Transportation by ambulance

The insured person has repetitive medical treatment (serial treatment) abroad. Under certain conditions, serial transport by taxi can be covered by the health insurance.

Conditions of coverage

The insured person must take the necessary preliminary steps for the treatment abroad to be covered by the health insurance.

Serial transport by ambulance is covered on condition that a prior medical prescription, issued by the doctor in charge of the treatment on a special form and accepted in advance by the CNS, specifies separately for the outward and return journey the medical reasons why a lying or semi-seated position is essential.

For prolongations in the case of chemotherapy, radiotherapy, dialysis or any other serial treatment, the request does not have to be made prior to transport, but must still be submitted to the CNS as soon as possible.

Serial transport by ambulance to the national centre for functional re-education and rehabilitation or to a geriatric or cardiac rehabilitation service in a hospital is only covered for a maximum of 20 days of treatment.

Transport for post-organ transplant follow-up is only covered for a maximum of six months from the date of the organ transplant.

Ambulance transport costs are covered only if the related benefits are provided by a provider approved by the Council of Administration of the National Health Fund.

Procedures

Certificate of coverage

For any coverage of serial transport costs, the insured must have a certificate of coverage issued by the CNS valid for the period during which the transport takes place.

To receive this certificate of coverage, the treating physician must complete the form "Request for coverage by the health insurance of the cost of serial transport" and indicate separately for the outward and return journey the medical reasons why a lying or semi-seated position is essential.

This form, which serves as a medical prescription, must be submitted to the CNS beforehand. The CNS carries out an administrative check of the file. If this check is satisfactory, the CNS issues a certificate of reimbursement, which is sent to the insured person.

Reimbursement / Coverage

The insured may:

• give the approved transport provider the certificate of coverage as well as the document summarising the days and hours of attendance for the serial treatment (proof of attendance for the dates on which the transport took place) so that the transport provider can request coverage through the third-party payment system. If all the conditions are met, the insured person only pays to the provider the part of the costs not covered by the health insurance.
  
• advance the costs and subsequently request reimbursement from the CNS. The documents to be enclosed are the paid invoice from the approved transport provider, the document summarising the days and hours of attendance for the serial treatment (proof of attendance for the dates on which the transport took place) and the valid certificate of coverage.

Coverage rate

Ambulance transportation is covered at the rate of hundred percent (100%) of the invoices issued on the basis:

• of a minimum of thirty-nine euros and seven cent (€39.07) per trip,
• or of an amount of one euro and twenty-nine cents (€1.29) per kilometer.

The transport provider is allowed to charge tariffs that exceed the statutory participation of the CNS.

 

For the calculation of the route, the shortest distance is taken into account between:

• the normal station of the ambulance closest to the insured's departure,
• the place of departure of the insured,
• the place where he receives treatment,
• the place to which the insured person returns, if necessary, after receiving treatment,
• the place where the ambulance is normally stationed.

Waiting periods are covered at the rate of 100 percent (100%), taken into account at the rate of thirty-one cents (€0.31) per minute for a return trip to the insured's point of departure. These costs can only be covered if the costs for waiting time are less than the amount covered for the outward and return journey.

Disinfection of the ambulance is covered in full at a flat rate of one hundred and sixteen euros and nineteen cent (€116.19) only on the basis of a reasoned medical prescription issued either by the doctor who ordered the transport or by the doctor treating the insured person on admission.