Chapter II: Healthcare
When are you entitled to healthcare?
If you are an employee, a self-employed person, a farmer, a recipient of a social security benefit (old-age, invalidity or survivor’s pension, unemployment benefit, permanent social assistance), or a permanent resident who is not insured under any other heading, it is mandatory to be health-insured.
Additionally, dependent family members, including spouses or cohabitating partners, children and step-children, and certain other persons who need to be looked after, are also entitled to healthcare.
As a rule, no prior insurance period is required to be entitled to healthcare. Some exceptions might concern orthopaedic equipment, spectacles, hearing aids, prosthetics and other medical aids.
What is covered?
Under this insurance, you have access to physicians or primary medical centres contracted by the Health Insurance Institute of Slovenia. If they do not have supplementary insurance for co-payments, persons under the mandatory insurance scheme have to share the costs of healthcare, ranging from five to 90% (in 2009, 2010 and 2011). For some medical benefits there are no co-payments. For instance, there are no user charges for preventive healthcare, treatment and rehabilitation of children (including pharmaceuticals from the positive and intermediate lists), students and women, and for some serious diseases, urgent healthcare and some other benefits.
Healthcare which is not required for medical purposes, such as cosmetic surgery and pharmaceuticals not found on the positive or intermediate lists, and alternative healthcare like homeopathy, are not covered by the mandatory health insurance. They have to be paid for by the patients themselves.
You may be entitled to the reimbursement of travel expenses, if for example you have to visit a physician outside your place of residence or you are sent/summoned there by the responsible physician. If the journey lasts for more than 12 hours, limited accommodation expenses may also be reimbursed.
How is healthcare accessed?
You may freely choose your personal physician, i.e. general practitioner, gynaecologist,
paediatrician and dentist. They act as so called ‘gatekeepers’, and a specialist can be accessed only on referral by a general practitioner. Once a referral has taken place, medical treatment, specialists, public and contracted private hospitals may also be freely chosen.
Names and addresses of the public and private contracted physicians who deliver healthcare are available on the Health Insurance Institute of Slovenia directory: Izvajalci zdravstvenih storitev.
Your right to healthcare benefits when moving within Europe
If you are staying or residing in another country of the European Union, Iceland, Liechtenstein, Norway or Switzerland, you and your family may benefit from the public healthcare services provided there. This does not necessarily mean that treatment will be free of charge; it depends on the national rules.
If you are planning a temporary stay (holidays, business trip, etc.) in another EU country, Iceland, Liechtenstein, Norway or Switzerland, apply for a European Health Insurance Card (EHIC) before leaving. Further information about the EHIC and how to apply for one is available at: http://ehic.europa.eu.
If you are planning to move permanently to another EU country, further information on your rights regarding healthcare is available at http://ec.europa.eu/social-securitycoordination.