Marie suffers from hip joint arthrosis. She has been referred for surgery at a hospital in Norway. Marie wants to have the procedure done in another EU/EEA country. She chooses a hospital in Germany that has available capacity to perform the hip surgery. She obtains confirmation of an offer to have the procedure done at this hospital.
Hospital treatment and other specialised health services in EU/EEA countries
Expenses on specialised healthcare in another EU/EEA country are refundable subject to certain terms and conditions. Go through all the steps in this guide to understand your rights and what you need to do. The application form is included in Step 8.
Before you travel
You can apply for reimbursement of your expenses on healthcare from the specialised health service in other countries within the EU/EEA if the treatment is equivalent to the healthcare you would have received in Norway.
If you travel to other EU/EEA countries to receive healthcare, you can apply for reimbursement of your expenses on medical investigations and/or treatment at a hospital or outpatient clinic.
Your entitlement to reimbursement applies both if you travel abroad for the purpose of receiving healthcare and if you are staying in another EU/EEA country when the need for healthcare arises. Note, however, that this scheme is not applicable to Switzerland.
To be eligible to use this scheme, you must be a member of the Norwegian National Insurance Scheme. In many cases, the scheme also applies to family members. You are not entitled to a subsidy from Norway for treatment in an EU/EEA country you are regarded as ordinarily resident in. Click here for important information on who qualifies for the scheme.
To reduce the financial risk, you can apply to Helfo for prior notification before you go abroad. If you have prior notification for treatment in the UK, se step 3.
If you intend to travel abroad to receive healthcare, you must first obtain a referral from a healthcare professional in Norway.
If you are already in another EU/EEA country when the need for healthcare arises, you must obtain a referral from a healthcare professional who is authorised to make referrals in the country of treatment. In such cases, the referral must be made by a healthcare professional who is comparable with one of the treatment provider categories authorised to make referrals under the Norwegian rules.
If the country you receive treatment in does not have a referrals procedure for specialised healthcare, you must enclose documentation that you consulted a healthcare professional before treatment to establish that you required the healthcare. The documentation must be from the same type of healthcare professional authorised to make referrals in Norway.
If you need urgent healthcare, no referral is required.
Medical documentation you need to take with you
When you consult a treatment provider abroad, it may be helpful to bring a copy of your summary patient care record, information about any medication you are taking, and any relevant test results.
If you have had a long wait for treatment
If you have been given a maximum waiting time from a treatment provider within the specialised health service in Norway, but have not received treatment within that time, you have the right to have the Helfo Patient Referral Unit arrange for alternative treatment for you. Click this link for more information about exceeded waiting time.
If you have been affected by a medically indefensible long waiting time from a treatment provider in Norway (in Norwegian), regardless of whether the guaranteed waiting time was exceeded or not, you may apply to receive medical treatment abroad. If you are granted this right, you will be issued with an entitlement form. This is your proof that you do not have to pay out of pocket for hospital treatment in another EEA country.
If the specialised health service does not have sufficient medical expertise
If you cannot receive treatment within the specialised health service in Norway due to insufficient medical expertise (in Norwegian), you may be entitled to treatment abroad under a different scheme.
The types of treatment that are to be available to patients in Norway are well defined. As new methods of treatment (including drugs, diagnostics and procedures) are introduced, these are assessed by The National System for the Introduction of New Health Technologies.
You must locate a treatment provider yourself
You will need to find a treatment provider in another EU/EEA country and personally obtain an offer to accept you for medical treatment.
You are free to consult the practitioner of your choice. Any treatment provider you choose must be licensed to practise in the country in which the treatment will be provided. While most practitioners are licensed, it is still up to you to ensure that the treatment provider holds a valid licence in the country in question. Responsibility for obtaining proof of this professional authorisation rests with you alone.
The National Contact Point in the destination country (in Norwegian) will be able to provide you with a list of treatment providers in that country.
Helfo has no list of licensed practitioners. No such list exists because it would be too comprehensive.
Treatment within a specialised health service abroad may prove costly. To reduce your financial risk, you have the option of applying to Helfo for prior notification.
The prior notification is issued in a decision letter from Helfo granting you economic support for the healthcare you are planning. The decision letter tells you the maximum reimbursement amount you can receive for the healthcare. The prior notification is legally binding on Helfo, but is valid only for the healthcare specified in the decision letter.
