Co-payment system - what do you have to pay for health care?

Maximum payment 

General: 35.824 ISK. 

The elderly, the disabled and individuals receiving rehabilitation pension from Tryggingastofnun: ISK 23,884. 

Children 2-18 years: 23.884 ISK. 

Children under 2 years old: No fee. 

Children within the same family are counted as one child in the payment participation system. 

Children under the age of 18 receive the service free of charge if they have a referral from a doctor. Otherwise, 30% of the tariff is paid, which counts towards the payment participation system.  

Monthly payment after the maximum payment is reached 

General: 5.971 ISK. 

The elderly, the disabled and individuals receiving rehabilitation pension from Tryggingastofnun: ISK 3,981. 

Children under 18 years of age: ISK 3,981. 

If you do not use health care services for the next few months, the monthly fee will accumulate and be added to the next payment.  

Iceland Health receives information about payments on a daily basis. It may happen that an individual pays too much for services if the payment status has not been updated between arrivals. 

The system automatically updates and recalculates the balance. If an individual paid too much, they will automatically receive a refund to their bank account and will be notified by email.  

Review your registration to your bank account and email address.  

If an invoice is missing on My Pages, contact your healthcare provider, as the invoice has not been returned to Iceland Health. 

The prices in the example are based on an individual who pays a general price. Other prices apply for senior citizens, the disabled and children. 

Beginning of service 

An individual uses health services for the first time in 6 months. The fee for the service is ISK 36,000.  

• He pays the maximum amount of ISK 35,824. 

Next month, he will have to undergo a trial that costs 47,000 ISK.  

• Then he only pays 5.971 ISK. 

Later the same month, he returns to the doctor and the fee is ISK 3,500.  

• Then he does not pay anything for that visit as he has reached the maximum payment for that month. 

Service resumes in a few months 

The maximum payment increases by ISK 5,971 for each month that an individual does not use health services until it reaches ISK 35,824.  Two months later, he undergoes a trial that costs 8,000 ISK.  

• He then pays the entire fee, ISK 8,000. 

• The difference (11,942 - 8,000 = 3,942) ISK is transferred to the next time it has to be paid. 

The following month, he will see a doctor and the fee is ISK 15,000. 

• He then pays 5,971 + 3,942 = 9,913 ISK. 

The following services count towards the payment participation system 

• Healthcare Admission Fees 

• Hospital admission fees for day wards and outpatient wards 

• Self-employed specialty doctors 

• Research, radiographic and imaging and bone density measurements 

• Treatment of skin diseases - solariums at the Dermatology Centre and Spóex 

• Children's psychological services according to the conditions of the framework agreement between Iceland Health and the Icelandic Psychological Association 

• Physiotherapy 

• Occupational therapy 

• Speech therapy

Iceland Health subsidizes the following health services for individuals with referrals: 

• Paediatric Specialty Medical Services, Research, Radiology and Imaging 

  • A general practitioner or primary care physician issues a referral. 

• Physiotherapy, speech therapy and occupational therapy for all age groups 

  • A doctor or physiotherapist at a health care centre issues a referral. 

• Psychological services for children with psychologists who have a contract with Iceland Health 

  • The referral must be from certain referral teams or child psychiatrists. 

Payment participation for cataract surgery, light therapy on the skin and specific plastic surgery is subject to the prior approval of Iceland Health. 

Referral to specialist doctors 

• Emergency and on-call services for paediatricians, gynaecologists and ophthalmologists are free of charge for children and thus no referrals are needed. 

• A specialist doctor who has received a referral from a general practitioner or primary care physician can refer to another specialist doctor.  

• A referral from a general practitioner or primary care physician for imaging and examination services is not required. 

• A hospital doctor can refer a child to a specialist doctor. 

• A referral may be issued for children with chronic illnesses or disabilities that is valid until the age of 18. 

Referral to physiotherapy 

• It is possible to attend up to six sessions of physiotherapy without a referral. 

• A doctor or physiotherapist at a health care centre issues a referral. 

• A referral gives a 15-time authorization for one year from the start of treatment. 

• An individual chooses a physiotherapist. The referral is returned to the physiotherapist or the physiotherapist picks up the referral electronically. The physiotherapist sends a referral to Iceland Health. 

• Children under the age of 18 with a referral from a doctor do not pay for the service based on the price list of Iceland Health. 

• General users, the elderly and the disabled pay according to their payment status. 

• The physiotherapist assesses whether there is a need for more sessions to complete treatment and applies to Iceland Health if necessary. 

Speech therapy referral 

Iceland Health's payment participation for abnormalities in language development and pronunciation is limited to children who have major abnormalities. Further information on the definition of major deviations in the framework agreement with speech pathologists. 

There is an agreement on the involvement of municipalities in speech therapy for children with minor deviations, and this treatment is therefore not covered by the payment participation of Iceland Health. 

