+Airteagal 25 Fanacht i mBallstát seachas an Ballstát inniúil
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Airteagal 25 Fanacht i mBallstát seachas an Ballstát inniúil

Airteagal 25

Fanacht i mBallstát seachas an Ballstát inniúil

A.   Nós imeachta agus raon feidhme cirt

1.  Chun críocha chur i bhfeidhm Airteagal 19 den bhun-Rialachán, tíolacfaidh an duine árachaithe doiciméad arna eisiúint ag an institiúid inniúil lena léireofaí don soláthróir cúraim sláinte i mBallstát an fhanachta a theidlíocht chun sochar comhchineáil. Mura mbeidh doiciméad den sórt sin ag an duine árachaithe, rachaidh institiúid na háite fanachta, ar iarraidh nó más gá ar shlí eile, i dteagmháil leis an institiúid inniúil chun doiciméad den sórt sin a fháil.

2.  Léireoidh an doiciméad sin go bhfuil an duine árachaithe i dteideal sochar comhchineáil faoi na coinníollacha a leagtar amach in Airteagal 19 den bhun-Rialachán ar na téarmaí céanna leis na téarmaí is infheidhme maidir le daoine atá árachaithe faoi reachtaíocht Bhallstát an fhanachta.

3.  Tagróidh na sochair chomhchineáil dá dtagraítear in Airteagal 19(1) den bhun-Rialachán do na sochair chomhchineáil a sholáthraítear i mBallstát an fhanachta, i gcomhréir le reachtaíocht an Bhallstáit sin, agus a thagann chun bheith riachtanach ar fhorais liachta d’fhonn nach gceanglófaí ar an duine árachaithe filleadh ar an mBallstát inniúil, roimh dheireadh na ré pleanáilte fanachta, chun an chóireáil atá riachtanach a fháil.

B.   Nós imeachta agus socruithe chun na costais a sheasamh agus chun aisíocaíocht sochar comhchineáil a sholáthar

4.  Má d’iompair an duine árachaithe costais na sochar comhchineáil uile a soláthraíodh faoi chuimsiú Airteagal 19 den bhun-Rialachán nó costais coda díobh, agus má chumasaítear le reachtaíocht a chuireann institiúid na háite fanachta i bhfeidhm costais seo a aisíoc leis an duine árachaithe, féadfaidh sé iarratas ar aisíoc a chur chuig institiúid na háite fanachta. Sa chás sin, aisíocfaidh an institiúid sin go díreach leis an duine sin suim na gcostas a fhreagróidh do na sochair sin laistigh de theorainneacha agus faoi choinníollacha na rátaí a leagtar síos ina reachtaíocht.

5.  Mura ndearnadh aisíocaíocht na gcostas sin a iarraidh go díreach ar institiúid na háite fanachta, déanfaidh an institiúid inniúil na costais a tabhaíodh a aisíoc leis an duine lena mbaineann i gcomhréir leis na rátaí aisíocaíochta arna riar ag institiúid na háite fanachta, nó leis na méideanna a bheadh faoi réir a n-aisíoca le hinstitiúid na háite fanachta, dá mbeadh feidhm ag Airteagal 62 den Rialachán cur chun feidhme sa chás lena mbaineann.

Cuirfidh institiúid na háite fanachta an fhaisnéis uile is gá faoi na rátaí sin nó faoi na méideanna sin ar fáil don institiúid inniúil arna iarraidh sin di.

6.  De mhaolú ar mhír 5, féadfaidh an institiúid inniúil aisíoc na gcostas a tabhaíodh, laistigh de theorainneacha agus faoi choinníollacha na rátaí aisíoca a leagtar síos ina reachtaíocht, a ghabháil uirthi féin, ar chuntar go mbeidh an duine árachaithe tar éis a aontú go gcuirfí an fhoráil seo i bhfeidhm maidir leis.

7.  Mura bhforáiltear le reachtaíocht an Bhallstáit fhanachta d’aisíoc de bhun mhír 4 agus mhír 5 sa chás lena mbaineann, féadfaidh an institiúid inniúil na costais a aisíoc laistigh de theorainneacha agus faoi choinníollacha na rátaí a leagtar síos ina reachtaíocht, gan aontú an duine árachaithe.

