Employees:

Health Care and Sickness Benefit Compulsory Insurance Act (Loi relative à l'assurance obligatoire soins de santé et indemnités/Wet betreffende de verplichte verzekering voor geneeskundige verzorging en uitkeringen), co-ordinated on 14 July 1994 and Royal Decree of 3 July 1996 on the execution of this Act.

Act on Hospitals and other Care Facilities (Loi relative aux hôpitaux et à d'autres établissements de soins/Wet betreffende de ziekenhuizen en andere verzorgingsinrichtingen), co-ordinated on 10 July 2008.

Law of 27 June 1969 revising the Decree-law of 28 December 1944 on the social security of workers.

Health Care Act (Terveydenhuoltolaki) of 30 December 2010.

Primary Health Care Act (Kansanterveyslaki) of 28 January 1972.

Sickness Insurance Act (Sairausvakuutuslaki) of 21 December 2004.

Act on Specialised Medical Care (Erikoissairaanhoitolaki) of 1 December 1989.

Patient Fees Act (Asiakasmaksulaki) of 3 August 1992.

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Social Security Code (Code de la sécurité sociale), Book III, articles L 321-1, and following.

Several other systems, especially for the self-employed and for certain salaried employees.

Social Code (Sozialgesetzbuch), Book V, introduced by the Health Reform Act (Gesundheits-Reformgesetz) of 20 December 1988, last amended by Article 1 of the Act of 27 March 2013 (BGBI. I p. 261).

Law No. 833 of 23 December 1978 instituting the National Health Service (Legge 23 Dicembre 1978 n. 833 - Istituzione del Servizio Sanitario Nazionale, S.S.N.).

Legislative Decree No. 502 of 30 December 1992 (Decreto Legislativo 30 Dicembre 1992 n. 502 - Riordino della disciplina in materia sanitaria).

Legislative Decree No. 517 of 7 December 1993 (Decreto Legislativo 7 Dicembre 1993 n. 517 - Modificazioni al Decreto Legislativo 30 Dicembre 1992, n. 502).

Legislative Decree No. 229 of 19 June 1999 (Decreto Legislativo 19 Giugno 1999 n. 229 - Norme per la razionalizzazione del Servizio sanitario nazionale).

Legislative Decree No. 230 of 22 June 1999 (Decreto Legislativo 22 Giugno 1999 n. 230 - Riordino della medicina penitenziaria).

Prime Minister Decree of 29 November 2001 (Decreto del Presidente del Consiglio dei Ministri 29 Novembre 2001 - Definizione dei Livelli Essenziali di Assistenza)

National Health Service (Serviço Nacional de Saúde): Law 56/79 of 15 September 1979.

Framework Law on Health (Lei de Bases da Saúde): Law 48/90 of 24 August 1990.

General scheme of State contribution towards the price of pharmaceuticals (Regime geral de comparticipação do Estado no preço dos medicamentos): Statutory Decree 48-A/2010 of 13 May 2010, as amended onseveral occasions.

Bylaws of the National Health Service (Estatuto do Serviço Nacional de Saúde): Statutory Decree 11/93 of 15 January 1993, as amended on several occasions.

Scheme of co-payments in the framework of the National Health Service (Regime das taxas moderadoras no âmbito do Serviço Nacional de Saúde): Statutory Decree 113/2011 of 29 November 2011 republished in a consolidated version by Statutory Decree 128/2012 of 26 June 2012, as amended on several occasions.

National Health Service and Community Care Act 1990.

National Health Service (Primary Care Act) 1997.

Health and Social Care Act 2001.

National Health Service Reform and Health Care Professions Act 2002.

National Health Service (Charges to Overseas Visitors) Regulations 2011.

NHS (General Medical Services Contracts) Regulations 2004.

NHS (Primary Medical Services Agreements) Regulations 2004.

National Health Service Act 2006.

Tax financed universal public health service for all residents.

• Public health service for all inhabitants (based on residency) operated by municipalities. Financed by taxes and patient fees.
  
• Private health care supplements the public scheme. Private health care services are partly refunded by general sickness insurance. Supplements are financed by contributions paid by the insured and a subsidy from the State (fifty-fifty-principle).
  

Tax-financed National Health Service for all inhabitants (based on residency).

Tax financed public health service for all inhabitants (based in residency).

All salaried workers and assimilated categories, such as:

• Pensioners (including widows and widowers, orphans, and disabled persons).
• Unemployed persons.
• Disabled persons.
• Higher education students.
• Certain members of the clergy and of religious communities.
• Persons listed on the national register as individuals.
• Certain members of the former public service in Africa.
  

All self-employed persons subject to compulsory health insurance.

All residents.

• Persons in paid employment and those receiving vocational training, trainees.
  
• Pensioners with a sufficient period of insurance.
  
• Unemployed persons receiving unemployment insurance benefits.
  
• Disabled persons in sheltered employment.
  
• Persons participating in vocational rehabilitation and people being trained for some form of employment in special training institutions of the youth assistance (Jugendhilfe).
  
• Students in recognised higher education.
  
• Farmers and helping members of their family.
  
• Artists and writers.
  
