Requested by SK EMN NCP on 23 rd November Compilation produced on 3 rd February 2012

Transcription

1 Ad-Hoc Query on the System of Public Health Insurance for Asylum Seekers, Persons who have been Granted Asylum and Persons who have been Granted Subsidiary Protection Requested by SK EMN NCP on 23 rd November 2011 Compilation produced on 3 rd February 2012 Responses from Austria, Bulgaria, Czech Republic, Estonia, Finland, France, Hungary, Italy, Latvia, Lithuania, Luxembourg, Netherlands, Poland, Slovak Republic, Slovenia, Spain, Sweden, United Kingdom plus Norway (19 in Total) Disclaimer: The following responses have been provided primarily for the purpose of information exchange among EMN NCPs in the framework of the EMN. The contributing EMN NCPs have provided, to the best of their knowledge, information that is up-to-date, objective and reliable. Note, however, that the information provided does 1. Background Information The Slovak Republic is interested in finding out how the Member States' systems of public health insurance deal with asylum seekers, persons who have been granted asylum and persons who have been granted subsidiary protection. 1. Are asylum seekers, persons who have been granted asylum and persons who have been granted subsidiary protection part of the public health insurance system like citizens of your Member State? a) If yes, how does this system work in practice? 2. If no, how do you arrange health insurance for: - asylum seekers, - persons who have been granted asylum and 1 of 10

2 - persons who have been granted subsidiary protection? We would very much appreciate your responses by 23 rd December Responses Wider Dissemination? Austria No This EMN NCP has provided a response to the requesting EMN NCP. However, they have requested that it is not disseminated further. Bulgaria Yes Obligatory insured by the Bulgarian National Health Insurance Fund are the persons with refugee status, humanitarian status or asylum. The obligation for insurance occurs from the date of opening procedures for granting refugee status or right of asylum. Insured for the account of the republican budget are the persons under proceedings for granting refugee status or right to asylum. Czech Republic Yes 1. Yes. a) Health insurance of asylum seekers, persons who have been granted asylum or subsidiary protection, unless they have income from employment or self-employment, is paid for by the state. For the details of public healthcare system in the Czech Republic see the brochure Information for foreigners in the Czech Republic, p , which is available at 2. Not applicable. Estonia Yes Persons who have been granted asylum or subsidiary protection are part of the public health insurance system in Estonia. So, they are justified to use the same health services on the same conditions as the citizens of Estonia. In practice the data of the refugee or person granted subsidiary protection are entered in the register of health insurance and the person can visit the doctor by following the same terms as citizens of Estonia. The asylum seekers are not part of the public health insurance system in Estonia. The asylum seekers are entitled to receive emergency medical care and in case of necessity the medical examination is conducted by the doctor. If the asylum seeker has problems with his/her health one contacts the responsible person of the reception centre who helps to contact the family physician. Finland Yes 1-2. Health care is in Finland mainly provided on the basis of residence and is primarily financed with general tax revenues. There are both public and private sector providers. Primary health care services are the responsibility of municipalities and are generally provided through local health centres. In the Åland Islands the province of Åland is responsible for organising the health care services. Each municipality has a health centre, with the exception of some small municipalities, which may share resources with a neighbouring municipality. The health centres provide residents with physician, dental, laboratory and radiographic services. The municipalities own 2 of 10

