Planned treatment abroad

If you have health insurance arranged in Slovenia, you have the right to planned treatment abroad.

You can obtain the right to planned treatment abroad if:

Frequently Asked Questions

1. Planned medical treatment abroad due to exhausted treatment options in Slovenia

To obtain the right to receive medical treatment abroad due to exhausted treatment options in Slovenia you must meet the following conditions:

  • have health insurance in Slovenia and
  • have an authorisation from the ZZZS for planned medical treatment abroad due to exhausted treatment options in Slovenia (before or after receiving treatment abroad).

The process to obtain authorisation for planned medical treatment abroad due to exhausted treatment options in Slovenia

Fill out the application for approval of planned medical treatment abroad due to exhausted treatment options in Slovenia with the following data:

  • personal data,
  • data on the representative or proxy holder, if any,
  • data on the medical referral (if you have already selected a healthcare provider abroad you can quote the provider, as well as the country in which you intend to undertake the treatment and a short explanation regarding the medical referral).

Submit the following with the application:

  • medical records on your medical treatment in Slovenia to date and
  • documents on treatments, examinations or tests abroad already carried out, if any.

Possible ways of submitting the application:

  • via an online form (you do not need a digital certificate for electronic signing to submit)
  • by mail: Miklošičeva cesta 24, 1000 Ljubljana or
  • by email: OELJ@zzzs.si or
  • in person: Mala ulica 3, 1000 Ljubljana.

Before adopting a decision on the medical treatment abroad due to exhaustion of treatment options in Slovenia, the ZZZS shall obtain a written opinion from the council of doctors or the relevant clinic or institute:

  • on your medical condition and a description of past treatments,
  • what kind of treatment you need,
  • if all treatment options in Slovenia are indeed exhausted,
  • if a medical treatment abroad is expected to provide a cure or improve your medical condition or prevent a further deterioration,
  • how long the proposed treatment, examination or test is supposed to last,
  • if you require an escort and what kind (amateur or professional),
  • what means of transport is required in view of your medical condition,
  • the name of the closest provider abroad, where the treatment is supposed to be implemented.

Based on the medical and other documentation, the opinion of the relevant clinic or institute and an eventual opinion of the designated doctor, member of the medical committee or another doctor of the ZZZS, the ZZZS decides on the merit of the proposed medical treatment abroad (issues a decision of the authorisation of a planned medical treatment abroad).

Coverage of costs of planned medical treatment abroad due to exhausted treatment options in Slovenia

If the ZZZS authorises your medical treatment abroad due to exhausted treatment options in Slovenia, it will issue you a document for assuming the costs which you submit to the provider abroad:

  • S2 (for healthcare providers in the EU, EEA and Switzerland),
  • SI/RM 4, SI/BIH 4, SI/SRB 4 or SI/MNE 4 (for healthcare providers in Northern Macedonia, Bosnia and Herzegovina, Serbia and Montenegro) or
  • authorization for assuming the treatment costs if the healthcare provider abroad does not accept any of the above listed documents.

Travel, food, accommodation, and escort costs

If the ZZZS authorizes your treatment abroad, it will also decide on your right to reimbursement of travel, food, accommodation, and escort costs.

After your treatment abroad, fill out the application for reimbursement of costs of your planned medical treatment abroad as well as your travel costs with the following data:

  • personal data,
  • information on your bank account, to which the funds shall be transferred,
  • data on the representative or proxy holder, if any,
  • data on the previously issued decision of the ZZZS,
  • data on the medical referral.

Submit the following with the application:

  • invoice and proof of payment of the medical and other services rendered (accommodation),
  • supporting documents on the medical treatment abroad,
  • travel itinerary (departure time and date, arrival time and date, kilometres travelled etc.),
  • tickets or other supporting documents showing that the transport was paid for.

Possible ways of submitting the application:

Reimbursement of costs of medical treatment received if you had no prior authorisation of the ZZZS

Fill out the application for reimbursement of costs of the planned medical treatment abroad and travel costs with the following data:

  • personal data,
  • information on your bank account, to which the funds shall be transferred,
  • data on the representative or proxy holder, if any,
  • supporting documents on the medical treatment you received abroad,
  • data on other expenses.

Submit the following with the application:

  • medical records on the medical treatment you received abroad,
  • medical records on your medical treatment in Slovenia to date,
  • invoice and proof of payment of the invoice for medical treatment you received abroad,
  • invoice and proof of payment of other services (accommodation),
  • travel itinerary (departure time and date, arrival time and date, kilometres travelled etc.),
  • tickets or other supporting documents showing that the transport was paid for.