• Persons having no other right to healthcare services in case of sickness (under certain conditions).
  

• All the Italian residents, included those detached abroad for professional reasons (law No. 398 of 3 October 1987),
• all EU residents subject to Italian law, except for those who are entitled to health care through the appropriate bodies in the other member States of the EU, according to the Regulation (EC) 883/2004,
  
• extra-EU citizens and their dependent family members, when holder of a residence permit issued for one of the reasons stipulated in the frame of the compulsory registration at the National Health Service (Servizio Sanitario Nazionale, S.S.N.), art. 34 of Legislative Decree No. 286 of 25 July 1998,
  
• Italian and EU non residents and their dependent family, who are employed or self-employed in Italy and subject to the Italian law,
  
• extra-EU citizens and their dependent family members, registered at the National Health Service, according to a Social Security agreement with their Country of origin,
  
• extra-EU citizens without a residence permit (Temporarily Present Foreigner – STP) but olnly for urgent and essential clinical and hospital treatments according to art. 35 of Legislative Decree n. 286 of 25 July 1998.

All residents.

• All residents.
  
• Non-residents liable to Dutch wages and salaries tax in connection with employment in the Netherlands.
  

All persons “ordinarily resident” in the UK.

No exemptions.

Not applicable: universal system.

Not applicable: universal system.

No exemptions.

• Italian and foreign citizens residing abroad but temporarily in Italy.
  
• Foreign workers holding a residence permit for business and others who are not taxed in Italy.
  
• Foreign citizens holding a residence permit for medical reasons.
  

Not applicable: universal system.

Not applicable: universal system.

Not applicable: universal system.

No possibility of voluntary insurance.

Not applicable: universal system.

Not applicable: universal system.

No possibility for voluntary insurance.

Voluntary insurance is possible after withdrawal from compulsory insurance or from family insurance as well as in case of first-time employment in Germany with annual earnings exceeding the annual income limit.

• foreign citizens holding a residence permit valid more than 3 months.
  
• foreign citizens in Italy for studying or working au pair, despite the length of their residence permit.
  

Not applicable: universal system.

Not applicable: universal system.

Not applicable: universal system.

Spouse, cohabitant, children under 25 years of age (6 categories), ascendants (in some cases parents in law).
Income conditions: earnings, pensions, annuities, allowances or indemnities lower than € 2,326.00 per quarter.

Not applicable: universal system.

All residents are individually covered.

Not applicable: universal system. All residents are individually covered.

Spouse and children, income not exceeding €395 or €450 per month if employed in insignificant employment, provided they are not insured in their own right, or active as self-employed. Age limit for children. Some other exclusions.

Divorced spouses, whose non-contributory family insurance ends after the divorce, can insure themselves voluntarily after the divorce has become final subject to certain conditions (previous insurance periods necessary).

Beneficiary's dependent family members.

Not applicable: universal system. All residents are individually covered.

Not applicable: universal system. All residents are individually covered.

Unlimited. When an employee withdraws from the insurance scheme, benefits cease to be paid basically at the end of membership; for compulsory members entitlement to benefits continues for maximum one month after end of membership.

All doctors registered with the Order of Doctors (Ordre des médecins/Orde der geneesheren) and approved by the Minister of Public Health (Ministre de la Santé publique/Minister van Volksgezondheid).

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

All doctors qualified to practice.

The following doctors are able to provide medical care services covered by social security:

• doctors employed either by the regional health authorities, or by the public or contracted hospitals;
  
• general practitioners, pediatricians and specialists approved under the contract concluded between the SISAC (Interregional Structure) and the Ministry of Health, approved in State/Regions Conference.

Doctors employed either by regional health authorities or by hospitals. Specialists approved under agreement between the Order of Medical Practitioners and the Ministry of Health for the purpose of consultations for persons unable to reach an official clinic within a specified time.

All doctors qualified to practise.

Doctors licensed to practice by the General Medical Council (the statutory licensing body).

Local Primary Care Organisations (PCO) are responsible for the delivery of NHS primary medical services - i.e. general practitioner (GP) services - for NHS patients through four contractual routes:

• General Medical Services (GMS); traditional model of general practice delivered under a nationally negotiated contract.
  
• Personal Medical Services (PMS); created in 1997 and intended to deliver, through a local contract, a locally sensitive version of GMS and address needs not otherwise met by GMS. Services can be narrower through “Specialist” PMS (SPMS). PMS increasingly mimics GMS.
  
• Primary Care Trust Medical Services (PCTMS); directly provided as well as managed by the PCO, often to fill a perceived gap in provision or for part of a service, eg Out of Hours (OOHs) care.
  
• Alternative Provider Medical Services (APMS); created in 2004 allows primary medical services to be competed for by the private, voluntary and public sectors, sometimes in partnership, generally for a comprehensive primary medical service but can be narrower. Some OOHs providers are de facto APMS. GP practices can acquire APMS contracts.
  

Payment on a fee-for-service basis. Scales of fees fixed by agreement between the insuring bodies and doctors' organisations or, failing this, laid down officially.