3 and operate almost all of the hospitals. In addition there are a few private hospitals. Private sector services, which mainly provide out patient care, complement the public services. The private sector also comprises a few hospitals, rehabilitation facilities as well as all pharmacies with the exception of those operating in conjunction with a general hospital. Patients who use private sector services pay the entire cost of the service to the provider, after which they can apply for refund from Kansaneläkelaitos (Kela) under the Health Insurance Act. Asylum seekers are entitled to emergency health care. After issuance of residence permit in Finland persons with refugee status and subsidiary protection status are entitled to public health care. France Yes 1. Yes a) - Access to health care for asylum seekers In France, an asylum seeker is eligible for free health care for people on low incomes (Couverture maladie universale =CMU). This cover is provided from the time the asylum seeker files his/her asylum application if he/she presents either a notice to go to the prefecture, or a temporary residence document (APS or acknowledgement recording the submission of an application for asylum), together with a document certifying his/her address. It will cover all medical and hospital expenses for the asylum seeker, his/her spouse and his/her minor children. The application for free health care for people on low incomes (CMU) must be made to his/her local health insurance office (Caisse primaire d assurance maladie = CPAM). The right to basic free health care for people on low incomes (CMU) is permanent. The right to supplementary CMU is valid for one year. It is therefore necessary to apply for the renewal of the supplementary cover every year. While waiting to benefit from free health care for people on low incomes (CMU), asylum seekers can go to hospitals with permanent health care access points (Permanences d Accès Aux Soins de Santé PASS). If the asylum seeker has not been accepted for residence and his/her application for asylum is being considered as a priority procedure, he/she is eligible for State medical assistance (aide médicale de l État = AME) on condition that he/she can prove 3 months residence in France. His/her application for State medical assistance (AME) must be made to his/her local health insurance office (CPAM) or to a hospital where there is a permanent health care access point (Permanences d Accès Aux Soins de Santé = PASS). - Access to health care for third country nationals who have been granted refugee or subsidiary protection status Once in possession of an APS or an acknowledgement recording the submission of an application for asylum, an asylum seeker is eligible for free health care for people on low incomes. He/she does not have to register again to the local health insurance office (CPAM) when he/she has been granted refugee or subsidiary protection status. However, he/she should advise the local health insurance office (CPAM) of his place of residence of the changed situation. If his/her asylum application was processed as a priority procedure without acceptance for residence, he/she will have to apply for free 3 of 10

4 health care for people on low incomes (CMU) at his/her local health insurance office (CPAM). As soon as he/she gets a job, the foreigner who has been granted the refugee status or the subsidiary protection has to register to the Social Security to join the basic system for employees. Hungary Yes Recognised refugees and beneficiaries of subsidiary protection can be part of the public health insurance system under the same conditions as Hungarian citizens, as Article 10 (1) of the Asylum Act stipulates that: unless a rule of law or government decree expressly provides otherwise, a refugee shall have the rights and obligations of a Hungarian citizen with exceptions set out in subsections (2) and (3). Furthermore, according to Article 17 (1), beneficiaries of subsidiary protection shall have the same rights and obligations as refugees, unless a rule of law or a governmental decree expressly provides otherwise. Asylum seekers can become part of the public health insurance system by getting employed after 1 year from the submission of their application for international protection under the same conditions as refugees or beneficiaries of subsidiary protection. If the asylum seeker, refugee or beneficiary of subsidiary protection is not covered by social security, he/she shall be entitled to the following health care services free of charge: (If the refugee or beneficiary of subsidiary protection is not covered by the social security system he/she is only entitled to the afore-mentioned health care services for one year from the date the decision on his/her recognition becomes legally binding.) a) examinations and medical treatments falling within the scope of care provided by general practitioners; b) examinations and medical treatments provided by policlinics for ambulant patients in the case of emergencies, as well as medication and bandages used in the course of treatment; c) hospital care in the case of emergencies, as well as treatments prescribed by doctors treating an emergency including surgery interventions, as well as medical supplies and prosthetics used in the course of treatment, medical treatment, medication and bandages required for the treatment, and meals; d) upon medical treatment received in a policlinic or hospital care, until their illness is cured or their condition is stabilised da) the necessary examinations and medical treatments; db) medicaments not covered by medication referred to in paragraph h) that cannot be substituted by any other means and medical appliances for the administration of medication; e) medical appliances on doctor s orders other than those covered by Sub-paragraph db) of paragraph d), as well as the repair of said appliances; f) emergency dental care and odontotherapy, provided that the treatment used by the person seeking recognition falls within the lowest compensation category; g) prenatal care and obstetrics, abortion in accordance with the conditions defined in the Act on the protection of the life of embrios; h) medication and bandages that may be ordered for those entitled to public health care free of charge as provided in a separate legal instrument, or with 90% or 100% social security coverage pursuant to a health care provision ; i) transportation by ambulance in the case of health care provisions in accordance with paragraphs b), c), d) da) and g) if they cannot be 4 of 10

