+Airteagal 26 Cóireáil sceidealta
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Airteagal 26 Cóireáil sceidealta

Airteagal 26

Cóireáil sceidealta

A.   Nós imeachta um údarú

1.  Chun críocha chur i bhfeidhm Airteagal 20(1) den bhun-Rialachán, déanfaidh an duine árachaithe doiciméad arna eisiúint ag an institiúid inniúil a thíolacadh d’institiúid na háite fanachta. Chun críocha an Airteagail seo, ciallóidh an institiúid inniúil an institiúid a iompróidh costas na cóireála sceidealta; sna cásanna dá dtagraítear in Airteagal 20(4) agus in Airteagal 27(5) den bhun-Rialachán agus ina ndéanfar na sochair chomhchineáil arna soláthar i mBallstát an chónaithe a aisíoc ar bhonn méideanna socraithe, ciallóidh an institiúid inniúil institiúid na háite cónaithe.

2.  Mura bhfuil cónaí ar an duine árachaithe sa Bhallstát inniúil, iarrfaidh sé údarú ar institiúid na háite cónaithe a sheolfaidh ar aghaidh chuig an institiúid inniúil gan mhoill é.

Sa chás seo, deimhneoidh institiúid na háite cónaithe i ndearbhú cibé acu an bhfuil coinníollacha a leagtar amach sa dara habairt d’Airteagal 20(2) den bhun-Rialachán á gcomhlíonadh i mBallstát an chónaithe.

Ní fhéadfaidh an institiúid inniúil diúltú an t-údarú arna iarraidh a dheonú, ach amháin i gcás nach mbeidh na coinníollacha a leagtar amach sa dara habairt d’Airteagal 20(2) den bhun-Rialachán á gcomhlíonadh i mBallstát cónaithe an duine árachaithe, i gcomhréir le measúnú institiúid na háite cónaithe, nó i gcás ina bhféadfar an chóireáil chéanna a sholáthar sa Bhallstát inniúil féin, laistigh de theorainn ama atá inchosanta ó thaobh an leighis de, ag cur san áireamh staid sláinte reatha an duine lena mbaineann chomh maith leis an gcúrsa is dóigh a bheadh ag an tinneas atá ar an duine lena mbaineann.

Cuirfidh an institiúid inniúil institiúid na háite cónaithe ar an eolas maidir lena cinneadh.

Mura mbeidh freagra faighte laistigh de na spriocdhátaí a leagtar amach lena reachtaíocht náisiúnta, measfar go mbeidh an t-údarú deonaithe ag an institiúid inniúil.

3.  Má tá gá ag duine árachaithe, nach bhfuil cónaí air sa Bhallstát inniúil, le cóireáil phráinneach shár-riachtanach agus nach féidir an t-údarú a dhiúltú i gcomhréir leis an dara habairt d’Airteagal 20(2) den bhun-Rialachán, deonóidh institiúid na háite cónaithe an t-údarú thar ceann na hinstitiúide inniúla, agus cuirfidh institiúid na háite cónaithe an institiúid inniúil ar an eolas láithreach.

Glacfaidh an institiúid inniúil leis na cinntí agus leis na roghanna cóireála ó na dochtúirí arna bhformheas ag institiúid na háite cónaithe a eisíonn an t-údarú maidir leis an ngá atá le cóireáil phráinneach, shár-riachtanach.

4.  Aon tráth i rith an nós imeachta lena ndeonaítear an t-údarú, forchoimeádfaidh an institiúid inniúil an ceart chun an duine árachaithe a chur faoi scrúdú ag dochtúir a roghnóidh sí sa Bhallstát fanachta nó cónaithe.

5.  Cuirfidh institiúid na háite fanachta, gan dochar d’aon chinneadh maidir le húdarú, an institiúid inniúil ar an eolas, más cosúil go bhfuil sé iomchuí ó thaobh an leighis de, an chóireáil a chumhdaítear leis an údarú atá ann cheana a fhorlíonadh.

B.   Costas na sochar comhchineáil arna dtabhú ag an duine árachaithe a ghlanadh

6.  Gan dochar do mhír 7, beidh feidhm mutatis mutandis ag Airteagal 25(4) agus (5) den Rialachán cur chun feidhme.

7.  Má d’iompair an duine árachaithe féin costais uile nó cuid de chostais na cóireála leighis arna húdarú, agus más ísle méid na gcostais a bhfuil sé d’oibleagáid ar an institiúid inniúil iad a aisíoc le hinstitiúid na háite fanachta nó leis an duine árachaithe i gcomhréir le mír 6 (costas iarbhír) ná méid na gcostas a bheadh uirthi a ghabháil uirthi féin as an gcóireáil chéanna sa Bhallstát inniúil (costas barúlach), aisíocfaidh an institiúid inniúil leis nó léi, arna iarraidh sin dó, costas na cóireála a thabhaigh an duine árachaithe go dtí méid na difríochta atá idir an costas barúlach agus an costas iarbhír. Ní fhéadfaidh méid na haisíocaíochta, áfach, dul thar mhéid na gcostas a thabhaigh an duine árachaithe iarbhír agus féadfar a chur san áireamh leis an méid a bheadh le híoc ag an duine árachaithe dá mba rud é gur sa Bhallstát inniúil a seachadadh an chóireáil.