If no contract exists or for non-approved doctors, fees fixed freely by doctors (except for certain categories of patients) and the insurance refund is laid down by royal decree.

Fees are fixed by agreement between the Danish Medical Association and the public health service. General practitioner’s (GP) fees are calculated according to the number of patients registered and of the medical services performed. Specialists are paid a flat-rate sum for each medical intervention.

Hospital doctors are, in general, paid on the basis of a monthly salary plus certain supplementary payments.

Doctors working at public hospitals or health centres (Terveyskeskus) are employed and paid by the municipalities.

Doctors working in private sector are paid on a fee-for-service basis.

Remuneration package to the respective association of sickness fund doctors (Kassenärztliche Vereinigung) by the sickness insurance: the remuneration is mainly based on the morbidity of the insured person. That means, that for additional benefits that result from an increase of need for treatment of the insured person, more remuneration is provided by the sickness insurance.

The contract doctors bill their services to the association of sickness fund doctors according to a fee distribution scale (Honorarverteilungsmaßstabs). The fee distribution scale is set by the association of sickness fund doctors in consultation with the associations of sickness funds.
Next to the remuneration of the association of sickness fund doctors, it is possible for doctors to gain more Income through individual contracts with the sickness funds, such as for primary care.

Employed doctors and hospital doctors: variable monthly wages, determined by the government according to professional categories.

General practitioners and pediatricians of free choice (family doctors): Flat-rate yearly amount per capita.

Approved specialists: Flat-rate amount per hour.

Employed doctors: monthly salary set by government, varying according to professional category.

Approved doctors: payment on fee for service basis. Amounts are fixed according to a scale of fees decided by the Government and periodically revised.

Doctors employed by the public health authorities are salaried.

Affiliated private practitioners are paid according to a tariff fixed after negotiations between the county councils (landsting) or regions (regioner) and the doctors' organisation.

• Fixed: paid by the Dutch Health Care Insurance Board (College voor zorgverzekeringen, CVZ) directly to healthcare providers,
  
• Regulated: maximised tariffs paid by the private health insurance companies (case mix A or A-DBCs),
  
• Free: free tariffs paid by the private health insurance companies (case mix B or B-DBCs Free Segment).
  

GMS contracts are between practices (contractors) and PCOs. GMS contractors are entitled to payments as set out in the Statement of Financial Entitlement (SFE). Responsibility for funding the contract lies with PCOs.

Public hospitals are the responsibility of the regional health authorities and are financed by taxes.

Private hospitals: the regional health authorities may conclude agreements with private hospitals. Private hospitals are only financed by taxes when providing services instead of public hospitals (e.g. in case of excess waiting time, see “Benefits, 2. Hospitalisation, Choice of and access to hospital”).

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Public hospitals and private health care institutions: payments linked to activity.

Except for those acting as a hospital trust with a proper legal status in each region (i. e. highly specialised and/or University hospitals) hospital structures are the responsibility of the Local Health Authority (Aziende sanitarie locali - ASL).
The following structures are able to provide hospital care services covered by social security:

• public hospitals set up by the regional health authorities;
• private clinics contracted by the regional authorities.
  

They are financed on the basis of a price scale for benefits provided.

Public hospitals established and financed by the county councils (landsting) or regions (regioner).

Private hospitals: the county councils or regions may conclude agreement with private hospitals.

• Fixed: paid by the Dutch Health Care Insurance Board (College voor zorgverzekeringen, CVZ),
  
• Regulated: maximised tariffs paid by the private health insurance companies,
  
• Free: free tariffs paid by the private health insurance companies.
  

Free choice of doctor.

Direct payment of provider of care by the insurance body, if beneficiary is hospitalised.

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Free choice of doctor.

Free choice among contracted sickness insurance fund doctors.

Free choice of general practitioner and pediatrician among those contracted with the Region and operating in the insured residence area. The choice is confirmed as long as the insured does not decide otherwise.

Free choice of doctor.

Free choice by patient (or parent/guardian), subject to acceptance by the practice of an application to join its list of NHS patients. Patient usually has to reside within geographical practice boundary. Where a practice refuses such an application, it may offer to treat the person on a private, paying basis.

If a person, who should be able to register as a NHS patient, cannot find a practice willing to accept them, the Primary Care Organisation has the power to assign a patient to a practice's list.

Free choice for patients and free access to doctors.

Group 1: The GP refers each particular case to the specialist.

Group 2: Free choice.

Free choice among contracted specialists.

It is necessary a prescription made out by a general practitioner or by a specialist employed or contracted with the National Health Service (SSN).

Direct access is possible, but referral via the general practitioner is preferred.

Access via the general practitioner.

Through a general practitioner. There is no direct access to specialists.

The public health service at a regional level pays the public health service’s contribution directly to the doctor.

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Advance on fees by insured person. Refund based upon agreed or official rates.

There is no payment made by the insured person for treatment received from a doctor employed or contracted with the National Health Service (SSN).

No fees to be paid by the patient. Payments are made directly by the National Health Service (Serviço Nacional de Saúde).

Patient charges must not exceed 25% for general medical care. Charges are higher (40%) for certain specialist medical interventions. In excess of a certain annual amount paid by the insured themselves, the so-called maximum ceiling, certain categories of insured and will benefit from this point onwards from free health care services.

