph 9(a) and (b) shall be restricted to what is necessary and proportionate and may not constitute a means of arbitrary discrimination or an unjustified obstacle to the free movement of goods , persons or services.
Države članice uradno obvestijo Komisijo o vsaki odločitvi za omejitev povračila stroškov iz razlogov, navedenih v odstavku 9(a).
Member States shall notify the Commission of any decisions to limit reimbursement on the grounds stated in paragraph 9(a).
Države članice pacientom ponudijo prostovoljni sistem predhodnega obvestila, kjer pacient ob obvestilu prejme pisno izjavo o najvišjem znesku za povračilo stroškov.
Member States may offer patients a voluntary system of prior notification whereby, in return for such notification , the patient shall receive a written confirmation of the maximum amount that will be paid .
Ko pacient to izjavo predloži bolnišnici, ki naj bi izvajala zdravljenje, ji država članica njegovega zdravstvenega zavarovanja nato neposredno povrne stroške zdravljenja.
On presentation of that written confirmation by the patient at the hospital of treatment, reimbursement shall be made directly to that hospital by the Member State of affiliation.
Kadar se uporablja ta prostovoljni sistem, pristojni organ države članice pacientovega zdravstvenega zavarovanja povrne stroške neposredno bolnišnici, ki je izvedla zdravljenje.
When this voluntary system is applied, the reimbursement shall then be done directly by the competent authority of the Member State of affiliation to the hospital of treatement.
Država članica zdravstvenega zavarovanja lahko povračilo stroškov za čezmejno zdravstveno varstvo v skladu s tem členom in členom 9 pogojuje s predhodno odobritvijo.
The Member State of affiliation may make the reimbursement of costs of cross-border healthcare subject to prior authorisation, in accordance with this Article and Article 9.
Zdravstveno varstvo, za katero se lahko zahteva predhodna odobritev, je omejeno na zdravstveno varstvo, ki:
Healthcare that may be subject to prior authorisation shall be limited to healthcare which:
Zdravstveno varstvo, za katero se lahko zahteva predhodna odobritev, država članica pacientovega zdravstvenega zavarovanja opredeli na seznamu, ki ga posreduje Komisiji.
Healthcare that may be subject to prior authorisation shall be set out in a list , by the Member State of affiliation , to be transmitted to the Commission .
Omejeno je na zdravstveno varstvo, ki:
It shall be limited to healthcare which:
(a) je načrtovano in vključuje, da zadevni pacient v bolnišnici prebije vsaj eno noč;
(a) is made subject to planning in so far as it involves overnight hospital accommodation of the patient in question for at least one night;
(b) je načrtovano in je potrebna uporaba visoko specializirane medicinske infrastrukture ali medicinske opreme, ki je povezana z visokimi stroški;
(b) is made subject to planning in so far as it requires the use of highly specialised and costintensive medical infrastructure or medical equipment or
(b) je načrtovano in je potrebna uporaba visokospecializirane medicinske infrastrukture ali medicinske opreme, ki je povezana z visokimi stroški;
(b) is made subject to planning in so far as it requires the use of highly specialised and cost-intensive medical infrastructure or medical equipment or
(c) vključuje oblike zdravljenja, ki pomenijo posebno tveganje za pacienta ali prebivalce ali bi bile povod za resne in konkretne pomisleke glede kakovosti ali varnosti oskrbe, z izjemo zdravstvenega varstva, za katerega velja zakonodaja Unije, ki zagotavlja minimalno raven varnosti in kakovosti po vsej Uniji .
(c) involves treatments presenting a particular risk for the patient or the population or which could raise serious and specific concerns relating to the quality or safety of the care with the exception of healthcare which is subject to Union legislation ensuring a minimum level of safety and quality throughout the Union ;
(c) predstavlja posebno tveganje za pacienta ali prebivalce.
(c) involves treatments presenting a particular risk for the patient or the population;
Država članica pacientovega zdravstvenega zavarovanja lahko uvede sistem predhodne odobritve za povračilo stroškov iz svojega sistema socialne varnosti za bolnišnično oskrbo, ki se izvaja v drugi državi članici, kadar so izpolnjeni naslednji pogoji:
The Member State of affiliation may provide for a system of prior authorisation for reimbursement by its social security system of cross-border healthcare where the following conditions are met:
(a) če bi se storitev zdravstvenega varstva izvajala na ozemlju države članice, bi stroške kril njen sistem socialne varnosti, ter
(a) had the healthcare been provided on its territory, it would have been assumed by the Member State's social security system; and
(b) bi lahko odsotnost predhodne odobritve resno ogrozila ali bi verjetno ogrozila:
(b) the absence of prior authorisation could seriously undermine or be likely to undermine:
(i) finančno ravnotežje sistema socialne varnosti države članice in/ali
(i) the financial balance of the Member State 's social security system; and/or
(ii) načrtovanje in racionalizacijo v sektorju bolnišnic, da se prepreči njihova preobremenjenost, neuravnoteženost v zagotavljanju bolnišnične oskrbe ter logistične in finančne izgube, pa tudi za vzdrževanje vsem dostopne uravnotežene zdravniške in bolnišnične storitve ali vzdrževanje zmogljivosti zdravljenja ali zdravniških kompetenc na ozemlju zadevne države članice.