C.   Costais taistil agus fanachta mar chuid de chóireáil sceidealta a ghlanadh

8.  I gcás ina bhforálfar le reachtaíocht náisiúnta na hinstitiúide inniúla d’aisíoc costas taistil agus costas fanachta atá doscartha ó chóireáil an duine árachaithe, gabhfaidh an institiúid seo uirthi féin na costais don duine lena mbaineann agus, más gá, do dhuine a chaithfidh é thionlacan, nuair a dheonófar údarú i gcás cóireála i mBallstát eile.

D.   Daoine den teaghlach

9.  Beidh feidhm ag míreanna 1 go 8 mutatis mutandis maidir le daoine de theaghlach na ndaoine árachaithe.

1. Forbhreathnú

,
Teideal Rialáil
Article 26 1.
For the purposes of the application of Article 20(1) of the basic Regulation, the insured person shall present a document issued by the competent institution to the institution of the place of stay. For the purposes of this Article, the competent institution shall mean the institution which bears the cost of the scheduled treatment; in the cases referred to in Article 20(4) and 27(5) of the basic Regulation, in which the benefits in kind provided in the Member State of residence are reimbursed on the basis of fixed amounts, the competent institution shall mean the institution of the place of residence.
Article 26 2.

If an insured person does not reside in the competent Member State, he shall request authorisation from the institution of the place of residence, which shall forward it to the competent institution without delay.

In that event, the institution of the place of residence shall certify in a statement whether the conditions set out in the second sentence of Article 20(2) of the basic Regulation are met in the Member State of residence.

The competent institution may refuse to grant the requested authorisation only if, in accordance with the assessment of the institution of the place of residence, the conditions set out in the second sentence of Article 20(2) of the basic Regulation are not met in the Member State of residence of the insured person, or if the same treatment can be provided in the competent Member State itself, within a time-limit which is medically justifiable, taking into account the current state of health and the probable course of illness of the person concerned.

The competent institution shall inform the institution of the place of residence of its decision.

In the absence of a reply within the deadlines set by its national legislation, the authorisation shall be considered to have been granted by the competent institution.

Article 26 3.

If an insured person who does not reside in the competent Member State is in need of urgent vitally necessary treatment, and the authorisation cannot be refused in accordance with the second sentence of Article 20(2) of the basic Regulation, the authorisation shall be granted by the institution of the place of residence on behalf of the competent institution, which shall be immediately informed by the institution of the place of residence.

The competent institution shall accept the findings and the treatment options of the doctors approved by the institution of the place of residence that issues the authorisation, concerning the need for urgent vitally necessary treatment.

Article 26 4.
At any time during the procedure granting the authorisation, the competent institution shall retain the right to have the insured person examined by a doctor of its own choice in the Member State of stay or residence.
Article 26 5.
The institution of the place of stay shall, without prejudice to any decision regarding authorisation, inform the competent institution if it appears medically appropriate to supplement the treatment covered by the existing authorisation.

B.   Meeting the cost of benefits in kind incurred by the insured person

Article 26 6.
Without prejudice to paragraph 7, Article 25(4) and (5) of the implementing Regulation shall apply mutatis mutandis.
Article 26 7.
If the insured person has actually borne all or part of the costs for the authorised medical treatment him or herself and the costs which the competent institution is obliged to reimburse to the institution of the place of stay or to the insured person according to paragraph 6 (actual cost) are lower than the costs which it would have had to assume for the same treatment in the competent Member State (notional cost), the competent institution shall reimburse, upon request, the cost of treatment incurred by the insured person up to the amount by which the notional cost exceeds the actual cost. The reimbursed sum may not, however, exceed the costs actually incurred by the insured person and may take account of the amount which the insured person would have had to pay if the treatment had been delivered in the competent Member State.

C.   Meeting the costs of travel and stay as part of scheduled treatment

Article 26 8.
Where the national legislation of the competent institution provides for the reimbursement of the costs of travel and stay which are inseparable from the treatment of the insured person, such costs for the person concerned and, if necessary, for a person who must accompany him/her, shall be assumed by this institution when an authorisation is granted in the case of treatment in another Member State.

D.   Family members

Article 26 9.
Paragraphs 1 to 8 shall apply mutatis mutandis to the members of the family of the insured persons.

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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