EHIF reimburses self-care medical devices that can be used to treat diseases and injuries, or which help prevent the aggravation of diseases.
Reimbursable medical devices include, for example, accessories for measuring and correcting blood glucose for diabetics (glucometer test strips, lancets, insulin needles), stoma care products, orthoses, bladder catheters and wound dressings, as well as devices for patients with sleep apnea and compression products for the treatment of both lymphedema and venous insufficiency and ulcers.
Attending physician determines the need for a medical device. If you have been diagnosed with a disease that requires a medical devices listed in the EHIF’s list of medical devices and your medical condition meets the conditions for reimbursement, then your attending physician will issue to you a digital medical device card (N.B. There are no paper cards!).
After issuing of the medical device card, you can immediately go to a pharmacy or contact the seller of the medical device directly and buy the medical device prescribed by your doctor at a discount. You have to present your ID for this. When purchasing a device for someone else, you also need the personal identification code of the person to whom the device is for (it is not necessary to bring his/her identity document with you).
The list of medical devices is updated annually based on proposals from manufacturers and professional associations and price agreements with manufacturers.
See which medical devices are reimbursed by EHIF:
- Diabetic patients: glucometer test strips, lancets, disposable needles for insulin delivery systems, and in addition for children under 19 years of age: insulin pump, continuous glucose monitoring kit and accessories (infusion sets, reservoirs, glucose sensors).
- Patients with asthma: spacers for children with asthma up to 10 years of age.
- Patients with colostomy, ileostomy, urostomy or fistula: ostomy bags, ostomy rings, ostomy baseplates and their attachments, ostomy care products (creams, powders, pastes, protective products and adhesive removers, odor neutralizing agents), ostomy bag belts.
- Patients with tracheostomy tube: tracheal cannulas, tracheostomy patches, filters and skin cleansing patches, tracheostomy protectors.
- Post-trauma or -surgery: primary prostheses and prosthesis replacements, orthoses and sole supports.
- Burn patients, and patients with lymphedema or venous insufficiency: compression garments.
- Contact lenses for the treatment of keratopathy, keratoconus and aphakia in children up to 6 years of age.
- Wound dressings for the treatment of venous, diabetic, atypical or lymphedema wounds or bedsores, complicated surgical wounds, post-irradiation or burn wounds, or degenerating tumors.
- Patients with sleep apnea: automatic continuous positive airway pressure (CPAP) device and positive pressure device masks.
- In case of severe ichthyosis: skin care products.
In addition, we reimburse aspiration probes for patients on home ventilation therapy or with tracheostomy, dysphagia due to neurological damage or lack of cough reflex due to neuromuscular disease EHIF also reimburses disposable bladder catheters for neurological pathology or urethral strictures, after pelvic surgery or radiation and for patients diagnosed with N31.0 who require daily self-catheterization. We also reimburse injection needles for patients with Parkinson's disease on apomorphine injection therapy and for patients with growth failure taking medicines containing growth hormones.
More detailed reimbursement terms are described in the list of medical devices.
Explanation of the reference price system
The reference price system is applied when there are more than two comparable medical devices in one group of medical devices. When the reference price system is applied, the discount is calculated based on the second cheapest unit price (for example, the price of 1 piece) of medical devices belonging to the same reference price group. If the actual price of reimbursable medical device is higher than the group’s reference price, EHIF will reimburse 90% or 50% of the reference price. The patient will pay the remaining part of the reference price and the difference between the reference price and the actual selling price. If a medical device is cheaper than the group’s reference price, the discount is calculated on the actual selling price of the medical device.
For example, the EHIF's list of medical devices includes products with a package containing 50 test strips and the cheapest package costs 15 euros, the next one costs 16 euros and the third one 16.90 euros. The prices of 1 piece are 0.3000, 0.3200 and 0.3380 euros, respectively. In this case, for EHIF, the reference price of 50 test strips is 50 * 0.3200 = 16.00 euros, from which the discount of 90% is calculated. The person has to pay out of their pocket 10%, i.e. the patient must pay 1.5 euros for the cheapest package and 1.60 euros for a package equal to the reference price. However, if a person prefers a product of a more expensive price group, for example, buys a product at a price of 16.90 euros, then in addition to 1.60 euros, he or she also has to pay the amount exceeding the reference price (i.e. 0.90 euros), i.e. a total of 2.50 euros.
Specific reference price groups, the name and price of the medical device package on which the price is based, and medical devices to which the reference price is applied are listed in the EHIF's list of medical devices under respective medical device groups. Packages for which the reference price system is applied in calculating the EHIF benefit are marked with an asterisk in the list.