Basic criteria:

• being part of a specific social category;
  
• being part of a household with income under certain levels;
  

In concrete terms, the following ceilings are applicable according to annual income:

• up to € 17,719.92: € 450 (€ 350 for chronic diseases);
  
• from € 17,719.93 to € 27,241.07: € 650 (€ 550 for chronic diseases);
  
• from € 27,241.08 to € 36,762.25: € 1,000 (€ 900 for chronic diseases);
  
• from € 36,762.26 to € 45,886.69: € 1,400 (€ 1,300 for chronic diseases);
  
• from € 45,886.70: € 1,800 (€ 1,700 for chronic diseases).
  

Group 1: No charges (treatment by the chosen GP or a specialist to whom he refers the patient).

Group 2: The part of expenses which exceeds the amount fixed by the public scheme for Group 1.

Health centre:
Doctor visit maximum € 14.70 for the first three visits in a calendar year or an annual fee of maximum € 29.30 for 12 months depending on the municipality; most other services free of charge. However, € 20.20 may be charged for an on-call-visit to a health centre at night-time and on weekends.

Private doctor:
The system allows the patient to directly know the reimbursement amount. The patient is reimbursed part of the private doctor’s fee and the examination and treatment charges according to a schedule of fixed charges. The maximum reimbursable fee is often smaller than the fee charged by the doctor.

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Share borne by insured person:

• 30% for ambulatory treatment (GP or specialists, in consulting room or in hospital),
• 20% for hospital treatment,
  
• flat-rate co-payment of €1 per medical intervention within a limit of €50 per person and per year,
  
• flat-rate co-payment of €18 for serious medical intervention (of a minimum rate of €120).
  

Insured persons pay up to €36.15 per prescription (this amount can vary slightly from Region to Region) for health services in specialist outpatient clinics. Each prescription may include up to 8 different health treatments within the same specialty and up to 6 rehabilitation cycle of treatments. Health services are listed in the official tariff nomenclature (Annex to Ministerial Decree of 22 July 1996).
An additional fixed amount of €10.00 is requested for each prescription, to be paid to the National Health Service (SSN.).

The payment of the insured person's share borne varies according to the medical visit:

• visit at home,

• normal or urgent visit,

• visit in a central or regional hospital,

• visit in a health centre.
  

It also depends on the diagnosis and therapy auxiliary elements.

Patients pay between SEK 120 (€13) and SEK 300 (€33) per visit to a doctor.

For specialist care, patients pay between SEK 200 (€22) and SEK 350 (€38).

Emergency cases: between SEK 200 (€22) and SEK 450 (€49).

No charges to patients ordinarily resident in the UK or charge-exempt overseas visitors for NHS hospital services, but see below for prescription and other charges.

The increased reimbursement system (l’intervention majorée/de verhoogde verzekeringstegemoetkoming) is automatically granted to the following persons:

• beneficiaries of the integration income (revenu d'intégration/leefloon) or of an equivalent benefit (over a period of three full months without interruption),
  
• recipients of the guarantee of income for elderly persons (garantie de revenus aux personnes âgées/inkomensgarantie voor ouderen - IGO),
  
• beneficiaries of a disabled persons’ allowance,
  
• children with a physical or mental disability of at least 66%,
  
• unaccompanied foreign minors,
  
• orphan children having lost both parents.
  

The granting of the increased reimbursement is means-tested in case of the following persons:

• applicants (not belonging to the abovementioned categories) who are part of households on low and stable income, such as pensioners: the income ceiling (applied to the income of the year preceding the request for increased reimbursement) amounts to € 16,743.70 + € 3,099.72 per additional member present in the household (for the 2014 year of application),
  
• Widow(er)s, pensioners, long-term unemployed, recipients of invalidity benefit and assimilated persons, disabled persons not in receipt of benefits and single parent families: the income ceiling (applied to the income of the month preceding the request for increased reimbursement) amounts to € 16,965.47 + € 3,140.77 (for applications as of July 2014).
  

No exemptions or reductions.

Health centre:
Patients under the age of 18 are exempt from fees.

Public sector:
An overall ceiling of € 679 per year for public sector fees (excluding e.g. fees for dental care).

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Costs completely covered at 100% of the responsibility rate, in particular:

• Beneficiaries of an invalidity pension (pension d'invalidité),
  
• beneficiaries of a work injury pension (rente accident du travail) at a rate > 66.66% together with their family members,
  
• persons suffering from certain diseases, for those diseases only,
  
• persons with resources under a certain ceiling.
  

Exemption from the €1 flat-rate co-payment for:

• Children under 18 years of age,
  
• persons with resources below a certain limit.
  

Tests, visits to a consultant and medication of group A are free of charge, based on the household income and disability, for:

• civil disabled (more than 2/3 of invalidity);
  
• service disabled (categories 1 to 5);
  
• war disabled (cat. 1 to 5);
  
• children up to 6 years and persons aged over 65 whose family income is below €36,151.98;
  
• recipients of minimum pensions (pensione minima) aged over 65 and unemployed persons with an annual family income of less than €8,263: this limit amounts to €11,362 for a couple and is increased by €516 for each dependent child;
  
• recipients of the welfare-based social allowance (assegno sociale) and their dependent family;
  
• blind and deaf mute.
  