(ii) the planning and rationalisation carried out in the hospital sector to avoid hospital overcapacity, imbalance in the supply of hospital care and logistical and financial wastage, the maintenance of a balanced medical and hospital service open to all, or the maintenance of treatment capacity or medical competence on the territory of the concerned Member State.
(Stališče EP– člen 8(2))
(EP position Article 8(2))
Predlog spremembe 76 iz prve obravnave.
1st reading - AM 76
Sistem predhodne odobritve , vključno z merili za zavrnitev predhodne odobritve pacientom, je omejen na to kar je nujno in sorazmerno ter ne sme predstavljati sredstva za samovoljno diskriminacijo.
The system of prior authorisation , including the criteria for refusing prior authorisation to patients, shall be limited to what is necessary and proportionate and may not constitute a means of arbitrary discrimination.
Sistem predhodne odobritve se uporablja brez poseganja v Uredbo (ES) št. 883/2004 in je omejen na to , kar je nujno in sorazmerno , ter ne sme biti sredstvo samovoljne diskriminacije ali ovira za prosti pretok pacientov, storitev ali blaga, na primer zdravil in medicinskih pripomočkov.
The system of prior authorisation shall apply without prejudice to Regulation (EC) No 883/2004 and shall be limited to what is necessary and proportionate and may not constitute a means of arbitrary discrimination or an obstacle to the free movement of patients or goods, such as medicinal products and medical devices .
Države članice obvestijo Komisijo o vsaki odločitvi za omejitev povračila stroškov iz utemeljenih razlogov, kakor je navedeno v tem členu.
Member States shall notify the Commission of any decisions to limit reimbursement on justified grounds as stated in this Article.
Predlog spremembe 77 iz prve obravnave.
1st reading - AM 77
Glede zahtevka za predhodno odobritev, ki ga zavarovana oseba vloži z namenom, da bi prejela zdravstveno varstvo v drugi državi članici, država članica pacientovega zdravstvenega zavarovanja ugotovi , ali so izpolnjeni pogoji iz Uredbe (ES) št. 883/2004.
With regard to any request for prior authorisation made by an insured person with a view to receiving cross-border healthcare , the Member State of affiliation shall ascertain whether the conditions laid down in Regulation (EC) No 883/2004 are met.
Če so izpolnjeni, se predhodna odobritev poda v skladu z navedeno uredbo.
Where those conditions are met, the prior authorisation shall be granted pursuant to that Regulation.
(Stališče EP– člen 8(8))
(EP position Article 8(8))
Država članica zdravstvenega zavarovanja lahko predhodno odobritev zavrne med drugim iz naslednjih razlogov:
The Member State of affiliation may refuse to grant prior authorisation for reasons including, but not limited to, the following:
Država članica zdravstvenega zavarovanja lahko brez poseganja v odstavek 3 predhodno odobritev zavrne samo iz naslednjih razlogov:
Without prejudice to paragraph 3, the Member State of affiliation may refuse to grant prior authorisation only for the following reasons :
(a) če pacient v skladu s členom 7 ni upravičen do zadevnega zdravstvenega varstva;
(a) if the patient is not entitled to the healthcare in question, in accordance with Article 7;
(b) če se to zdravstveno varstvo lahko – ob upoštevanju trenutnega zdravstvenega stanja pacienta in verjetnega poteka bolezni – v roku, ki je zdravstveno dopusten, opravi na njenem ozemlju;
(b) if this healthcare can be provided on its territory within a time-limit which is medically justifiable, taking into account the current state of health and the probable course of the illness of the person concerned;
(c) če bo pacient skladno s klinično oceno s precejšnjo gotovostjo izpostavljen tveganju za varnost pacienta, ki se ne more razumeti kot sprejemljivo, pri čemer se upoštevajo morebitne prednosti, ki bi jih za pacienta imelo čezmejno zdravstveno varstvo;
(c) if the patient will, according to a clinical evaluation, be exposed with reasonable certainty to a patient-safety risk that cannot be regarded as acceptable, taking into account the potential benefit for the patient of the sought cross-border healthcare;
(d) če bo širša javnost zaradi zadevnega čezmejnega zdravstvenega varstva z zadostno gotovostjo izpostavljena varnostnemu tveganju;
(d) if the general public will be exposed with reasonable certainty to a substantial safety hazard as a result of the cross-border healthcare in question;
Člen 8 – odstavek 5 – točka e
Article 8 – paragraph 5 – point e
(e) če mora biti zadevno zdravstveno varstvo zagotovljeno s strani izvajalcev zdravstvenega varstva, glede katerih obstajajo resni in konkretni pomisleki v zvezi s spoštovanjem standardov in smernic glede kakovosti oskrbe in pacientove varnosti, vključno z določbami o nadzoru, ne glede na to, ali te standarde in smernice določajo zakoni in predpisi ali akreditacijski sistemi, ki jih je določila država članica zdravljenja.
(e) if this healthcare is to be provided by healthcare providers that raise serious and specific concerns relating to the respect of standards and guidelines on quality of care and patient safety , including provisions on supervision, whether these standards and guidelines are laid down by laws and regulations or through accreditation systems established by the Member State of treatment.