Applying is voluntary, and only priority patients («rettighetspasienter») are eligible for prior notification. The status of 'priority patient' means that your referral has been assessed by the specialised health service, at a hospital for example, as warranting treatment by a specialist.
If you apply for prior notification, you must first have obtained a formal offer to provide medical treatment from another EU/EEA country. If you are granted prior notification, this will tell you in advance whether the cost of all or part of the desired treatment will be covered by the Norwegian health service. When considering whether to grant your application for prior notification, Helfo will decide if the treatment you are seeking abroad is equivalent to the treatment you would have received from the public health service in Norway. You must document
- that you are a priority patient
- that you have received an offer of treatment in another EU/EEA country – this must show the type of treatment and the anticipated cost
If you have been evaluated by the specialised health service in Norway, you should also send in a copy of this evaluation.
See Steps 7 and 8 for the application form and a list of the documents you are required to send in.
If you are granted a prior notification, the notification letter will state the maximum amount of reimbursement you will be eligible for, to cover the treatment you have applied for. You will need to pay for the treatment up front, and then send in an application to Helfo for the reimbursement afterwards.
Staged prior notification
A prior notification may be staged, meaning that it can be granted at different stages of the treatment, that is, diagnostics, treatment, follow-up care and so forth.
If you are assessed as being entitled to diagnostics because the type of treatment you require has not been clarified, you will then only receive prior notification for the diagnostic stage.
If other treatment needs are discovered along the way over and above the treatment covered by the prior notification, you have no guarantee that such treatment will be covered. You are only guaranteed cover for the treatment comprised by the prior notification, and any extra healthcare the treatment provider finds necessary will have to be evaluated after the event. The basis for evaluating whether extra treatment can be covered will be whether it would have been provided in Norway.
Prior notification for treatment in the UK
The United Kingdom of Great Britain and Northern Ireland have left the European Union. You will therefore not be entitled to reimbursement of expenses for planned treatment after December 31. 2020.
If you already have received prior notification for treatment in the United Kingdom, and you receive the treatment within the validity period of the prior notification, Helfo will still be able to reimburse your costs for the treatment according to the practice described above.
Read more about Brexit at regjeringen.no (in Norwegian).
Marie is a priority patient and has obtained an offer of medical treatment from Germany. She now applies to Helfo for prior notification. Together with her application to Helfo, she encloses confirmation from the hospital in Norway that she has been booked in for hip surgery, along with her summary patient care record and discharge summary from Norway. She also encloses written proof of the offer of treatment from Germany.
Which treatments qualify for reimbursement?
If you receive treatment in another EU/EEA country, you will be reimburse according to the described rules if the treatment is equivalent to the healthcare you would have received in Norway.
The healthcare you receive must be either equivalent to or comparable with the healthcare you would have received within the Norwegian public health service. In other words, you will not be eligible for any reimbursement of expenses for other treatments or more extensive treatment than the Norwegian specialised health service offers you.
Helfo's assessment of whether the healthcare is comparable with what you would have received in Norway is based on the medical documentation in your case. This will be compared with Norwegian national policy and guidance documents. If this is not available for the healthcare in question, other factors may be taken into consideration:
- What is the expected, documented benefit of the healthcare?
- Are the anticipated costs warranted by the benefit of the intervention?
- What healthcare technologies (drugs, devices, equipment) will be used?
- Is it safe/riskier for you to receive the treatment abroad?
You can have your expenses reimbursed up to the equivalent amount to the cost of the healthcare would have cost within the Norwegian national health service. You should therefore bear in mind that the reimbursement amount may be lower than your actual expenses.
Costs for specialised health services within the Norwegian public health service are set through the Norwegian Diagnosis-Related Group (DRG) system. The DRG system is a way of establishing prices for different patient groups. The amount of the reimbursement you will be entitled to for hospital treatment in another EU/EEA country is based on the estimated cost in Norway, which is assumed to be 80 per cent of the DRG rate. This is because the calculation using the DRG rate produces an average cost that covers not only the treatment costs, but also the hospital's other costs, which are estimated to amount to 20 per cent.
If your expenses are lower than the estimated cost in Norway, the reimbursement amount will be the same as your actual expenses.
Some hospitals abroad register foreign patients as private patients. This also applies to hospitals under the public health service in the country providing the treatment. This may mean higher costs for you. Examples of expenses that are not covered would be additional fees to doctors, room upgrades and the like.