Are partly free of charge for:

• those suffering from a chronic illness and inducing a disability;
  
• service disabled (categories 6 to 8);
  
• war disabled (cat. 6 to 8);
  
• in the case of pregnancy and maternity.

Exemption for some specific groups, e.g.: pregnant women; children under the age of 12; persons in situation of need, whose income does not exceed 1.5 times the indexing reference of social support IAS (indexante dos apoios sociais = € 419.22); and unemployed persons registered with the job centre whose unemployment benefit does not exceed 1.5 times the IAS.

Most county councils do not charge any fees for children/youth.

Limitations for high costs. When a person within a 12-month period has costs for public health and medical care the limit is a maximum of SEK 1,100 (€120). For pharmaceutical products, see “4. Pharmaceutical products”.

Certain county councils (landsting) or regions (regioner) apply lower rates to some groups, e.g. people over 65 years old.

Free choice of licensed hospitals.

Hospital treatment requires the admission by a medical doctor (except for emergencies).

Free choice of a public or private hospital under contract. Access upon prescription of the general practitioner or of the specialist employed or contracted with the National Health Service (SSN), except in emergency cases.

• Since January 2005, all patients needing cataract surgery have been offered the choice of 2 or more providers at the point of referral from the GP;
• Since December 2005, all patients requiring a coronary artery bypass graft, angioplasty, or heart valve operation, have been offered the choice of 4 or more hospitals at the point of referral by the cardiologist,
• Patients needing a referral for elective care will be offered the choice of 4-5 providers for their treatment when referred by their GP and a booked appointment for a date and time which suits them. These providers may include NHS trusts, NHS and IS treatment centres and private hospitals.

Complete refund (public ward).
Patient charges:

• admission fee: € 42.58,
  
• subsequently € 15.31 per day.
  

€ 25.52 per day in case of hospitalisation in a psychiatric home for more than 5 years.

Services charged for: accommodation costs, pharmaceutical costs, medical fees, other supplies (e.g. blood), miscellaneous costs (e.g. use of telephone) and any supplements (single room).
Lump sums: € 0.62 per day for pharmaceutical costs, € 16.40 per admission for medico-technical services, € 7.44 for clinical biology and € 6.20 for radiology.
Fixed contribution by the insurance for approved homes for the aged, protected homes, nursing homes and psychiatric homes, day-care centre.

Public hospitals, approved private establishments and private hospitals with agreement with the regional health authorities: No charge.

Non-approved private establishments: patients pay all costs.

Public hospital:
The fee for an out-patient visit is € 29.30, for day surgery € 96.40. The fee for in-patient care is € 34.80 a day. Patients receiving long-term institutional care at a ward (over three months) are charged a fee in accordance with their means. Such a fee, however, may be no more than 85% of the patient´s net monthly income (if a person has a spouse who has lower income, the fee may be no more than 42.5% of their combined net monthly income).
Irrespective of this, minimum € 99 per month must be left for patient´s personal use.

Private hospital:
Part of the doctor's fee and costs for examination and care are refunded by the sickness insurance.

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):
20% of costs.

Hospitalisation fee (forfait hospitalier): €18 (€13.50 in a psychiatric unit) per day, including the day of discharge.

Flat-rate co-payment of €18 for serious medical intervention (of a minimum rate of €120).

Direct assistance free without choosing a room.

No participation in charges in public ward (or in private room if recommended by the doctor).

If in private room freely chosen by beneficiaries, charges are payable in full by the beneficiaries, as well as private hospital and clinic charges.

The patient will be charged maximum SEK 180 (€19) per 24 hours.

No charge to patients ordinarily resident in the UK or charge-exempt overseas visitors, except where the patient asks for special amenities or for extra treatment which is not clinically necessary.

Notably for dependent children, beneficiaries of the increased reimbursement system (bénéficiaires de l’intervention majorée /rechthebbenden op de verhoogde verzekeringstegemoetkoming) and the assimilated unemployed: € 5.44 per day.

When hospitalised within a psychiatric home for more than 5 years:

• For those benefiting from the preferential scheme, for the assimilated unemployed with no dependent person or without the obligation of paying an alimony by legal decision or by notarised deed: € 15.31 per day.
  
• For normal beneficiaries, for those benefiting from the preferential scheme with dependants or obligation of paying an alimony by legal decision or by notarised deed and their dependants: € 5.44 per day.
  

See also “1. Medical treatment, Exemption or reduction of patient charges”.

Non-approved private establishments: In the case where a public hospital refers a patient to a private establishment: no charge.

Public hospital:
An overall ceiling of € 679 per year for public sector fees. € 16.10 per day is charged for in-patient care in the hospitals after reaching the ceiling.

Patient under the age of 18 may be charged only for the first seven treatment days in a calendar year.

The fee for in-patient care in psychiatric units is € 16.10.

Not applicable: no charges.

