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A person covered by Compulsory Health Insurance can receive medical treatment free of charge
2014-10-31

The National Health Insurance Fund under the Ministry of Health (NHIF) reminds that all patients covered with the compulsory health insurance (CHI) can receive all required services in health care institutions located in Lithuania of charge. Payments for all these services are made from the means of the budget of Compulsory Health Insurance Fund for health care institutions, which have entered into the agreements with the Fund.

 

This means that patient should not pay for medical treatment from his/her own pocket, as the services shall be paid by territorial health insurance funds (THIF) according to the uniform prices approved by the legal acts.

However, there have been some cases reported, when patients were asked to pay for the services even in the healthcare establishments working under the agreements with the territorial health insurance funds. Patients rather often send requests to the NHIF and THIFs asking for explanations, how it should be in reality. It has happened sometimes that patients first paid for the services and later found out that payment was not required at all and healthcare institutions had to repay a patient. Thus, one should not hasten to pay – in such cases, ask health professionals to explain, whether payment is really required.

 

Therefore NHIF encourages to inquire and get convinced before paying. We always advise patients to clarify all questions they may have at a healthcare institution first of all. If you fail to get information from a treating physician, do not find it on a noticeboard or on an institutional website, you should apply to the administration of health institution, and, if you still have any concerns regarding answers received, consult with THIF specialists.

 

It is important to know, however, that in some cases a patient covered by CHI should pay additionally for a healthcare service. This applies only when a patient himself/herself decides to have more expensive services, materials or procedures, requests for additional services or procedures, wants to have a consultation with a physician specialist without a referral from family physician. Additional payment will be also applied when a patient is referred for a consultation with physician specialist, employed at a healthcare institution, which has not entered into an agreement with THIF. In all these cases a patient should decide – whether to ask for such services and to pay additionally.

 

NHIF reminds that the patients, who want to receive the services they are entitled to free of charge, need to arrange a visit with their family physician and he/she will decide what help is required. Your family physician also should inform you which services are reimbursed by the CHIF. The table below provides more detail information.

 

What can a person covered by CHI receive from the CHIF budget?

 

Services at healthcare institutions entering into the agreements with territorial health insurance funds
Services of family physician For the patients registered at a healthcare institution
Dentistry services, including reimbursement of prosthetic dentistry services for elderly people and childrenThe following groups are entitled to have the right for free prosthetic dentistry services: people reaching pension age, disabled individuals (disabled or partially disabled for work) and children under 18 years old. There are some exceptions: you may need to pay for dentistry materials and disposable means.
Specialised out-patient servicesPatients presenting a referral from their family practitioner or a specialist of other field are provided with the services free of charge.
In- patient services In-patient services, required examinations, medicines and medical aids should be provided for the patients presenting a physician's referral free of charge.
Medical rehabilitation services Medical rehabilitation for adult patients shall be prescribed by their treating physician, based on recommendations of physician of physical medicine and rehabilitation and for children – by a physician of physical medicine and rehabilitation.
Preventive programmes In accordance with the preventive programmes implemented in Lithuania – examinations for cervical, breast, prostate and colorectal cancer as well as cardiovascular diseases are provided free of charge. In addition, molars of children aged 6 to 14 years shall be covered with sealants – special substance protecting against caries.
Medicines and medical aids in the hospitals, purchased according to centralised procedure by NHIF or by hospitals themselvesMedicines and medical aids purchased by NHIF shall be supplied according to the agreements and distributed among the healthcare establishments.
At the pharmacies working under the agreements with territorial health insurance funds
Reimbursable medicines and medical aids They can be issued for the patients treated at polyclinic, family practitioner office or even at a hospital. Prescriptions for them shall be written using the passports for reimbursable medicines.
At the orthopaedic establishments, working under the agreements with territorial health insurance funds
Reimbursable orthopaedic devicesThese aids shall be produced in the factory and issued personally, when they are prescribed for a patient based on medical indications for diseases, traumas and defects. Full price or part of a price can be reimbursed.

Urgent medical care in the member states of EU and  in Norway, Lichtenstein, Island and Switzerland

If  European Health Insurance Card (EHIC) is presented Urgent care shall be provided at the establishments belonging to the national healthcare system according to the rules applicable in a foreign country.

Cross-border healthcare services, when patient goes for treatment to the member States

of the European Union (EU)

With a referral of physician of our countryA person who received healthcare services in a foreign country first of all shall pay a full price of the treatment and later – to apply for reimbursement to a territorial health insurance fund. It is important to know that only services reimbursable in Lithuania shall be reimbursed applying the same tariffs as in Lithuania.

 

NHIF Public Relations

Phone +370 5 236 4105, +370 5 237 0717, +370 236 4168

A person covered by Compulsory Health Insurance can receive medical treatment free of charge