Marie has made inquiries and found out that the hospital that will be performing the hip surgery in Germany uses the same surgical procedure as in Norway. She has been granted prior notification, and therefore knows in advance that her expenses on treatment in Germany will be authorised for reimbursement. The prior notification she received also informed her of the maximum reimbursement she can receive. She is aware that if the treatment turns out to be more expensive than what the equivalent treatment would have cost in Norway, she will have to bear the cost of the excess amount herself.
The risks of undergoing treatment abroad
The risk of being infected by bacteria that are resistant to antibiotics, such as «staph» bacteria, called MRSA, is higher if you have treatment outside Norway.
The first aspect to consider is that the treatment you receive abroad must be equivalent to what you would receive in Norway, and may need to be followed up by the Norwegian specialised health service. In some cases, there may be slight differences that make it difficult to provide follow-up care in Norway.
In the event of acute complications, it may in some cases also be difficult for the hospital in Norway to provide follow-up care for treatment provided abroad. This is because the procedure and/or the devices (e.g. implants) used may be of a different type than those used in Norway.
For follow-up care in Norway, you will have to join the ordinary waiting-list system.
Antibiotic-resistant bacteria (in Norwegian), such as the «Staph» bacteria called MRSA (methicillin-resistant Staphylococcus aureus), pose an increasing health risk in many countries. You will need to bear in mind that the risk of being infected with such bacteria is higher if you travel outside Norway for treatment.
If you have been hospitalised or received extensive outpatient care or dental care outside the Nordic region within the last 12 months, your regular GP will have to test you for strains of antibiotic-resistant bacteria before you can receive treatment from a hospital in Norway.
If you have any questions about this, please consult your GP.
Patient injury compensation
All forms of medical treatment carry a risk. If anything goes wrong during the medical care you receive in Norway, you can apply for compensation from the Norwegian System of Patient Injury Compensation (NPE).
If the medical care was provided in one of the Nordic countries, you can apply for compensation through the national systems for patient injury compensation in the individual countries. The NPE can advise you on how to proceed.
If you have suffered an injury as a result of treatment abroad, the rules in the country of treatment regarding compensation prevail, and you are personally responsible for claiming compensation.
If the country has a dedicated body for patient injury compensation, you will need to contact this body yourself. The National Contact Point in the country of treatment (in Norwegian) can assist you in contacting the right body. Alternatively, you may need to claim compensation for injury sustained as a result of medical care directly from the place of treatment.
The Norwegian Patient Injury Act only applies to hospitals and doctors abroad if the Norwegian health service has concluded a prior agreement with the place of treatment in a contract for procurement of services. An example of this cover would be when patients are sent abroad as a result of a maximum waiting time guarantee.
Returning to Norway
If you have had a surgical procedure, you may be advised that you should wait before flying home. Any stay abroad while you wait to fly home will be at your own expense.
If you require an alternative form of transport, for example, an extra seat on a plane, this will be at your own expense. If you need a companion to assist you, the cost of companion travel is also non-reimbursable.
Generally, only a fraction of travel expenses is reimbursable.
All forms of medical treatment carry a risk, and in some cases, the worst happens. Next of kin may face the additional burden that repatriation of the deceased is not covered by the Norwegian National Insurance Scheme.
An exception is if death occurs in one of the Nordic countries, in which case repatriation of the body is covered by the Norwegian National Insurance Scheme (only in Norwegian).
Limited reimbursement of travel expenses
You will not be reimbursed for more than you would have received if the treatment had been performed in Norway.
You can be reimbursed for the proportion of your travel expenses corresponding to what you would have received in Norway.
In Norway, the main rule is that your travel expenses are reimbursed at a standard rate per kilometer regardless of which means of transport you use. You must travel to the geographically closest location at which the healthcare can be provided. In order to be reimbursable, your journey from home must be longer than ten kilometers each way and cost more than the local minimum fare by scheduled public transport.
Claims for travel expenses reimbursements must be sent to Helfo on this claim form:
(The form is in Norwegian, but click here for an English guide with instructions for filling out the form “Reiseregningsskjema".)
Send the claim form with the other documentation – see the next step. If your application for coverage of expenses from Helfo is granted, Helfo will forward your travel expenses claim to the Norwegian regional health authorities' patient-travel service (Pasientreiser).
