08.02.2021
Foreign Healthcare Transactions
23 of all the social security agreements signed by our country are still in force and the agreements with following countries include healthcare insurance: Germany, Netherlands, Belgium, Austria, France, TRNC-Turkish Republic of Northern Cyprus, Macedonia, Azerbaijan, Romania, Czech Republic, Bosnia-Herzegovina, Albania, Luxemburg and Croatia.
However, the provisions on healthcare insurance in the agreements signed between Azerbaijan and Albania cannot be implemented due to the reasons stemming from their legislations.
Which persons can receive healthcare services abroad according to the social security agreements?
Unless otherwise provided in the agreement on social security, the following persons have the right to receive healthcare benefits on behalf of our Institution;
- Insured persons (banks, insurance and reassurance companies, chambers of commerce, chambers of industry, stock markets and the workers employed in the unions constituted by them) under the scope of letter (a) of the first paragraph of Article 4 of the Law No. 5510 and of transitional Article 20 of the Law No. 506 and their dependent family members. Of the persons specified in this scope, the following can receive healthcare benefits while staying or residing in a foreign country:
- Insured persons temporarily posted to a foreign country,
- Persons who are permanently posted to a foreign country and their dependent family members,,
- Dependent family members of the insured and retired persons staying abroad for educational reasons,,
- Insured and retired persons staying abroad for touristic purposes and their dependent family members,,
- Dependent family members of the insured persons who are permanently residing abroad and retired persons and their dependent family members,,
- Members of universal health insurance who are sent to another country for treatment and their dependent family members.,
- Apart from this; according to the legislation of our Institution, the following persons can avail themselves from the right to receive healthcare benefits provided by our Institution under the scope of universal health insurance on behalf of the contracted countries;
- For temporary stay; all the persons registered on the document (formulary) of right to healthcare benefits, only in cases of emergency,
- For permanent residence; persons specified in the social security agreements.
In this context, in order to receive healthcare benefits in our country, respective persons are required to be an insured member of universal health insurance or dependent of the insured in question.
Conditions for Receiving Healthcare Benefits for the Persons Having Foreign Insurance
Persons having foreign insurance, who either temporarily stay or permanently reside in our country, are required to get a formulary from the institution to which they are registered and submit it to the Departments of Foreign Services operating within the scope of Social Security Provincial Directorates/Social Security Centers in their place of stay or residence; or to the Social Security Centers designated by Social Security Provincial Directorates.
Through the Document of Healthcare Benefits under Social Security Agreement, they can avail themselves from right to healthcare benefits in contracted health facilities, like other insured members of universal health insurance, free of charge excluding the rates of contribution and share which have to be paid legally by the insured himself/herself.
In cases of emergency, the insured persons, coming from countries with whom a social security agreement including healthcare insurance applications has been concluded and who are temporarily staying in our country, can receive the formulary for the right to healthcare services from the “Department of Foreign Services” in their place of stay in Turkey by submitting the document issued by the social security institution in their country. Besides, these documents can be confirmed through Social Security Centers designated by Social Security Provincial Directorates.
Benefiting from Emergency Healthcare Services for the People Having Foreign Insurance
In order to receive healthcare services, foreign insured people are required to make an application to the contracted health facilities of the Ministry of Health or to the private or training health facilities with the “Document of Healthcare Benefits under Social Security Agreement.”
Only through the referral of our contracted units, services can be provided from the non-contracted health facilities. When a person applies directly to a non-contracted health facility, regardless of this regulation, his/her expenses of treatment can be covered by the Institution on condition that it is an emergency situation.
Whether the treatment is an emergency or not is determined through the inspection of the relevant submitted medical documents by the contracted health facilities.
In such a case, the insured person shall apply to the Social Security Provincial Directorate/Social Security Center together with the reports regarding his/her treatment and invoices if he/she has made the payment. If the treatment is accepted as an emergency, a reimbursement shall be made to the insured in accordance with the provisions set forth in Medical Enforcement Declaration (SUT).
