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SOS International: Be Careful When Relying On The Blue European Health Insurance Card In Spain

In recent years, in a number of Spanish cases, SOS International has received bills from public sector hospitals in relation to hospital treatment provided to Scandinavian travellers, not withstanding the fact that they had or, with the assistance of SOS International, were successful in acquiring the blue European Health Insurance Card.

Especially one public sector hospital in Gran Canaria has maintained that the travellers who received treatment at the hospital were not entitled to free hospital treatment. The demand for payment was not based in the patients being Scandinavian but the circumstances relating to the treatment, which the hospital found to be outside the right to free treatment under Spanish public health legislation. Since the blue European Health Insurance Card only entitles the carrier right to treatment on the terms set out in Spanish public health legislation, the hospital took the view that the bills were issued on the correct basis. Thus, whether treatment was provided to a Spanish resident or a Scandinavian traveller made no difference.

An example of there not being a right to free hospital treatment and where full payment is required is the situation where a patient is moved from a private hospital to a public sector hospital. These types of situations frequently occur in Gran Canaria as the treatment facilities of local public sector hospitals are wider-ranging than those of the private.

SOS International has looked into the legality of the practice of the hospital and the rules to which the hospital has referred. As travellers are not treated differently to Spanish residents, SOS has been unable to object to the practice based on EU regulation. In collaboration with a Spanish law firm, SOS International has instead investigated whether the practice of the hospital conformed to Spanish legislation and the framework of Spanish-federal legislation. The conclusion was that it was within the framework of the legislation. Thus, according to Spanish legislation, Spanish public sector hospitals may require full payment for treatment in specific situations.   

Karin Tranberg, Executive Vice President, says, ”This case shows that the legislation of an EU Member State on the right to free hospital treatment may be complicated and contain a number of exceptions and limitations which reflect on the coverage of the blue European Health Insurance Card. This makes it difficult for travellers to ascertain when free treatment is available if an accident should happen during the holiday. This also complicates the considerations as to which insurance cover should be taken out. There is also the issue that such a system is very different from those of the Scandinavian countries which are those best known to the travellers. Systems which are simpler because the right to free, acute hospital treatment is universal and, at the most, with a very limited co-pay. A more complicated system, here with Spain as an example, may present the traveller with a really unpleasant surprise once an accident has happened. SOS International fears that this type of legislation is an indication of a growing trend; first in Spain and then in other countries. From the perspective of the patient and end-user, we see this as a problem and we have, therefore, also passed on the information to the Danish citizen service centre, Borgerservice, and the Danish Patient Safety Authority”.

With respect to the approach to be taken by travellers at the moment, she says: ”This case emphasises the need for taking out travel insurance cover which, as a minimum, provides supplementary coverage to the blue European Health Insurance Card. That way, you are certain to be covered regardless of whether you are visiting an EU Member State with full, part or no entitlement to free hospital treatment.” 

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