Insured persons who find themselves in temporary economic hardship and for whom the payment of a medical invoice would represent an insurmountable cost as a result of their circumstances can ask an exceptional assistance.
Exceptional assistance means that the insured person who finds themselves in temporary economic hardship can submit a written request to the CNS, asking an upfront payment of the money which the insured person can expect from the CNS in order to pay for services provided by healthcare providers or approved suppliers. The CNS pays the money to which the insured person is entitled directly to the service provider by bank transfer, for a specific invoice.
The insured person will remain liable to pay the personal contribution.
The payment of a medical invoice or medical fees must represent an insurmountable cost for the insured person as a result of their circumstances.
The written request for exceptional assistance must:
- relate to specific medical fees or a specific medical invoice; a separate request must be issued for each set of medical fees or medical invoice
- relate to fees or a medical invoice issued by a healthcare provider or supplier approved by the CNS
- relate to a service or supply that meets all of the coverage eligibility criteria set out in the CNS statutes
- relate to a service or supply that is not covered directly under the third-party payment scheme (i.e. where no advance payment is required from the protected person, and the portion of the costs covered by the CNS is paid directly to the service provider)
- relate to fees or an invoice that exceeds €250 in value; this value will exclude any costs billed by the service provider or supplier in connection with a personal convenience (CP) made by the insured person or a situation in which a quotation is exceeded (DSD)
- relate to fees or an invoice issued no more than three months prior to the request date for the exceptional assistance.
The term "insurmountable cost" has a specific legal definition. As such, evidence of the individual's economic situation will need to be provided. All appropriate documentation in this respect must be included with the request.