Mandatory Health Insurance Rules
Step 3 - Medical Expense Settlement & the Employee
When employees work across borders, they might need healthcare in a country where they are not insured, typically, in their home country. To continue utilizing their home country's healthcare system, a Medical Expense Clause, as part of a social security treaty between the Country of Insurance and the Country of Residence, ensures a smooth financial and administrative settlement, provided the employee meets the specified requirements.
Conditions:
The employee must take out healthcare insurance in the country where they are mandatorily insured for cost of healthcare (the Country of Insurance).
Contributions for that insurance policy are typically paid to the healthcare insurer in the Country of Insurance.
To prove healthcare insurance in other countries, the employee must obtain an S1 (formerly 106) form from their healthcare insurer in the Country of Insurance.
This form needs to be registered with the designated healthcare insurer in the Country of Residence.
As proof of coverage for healthcare costs in the Country of Residence, the employee will receive an insurance card from the designated insurer in the Country of Residence.
Healthcare Coverage in the Country of Residence
Upon registration, employees are entitled to healthcare services in their Country of Residence, under the local rates and conditions of that country, as if they were insured residents.
Elaboration
A medical expense clause typically means that healthcare costs incurred in the Country of Residence are managed and settled directly by the healthcare insurer within that same country.
To enable this, the employee must first obtain an S1 (formerly 106) form from their healthcare insurer in the Country of Insurance. This form then needs to be registered with the designated healthcare insurer in the Country of Residence.
Caution
Family Members
When assessing social security applicability, the country where a family member is subject to social security must be determined independently of the employee's status. See step 4.
Tips & Best Practices
Declaring Medical Expenses: Country of Residence vs. Country of Insurance
A medical expense clause typically entitles an individual to receive healthcare in their country of residence, with costs covered by the mandatory health insurance in their country of insurance.