8.  Ní rachaidh an aisíocaíocht leis an duine árachaithe, ar aon chor, thar mhéid na gcostas a thabhaigh sé nó sí iarbhír.

9.  I gcás chaiteachais shuntasaigh, féadfaidh an institiúid inniúil réamhíocaíocht iomchuí a íoc leis an duine árachaithe a luaithe a dhéanfaidh an duine sin an t-iarratas ar aisíocaíocht a chur faoina bráid.

C.   Daoine den teaghlach

10.  Beidh feidhm ag míreanna 1 go 9 mutatis mutandis maidir le daoine de theaghlach an duine árachaithe.

1. Forbhreathnú

,
Teideal Rialáil
Article 25 1.
For the purposes of the application of Article 19 of the basic Regulation, the insured person shall present to the health care provider in the Member State of stay a document issued by the competent institution indicating his entitlement to benefits in kind. If the insured person does not have such a document, the institution of the place of stay, upon request or if otherwise necessary, shall contact the competent institution in order to obtain one.
Article 25 2.
That document shall indicate that the insured person is entitled to benefits in kind under the conditions laid down in Article 19 of the basic Regulation on the same terms as those applicable to persons insured under the legislation of the Member State of stay.
Article 25 3.
The benefits in kind referred to in Article 19(1) of the basic Regulation shall refer to the benefits in kind which are provided in the Member State of stay, in accordance with its legislation, and which become necessary on medical grounds with a view to preventing an insured person from being forced to return, before the end of the planned duration of stay, to the competent Member State to obtain the necessary treatment.

B.   Procedure and arrangements for meeting the costs and providing reimbursement of benefits in kind

Article 25 4.
If the insured person has actually borne the costs of all or part of the benefits in kind provided within the framework of Article 19 of the basic Regulation and if the legislation applied by the institution of the place of stay enables reimbursement of those costs to an insured person, he may send an application for reimbursement to the institution of the place of stay. In that case, that institution shall reimburse directly to that person the amount of the costs corresponding to those benefits within the limits of and under the conditions of the reimbursement rates laid down in its legislation.
Article 25 5.

If the reimbursement of such costs has not been requested directly from the institution of the place of stay, the costs incurred shall be reimbursed to the person concerned by the competent institution in accordance with the reimbursement rates administered by the institution of the place of stay or the amounts which would have been subject to reimbursement to the institution of the place of stay, if Article 62 of the implementing Regulation had applied in the case concerned.

The institution of the place of stay shall provide the competent institution, upon request, with all necessary information about these rates or amounts.

Article 25 6.
By way of derogation from paragraph 5, the competent institution may undertake the reimbursement of the costs incurred within the limits of and under the conditions of the reimbursement rates laid down in its legislation, provided that the insured person has agreed to this provision being applied to him/her.
Article 25 7.
If the legislation of the Member State of stay does not provide for reimbursement pursuant to paragraphs 4 and 5 in the case concerned, the competent institution may reimburse the costs within the limits of and under the conditions of the reimbursement rates laid down in its legislation, without the agreement of the insured person.
Article 25 8.
The reimbursement to the insured person shall not, in any event, exceed the amount of costs actually incurred by him/her.
Article 25 9.
In the case of substantial expenditure, the competent institution may pay the insured person an appropriate advance as soon as that person submits the application for reimbursement to it.

C.   Family Members

Article 25 10.
Paragraphs 1 to 9 shall apply mutatis mutandis to the members of the family of the insured person.

1.1 Tagairtí

1.2 Ceanglais aitheanta

1.3 Caighdeáin ghaolmhara

2. Ceanglais aitheanta

Ceanglais
Foinse Ceanglas

3. Caighdeáin ghaolmhara

Caighdeáin
Foinse Ceanglas
  • Builddate: 01.01.2018 00:00:00 -Doknr: CELEX:32009R0987
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