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Who is entitled to medical benefits under the special act, how are service providers to verify these entitlements – the National Health Fund clarified these issues in the announcements that appeared on the fund’s website. It also applies to primary health care and drug reimbursement.
The National Health Fund issued five announcements explaining the legal issues and responding to doubts regarding the provision of medical assistance by healthcare providers to Ukrainian citizens under the Act on Assistance to Ukrainian Citizens in Connection with an Armed Conflict in the Territory of that State. Recipes entered into force on March 12, 2022, with effect from February 24, 2022.
Refugees from Ukraine – who can count on medical care?
The fund recalled that the special act grants the right to medical benefits, drug reimbursement and the supply of medical devices Ukrainian citizens who came to Poland in connection with the aggression of Our Country, on the same terms as the insured. Moreover, it grants the right to medical services provided by healthcare providers, on the basis of contracts for the provision of healthcare services, and by pharmacies, on the basis of contracts for the implementation of prescriptions concluded with the National Health Fund.
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The National Health Fund (NFZ) informed that the following persons are entitled to medical services in accordance with applicable regulations: Ukrainian citizens and spouses of Ukrainian citizens not having Ukrainian citizenship – all of them those who directly crossed the Polish-Ukrainian border as well Ukrainian citizens with a Pole’s Card (they did not have to cross the Polish-Ukrainian border directly) and the closest family members of a Ukrainian citizen with a Pole’s Card. The rights apply to people who came to Poland from February 24, 2022, including children born in Poland in the first two cases.
Who is not entitled to benefits?
“The entitlement to medical benefits under the special act is not granted to people who before February 24, 2022 legally resided in Poland on the basis of residence permits or had the refugee status, or who applied for such status” – noted the National Health Fund.
The Fund specified that to “immediate family»You can include: spouse, ascendants (parents, grandparents), descendants (children, grandchildren), siblings, related in the same line or degree (son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, sister-in-law, stepchild) and her spouse, as well as a person who is living together.
At the same time, the National Health Fund explained that all eligible persons are entitled to healthcare services provided in Poland, on the same terms and in the same scope as those insured in Poland, with the exception of, however, spa treatment, spa rehabilitation, the right to treatment abroad, reimbursement of funds for treatment for abroad under the “cross-border” directive.
They also have the right to medicinal products under the health programs of the Ministry of Health and the right to vaccination against COVID-19, coronavirus testing (antigen and PCR) and treatment related to COVID-19, and children – immunization as part of the immunization schedule ( Protective Vaccination Program – PSO for 2022).
NHF: all benefits are free
All these benefits – as the National Health Fund reminded – are provided to the entitled persons free of charge. They are financed by the state budget through the National Health Fund.
A citizen of Ukraine will lose the entitlement to medical benefits under the special act if he or she leaves Poland for more than a month.
The fund also announced that also people who were not covered by the special act, who found themselves in Poland as a result of the war in Ukraine – i.e. Ukrainian citizens who lived in Ukraine before February 24, 2022 and members of their families, third-country nationals and stateless persons who In February 24, they enjoyed international protection in Ukraine (refugees) and their family members, as well as third-country nationals and stateless persons who stayed in Ukraine before February 2022, 24 on the basis of a permanent residence permit, and cannot safely return to their country – are entitled to medical care.
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As for the verification of entitlements, after the entry into force of the special act, it can be additionally carried out on the basis of: a special PESEL number assigned to Ukrainian citizens, an e-document (adults who register in the commune and will be given a PESEL number and set up a trusted profile, can activate an e-document confirming the status of an authorized person), a printout of the confirmation of creating a trusted authorized person profile (includes: name and surname, PESEL number).
The National Health Fund also announced that “benefits provided to eligible persons should be reported through NHF reporting messages (specifically the SWIAD message), at the earliest together with the settlement of benefits from March 2022”.
At the same time, the fund referred to health care in the context of the provisions of the special act, pointing out that a person entitled to benefits under the special act may use such care on the basis of a person not included in the active list of a given service provider.
“Services provided to eligible persons under the special act, including those provided from February 24 to March 11, 2022, should be reported in accordance with the Ordinance of the Minister of Health of September 8, 2015 on general terms and conditions of contracts for the provision of healthcare services (Journal of Laws of 2020, item 320, as amended), with the use of NHF reporting messages, at the earliest including the settlement of benefits from March 2022 »- marked.
Recipes for refugees from Ukraine
The Fund also emphasized that reimbursed prescriptions and medical devices are available to persons entitled under the special act on the same terms as the insured.
«(…) In order to provide a benefit in kind (ordering a drug by issuing a prescription), the patient’s entitlement should be verified and this entitlement must be recorded in the medical records. The rules for issuing prescriptions are identical to those for EU citizens with the right to benefits, subject to an identifier, which will have a value depending on the document that the person entitled under the special act will have. A prescription refunded for a child who does not have an identity document may be issued if it is possible to indicate a guardian who meets the conditions for the types of documents confirming identity »- wrote the National Health Fund.
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He further emphasized that the prescription issued to an authorized person under the special act must contain the IN code. It is issued to patients other than the insured who are entitled to free healthcare services.
«A person entitled under the special act who does not have a special PESEL number, whose electronic prescription is issued by an authorized person in Poland, should receive an information printout with the access key additionally presented in the form of a barcode, which will allow the person who provides the prescription to read the prescription from the electronic platform SIM (P1) »- emphasized the fund.
The patient fulfills such a prescription with the code IN, as in the case of EU citizens with the right to benefits, subject to the lack of the obligation to have an EHIC or NFZ certification.
“There is no need to copy / scan the document confirming the rights” – assured the National Health Fund.
Author: Klaudia Torchała
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