Planned medical treatment abroad due to exhausted treatment options in Slovenia
To obtain the right to receive medical treatment abroad due to exhausted treatment options in Slovenia you have to meet the following conditions:
- have health insurance in Slovenia and
- have an authorisation from the ZZZS for planned medical treatment abroad due to exhausted treatment options in Slovenia (before or after receiving treatment abroad).
The process to obtain authorisation for planned medical treatment abroad due to exhausted treatment options in Slovenia
Fill out the Application for approval of planned medical treatment abroad due to exhausted treatment options 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 (if you have already selected a healthcare provider abroad you can quote the provider, as well as the country in which you intend to undertake the treatment and a short explanation regarding the medical referral).
Submit the following with the application:
- medical records on your medical treatment in Slovenia to date and
- documents on treatments, examinations or tests abroad already carried out, if any.
Submit the application for authorisation, together with all the 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.
Before adopting a decision on the medical treatment abroad due to exhaustion of treatment options in Slovenia, the ZZZS shall obtain a written opinion from the council of doctors or the relevant clinic or institute:
- on your medical condition and a description of past treatments,
- what kind of treatment you need,
- if all treatment options in Slovenia are indeed exhausted,
- if a medical treatment abroad is expected to provide a cure or improve your medical condition or prevent a further deterioration,
- how long the proposed treatment, examination or test is supposed to last,
- if you require an escort and what kind (amateur or professional),
- what means of transport is required in view of your medical condition,
- the name of the closest provider abroad, where the treatment is supposed to be implemented.
Based on the medical and other documentation, the opinion of the relevant clinic or institute and an eventual opinion of the designated doctor, member of the medical committee or another doctor of the ZZZS, the ZZZS decides on the merit of the proposed medical treatment abroad (issues a decision of the authorisation of a planned medical treatment abroad).
Coverage of costs of planned medical treatment abroad due to exhausted treatment options in Slovenia
If the ZZZS authorises your medical treatment abroad due to exhausted treatment options in Slovenia, it will issue you a document for assuming the costs which you submit to the provider abroad:
- form S2 (for healthcare providers in the EU, EEA and Switzerland),
- form SI/RM 4, SI/BIH 4, SI/SRB 4 or SI/MNE 4 (for healthcare providers in Northern Macedonia, Bosnia and Herzegovina, Serbia and Montenegro) or
- authorization for assuming the treatment costs if the healthcare provider abroad does not accept any of the above listed documents.
Travel, food, accommodation and escort costs
If the ZZZS authorizes 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 as well as your travel costs 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 medical treatment received if you had no prior authorisation of the ZZZS
Fill out the Application for reimbursement of costs of the planned medical treatment abroad and travel costs 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,
- supporting documents on the medical treatment you received abroad,
- data on other expenses.
Submit the following with the application:
- medical records on the medical treatment you received abroad,
- medical records on your medical treatment in Slovenia to date,
- original invoice and proof of payment of the invoice for medical treatment you received abroad,
- original invoice and proof of payment of 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 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 determines whether all treatment options in Slovenia were indeed exhausted and a treatment or examination in another country is reasonably expected to cure or improve your medical condition or prevent further deterioration.
If the ZZZS authorises your medical treatment abroad, it shall also decide on your right to reimbursement of treatment costs and eventual travel, accommodation and escort costs.
The amount of reimbursed costs of planned medical treatment abroad due to exhausted treatment options in Slovenia
The ZZZS shall reimburse the costs of medical services to the amount of actual costs.
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.
The ZZZS shall cover the costs from the compulsory health insurance, the eventual difference to the full value of medical services rendered shall be covered by the health insurance company, with which you have a contract for supplementary health insurance or you cover the difference yourself.
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 exhaustion of treatment options in Slovenia
After having received medical treatment abroad:
Application for reimbursement of costs of planned medical treatment abroad due to exhaustion of treatment options in Slovenia
