Prior authorisation under the Cross-Border Directive
If your waiting time for a guaranteed benefit in Poland is too long, and the benefit is listed in the appendix to the Regulation on the list of benefits, you can apply to obtain this treatment in another EU/EEA Member State using the provisions arising from the Cross-Border Directive.
Please note! You must first pay for the treatment you are planning yourself. Obtaining prior authorisation from the President of the National Health Fund is necessary in order for you to receive reimbursement of the costs of this treatment later on – in accordance with the reimbursement rules (Articles 42b–42h of the Act on healthcare benefits), i.e. in an amount no higher than the amount the National Health Fund pays for this benefit in Poland.
This mode of treatment can be carried out in EU/EEA Member States – both in facilities having a contract with a public insurance institution and in private facilities.
1. Model Application
The application is Appendix 1 to the Regulation of the Minister of Health on granting authorisation.
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 together with the attachments should be submitted to Centrala NFZ, ul. Rakowiecka 26/30, 02-528 Warszawa.
You can also submit your application as an electronic document, signed either with a qualified electronic signature, a personal signature or a trusted profile. The required attachments may be represented in digital form.
5. Conducting an investigation
The procedure aims to confirm the coexistence of the following conditions:
- the patient cannot be treated in Poland within the time limit required due to the state of health (too long waiting time for treatment),
- the treatment is a guaranteed benefit, i.e. it is included in the list of guaranteed benefits.
As a result of the investigation procedure, the President of the National Health Fund issues a decision – granting or refusing to grant authorisation for healthcare benefits in an EU/EEA Member State, as specified in the list of benefits.
6. Refusal of authorisation for treatment
The President of the National Health Fund may refuse to grant an authorisation if the requested benefit:
- is not a guaranteed benefit,
- can be provided in the country by a healthcare provider who has concluded a contract for the provision of healthcare benefits within a time limit not exceeding the patient’s maximum acceptable waiting time for the provision of the healthcare requested,
- poses a significant risk to the health of the patient which is not outweighed by the potential health benefits to be gained from obtaining the benefit,
- poses a significant health risk to the public,
- is to be provided by a healthcare provider operating in an EU/EEA Member State other than Poland, whose compliance with quality and safety standards established by the country in which it provides healthcare services is subject to substantial doubts.
7. Appealing against the decision
The decision of the President of the National Health Fund 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.
- Article 42b(9), Article 42f, Article 20(2)(6) and (11) of the Act on healthcare benefits
- Regulation on granting authorisation
- Regulation on the list of benefits
- Regulation on medical criteria
- Regulation on guaranteed benefits