5 transported by any other means due to their health condition; j) mandatory vaccination tied to their age. In this context, emergency is a change of the state of health without which immediate medical treatment would result in life-danger or serious or irreversible harm of health. Italy Yes Non EU citizens regularly staying in Italy have right to compulsory enrollment to the regional Health Service. Asylum applicants or International and Subsidiary Protection holders are considered as regularly staying, therefore they have right to public health insurance like Italian citizens. Latvia Yes Asylum seekers, refugees and persons granted subsidiary form of protection do not take part in public health insurance system. We would like to mention that in Latvia public health insurance system which includes all citizens does not exist. Asylum seekers receive medical care in amount and cases stipulated by different legal acts. Persons granted refugee status automatically receive permanent residency permit in Latvia and those granted subsidiary protection automatically receives temporary residency permit. Both groups of persons receive medical care the same way as other third country nationals who reside in Latvia with either temporary or permanent residency permit. Lithuania Yes 1. According to the Law on the Health Insurance only refugees are included into the public health insurance system. Persons granted subsidiary or temporary protection are insured only if they belong to particular groups (e.g. minors up to 18 years old, single parents with children, expecting mothers, persons at pension age, people with health conditions established by the Ministry of Health). Other persons who have been granted subsidiary or temporary protection but do not belong to a above mentioned group are insured during their integration period (up to 12 months) from the state funds for integration. After the integration period only employed persons are insured. Asylum seekers are not insured and they only receive emergency health care and can consult medical personnel at the Foreigners Reception Centre. 2. If no, how do you arrange health insurance for - asylum seekers medical services are provided at the Foreigners Reception Centre. - persons who have been granted asylum are included into the state insurance system and can access all available medical services. - persons who have been granted subsidiary protection are insured during they integration period (up to 12 months). After this period they are insured only if employed. Luxembourg Yes 1. Yes. In Luxembourg any person that is granted the status of international protection (i.e. asylum and subsidiary protection) has the same access to the public health system in the same conditions as the Luxemburgish nationals (article 51 (1) of the Law of 29 August 2008 on free movement of persons and immigration). 5 of 10

6 a) Any person that had been granted international protection (asylum or subsidiary protection) that are at least 25 years or older (except when the person is younger than 25 years old but is responsible for children) and that does not have any employment, benefits from the guarantee minimum income (revenue minimum garanti RMG). This income will allow the person that had been granted international protection to affiliate to the National Social Security System (health and maternity insurance). The monthly fee will be automatically deducted from the RMG. Seriously ill Children and adults will benefit from material or monetary aid, in the framework of the Long term care insurance (assurance-dépendance) that is part of the compulsory health insurance. b) The voluntary health insurance fees of persons that have been granted international protection status, that do not have an employment and that are not entitled to the RMG are paid by the Social Aid Office of the municipality where the person lives or by the OLAI (Office luxembourgeois de l accueil et l intégration). 2. In the case of asylum seekers, OLAI (Luxembourgish Office of Reception and Integration) take in charge the health insurance fees according to article 2 of the Social Insurance Code (Code des assurances sociales) during the period that the asylum seeker is entitled to benefit from social aid (article 1 of the Grand-ducal regulation of 1 September 2006, which fix the conditions and modalities for granting social aid to international protection applicants). The international protection applicant can benefit from his/her health insurance after a three months waiting period from the date when the affiliation application was filed in the Social Security Centre (Centre commun de la sécurité sociale). During these three months, the international protection applicant is not cover by the voluntary health insurance. However any urgent medical care will be taken care by OLAI. These expenses will be paid using vouchers issued by OLAI. The affiliation to the national health insurance system ends when the person that is granted international protection status (recognized refugee or granted subsidiary protection status) is granted the RMG, or the day that the rejected applicant for international protection leaves the country (voluntarily or by force). In case that the rejected applicant cannot leave the country or being expelled because of reasons beyond its control or because he/she had obtained a delay because of medical reasons, the voluntary health insurance fees will continue to be taken care by OLAI. Netherlands Yes The Netherlands has a special system exclusively for asylum seekers. However it is closely linked to our general system and based on the Dutch Health Care Insurance Law and General Law for Special Medical Expenses. The Regulation on Health Care for Asylum Seekers was formulated by the Central Agency for the Reception of Asylum Seekers (COA). COA is an independent administrative body funded by the Ministry of Justice. The Health Care Centre Asylum seekers (GC A) is a GP s practice organized nationwide to be the first contact point for medical care for all asylum seekers in the Netherlands. The GC A sees to the access to so-called primary care, GP s, dentists and hospitals. Public health care directed at prevention, screening and treatment of TB, remains a task of the municipalities and their regional health services. Each asylum seeker is being registered with a GP practise that works with the GC A near the Asylum seekers Centre where the asylum seeker is 6 of 10

