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Healthcare abroad paid by HELFO if you live in Norway

Healthcare abroad paid by Helfo if you live in Norway

If you are a resident of Norway who has the right to receive healthcare in Norway you can choose to access healthcare abroad in other countries in the European Union (EU), the European Economic Area (the EEA also includes Iceland, Liechtenstein and UK) or Switzerland and Helfo could pay or refund your expenses. Healthcare abroad paid by Helfo could be an option for you.

We will always advise you to ask for prior approval from Helfo before receiving treatment abroad (read more below). But we realise that not in all cases is possible to apply prior treatment abroad. For example, it is impossible to apply before treatment if when you had an accident whilst on holiday.

Below you will find all possible Norway state-funded healthcare options and refund options if you had already paid for your treatment.

Emergency or necessary treatment abroad is received in the state system EHIC route. Emergency healthcare abroad refunded by Helfo Norway.

EHIC route – apply for a refund if you already had received healthcare.  It applies only to emergencies or treatments provided without delay. In addition, providers abroad had to be public, not private.

The European Health Insurance Card (EHIC) issued in Norway gives you the right to access medically necessary, state-provided public healthcare in another EU/EEA state. Treatment provided is under the same conditions and at the same cost (free in some countries) as people insured in that country. EHIC gives you access to healthcare during a temporary stay. The benefits covered include, for example, emergency treatment, treatment of chronic or existing illnesses as well as pregnancy and childbirth. You can use EHIC when you are travelling abroad or when you are on holiday in another EU/EEA State.

The healthcare provider did not accept your EHIC card or you were not able to use it? You are still able to apply for a refund or ask Helfo to cover the bill.

Things to remember in order to apply for a refund via the EHIC route:

  • Treatment had to be state-provided;
  • The provider had to have an agreement with the state to provide this service;
  • You did visit the country temporarily (work, holidays etc.);
  • You can apply no later than 6 months after the treatment. If several treatments were received during a continuous stay in the hospital, the time limit starts from the date you were discharged from the hospital. As an example, if you had a car accident in Spain and needed surgery and physiotherapy, the application end period is 6 months after you have left the hospital, to claim hospital expenses and the last physio visit to claim physio treatment.

Planned, emergency or necessary medical treatment in a private clinic abroad– DIRECTIVE ROUTE POST TREATMENT. Healthcare abroad refunded by Helfo Norway.

Directive route (healthcare already received) – apply for a refund in Norway. If you had received and paid for healthcare abroad in a private clinic/hospital. Healthcare abroad paid by Helfo is possible even if you chose a private clinic.

You can claim a refund for treatment received abroad even if a provider was private and you prearranged the treatment. You had to pay for treatment in a state hospital abroad as a private (paying) patient? The EU directive route is giving all people legally living in Norway the right to receive a refund for treatment abroad. Within the Directive route, you can receive planned and emergency treatment provided by any clinic or hospital. In other words, you can get a refund if the treatment received would be offered to you in Norway.

The EU cross-border directive covers all healthcare provided or prescribed that is the same or equivalent to treatment in Norway. That means if you would have access to medical treatment In Bergen, you can access it in Warsaw. The EU cross border directive also covers medicine prescriptions and medical devices. 

In some situations, the Helfo could insist that you had to undergo the same steps if you would receive treatment in Norway. It means Helfo has a right to refuse a refund if you had surgery without having prior consultation. This is the path every patient within the Helfo system has to undergo.

Compared to the EHIC the EU directive route gives you access to emergency and necessary treatment in the private sector. In case your health condition worsened and there were no state hospitals nearby, you can use the directive route refund claim. Private hospitals do not usually accept EHIC, but paying for treatment and claiming a refund is possible. 

Things to remember in order to apply for a refund via the EU Directive route:

  • Treatment can be provided by state or private clinics/hospitals;
  • Treatment can be pre-arranged;
  • This option is not available if your treatment was received in Switzerland;
  • You can apply no later than 6 months after the treatment. If several treatments were received during a continuous stay in the hospital, the time limit starts from the date you were discharged from the hospital. As an example, if you had a hip replacement in Croatia, the application end period is 6 months after you have left the hospital.

Planned medical treatment in a private clinic abroad– DIRECTIVE ROUTE Norway

Directive route (planning to go abroad) – apply for permission to travel abroad. You can apply and receive permission to receive planned healthcare abroad in a private clinic/hospital. With the Directive route healthcare abroad paid by Helfo is possible.

If you are entitled to public health services by Helfo in Norway, you may choose to “buy” those medical services in another member state of the European Union (EU) or European Economic Area (EEA), which also includes Iceland and Liechtenstein. You will have to pay upfront and will be repaid the cost by the Helfo. Helfo refund requirements. This is provided for by the Cross-Border Healthcare Directive (EU Directive 2011/24/EU, pdf).

You will be refunded up to the cost of the public healthcare treatment in Norway, or the cost of your treatment abroad if that is less. Helfo can reimburse the proportion of your travel expenses corresponding to what you would have received in Norway. But other costs like hotels may not be refunded.

In order to qualify for a refund for health services in another country under the Directive you have to:

  1. Qualify for public healthcare in Norway.
  2. Have a letter of referral from a health professional in Norway or your doctor abroad. You can use a referral from your GP or specialist for public healthcare in Norway to access healthcare abroad.
  3. Arrange a consultation with a doctor abroad. You must have a consultation abroad if you are having surgery.
  4. Travel abroad for healthcare.
  5. Receive prior approval from Helfo (it is not mandatory, but advised. Helfo will inform you about the possible refund amount).
  6. This option is not available if you are planning to receive treatment in Switzerland;
  7. You will have to provide information (medical documents and invoices/receipts) on your treatment abroad within 6 months after the treatment. If several treatments were received during a continuous stay in the hospital, the time

Planned medical treatment in state system abroad– S2/E112 ROUTE Norway

S2/E112 route – apply for permission to travel abroad to receive planned healthcare abroad in the state clinic/hospital. Usually, it is for highly specialised medical treatment that you require and service is not available in Norway. Healthcare abroad paid by Helfo is possible and could be the solution in your situation.

If you are living in Norway and require treatment that is not available to you in Norway, you may be able to use the Treatment Abroad Scheme (S2/ E112). To get the treatment you require in another country in the European Union (EU), the European Economic Area (the EEA also includes Iceland, Liechtenstein and Norway) or Switzerland.

You will not be required to pay for your treatment in full with S2/E112. Almost all payments will be done between Helfo and the hospital. The hospital will ask you to pay only if the patient of their country would be asked to pay. For example, if in the country of your treatment patient needs to pay 100 EUR for a hospital stay so will you!

All treatments under S2/E112 must be within Norwegian law and either not available in Norway, or not available within medically justified time in Norway. Helfo will take into account your current health and the likely course of your illness or condition.

Your consultant will have to confirm that you need treatment abroad. You will need to provide information:

  • that you are entitled to necessary specialist healthcare (investigation or treatment);
  • referral letter to the specialist health service from a Norwegian health professional;
  • that treatment will be performed in the public sector and that hospital abroad is willing to accept the form EU/EEA form E112 (NO);
  • on patient care records and/or discharge summary.