Health insurance for pre-established medical treatment abroad

In March 2016 amendments to the health insurance act were approved, which includes implementation of the EU Directive in Iceland from 1 June 2016. A regulation no. 484/2016 has been established to further implement the Directive.

With the entry into force of the Act, the health insured person has the right to seek healthcare where he/she chooses himself/herself within the EEA area, the United Kingdom and Switzerland, subject to certain conditions. In addition, health insurance will pay the same amount as the service costs in Iceland. Travel and maintenance costs are not paid, nor are the costs of accompanying staff. It is also a condition that payment participation is available in Iceland for similar services.

If admission is required, applications must be submitted to Iceland Health in advance.

See different conditions according to different articles of regulation no. 484/2016.

Article 2 of the Regulation - General

"Now, the insured person chooses to seek health care in another member state of the EEA agreement and then reimburse Iceland Health for the cost of the service as if it were domestic health care, as long as the service corresponds to the services covered by health insurance in this country."

Article 9 of the Regulation - Prior approval

Before a health insured person decides to seek healthcare services in another EEA country pursuant to Article 2, he shall apply for prior approval of reimbursement or participation in costs from the Iceland Health in the following cases:

When a health insured person who has a rare disease or is considered to have a rare disease, applies for prior approval, Iceland Health may have an evaluation carried out by specialists in that field.

Iceland Health shall process applications for prior approval as soon as possible. The health of the patient shall be considered in processing applications and the urgency of the rapid processing for the health of the patient.

Article 12 of the Regulation - Essential medical services for temporary stay abroad.

“It is now necessary for a health insured person to seek healthcare services where he is temporarily abroad in a Member State of the EEA Agreement and the health insurance company shall then refund the costs thereof in accordance with the provisions of Article 2 in cases where the services are provided by a private institution or a person working outside the public health system in the relevant location.”

Covers the necessary healthcare services of a person insured by health insurance for temporary stay and when the services are provided outside the public healthcare system. No reimbursement is made under this article if an individual resides in another country.

Data transmission - important to read

When applying for reimbursement, the following documents must be submitted to Iceland Health:

• Application for reimbursement of foreign medical expenses

• Disaggregated, numbered authorised bill from the service provider accounting system

• Payment confirmation

• Medical notes (applies especially in case of admissions)

• Iceland Health have the right to request further data if necessary

Iceland Health recommends that all documents should always be requested in English, as the institution may require that the case documents be translated by a certified translator and that the cost is not paid by Iceland Health.

How can you send us your applications and the necessary documents?

• Send applications together with data with secure data submission via Data submission for individuals or the treating physician's Gagnagátt.
  

• Bring the application and documents to our customer service at Vínlandsleið 16. You can get help there with filling out the applications