Article56 Request Procedure for EEA Healthcare Treatment

Article56 of the European Health Insurance Card (EHIC) Regulation (EU)2018/947 sets out the right of patients who are insured in one EEA (European Economic Area) state to request reimbursement for medically necessary treatment received in another EEA state when the treatment is not covered by the host countrys public system. This page explains who can apply, what the request must contain, the steps involved, and practical tips for a smooth process.

1. Who is eligible?

• Insured persons anyone who holds a valid national health insurance card from an EEA member state.
• Legal residents the person must be a resident of the issuing country, not just a visitor.
• Medical necessity the treatment must be medically necessary and cannot be postponed until the patient returns home.
• Crossborder care the procedure must be performed in another EEA state where the public health system does not cover the treatment or where a waiting list would cause unreasonable delay.

2. When to use Article56

Typical situations include:

• Elective surgery that is unavailable or subject to a long waiting list in the home country.
• Specialist care or diagnostic tests that are only offered abroad.
• Emergency treatment received while traveling, when the host system refuses coverage.

3. What the request must contain

The written request to the health insurance institution (or its designated body) of the insured persons home country must include:

1. Full name, address, date of birth and the national health insurance number of the applicant.
2. Details of the intended treatment: type of care, expected dates, name and address of the foreign health provider.
3. Medical justification signed by a qualified physician in the home country, stating why the treatment cannot be provided locally or would cause undue delay.
4. Estimated cost of the treatment, including any anticipated followup care.
5. Confirmation that the applicant has a valid EHIC (or equivalent) at the time of the request.
6. Any additional documents required by the national insurer (e.g., previous test results, referral letters).

4. Stepbystep procedure

Step 1 Gather information

Contact the health provider abroad to obtain a detailed treatment plan and cost estimate. Ask for a written quotation that can be attached to the request.

Step 2 Obtain a medical justification

Visit a physician in your home country. The doctor must write a letter explaining:

• Why the treatment is medically necessary.
• Why it cannot be performed locally or would be delayed unreasonably.
• Any relevant clinical history.

Step 3 Complete the request form

Most insurers provide a specific Article56 request form on their website. Fill it out carefully, attach the medical letter, the foreign providers quotation, and a copy of your EHIC.

Step 4 Submit the request

Send the package by registered mail or use the insurers online portal if available. Keep a copy of the receipt or confirmation email.

Step 5 Await the decision

The insurer must acknowledge receipt within 15days and give a decision within 30days (the period can be extended by another 30days for complex cases). The response will be either:

• Approval stating the amount covered and any copayment required.
• Rejection with an explicit reason and information on how to appeal.

Step 6 Appeal (if necessary)

If the request is denied, you have the right to lodge an internal appeal with the insurer. The appeal must be filed within the timeframe indicated in the rejection letter (usually 30days). If the internal appeal is unsuccessful, you may take the case to the national health insurance ombudsman or the competent court.

5. Payment and reimbursement

When the request is approved, the insurer will usually pay the foreign provider directly, up to the agreed amount. Any excess cost must be covered by the patient. In cases where the provider does not accept direct payments, the patient pays the full amount abroad and later submits a claim form and receipts for reimbursement.

6. Practical tips

• Start early The entire process can take 23months. Begin as soon as you know the treatment is required.
• Check national variations While Article56 is EUwide, each country may have its own forms and additional requirements.
• Keep records Save copies of all correspondence, medical reports, and receipts.
• Language Provide translations of foreign documents if the insurer requires them.
• Use the EHIC wisely The card is not a substitute for the Article56 request; it only guarantees emergency care at the same cost as for residents.

7. Common pitfalls

1. Submitting an incomplete request Missing a medical justification or cost estimate leads to delays or automatic rejection.

2. Assuming approval The insurer may limit coverage to a percentage of the quoted cost.

3. Not confirming the foreign providers willingness to accept direct payment Some hospitals require upfront payment, which must be planned for.

8. Useful links

• European Health Insurance Card (EHIC) European Commission
• EuroHealthCare Fund Crossborder treatment guide
• Data protection for medical information (GDPR)

Understanding and correctly following the Article56 request procedure can make the difference between receiving timely, necessary care abroad and facing unexpected outofpocket expenses. By preparing thorough documentation, respecting national timelines, and staying informed about your rights, you can navigate the crossborder health system with confidence.