Comprising preventive and conservative treatment, extractions, dental prosthesis, and orthodontic treatment.

Refund:

• of cost of treatment: See medical care,
  
• of cost of dental plates, etc., subject to sickness fund doctor's approval, up to 100% if patient is over 50, or if younger, affected by specific complaints justifying the intervention of the insurance.
  

Children under 18 years of age: free dental care (except orthodontic treatment and non-reimbursable care).
Patient charges of up to 25% for ordinary insured persons over 18 years of age.

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Comprising preventive and conservative treatment, extractions and (submit to approval) orthodontic treatment.

Refund according to fixed rate as for medical care. Share borne by the insured person: 30%.

Full compensation of medically necessary conservative and surgical dental treatment. Full compensation of necessary orthodontist care for insured persons aged less than 18.

A system for persons up to 18 years of age of prophylactic measures designed to prevent dental disease.

Dental care is free of charge only for people with serious economic difficulties or serious illnesses (health or social vulnerability).
In all other cases, care is fully paid by the insured.

Free choice among the specialists of the private sector.

Reimbursement according the scale fixed by government.

Up to and including the calendar year in which a person reaches the age of 19, the person receives free dental care, which is financed by the county councils or regions (landsting or regioner).

From the calendar year in which a person reaches the age of 20, the person is covered by dental care insurance.

The insurance includes a high-cost protection scheme combined with a dental care voucher to encourage regular dental care check-ups. The compensation in the high-cost protection scheme is based on “reference prices” - 50% of the patient’s costs between SEK 3,000 (€326) and SEK 15,000 (€1,631) and 85% of the patient’s costs exceeding SEK 15,000 (€1,631).

• Dental care for children up to 18 years of age including preventive maintenance work, fluoride applications up to twice a year from the age of six, sealing, periodontal care and surgical treatment are included in the legally defined coverage;
  
• Adult dentures and specialist surgical treatments are only covered if it concerns a serious development disorder, growth disorder or an acquired defect of the dental/jaw/mouth system. Other dental treatments are only covered through voluntary supplemental insurance.
  

There are three standard charges for NHS dental treatment – GBP 18.50 (€23), GBP 50.50 (€63) or GBP 219 (€274), depending on treatment required.

No charge for:

• women who are pregnant, or who have had a baby in the preceding 12 months, when the course of treatment starts,
  
• people under 18,
  
• those aged 19 or under and in full-time education,
  
• people and their partners who are receiving Income-related Employment and Support Allowance (ESA), Income Support or Income-based Jobseekers' Allowance, or Pension Credit Guarantee Credit,
  
• people named on a Tax Credit NHS Exemption Certificate or a valid HC2 certificate.
  

People on a low income may be able to get help with the cost of treatment.

Dental treatment in the hospital and Community Dental Services may incur a charge depending on the type of treatment carried out.

For pensioners: depending on their financial situation and medical condition, the municipalities can cover 85% of the participation to the expenses by means of the Health allowance (Helbredstillæg).

Health centre:
Only for war veterans (full coverage).

Sickness insurance:
Refunded for war veterans.

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

Refund according to fixed rates. Share borne by the insured person: 30%.

Paid by the beneficiary.

Fees paid by patient. Refund of 75% of the fee according to official scale.

See dental treatment.

Patient charges depend on the category to which the pharmaceutical belongs (A, B, C, Cx, Cs, Fa and Fb):

• A (medicines of vital importance): co-payment set at 0% of the reimbursement base (ex-factory level), i.e. free of charge;
  
• B (therapeutically important medicines): co-payment set at € 2.50 increased by 27% of the reimbursement base. If the reimbursement base is less than € 14.38, co-payment is set at 44.20% of the reimbursement base; however, a ceiling of € 11.30 (€ 14.70 for a large box) applies;
  
• C (medicines for symptomatic treatment): co-payment set at € 5 increased by 54% of the reimbursement base. If the reimbursement base is less than € 14.38, co-payment is set at 88.39% of the reimbursement base; a ceiling of € 14.70 applies;
  
• Cs: co-payment set at € 6 increased by 65% of the reimbursement base. If the reimbursement base is less than € 14.38, co-payment is set at 106.07% of the reimbursement base; no co-payment ceiling;
  
• Cx (so-called transition category): co-payment set at € 8 increased by 86% of the reimbursement base. If the reimbursement base is less than € 14.38, co-payment is set at 141.43% of the reimbursement base; no co-payment ceiling;
  

• Fa: co-payment set at 0% of the reimbursement base, i.e. free of charge;
  
• Fb: see medicines of category B.
  

Patients in hospital: € 0.62 per day.

Refund of cost of preparations by pharmacist: Maximum share of insured person € 1.20 or € 2.40. Exemption made for long lasting treatments.

Charge reduced for beneficiaries of the increased reimbursement system (bénéficiaires de l’intervention majorée/rechthebbenden op de verhoogde verzekeringstegemoetkoming)).

Participation of the insured person dependent on the expenditure for medicines on list during the year:

• Expenditure under DKK 915 (€123): 100% of cost (persons under the age of 18: 40%).
  