Possible ways of submitting the application:

  • via an online form (you do not need a digital certificate for electronic signing to submit)
  • by mail: Miklošičeva cesta 24, 1000 Ljubljana or
  • by email: OELJ@zzzs.si or
  • in person: Mala ulica 3, 1000 Ljubljana.

Based on the submitted application and relevant supporting documents, the ZZZS determines whether all treatment options in Slovenia were indeed exhausted and a treatment or examination in another country is reasonably expected to cure or improve your medical condition or prevent further deterioration.

If the ZZZS authorises your medical treatment abroad, it shall also decide on your right to reimbursement of treatment costs and eventual travel, accommodation, and escort costs.

The amount of reimbursed costs of planned medical treatment abroad due to exhausted treatment options in Slovenia

The ZZZS shall reimburse the costs of medical services to the amount of actual costs.

The ZZZS shall reimburse transportation, food, escort and accommodation costs in accordance with its decision on the authorisation of the treatment and regulations on health insurance.

Legal basis

Applications

You can submit an application via an online form (you do not need a digital certificate for electronic signing to submit).

Before going for medical treatment abroad

Application for authorisation of planned medical treatment abroad due to exhaustion of treatment options in Slovenia

After having received medical treatment abroad

Application for reimbursement of costs of planned medical treatment abroad due to exhaustion of treatment options in Slovenia

2. Planned medical treatment abroad due to excessive waiting period in Slovenia

To obtain the right to medical treatment abroad due to excessive waiting period in Slovenia you must meet the following conditions:

  • have health insurance in Slovenia,
  • be placed on a waiting list at a healthcare provider in Slovenia,
  • have a set appointment at a healthcare provider in Slovenia,
  • have an authorisation from the ZZZS to receive medical treatment abroad due to exceeding the maximum allowed waiting period or a reasonable time frame at all healthcare providers in Slovenia (before or after receiving treatment) and
  • undergo treatment in another EU Member State, EEA Member State or Switzerland,
  • the selected healthcare provider in the EU Member State, EEA Member State or Switzerland is part of the public healthcare network in this country.

Waiting periods

Waiting periods in Slovenia

The terms waiting time, maximum permissible waiting time, waiting period, waiting list and reasonable time frame are defined in detail in the regulations governing patients’ rights.

Authorisation procedure of planned medical treatment abroad due to excessive waiting period in Slovenia

Fill out the application for authorisation of planned medical treatment abroad due to excessive waiting period in Slovenia with the following data:

  • personal data,
  • data on the representative or proxy holder, if any,
  • data on the medical referral (name of the selected healthcare provider abroad which is part of the public healthcare network, the country in which you intend to undertake the treatment and a short explanation regarding the medical referral).

Submit the following with the application:

  • supporting documents showing you are registered on a waiting list at a healthcare provider in Slovenia,
  • supporting documents showing a treatment date in Slovenia and at which healthcare provider,
  • medical records on your medical treatment in Slovenia to date.

Possible ways of submitting the application:

  • via an online form (you do not need a digital certificate for electronic signing to submit)
  • by mail: Miklošičeva cesta 24, 1000 Ljubljana or
  • by email: OELJ@zzzs.si or
  • in person: Mala ulica 3, 1000 Ljubljana.

As part of the authorisation procedure of medical treatments abroad, the ZZZS shall determine whether the maximum permissible waiting period for a specific service is exceeded and whether there is no other healthcare provider in Slovenia where this waiting period would not be exceeded.

If the ZZZS determines that the maximum allowed waiting period is exceeded at all healthcare providers in Slovenia, it shall authorise your treatment in another country in the EU, EEA or Switzerland.

If the ZZZS determines that the maximum allowed waiting period is not exceeded and that there is at least one healthcare provider in Slovenia which can provide treatment within the maximum allowed waiting period, the ZZZS shall determine whether the reasonable time frame period is exceeded.
In order to determine whether the reasonable time frame is exceeded, the ZZZS shall request a written opinion of the clinic or institute on the matter, whether in view of your position on the waiting list the expected waiting time exceeds the reasonable time frame.

After obtaining an opinion of the relevant clinic or institute, the ZZZS shall decide on the merit of a treatment abroad (it issues a decision on the authorisation of a planned medical treatment abroad).