Duration of Benefiting from Healthcare Services for Foreign Insured People who are Temporarily Staying in our Country and Determination of the Family Members to Receive Healthcare Benefits
People, who are temporarily staying in our country, have the right to healthcare benefits for the period specified in the documents that they brought with them. For temporary stay, people to receive healthcare benefits are determined according to the legislation of the country issuing the document.
In case healthcare benefit is needed after the expiration of the document;
- A new document for treatment period shall be requested from the contracted country by applying to the relevant unit of the Institution.
- Insured person shall directly contact with the insurance institution of the country to which he/she is subject and request a new document for treatment period. The healthcare services provided meanwhile have to be paid for.
- After the document for the extension of the period is received from the contracted country, a “Document of Healthcare Benefits under Social Security Agreement” shall be issued retrospectively and the expenses shall be reimbursed to the respective people pursuant to the provisions of Medical Enforcement Declaration (SUT).
Duration of Benefiting from Healthcare Services for Foreign Retired People who are Permanently Residing in our Country and Determination of the Family Members to Receive Healthcare Benefits
People, who are permanently residing in our country, have the right to receive healthcare benefits for the period specified in the documents issued by the institutions of the contracted countries until a notification regarding the termination of the right to healthcare benefits is received.
For the permanent residences, the people to receive healthcare benefits subject to the agreement.
In our agreements with Germany, Netherlands, Belgium, France, Czech Republic, T.R.N.C., Luxemburg and Croatia, family members are determined pursuant to the legislation of our Institution; while in our agreements with Macedonia, Romania, Azerbaijan, Bosnia-Herzegovina and Albania they are determined according to the legislation of the relevant country.
Documents of right to healthcare benefits in cases of permanent residence are sent to our Institution by the insurance institutions of contracted countries either for a long time or without specifying the date of termination of the right.
However, the rights of foreign insured people in order to receive healthcare benefits are sometimes terminated by the relevant sickness funds for various reasons.
For the purpose of checking whether foreign insured people’s rights to healthcare benefits are continuing or not, the mentioned documents are issued in every six months’ period and given to the relevant persons.
Where the Costs of Treatment can be reimbursed by Foreign Insured Persons who pay for Their Treatment without a Document of Right to Healthcare Benefits?
Foreign insured persons who pay for their treatment in our country without obtaining the document (formulary) for receiving healthcare benefits from the insurance institution to which he/she is registered shall keep their reports and invoices regarding the treatment. After returning to his/her country to which he/she is registered, he/she shall request a reimbursement by submitting the relevant reports and invoices indicating the healthcare expenses to the institution to which he/she is affiliated. In this case, if it is set forth in the agreement, the insurance institution receiving the application shall request information from our Institution on the specified cost of the treatment provided in our country by sending the relevant reports and invoices. Following the receipt of the notification on the specified cost of that treatment, institution shall reimburse the notified amount to relevant person.
Who can Receive Healthcare Benefits in Germany in Accordance with the Social Security Agreement between Germany and our Country?
Only our workers and retired workers were to avail themselves of the healthcare provisions of the Social Security Agreement signed with Germany.
By way of reaching a consensus with German liaison body, craftsmen and civil servants and people who are retired in this context and also their dependants are covered by the healthcare provisions of the Social Security Agreement between Turkey and Germany.
As a result of this regulation, all the insured and retired persons and their dependants going to Germany, have the opportunity to avail themselves of healthcare benefits.
Source: Social Security Istitution (SGK)
Legal Notice: The information in this article is intended for information purposes only. It is not intended for professional information purposes specific to a person or an institution. Every institution has different requirements because of its own circumstances even though they bear a resemblance to each other. Consequently, it is your interest to consult on an expert before taking a decision based on information stated in this article and putting into practice. Neither Karen Audit nor related person or institutions are not responsible for any damages or losses that might occur in consequence of the use of the information in this article by private or formal, real or legal person and institutions.
