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I know that when one has a European Health Insurance Card, he can get free or discharged treatment in all EU (+ few other) countries. This is quite clear.

However, I'm interested in what is the actual procedure: do I have to pay at the hospital and claim the money later, or do they simply not charge me anything or how is it?

(I'm asking because I'm Czech now in the Netherlands and I need to visit a specialist, I've got some serious ear inflammation.)

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If you have a smartphone, there is an official app to help you with that: Android or iOS –  Relaxed Jan 21 at 10:30
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Best would be to call your insurance company and ask. You should do it anyway as from experience with my own insurance company I know that they very much want to know before you go to a specialist that you are in medical trouble. They might not reimburse you (or cause a hard time) if you don't notify them as quickly as possible after concluding that you need medical help. –  Bart Arondson Jan 21 at 11:05
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Instead of calling your insurance company you might call a local GP. The might just know how to deal with cases like this. Either way, don't go to a hospital directly, a GP is probably able to help you out and the hospital may not accept you unless you're being referred to them by a GP. –  AVee Jan 21 at 15:15

2 Answers 2

up vote 8 down vote accepted

Being myself insured in the Netherlands, I am not 100% sure how it works for non-residents but the way health care is structured here is that there is no national health service but many independent providers and several private insurers. However, prices and insurance coverage are regulated.

In practice, general practitioner (huisarts) consultations are free at the point of use (billed directly to the insurer) but prescriptions and many other things are paid by the patient, at least in part. As far as I know, you should always try to consult a GP first and he or she will refer you to a specialist or hospital if needed.

Regarding the way you should use the EHIC, the best thing is to check the official app (iOS or Android) and always show the card whenever you seek health care. Apparently, one insurer, Agis, is responsible for claims for all foreigners using the EHIC (the English-language version of the website is apparently unavailable but there is a link to a PDF brochure in English at the bottom of the page).

In a nutshell, the EHIC provides you with a coverage equivalent to the “basic insurance” defined in the law so that a GP consultation should be free and other health care providers should be able to claim insured costs directly from Agis, which would basically acts as your insurer in the Netherlands.

If for some reasons some health care provider cannot take care of it directly, you might need to pay everything first and lodge a claim with Agis at the following address to get (part of) the money back:

Agis Zorgverzekeringen
Groep Buitenlands Recht
Postbus 1725
3800BS Amersfoort 

You will need to fill in the form provided on the website and send a copy of the bill, a copy of your EHIC and the IBAN number from your bank account. They also have a specific email and telephone number for international matters, they might be able to provide more details on what you should expect to pay should you need to be hospitalized:

gbr@agisweb.nl
+31 33 445 68 70

Finally, if everything else fails, you can still try to contact your insurance or health care administration in your country of residence. You should expect some paperwork and delays but they might still be able to reimburse some things. Waiting to be back and seeking reimbursement is not how the system is supposed to work so there might be difficulties but it's not completely impossible either.

Given that Dutch patients have deductibles (eigen risico) and a personal contribution to some expenses, you might have to cover part of the costs in any case. The EU app also suggests that some costs not covered in the Netherlands might still be claimed in your home country (specifically dental care if you are covered for it).

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Ok, this looks very useful, thanks. I've actually visited a GP already and paid EUR 26 for the visit, and another EUR 28 at a pharmacy for the medication. I'll call the given number tomorrow, and I'll let you know about the result, so that the answer can be completed. After all, it's an expense I'm willing to bear on my side if things don't go right, but it would be better to get it back of course. –  tohecz Jan 21 at 16:37
    
@tohecz If I understand all this correctly, you should be able to claim the costs of the GP consultation but probably not the full price of the medications. Let us know how it goes! –  Relaxed Jan 21 at 16:45
    
@Annoyed that would depend on the medication. Most medication prescribed by a Dutch GP is covered (even if the same medication were it prescribed by a hospital would not be fully covered, go figure). The personal risk (360 Euro for 2014 does not apply to GP consults and GP supplied medication, though blood tests and some other tests ordered by them and performed in hospital labs like X-rays do fall under it. A foreigner should be able to claim those bills to their own insurer, if covered by their policy at home, possibly at a different rate if Dutch prices are higher than their home prices. –  jwenting Jan 21 at 17:49
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The link is called “Medical care during a temporary stay in the Netherlands” under the “Brochure” title at the very bottom of the page. There is another page for pensioned people living abroad but I just checked again and that's not the one I linked to. Maybe there is something funny with the site but it works for me at least. –  Relaxed Jan 29 at 12:02
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So: I phoned to Agis yet when in the Netherlands, and I sent them the bills and my IBAN. This week, the money arrived, and they reimboursed both the GP visit and the medication. Yay! :) –  tohecz Mar 1 at 18:06

I don't think there is one generic answer for EU as a whole. In many countries you just have public health system, so you just go to public clinic, present your EHIC and get attended. End of story.

This is not the case for the Netherlands, as the health system here is complicated. Clinics are private, financing is dual (private insurance for more immediate care, public for long-term hospitalization etc.). In the Netherlands everyone has got to have private insurance and pay at least €90/month in premiums for the core package, while extended packages with full care and dental can go up to €150-200/month. Even with full package you're still charged (often quite a lot) for many things, although visiting general practitioner (huisarts in Dutch) is not one of them.

So in theory consult ought to be free if you show your EHIC upfront, but as I've said, clinics are private and it may vary. Fact that clerks are typically xenophobic doesn't help your case. Anyway, if you're going to have to pay upfront for visiting doctor, you can expect to have to pay somewhere between €50 and €100. Just remember to go to GP (huisarts), not to emergencies at a hospital.

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