Coverage of costs of the planned medical treatment abroad due to excessive waiting period in Slovenia

If the ZZZS authorises your medical treatment in an EU Member State, EEA Member State or Switzerland due to excessive waiting period in Slovenia, it will issue you a form S2 for assuming the costs and you submit the form to the healthcare provider abroad.

The selected healthcare provider in an EU Member State, EEA Member State or Switzerland must be part of the relevant country’s public healthcare network.

Travel, food, accommodation and escort costs

If the ZZZS authorises your treatment abroad, it will also decide on your right to reimbursement of travel, food, accommodation and escort costs.

After your treatment abroad, fill out the application for reimbursement of costs of your planned medical treatment abroad due to excessive waiting period in Slovenia with the following data:

  • personal data,
  • information on your bank account, to which the funds shall be transferred,
  • data on the representative or proxy holder, if any,
  • data on the previously issued decision of the ZZZS,
  • data on the medical referral.

Submit the following with the application:

  • invoice and proof of payment of the medical and other services rendered (accommodation),
  • supporting documents on the medical treatment abroad,
  • travel itinerary (departure time and date, arrival time and date, kilometres travelled etc.),
  • tickets or other supporting documents showing that the transport was paid for.

Possible ways of submitting the application:

Reimbursement of costs of a medical treatment received if you had no prior authorisation of the ZZZS

Fill out the application for the coverage of costs of planned medical treatment abroad due to excessive waiting period Slovenia with the following data:

  • personal data,
  • information on your bank account, to which the funds shall be transferred,
  • data on the representative or proxy holder, if any,
  • data on the medical treatment you received abroad.

Submit the following with the application:

  • medical records on your medical treatment in Slovenia to date,
  • medical records on the medical treatment you received abroad,
  • supporting documents showing you are registered on a waiting list at a healthcare provider in Slovenia,
  • supporting documents showing a treatment date in Slovenia and at which healthcare provider,
  • invoice and proof of payment of the invoice for the medical treatment you received abroad,
  • invoice and proof of payment for other services (accommodation),
  • travel itinerary (departure time and date, arrival time and date, kilometres travelled etc.),
  • tickets or other supporting documents showing that the transport was paid for.

Possible ways of submitting the application:

  • via an online form (you do not need a digital certificate for electronic signing to submit)
  • by mail: Miklošičeva cesta 24, 1000 Ljubljana or
  • by email: OELJ@zzzs.si or
  • in person: Mala ulica 3, 1000 Ljubljana.

Based on the submitted application and relevant supporting documents, the ZZZS retroactively determines whether you have gotten a date when registering on the waiting list at a healthcare provider in Slovenia that exceeds the maximum aloowed waiting period or reasonable time frame and there is no other healthcare provider in Slovenia where this time period would not be exceeded.  

If the ZZZS authorises your medical treatment abroad, it will also decide on your right to reimbursement of the treatment costs and eventual travel, accommodation, and escort costs.

Amount of reimbursement of costs of planned medical treatment abroad due to excessive waiting period in Slovenia

The ZZZS shall reimburse costs of medical services to the amount the service in question costs in the public healthcare network in the country where you received the treatment. The ZZZS shall obtain information on the amount of the reimbursement from the foreign insurance institution.

The ZZZS shall reimburse transportation, food, escort and accommodation costs in accordance with its decision on the authorisation of the treatment and regulations on health insurance.

Legal basis

Applications

You can submit an application via an online form (you do not need a digital certificate for electronic signing to submit).

Before going for medical treatment abroad

Application for authorisation of planned medical treatment abroad due to excessive waiting period in Slovenia

After having received medical treatment abroad

Application for reimbursement of costs of the planned medical treatment abroad due to excessive waiting period in Slovenia

3. Planned medical treatment abroad based on a medical referral from a doctor in Slovenia

To obtain the right to medical treatment abroad based on a medical referral from a doctor in Slovenia you must meet the following conditions:

  • have health insurance in Slovenia,
  • have a medical referral from a doctor in Slovenia before going abroad for treatment,
  • receive medical services abroad which you are entitled to under the compulsory health insurance in Slovenia,
  • undergo treatment in another EU Member State,
  • have prior authorisation of the ZZZS, if you will also claim coverage of healthcare services that demand spending a night at the hospital,
  • have prior authorisation of the ZZZS, if you will claim coverage of healthcare services abroad which are on the list for prior authorisation.

