Dla Pacjenta

Authorisation under the provisions on coordination

If you are registered on a waiting list for a given guaranteed benefit in Poland, but the waiting time is too long considering your state of health, you can apply for this treatment in another EU/EFTA/United Kingdom country.

The treatment you are planning must be provided in a facility in an EU/EFTA/United Kingdom country under the universal health care system. If you are authorised to obtain treatment, we will issue for you an authorisation form for treatment abroad – S2 form. You will need to provide this form to the facility abroad before treatment begins so that it can be carried out and billed to us under the provisions on coordination. Please note, however, that you will have to pay for treatment yourself if it is required for patients under the system in force in the relevant EU/EFTA/United Kingdom country (co-payment costs, for example, a daily flat rate for hospital stays).

1. Model Application

The application is Appendix 1 to the Regulation of the Minister of Health on granting authorisation.

MODEL APPLICATION NO 1

2. Completing the application

The application is completed by you and the doctor, who must meet the conditions set out in the Act on healthcare benefits.

Complete Part I.B., Part II and Part VI of the application and sign in the required fields. These parts of the application can also be completed on your behalf by:

a legal representative,
a spouse,
a blood relative or relative by affinity within the second degree lineal consanguinity,
a cohabiting person,
a person authorised by you – in this case attach a power of attorney to your application.

Please note! Please make sure to complete Part II.C of the application with your statement indicating:

the name and address of the facility where you are registered on the waiting list,
the medical category for which your case is classified (urgent/stable),
the time limit you have been given.

Then give the application to your doctor so that they can complete Part III of the application. The doctor who refers you for treatment abroad must be:

a health insurance doctor, or, colloquially, ‘to treat on the National Health Fund’

(according to the definition: a health insurance doctor is a provider of healthcare benefits with whom the National Health Fund has concluded a contract on the provision of healthcare benefits, or a doctor who is employed or practises at a provider of healthcare benefits with whom the national Health Fund has concluded a contract on the provision of healthcare benefits),

a consultant with a second degree specialty or a consultant in medicine relevant to the extent of the requested treatment or diagnostic tests.

3. Adding attachments

The application must be accompanied by the following documents:

a copy of the medical records (relating to the extent of treatment requested),
Polish translation of medical records – if they are in a foreign language (they do not have to be translated by a sworn translator).

4. Submitting the application together with the attachments

The application and attachments should be submitted to the President of the National Health Fund in the following way:

by post to the address of the National Health Fund Headquarters: ul. Rakowiecka 26/30, 02-528 Warsaw – if submitting a paper application, or
via the Electronic Delivery Address (ADE): AE:PL-98754-99859-GJBJA-29 – if submitting the application in electronic form.

Please note! The application must be signed with:

a. a handwritten signature – if submitting a traditional (paper) application,

b. a qualified electronic signature (i.e., an electronic signature that is submitted using a qualified electronic signature device and is based on a qualified electronic signature certificate), personal signature (i.e., advanced electronic signature), or trusted signature (i.e., by electronic signature using a trusted profile)
– in the case of submitting an application in the form of an electronic document.

In the case of submitting an application in electronic form, the required attachments may be respresented in digital form.

5. Conducting an investigation

The procedure aims to confirm the coexistence of the following conditions:

the patient cannot obtain treatment in Poland within a time limit which is medically justifiable, taking into account their current state of health and the probable course of the disease (‘waiting list condition’),
the treatment is a guaranteed benefit, i.e. it is included in the list of guaranteed benefits.

As a result of the investigation, the President of the National Health Fund issues a decision – authorisation or refusal of authorisation to provide a benefit or its continuation in another EU/EFTA/United Kingdom country.

If, in the application, you have also indicated a request to cover the costs of transport to the place of treatment abroad, the President of the national Health Fund will decide in the same decision whether or not to agree to cover them.

Please note! If you go for a treatment authorised by the President of the National Health Fund and you need to be transported to Poland because of your state of health after the treatment, you may submit an application to cover the costs of your return transport to Poland. The application is Appendix 3 to the Regulation of the Minister of Health on granting authorisation.

MODEL APPLICATION NO 3

6. Refusal of authorisation for treatment

The President of the National Health Fund may refuse to grant an authorisation if the requested benefit:

can be provided in the country by a healthcare provider who has concluded a contract with the National Health Fund for the provision of healthcare benefits within a time limit not exceeding the patient’s acceptable waiting time for the treatment
is not a guaranteed benefit.

7. Appealing against the decision

The decision of the President of the National Health Fund to refuse to grant an authorisation is final – it cannot be appealed.

If you disagree with the decision, you can lodge a complaint with the administrative court. You must do this within 30 days from the receipt of the decision.

Legal bases