+Artikolu 25 Żjara fi Stat Membru divers mill-Istat Membru kompetenti
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Artikolu 25 Żjara fi Stat Membru divers mill-Istat Membru kompetenti

Artikolu 25

Żjara fi Stat Membru divers mill-Istat Membru kompetenti

A)   Proċedura u ambitu tad-dritt

(1)  Għall-finijiet tal-applikazzjoni tal-Artikolu 19 tar-Regolament bażiku, il-persuna assigurata għandha tippreżenta lil min jipprovdi l-kura tas-saħħa fl-Istat Membru taż-żjara dokument maħruġ mill-istituzzjoni kompetenti tagħha li jindika l-intitolament tagħha għal benefiċċji in natura. Jekk il-persuna assigurata m’għandhiex dokument bħal dan, l-istituzzjoni tal-post taż-żjara, fuq talba jew jekk meħtieġ mod ieħor, għandha tikkuntattja lill-istituzzjoni kompetenti sabiex tikseb dokument bħal dan.

(2)  Dak id-dokument għandu jindika li l-persuna assigurata hija intitolata għal benefiċċji in natura taħt il-kondizzjonijiet stabbiliti fl-Artikolu 19 tar-Regolament bażiku bl-istess termini bħal dawk applikabbli għal persuni assigurati taħt il-leġislazzjoni tal-Istat Membru taż-żjara.

(3)  Il-benefiċċji in natura msemmija fl-Artikolu 19(1) tar-Regolament bażiku għandhom jirriferu għall-benefiċċji in natura li jkunu provduti fl-Istat Membru taż-żjara, konformement mal-leġislazzjoni tiegħu, u li jsiru meħtieġa fuq bażi medika bil-ħsieb li jiġi prevenut li persuna assigurata tiġi sfurzata li tirritorna, qabel it-tmiem tat-terminu taż-żjara ppjanata, fl-Istat Membru kompetenti biex tikseb il-kura li teħtieġ.

B)   Proċedura u arranġamenti biex jintlaħqu l-ispejjeż u jiġi provdut ħlas lura ta’ benefiċċji in natura

(4)  Jekk il-persuna assigurata fil-fatt tkun ġarrbet l-ispejjeż kollha jew parti mill-ispejjeż tal-benefiċċji in natura mogħtija fil-qafas tal-Artikolu 19 tar-Regolament bażiku u jekk il-leġislazzjoni applikata mill-istituzzjoni tal-post taż-żjara tippermetti l-ħlas lura ta’ dawk l-ispejjeż lill-persuna assigurata, hija tista’ tindirizza talba sabiex titħallas lura lill-istituzzjoni tal-post taż-żjara. F’dak il-każ, dik l-istituzzjoni għandha tħallas lura direttament lil dik il-persuna l-ammont tal-ispejjeż li jikkorrispondu għal dawn il-benefiċċji fil-limiti u taħt il-kondizzjonijiet tar-rati ta’ ħlas lura fil-leġislazzjoni tagħha.

(5)  Jekk il-ħlas lura ta’ dawn l-ispejjeż ma ntalabx direttament mill-istituzzjoni tal-post taż-żjara, l-ispejjeż għandhom jiġu mħallsa lura lill-persuna kkonċernata mill-istituzzjoni kompetenti abbażi tar-rati ta’ ħlas lura amministrati mill-istituzzjoni tal-post taż-żjara jew l-ammonti li kienu jkunu suġġetti għal rimbroż lill-istituzzjoni tal-post taż-żjara jekk l-Artikolu 62 tar-Regolament implimentattiv applikaw fil-każ konċernat.

L-istituzzjoni tal-post taż-żjara għandha l-obbligu li tipprovdi lill-istituzzjoni kompetenti, fuq talba, l-informazzjoni meħtieġa kolla dwar dawn ir-rati jew ammonti.

(6)  B’deroga mill-Paragrafu 6, l-istituzzjoni kompetenti tista’ tipproċedi għall-ħlas lura tal-ispejjeż li tħallsu fil-limiti u taħt il-kondizzjonijiet tar-rati ta’ ħlas lura fil-leġislazzjoni tagħha, sakemm il-persuna assigurata tkun qablet li din id-dispożizzjoni tiġi applikata għaliha.

(7)  Jekk il-leġislazzjoni tal-Istat Membru taż-żjara ma tipprovdix għal ħlas lura taħt il-paragrafi 5 u 6 fil-każ konċernat, l-istituzzjoni kompetenti tista’ tħallas lura l-ispejjeż fil-limiti u taħt il-kondizzjonijiet tar-rati ta’ ħlas lura fil-leġislazzjoni tagħha, mingħajr ma jkun meħtieġ il-qbil tal-persuna assigurata.

(8)  Il-ħlas lura lill-persuna assigurata m’għandux, fi kwalunkwe każ, jaqbeż l-ammont tal-ispejjeż fil-fatt imħallsa minnha.

(9)  Fil-każ ta’ infiq sostanzjali, l-istituzzjoni kompetenti tista’ tħallas lill-persuna assigurata ammont adegwat bil-quddiem malli dik il-persuna tippreżentalha t-talba għal ħlas lura.

C)   Membri tal-Familja

(10)  Il-paragrafi 1 sa 9 għandhom japplikaw mutatis mutandis għall-membri tal-familja tal-persuna assigurata.

1. Ħarsa ġenerali

,
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 Referenzi

1.2 Rekwiżiti identifikati

1.3 Standards relatati

2. Rekwiżiti identifikati

Rekwiżiti

3. Standards relatati

Standards
  • Builddate: 01.01.2018 00:00:00 -Doknr: CELEX:32009R0987
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