• Expenditure between DKK 915 (€123) and DKK 1,495 (€200): 50% (persons under the age of 18: 40%).
  
• Expenditure between DKK 1,495 (€200) and DKK 3,235 (€434): 25%.
  
• Expenditure over DKK 3,235 (€434): 15%.

The public health service can in special cases:

• contribute for medicines not on the list;
  
• raise the contribution when an expensive medicine is necessary;
  
• contribute fully to medicine for terminally ill persons;
  
• determine that for persons with an extensive, permanent and professionally well-documented need for medicinal products the reimbursement rate shall be 100% of the part of the total co-payment which is in excess of DKK 3,775 (€506) per year.

Public hospitals:
Costs included in fee.

Sickness insurance
35% of the costs of the refundable product are reimbursed provided it was prescribed by a qualified person. In case of serious and chronic diseases a number of listed pharmaceutical products qualify for refund of 65% of the costs or for refund of 100% of the costs exceeding € 3 per pharmaceutical product. If patient’s own costs for refundable pharmaceutical products during one calendar year exceed €610.00, the excess of € 1.50 per pharmaceutical product purchased on the basis of a prescription is refunded.
Certain pharmaceutical products belong to a reference price system.

Classification of authorised and registered medicines:

• Group A: Medicines termed "essential" or for chronic illness, free for all insured persons except for a fixed prescription charge (so called “ticket”) that may differ in each Region. Each Region can define the amount and the categories that are exempt.
  
• Group C: Other medicines (including those for which a prescription is not required) whose cost is borne fully by the insured person.

• The patient pays the whole cost up to and including SEK 1,100 (€120) during a period of 12 months from the first purchase.
  
• Costs between SEK 1,100 (€120) and SEK 2,100 (€228) are subsidised by 50%.
  
• Costs between SEK 2,100 (€228) and SEK 3,900 (€424) are subsidised by 75%.
  
• Costs between SEK 3,900 (€424) and SEK 5,400 (€587) are subsidised by 90%.
  
• Costs above SEK 5,400 (€587) are subsidised totally.
  

The Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket) decides which products will be subsidised within this scheme.

Charge of GBP 8.05 (€ 10) per prescribed item.

An annual (or 3 months) prescription prepayment certificate can be bought which offers considerable savings to those who need regular medication. The cost of the certificate is GBP 104.00 (€ 130) (England) for one year and GBP 29.10 (€ 36) (England) for 3 months.

There is no charge for children under 16, people aged 16-18 and still in full-time education, people aged 60 or over, pregnant women and women who have given birth in the last 12 months, War Pensioners (for their accepted disability), people and their partner receiving Income Support or income-based Jobseekers' Allowance, income-based Employment and Support Allowance, Pension Credit Guarantee Credit, or Tax Credit (and named on a Tax Credit NHS Exemption Certificate), or named on valid HC2 certificate, some other people on low incomes, and people suffering from specified conditions.

• Frames and spectacle lenses for persons under 19 years of age;
  
• Contact lenses: beneficiaries aged 19 to 65;
  
• Spectacle lenses: beneficiaries aged 19 to 65 (as of ca. 8.25 dioptres) and beneficiaries aged over 65 (as of ca. 4.25 dioptres).
  

Medical aids and remedies are provided free of charge to patients in hospitals if they are part of the treatment given in the hospitals.

Hearing aids are free of charge if provided by a hospital. They may also be obtained from approved private providers with a subsidy of up to DDK 6,350 (€851).

Health centre:

Prosthesis and hearing-aids are in most cases free of charge.

Sickness Insurance:

Not refundable.

The prices for medical supplies are agreed between the sickness funds and the care providers. If there are fixed amounts determined for medical supplies, these constitute the ceiling for the contract prices.

Participation of the insured:
10% of the cost for aids, at least € 5, € 10 at most, not more than the price of the product. 10% of the costs for remedies plus an additional € 10 per prescription; children are exempted.

The entitlement to vision aids is limited to children and young persons up to the completion of the age of 18 and to insured persons with severe vision impairments. Therapeutic vision aids used for treatment of eye injuries or eye diseases are excluded from this restriction.

Prosthesis: supplied to the different categories of disabled by the Local Health Authority (Azienda Sanitaria Locale – ASL)

Spectacles and hearing-aids are free of charge only for specific visual and hearing inpairment (DM n. 332 del 27 agosto 1999).

Expenses sustained in relation to prosthesis and medical aids supplied to insured persons who need to recover from an accident at work or occupational disease are covered by the National Insurance Institute for Employment Injuries (Istituto Nazionale contro gli infortuni sul lavoro - INAIL).

80% charge for prosthesis on the official list.

Spectacles: Fees paid by patient. Refund of 75% of the fee according to official scale.

• Orthopaedic shoes: share in cost of €71 per year for those aged up to age 16; and €141 per year for those aged 16 and over;
  
• Hearing appliances: share in cost of 25% of the purchasing price. Costs of replacement, batteries and maintenance are at the insured’s expense.
  

Free assistance and treatment given by nurse at home if recommended by a doctor.

Share of cost for transport to doctor or hospital for pensioners who are insured in Group 1, and in certain other cases and circumstances.

