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Consent for the coverage of medical transportation costs of a person insured in the Fund - Basic Information

1 General  Information

The transport of a patient who is hospitalized on the territory of another Member State of the EU/EFTA and receives benefits under the provisions of coordination, in order to continue treatment in Poland, is possible on the basis of Art. 42i par. 9 of the Act of 27 August 2004 on health care services financed from public funds (Journal of Laws of 2015, No. 581, as amended). The authorization to cover medical transportation costs to the place of further treatment in the country is the responsibility of the Director of the Regional Branch of the  Fund. As a rule, the Regional Branch of the National Health Fund, to which you can submit an application, is the branch with  jurisdiction over the place of residence of the applicant. Territorial jurisdiction is defined in Art. 42i par. 3 of the Act.

NHF agrees to transport the patient on the cheapest means of medical transport that can be used, taking into account the patient's health status. The consent to cover the cost of transportation is issued before its execution and applies to finance the entire costs. NHF does not reimburse any transportation costs for transport to the place of  further treatment in the country that had been  incurred before.

The transport should not take place if the patient or his/her  legal representative did not give their consent to it. A foreign provider should not influence the decision of the patient.

2 Entities eligible to submit an application

The application may be submitted by:

• the beneficiary (patient) or

• spouse of the beneficiary (patient) or,

• a relative or affinity of the beneficiary (patient) up to the second degree in  direct line or,

• a person staying in cohabitation with the beneficiary (patient) or,

• the legal representative of the beneficiary (patient) or,

• a person authorized by the beneficiary (patient) or,

• a competent institution, the institution of the place of residence, the institution of the place of stay or liaison body in another Member State of the European Union or in a Member State of the European Free Trade Association (EFTA).

3 Necessary documentation

The application must be accompanied by documentation prepared by the hospital in which the applicant is currently staying, including the following:

• current clinical diagnosis,

• a description of the current health status,

• the probable extent and duration of the treatment,

• an indication of the possible means of transport to be used according to the current health status of the applicant,

• preliminary cost estimate of further treatment costs.

In the case the documentation has been prepared in a foreign language, the application must be accompanied by a translation into Polish. It does not have to be drawn up by a sworn translator.

4 The decision

The Regional Branch of the National Health Fund verifies the application and the documentation, and then within 5 working days from the date of receipt of the application, the Branch Director grants consent for the coverage of the transportation costs or refuses it  and notifies the applicant about the decision  immediately.

If  all the procedural conditions are met with, the release of the consent will be possible in the case of the fulfillment of the condition specified in Art. 42i par. 9 of the Act, that is, in the case when the cost of medical treatment abroad outweigh the costs of transport and treatment in the country.

In no case, however, is it possible to carry out the transport to the country without an express statement of will of the person  whom the transport concerns  or his/her  legal representative in terms of granting consent to the transportation  and to continuing treatment in the country and when the health status of the applicant prevents him/her from  the use of any means of transport.

5 Example

Mr. Jan Kowalski had an accident during his stay in Austria. As a consequence of the accident  he benefits from  health services provided in an Austrian hospital under the provisions of the coordination and requires long-term treatment. Mr. Kowalski wants to be treated in Poland because of the desire to maintain contact with the family. Therefore, he submits an application to the appropriate Regional Branch of the NHF NFZ for consent  to cover the medical transportation costs, accompanied by medical documentation prepared by the Austrian hospital. The medical records identify the current health status of Mr. Kowalski and current clinical diagnosis of the disease and state that the health status allows the transport and also identify the possible means of transport (e.g. medical road  transport  with the assistance of a paramedic). On the basis of this documentation,  the  Austrian provider  defines the scope (e.g. hospitalization - certain treatments) and duration of further treatment (e.g. a month) and its estimated  cost (17 thousand PLN).

As a result of relevant investigations, the Regional Branch determined that the cost of the same treatment in Poland is 5 thousand PLN, and the cost of medical transport  accompanied by a paramedic from the hospital in Austria to the Polish provider is 4 thousand PLN. In connection with the fulfillment of the economic condition under Art. 42i par. 9 of the Act,  the Director of the Regional Branch of the National Health Fund grants consent for the coverage of  transport costs, because the expected cost of further treatment abroad (17 thousand PLN) exceeded the total expected costs of treatment in Poland and transport (9 thousand PLN).