2011 - health insurance romania

09/04/23 OEP - National Health Insurance Fund Hungary

1

National Health National Health Insurance FundInsurance Fund Hungary Hungary

The coordination of social security in EuropeThe coordination of social security in Europe

Health insuranceHealth insurance

Dr. Sándor Hódi

National Health Insurance Fund Hungary


2

OutlineOutline

1.1. FactFactss

2.2. Questions and problems as regards the Questions and problems as regards the implementation of Regulation 883/2004/EC and implementation of Regulation 883/2004/EC and 987/2009/EC987/2009/EC

3.3. Future challengesFuture challenges



3

1. Facts1. Facts

Implementation of the RegulationsImplementation of the Regulations – – Implementing Implementing bodiesbodies

National Health Insurance Fund:

- Liaison body according to b) Art. 1 of IR;

- Authorization of scheduled treatment according to Art. 26 of IR;

- Reimbursement procedure according to Title IV. of the Regulation;

- Reimbursement of costs of ambulance services;

- Authority of second instance in cases e.g. application for S1 form or for EHIC, furthermore in reimbursement procedure according to Art. 25 IR;

1. 1. Facts – Implementation of the RegulationsFacts – Implementation of the RegulationsImplementing bodiesImplementing bodies


4

Local Government offices:

- Established in 1 January 2011;

- 19 on the basis of the county system of Hungary;

- The local health insurance bodies are integrated in the local government offices;

- Professional control exercised by the National Health Insurance Fund;

- Administrative control and supervision exercised by the Ministry of Justice;

- Competence: issue E-forms, portable documents and SEDs, issue

EHIC, reimbursement of costs of treatment in other Member State;



5

Ministry of Health

Supervision

National Health Insurance Fund

Ministry of Justice

19 government offices


Professional control

Administrative control


6

1. 1. FactsFactsImplementation of the RegulationsImplementation of the Regulations – – Entitlement to Entitlement to

benefits in kind and cash benefitsbenefits in kind and cash benefits

Entitlement to benefits in kind:- Insured persons e.g. workers, self-employed persons,

unemployed persons etc.- Entitlement according to the Act on the Service of

Compulsory Health Insurance e.g. pensioners, students;- Entitlement pursuant to EU law e.g. EHIC or S1;- Entitlement according to bilateral agreements;- Entitlement on the basis of an agreement with the insurer;- Entitlement on the basis of residence in Hungary and the

payment of the flat rate contribution;

1. 1. Facts – Implementation of the RegulationsFacts – Implementation of the RegulationsEntitlement to benefits in kind and cash benefitsEntitlement to benefits in kind and cash benefits


7

Entitlement to cash benefits:

- Only insured persons

Cash benefits of the Hungarian health insurance system:

- Sick pay;

- Sick pay in case of occupational accident;

- Maternity benefits;

1. 1. Facts – Implementation of the RegulationsFacts – Implementation of the RegulationsEntitlement to benefits in kind and cash benefitsEntitlement to benefits in kind and cash benefits


8

National Health Insurance Fund

1. 1. Facts – Implementation of the RegulationsFacts – Implementation of the RegulationsHealth Insurance ContributionsHealth Insurance Contributions

Tax Office

employeeemployer

6%2%

Monthly transfer


9

2. Questions and problems as regards the 2. Questions and problems as regards the implementation of the Regulationsimplementation of the Regulations

The lack of E115 formThe lack of E115 form

Section No. 8 of Art. 27 of IR prescribes that:

”…the particulars of the certificate of incapacity for work of an insured person drawn up in another Member State on the basis of the medical findings of the examining doctor or institution shall have the same legal value as a certificate drawn up in the competent Member State…”

2. Questions and problems as regards the2. Questions and problems as regards the implementation of the Regulations – The lack implementation of the Regulations – The lack

of E115 formof E115 form


10

Consequence: all certificates of incapacity for work of an insured person drawn up in another Member State shall be accepted irrespective, for instance, of its form, language etc. and the sick pay shall be paid.

Problem: the local health insurance bodies cannot define the content of the document and the sick pay must be paid on the basis of such a document.

General solution: the application of the former E115 form or developing a new document.




11

Our temporary solution: - we requested the liaison bodies of other Member States

for responding us about their practice:- Answers:

- The further application of form E115;- No answer; - The application of the national certificate of

incapacity for work.

Sending us a sample Publication of the sample for

the local health insurance

bodies

If regrets arise concerning the validity of the form, it must be sent to the National Health Insurance Fund for final decision.




12

Problem: Many persons, who are insured in Hungary but have their residence in another Member State request for granting the benefits in kind on the basis of an S1/106 form also for the spouse. The local health insurance bodies reject the application.

Solution: use of EHIC.

Reasoning: The Hungarian legislation recognizes only the child under the age of 18 as a member of family.

2. Questions and problems as regards the2. Questions and problems as regards the implementation of the Regulations – implementation of the Regulations – The The

concept of member of familyconcept of member of family


13

Problem: People, who are resident in Hungary and are not entitled to benefits in kind, are subject to payment of a flat rate contribution of 5100 HUF/month (precondition: one year continuous residence in Hungary – residence in another EEA-Member State is taken into account – E104/Decision E1). These people often apply for forms and portable documents e.g. A1 or S1.

Decision: The A1 or S1 cannot be issued.

Reasoning: The payment of the flat rate contribution entitles only to benefits in kind. The only form that can be issued on the basis of this entitlement is the EHIC.

2. Questions and problems as regards the2. Questions and problems as regards the implementation of the Regulations – Entitlement implementation of the Regulations – Entitlement

to benefits on the basis of residenceto benefits on the basis of residence


14

Difficulties of determination of residence in case of S1 form:

Parallel application of Art. 11 of IR and national law

The residence in other Member State was never determined according to Art. 11

2. Questions and problems as regards the2. Questions and problems as regards the implementation of the Regulations – Concept of implementation of the Regulations – Concept of

residenceresidence


15

3. 3. Challenges – The crossChallenges – The cross--border health care border health care directivedirective

3. Challenges3. Challenges

The cross-border healthcare directiveThe cross-border healthcare directive (2011/24/EU) (2011/24/EU)

Deadline for implementation:

-25 October 2013

Relevant issues in relation to health insurance:

- Reimbursement of costs

- The authorization procedure

good opportunity for regional (border) cooperation with Romania


16

Thank You for Your AttentionThank You for Your Attention


2011 - health insurance romania

Economy & Finance