Authorisation procedure of planned medical treatment abroad based on a medical referral from a doctor in Slovenia

You require prior authorisation of the ZZZS if you will receive the following in an EU Member State:

Fill out the application for authorisation of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia with the following data:

  • personal data,
  • data on the representative or proxy holder, if any,
  • data on the medical referral (name of the selected healthcare provider in an EU Member State, the country in which you intend to undertake the treatment and a short explanation regarding the medical referral).

Submit the following with the application:

  • supporting documents showing you are registered on a waiting list at a healthcare provider in Slovenia,
  • supporting documents showing a treatment date in Slovenia and at which healthcare provider,
  • medical records on your medical treatment in Slovenia to date.

Possible ways of submitting the application:

  • via an online form (you do not need a digital certificate for electronic signing to submit)
  • by mail: Miklošičeva cesta 24, 1000 Ljubljana or
  • by email: OELJ@zzzs.si or
  • in person: Mala ulica 3, 1000 Ljubljana.

Prior authorisation shall not be granted if:

  • the medical service can be provided within the maximum allowed waiting period from at least one healthcare provider in Slovenia,
  • you will be, with reasonable certainty, exposed to risk that cannot be deemed acceptable,
  • on account of the medical service that is the subject of prior authorisation, the general public will be exposed to risk with reasonable certainty.

As part of the authorisation procedure of the medical treatment abroad, the ZZZS shall determine whether the maximum allowed waiting period for a specific service is exceeded and whether there is no other healthcare provider in Slovenia where this waiting period would not be exceeded.

If the ZZZS determines that the maximum allowed waiting period is exceeded at all healthcare providers in Slovenia, it shall authorise your treatment in another country in the EU, EEA or Switzerland.

If the ZZZS determines that the maximum allowed waiting period is not exceeded and that there is at least one healthcare provider in Slovenia that can provide treatment within the maximum allowed waiting period, the ZZZS shall determine whether a reasonable time frame is exceeded.
In order to determine whether a reasonable time frame is exceeded, the ZZZS shall request a written opinion of the clinic or institute on the matter, whether in view of your position on the waiting list the expected waiting time exceeds a reasonable time frame.
After obtaining an opinion from the relevant clinic or institute, the ZZZS shall decide on the merit of a treatment abroad (it issues a decision on the authorisation of the planned medical treatment abroad).

Cost coverage of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia

You pay for treatment in an EU Member State yourself and afterwards claim reimbursement of the costs. This also applies if you had prior authorisation of the ZZZS.

Fill out the application for reimbursement of costs of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia with the following data:

  • personal data,
  • information on your bank account, to which the funds shall be transferred,
  • data on the representative or proxy holder, if any,
  • if you had prior authorisation of the ZZZS, data on the authorisation,
  • data on the medical treatment you received abroad.

Submit the following with the application:

  • invoice and proof of payment of medical and other services rendered (accommodation),
  • medical records on the medical treatment you received abroad,
  • proof that you had a medical referral from your doctor in Slovenia (if you had prior authorisation of the ZZZS you do not need to submit any such proof).

Possible ways of submitting the application:

You are not entitled to reimbursement of medical costs abroad in case of:

  • medical services in a basic medical practice (services of a chosen personal physician, dentist, gynaecologist etc.),
  • medical services in the field of long-term care, including non-emergency hospital treatments and care in social security institutions,
  • medical services in the field of obtaining and transplanting parts of the human body,
  • medical services in the field of screening programmes,
  • cohabitation of one of the parents in a healthcare institution with a sick child up to 5 years of age,
  • medical devices that you rent as accessories for treatment, care and rehabilitation at home,
  • training a guide dog, to which a blind person in entitled to,
  • travel costs and escort costs.

Amount of reimbursed costs of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia

The ZZZS shall reimburse costs in the amount of the average price of such services in Slovenia, but not exceeding the actual costs.
If the price of the service is higher in Slovenia, the actual cost of the service in another EU Member State shall be reimbursed.

The ZZZS shall not reimburse you any travel and accommodation costs.

Legal basis

Applications

You can submit an application via an online form (you do not need a digital certificate for electronic signing to submit).

Before going for medical treatment abroad:

Application for authorisation of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia

After having received medical treatment abroad:

Application for reimbursement of costs of planned medical treatment abroad on the basis of a medical referral from a doctor in Slovenia