EHIF reimburses self-care medical devices that can be used to treat diseases and injuries, or which help prevent the aggravation of diseases.
Reimbursable medical devices include, for example, accessories for measuring and correcting blood glucose for diabetics (glucometer test strips, lancets, insulin needles), stoma care products, orthoses, bladder catheters and wound dressings, as well as devices for patients with sleep apnea and compression products for the treatment of both lymphedema and venous insufficiency and ulcers.
Attending physician determines the need for a medical device. If you have been diagnosed with a disease that requires a medical devices listed in the EHIF’s list of medical devices and your medical condition meets the conditions for reimbursement, then your attending physician will issue to you a digital medical device card (N.B. There are no paper cards!).
After issuing of the medical device card, you can immediately go to a pharmacy or contact the seller of the medical device directly and buy the medical device prescribed by your doctor at a discount. You have to present your ID for this. When purchasing a device for someone else, you also need the personal identification code of the person to whom the device is for (it is not necessary to bring his/her identity document with you).
The list of medical devices is updated annually based on proposals from manufacturers and professional associations and price agreements with manufacturers.
- Diabetic patients: glucometer test strips, lancets, disposable needles for insulin delivery systems, and in addition for children under 19 years of age: insulin pump, continuous glucose monitoring kit and accessories (infusion sets, reservoirs, glucose sensors).
- Patients with asthma: spacers for children with asthma up to 10 years of age.
- Patients with colostomy, ileostomy, urostomy or fistula: ostomy bags, ostomy rings, ostomy baseplates and their attachments, ostomy care products (creams, powders, pastes, protective products and adhesive removers, odor neutralizing agents), ostomy bag belts.
- Patients with tracheostomy tube: tracheal cannulas, tracheostomy patches, filters and skin cleansing patches, tracheostomy protectors.
- Post-trauma or -surgery: primary prostheses and prosthesis replacements, orthoses and sole supports.
- Burn patients, and patients with lymphedema or venous insufficiency: compression garments.
- Contact lenses for the treatment of keratopathy, keratoconus and aphakia in children up to 6 years of age.
- Wound dressings for the treatment of venous, diabetic, atypical or lymphedema wounds or bedsores, complicated surgical wounds, post-irradiation or burn wounds, or degenerating tumors.
- Patients with sleep apnea: automatic continuous positive airway pressure (CPAP) device and positive pressure device masks.
- In case of severe ichthyosis: skin care products.
In addition, we reimburse aspiration probes for patients on home ventilation therapy or with tracheostomy, dysphagia due to neurological damage or lack of cough reflex due to neuromuscular disease EHIF also reimburses disposable bladder catheters for neurological pathology or urethral strictures, after pelvic surgery or radiation and for patients diagnosed with N31.0 who require daily self-catheterization. We also reimburse injection needles for patients with Parkinson's disease on apomorphine injection therapy and for patients with growth failure taking medicines containing growth hormones.
More detailed reimbursement terms are described in the list of medical devices.
The ceiling price system is applied when there are more than two comparable medical devices in a group. When the ceiling price system is applied, the discount is calculated based on the cost-effectiveness of the medical devices belonging to the same price ceiling group using the unit price (e.g., price per unit). If the actual cost of a reimbursable medical device is higher than the intra-group ceiling price, the Health Insurance Fund reimburses 90% or 50% of the ceiling price. The remaining portion of the ceiling price and the difference between the ceiling price and the actual selling price are borne by the patient. If the medical device is cheaper than the intra-group ceiling price, the discount is calculated based on the actual selling price of the medical device.
For example, in the Health Insurance Fund's list of medical devices, there are products containing 50 test strips in a package, with the cheapest package costing 15 euros, the next one 16.00 euros, and the third one 16.90 euros. The unit prices are 0.3000, 0.3200, and 0.3380 euros, respectively. In this case, the ceiling price for 50 test strips for the Health Insurance Fund is 50 * 0.3200 = 16.00 euros, from which a discount of 90% is calculated. The patient's out-of-pocket cost is 10%, meaning the patient must pay 1.5 euros for the cheapest package and 1.60 euros for a package with a price equal to the ceiling price. However, if the patient prefers a more expensive price group, for example, buys a product for 16.90 euros, then they must pay an additional amount exceeding the ceiling price (i.e., 0.90 euros), making a total of 2.50 euros.
Specific ceiling price groups, the package name and price of the medical device used as the basis for the ceiling price, and the medical devices subject to the ceiling price are listed in the Health Insurance Fund's list of medical devices.
Medical Device Card
A document digitally issued by a doctor to an insured person for prescribing the necessary medical devices, taking into account the conditions of the Health Insurance Fund's list of medical devices. When issuing a digital medical device card/prescription, two documents are always created: the medical device card (which is a unique document not visible to the doctor and pharmacy, based on which the calculation of the medical device limit is performed) and the supporting document required for the sale of the medical device associated with the card - the medical device prescription. The prescription for the medical device displays all the card's data and options.
The doctor specifies with the medical device card:
- the group of medical devices to which the patient is entitled to receive under preferential conditions;
- the reimbursement condition under which the patient is entitled to reimbursement (depending on the patient's age, severity of the disease, etc., devices are reimbursed in different quantities).
The digital medical device card is compiled in the prescription center and is group-based, meaning that all medical devices belonging to the respective group can be issued based on it. At the same time, a patient can have only one card for one group of medical devices.
Medical device cards can have either a repeated or a single limit period. In the case of a single limit period card, the card expires after the limit period ends. For medical devices where the patient's health condition or need may change over time or for expensive devices, the card is valid only once. If, upon evaluating the patient's condition, it becomes clear that the need for the device is ongoing, and the patient follows the treatment recommendations, the treating doctor may prescribe a new card.
For cards with a repeated limit period, the eligibility is renewed automatically, as the patient's need is unlikely to change significantly over time. Renewals for repeated cards occur at the beginning of each limit period (usually on 01.01 and 01.07).
To purchase a device, the patient must contact a pharmacy or a seller who has a contract with the Health Insurance Fund and present an identity document. When purchasing a device for someone else, it is necessary to provide the personal identification code of the person for whom the device is being purchased (their identity document is not required). Check Health Insurance Fund's medical device sales partners here.