The first principle to bear in mind is that an EHIC entitles the user to public health care in another Member State on the same basis as a resident of that State.
In some States, e.g. France this involves a co payment and such co payments are non refundable.
If a client avails of private health care no refund is payable.
Generally speaking a refund is only due if a client availed of a public health service and was charged for same because they did not present a valid EHIC on the occasion or if they were charged in error by the service provider in the other State.
The E126 form is used between States to establish:
- If the person availed of a public health services
- The level of refund that is due to the client.
On return of a completed E126 form from another State, the local office should be able to determine if a refund is due or not.
If a refund is due the amount determined on the E126 should be processed promptly and paid to the client.
In the event that no refund is due then that decision should be communicated to the client outlining the reasons for refusal.
The exception to the above is where Ireland has a waiver agreement with a number of countries whereby it has been agreed that we will treat people from those States and they will treat people from Ireland on the same basis as their own residents. The costs incurred by the State will be borne by them.
The States currently in this arrangement are Luxembourg, Denmark, France, Sweden and Belgium.
Form E126 is processed in the normal way in these cases, the only difference being that the refund is payable by the State in which the treatment was provided.