• Children under the age of 18 with a referral from a doctor and a diagnosis and evaluation from a speech pathologist receive speech therapy free of charge if the conditions are met. Prior approval is required from Iceland Health. 

• General users, the elderly and the disabled pay according to their payment status in the payment participation system. 

• A referral gives a 15-time authorization for one year from the start of treatment. 

• An individual chooses a speech pathologist and makes a referral to him. 

• Iceland Health participates in one diagnosis per 12-month period and counseling on two occasions according to further conditions in the framework agreement for speech pathologists. 

• A speech pathologist assesses whether more sessions are needed to complete treatment and applies to Iceland Health if necessary. 

Reference to occupational therapy 

• Children under the age of 18 with a referral from a doctor receive occupational therapy free of charge, otherwise they must be paid for 30% of the price list. 

• General users, the elderly and the disabled pay according to their payment status in the payment participation system. 

• A referral gives a 15-time authorization for one year from the start of treatment. 

• There is an agreement with Iceland Health for the services of occupational therapists at the Training Centre, the Rheumatism Association and Bjarg Akureyri. 

• The occupational therapist assesses whether there is a need for more sessions to complete treatment and applies to Iceland Health if necessary. 

Skin treatment 

• A doctor will issue a referral for phototherapy. 

• Laser treatment is subject to the prior approval of Iceland Health. 

Children's psychological services 

• The referral is only valid for psychologists who have an agreement with Iceland Health. 

• The referral must be from certain diagnostic teams or child psychiatrists. 

Plastic surgery 

• Health insured individuals are entitled to payment participation for necessary plastic surgery.  

• Before treatment begins, you must apply for the prior approval of Iceland Health. A response to the application is received in the applicant's digital mailbox. 

• If the application is approved, payment is made according to the payment status 

Cataract surgery 

An individual must meet certain conditions for cataract surgery with the payment participation of Iceland Health. 

Three parties have entered into an agreement with Iceland Health on payment participation for cataract surgery: Landspítali University Hospital (LSH), Akureyri Hospital (SAK) and Lentis ehf. (Davíð Þór Bragason and Keith Fogg). 

• Operation at the Landspítali University Hospital: You do not need to contact Iceland Health in advance. We are charged according to the payment status. 

• Surgery on SAK: The ophthalmologist sends an application for payment participation to Iceland Health for approval. 

• If the application is approved, payment is made according to the payment status. 

Heilsugæslan is the first port of call for those who need health care.  

Everyone must be registered at a health care centre or with a self-employed general practitioner. 

If an individual is not registered at a health care centre, he/she is automatically registered at the centre closest to his/her legal residence. The registration can be changed to another health care centre or to a self-employed GP.  

View registration on My Pages. 

Health care centres in the capital area 

Services of general practitioners outside daytime hours 

• Læknavaktin takes care of reception and visits after daytime hours.  

• Information and counselling services are available at 1770. 

Iceland Health contributes to the cost of necessary plastic surgery by a contracted specialist. 

The treatment must significantly improve the impairment of physical function caused by birth defects, developmental abnormalities, trauma, infections, tumours or other diseases and in the case of the correction of blemishes after wounds or accidents.  

Information on the diseases/conditions covered by Iceland Health's payment participation. - Only available in Icelandic

Exclusions 

If an exemption from the conditions is requested, it must be applied for to Iceland Health in advance.  

An application for an exemption must be accompanied by a certificate from a health care clinic or general practitioner regarding reduced physical skills. Impaired physical function refers to pain or other impairment of bodily functions that interfere with activities of daily living. 

Iceland Health assesses whether there are reduced skills that allow the institution to grant an exemption. In the case of services that require hospitalization, the hospital must decide whether to grant an exemption. 

Iceland Health contributes to the cost of necessary treatment for a skin disease. The treatment must be according to the doctor's instructions but provided by someone other than a doctor. 

The treatment must be carried out by an operator that has the confirmation of the Directorate of Health and operates according to an agreement with the Ministry of Health. 

The treatments are as follows: 

Radiotherapy 

Iceland Health pays 80% of the cost of treatment of skin diseases consisting of B-rays and/or B- and A-rays, with or without ointments. 

PUVA treatment 

Iceland Health pays 90% of the cost of treating skin diseases involved in PUVA treatment. 

Psoriasis og exem 

Iceland Health pays the cost of psoriasis and eczema patients who need to seek medical care in treatment facilities, which replaces hospitalization.  

• Patients pay the cost of travel for treatment.  

• Payment participations are limited to up to 23 sessions per patient during a treatment period.  

• Health insurance has an agreement with Blue Lagoon for this treatment. 

• The need for treatment must be assessed by a doctor and it must be confirmed by the Blue Lagoon dermatologist.