Marie lives in Nesna, Norway. Her nearest place of treatment in Norway would be in Mo i Rana. Although Marie is going abroad, she will only be entitled to expenses for the return journey Nesna - Mo i Rana - Nesna at a standard rate per kilometre. She takes care to keep all her travel documents.
Don't forget the documentation!
The documentation requirements differ depending on whether you are applying for prior notification or claiming reimbursement after receiving treatment in another EU/EEA country.
If you are applying for prior notification:
The following documentation must always be enclosed with an application for prior notification:
- Letter from the specialised health service that you are entitled to the necessary healthcare.
- Confirmation that you have a formal offer of treatment abroad – you must document what treatment you are planning to receive and the estimated cost.
- Copy of the foreign treatment provider's licence to practise and specialist authorisation in the country of treatment (only for treatment outside of a hospital).
- If you have been seen or treated within the specialised health service in Norway for your medical condition: a copy of the specialist's opinion.
If you are applying for reimbursement after treatment:
The following documentation must always be enclosed with an application for reimbursement:
- Referral: If you planned the healthcare before travelling abroad, you must enclose the referral from the healthcare professional who practises in Norway. If the need for healthcare arose abroad, you must enclose the referral from a healthcare professional in the country where you received the healthcare. If the need for healthcare was a medical emergency, you must attach your discharge summary from the hospital to prove that you required emergency medical care. If you have no referral but were receiving a course of treatment from the specialised health service in Norway, you can enclose documents to prove that you required further treatment for your medical condition.
- Summary care record/discharge summary from abroad.
- Original itemised invoice showing the cost per treatment.
- Original receipt or other documentation as proof of payment, such as a bank statement.
The following documentation must be enclosed if relevant for your claim:
- If you have been assessed by the Norwegian specialised health service for your medical condition: a copy of the assessment.
- The letter confirming your entitlement to treatment within the specialised health service or the letter advising you of the date of your appointment.
- If the treatment is for an occupational injury: a copy of the decision letter concerning that occupational injury.
- Other documentation you believe to be relevant for your application.
Translation of documentation
All documentation must be in Norwegian, Danish, Swedish or English. You should therefore try to get the documentation issued in one of these languages. If the original documents are in another language, Helfo may ask you to have them translated by a state-authorised translator. You must pay for the translation yourself. If you enclose a translation, you must also enclose the original.
Marie makes sure she gets all the documentation she needs from the hospital stay in Germany before she applies for reimbursement from Helfo.
Submit your application digitally
You can apply to Helfo for prior notification before travelling abroad for treatment, or you can apply for reimbursement of expenses on treatment in another EU/EEA country after you have completed that treatment.
For details of documentation requirements, see under «Don't forget the documentation!». The application form and documentation must be sent to Helfo within 6 months of each individual treatment date. If treatment was received during a continuous stay in hospital, the time limit starts from the date you were discharged from the hospital.
The normal processing time for a prior notification is up to 4 weeks from our receipt of a complete application.
The normal processing time for a treatment expenses reimbursement claim is up to 12 weeks.
If you are unable to use our digital form, you can send us paper forms instead. Remember documentation!
To apply for prior notification, use this form:
To apply for reimbursement after you have received treatment, use this form:
Send your application to: Helfo, Postboks 2415, 3104 Tønsberg.
Marie fills out the application form and sends this together with all the relevant documentation to Helfo within 6 months. Marie is entitled to reimbursement of what her treatment would have cost the Norwegian national health service.
If you have any questions, please call Veiledning helsenorge.no (user service): +47 23 32 70 00
Several types of healthcare provide entitlement to an exemption card for healthcare expenses once you have paid user fees up to a certain amount (the user-fee limit).
This also applies if the healthcare is received in another EU/EEA country.
The user fee payable will be calculated during processing of your claim for reimbursement for treatment abroad. This user fee will be entered in the user-fee registry and will form the basis for a healthcare exemption card. If you already hold an exemption card, the user fee will be paid to you together with the reimbursement.
Once you have been issued with an exemption card by Helfo, you will no longer have to pay user fees for healthcare covered by the exemption card scheme. The exemption card is valid in Norway. In other EU/EEA countries you must pay for treatment out of pocket.
Read more about maximum user fees and which types of healthcare are comprised by the exemption card system here (in Norwegian).