For both categories of insured persons, share of cost is met for dietetic nutrition prescribed by a doctor, treatment by chiropractor, physiotherapist, chiropodist or psychologist to whom the general practitioner has referred the insured.

For both categories of insured persons, share of cost is met for treatment by chiropractor without prescription from the general practitioner.

• Travel and transport costs are compensated from the sickness insurance after deduction of patient's own liability of €14.25. Compensation is usually based on the cost of reaching the nearest health centre or hospital and the least expensive mode for transportation.
  
• If the patient's share of travel costs during the same calendar year is more than €242.25, the excess amount is fully refunded.
  
• If the patient needs to stay overnight when travelling to medical examination, accommodation is refunded up to a maximum of €20.18 per night.
  

General scheme for employees (Régime général d'assurance maladie des travailleurs salariés, RGAMTS):

• Medical aids.
  
• Transportation in case of hospitalisation.
  
• Preventive benefits etc.
  
• Supplementary benefits and aid benefits which may be granted by the sickness insurance fund for social and medical treatment.
  
• Sanatorium: Subject to sickness fund's prior approval. No share borne by insured person.
  
• Spa: Subject to sickness fund's prior approval. Refund of medical fees and cost of treatment in a thermal centre. No cash benefits (indemnités journalières) in principle (except for social and medical treatment provided by the sickness fund).
  

Other benefits of sickness insurance:

• Home care: Basic nursing and treatment as well as household assistance. Participation: 10% of the daily costs for the first 28 days in the calendar year, plus € 10 per prescription, except for children.
• Household aid, i.e. replacement in the household, or payment of cost of household assistant. Participation: 10%, at least € 5 and € 10 at most. Never more than the actual cost.
  
• In certain cases the cost for rescue and transport to the hospital or the doctor are covered; Participation per journey: 10%, at least € 5 and € 10 at most. Never more than the actual cost.
  
• Payment of medical services for ambulatory preventive or rehabilitative services; contribution to the other costs of ambulatory preventive services (accommodation, nursing, transportation) up to € 13 or € 21 for chronically ill infants per day.
  
• Full compensation with a € 10 co-payment by the insured patient per day (max. 28 days per year) for preventive and curative services for mothers, except for children and insured persons, once a critical limit has been exceeded.
  
• Full compensation for institutional preventive or rehabilitative services, except for co-payment of insured person of € 10 per day (max. 28 days per year), except for children.
  
• Specialised outpatient palliative care: compensation of medical and care related services for specialised outpatient palliative care with special considerations for the needs of children.
  
• Residential and outpatient hospice services: since 1 August 2009, full compensation of additional costs with deduction of benefits of the long-term care insurance. The minimum contribution payment was raised from 6 to 7% of the monthly reference amount. In case of outpatient hospice services, fixed labour cost subsidies are awarded.
  
• Special benefits of farm and household assistance of the agricultural sickness insurance.
  

Benefits of long-term care insurance: see Table XII "Long-term care".

One cycle of thermal treatment per year, only for pathology listed in DM of 12 August 1992 and subject to prior approval of the Local Health Authority (Azienda Sanitaria Locae - ASL).

Participation: €3.10 for the prescription, plus €50.00 for each cycle of treatment.
Some categories of insured persons (exempted due to low income or severe disability) only pay the fixed amount of €3.10.
Totally disabled are entitled to full exemption.
Thermal treatment and health resort stays prescribed in relation to specific occupational diseases are entirely covered by the National Insurance Institute for Employment Injuries (Istituto Nazionale contro gli infortuni sul lavoro - INAIL).

Insured persons who suffer from an accident at work or an occupational disease are entitled to reimbursement from the National Insurance Institute for Employment Injuries (Istituto Nazionale contro gli infortuni sul lavoro, INAIL) (according to Circular No. 62 of 11 November 2012) in relation to the medical treatments needed for their psychophysical recovery, as prescribed by their doctors.

Payment of travel costs for patients living in remote areas, subject to certain conditions.

Reimbursement of cost of treatment in thermal centres in line with prevailing official scale, after receiving permission.

Reimbursement for transportation costs on certain conditions.

Other benefits under the Health Insurance Act (Zorgverzekeringswet, Zvw):

• medical devices,
  
• transport of certain groups of patients,
  
• services provided by an audiological centre,
  
• services of a genetic testing centre,
  
• non-clinical haemodialysis,
  
• services for patients with chronic recurring respiratory problems,
  
• rehabilitation,
  
• thrombosis prevention,
  
• mental health care.
  

Other benefits under the General Exceptional Medical Expenses Act (Algemene wet bijzondere ziektekosten, AWBZ):

• general nursing and care,
  
• care for the blind and partially sighted,
  
• care for people with learning disabilities,
  
• healthcare for mother and child,
  
• other kinds of care.
  

See also Table XII “Long-term care”.

Various additional benefits provided under the National Health Service and by local authorities, e.g. free transport to hospital, or in cases of medical need, reimbursement of hospital travelling costs in certain cases, district nursing, midwifery and health visiting services, family planning services, physiotherapy services.