7 living. The GP offers the same care to asylum seekers as it is offered to all regular patients. The GP is responsible for the primary health care, just like he is for all Dutch patients. In order to book an appointment with a GP, the asylum seeker phones the GC A Practice line. This is a medical call centre where health care assistants cooperating closely with the GP s- help asylum seekers with their medicalquestions. Asylum seekers are insured for most medical costs. However some costs, like for example IVF, are excluded. On the other hand the GP pays a lot of attention to mental support and social medical advice because of the situation the asylum seekers are in. The health insurance is being paid by COA. As soon as an asylum seeker has been granted a residence permit for staying in the Netherlands he or she is obliged to take out insurance for medical care by one of the insurance companies in the Netherlands just like all Dutch citizens are obliged to. The premium/contribution for this insurance has to be paid by the persons themselves. There is no difference between asylum seekers who are granted asylum and asylum seekers who are granted subsidiary protection Poland Yes Asylum seekers, persons who have been granted refugee status and subsidiary protection have access to the same medical assistance as Polish citizens. Depending on the status of the person different authorities are involved in financing medical assistance or the public health insurance system. Asylum seekers Asylum seekers are not part of the public health insurance system, but have access to the same medical services as Polish citizens. Health care for asylum seekers is organized by the Office for Foreigners. Medical services are realized based on civil-law agreements signed between the Head of the Office for Foreigners and healthcare providers selected in public contract proceedings (currently the Central Clinical Hospital of the Ministry of Interior coordinates medical assistance for asylum seekers). Foreigners applying for refugee status are granted the following medical services: basic health care, specialist consultations, specialist examination, hospitalization, medical services included in the State Medical Rescue system, rehabilitation and dentist surgery. Basic health care services are realized in medical points, which are localized in each center for foreigners applying for refugee status, however examinations, specialist consultations and hospitalization take place in the mandatory hospitals or in other medical health care centers with which the mandatory has signed agreements. Costs resulting from medical services for persons applying for refugee status are covered from the financial resources of the Office for Foreigners and come from the state budget. Refugee status and subsidiary protection Foreigners who received refugee status or subsidiary protection in Poland have the right to apply for an Individual Integration Program, which lasts 12 months. These programs are realized by Family Support Centres, which pay the public health insurance fee for the refugees and beneficiaries of subsidiary protection during the period of the programs. On the basis of this refugees and beneficiaries of subsidiary protection are enabled to the same health services as Polish citizens. When the Integration Program ends the health insurance is financed depending on the employment situation of each person: 7 of 10

8 - Legal employment: the employer is obliged to pay the health insurance fee, as part of the salary; - Unemployment: in this case refugees or beneficiaries of subsidiary protection should register themselves in the job centre, which pays the health insurance fee. Slovak Republic Yes Persons who have been granted asylum are part of the public health insurance system like citizens of the Slovak Republic. Asylum seekers and persons who have been granted subsidiary protection are not involved in the system. They obtain medical cards issued by the Migration Office of the Ministry of Interior of the Slovak Republic upon which they get medical care. Emergency medical care is covered by the budget of the Migration Office. Slovenia Yes 1. The health issue of international protection (IP) seekers and persons with granted international protection (IP) status is regulated by the relevant special provisions, included in the Slovenian International Protection Act IPA (Official Gazette of the Republic of Slovenia No. 11/21 February 2011, p official consolidated version of the law and No. 98 of 2 December Constitutional Court's Decision: U-I-292/09-9 of 20 October 2011). In Slovenia, persons with granted IP status are part of the public health insurance system and IP seekers are not. It needs to be stressed that minor IP seekers are entitled to health care under the same terms as Slovene citizens, but the costs for medical services are covered by the Slovenian Ministry of Health (from the national budged) for all IP seekers. 1.1 international protection (IP) seekers: The IP seekers have the right to emergency treatment (the seventh indent of Article 78 of the IPA). The Article 84 (Health care) of the IPA defines: "(1) Emergency treatment of an applicant includes the right to: 1. Urgent medical assistance and transport by ambulance car based on the physician s decision and urgent dental interventions/assistance; 2. Urgent therapy (Emergency treatment) by decision of the doctor treating the applicant that includes: preserving vital functions, stopping major haemorrhages or preventing bleeding to death; preventing a sudden deterioration of condition that may cause permanent dysfunction of individual organs or vital functions; treatment of shock; services concerning chronic diseases and conditions the neglect of which can directly or in a short time cause disability other permanent damage or death; treatment of fevers and preventing infections from spreading that could cause sepsis; treatment or prevention of poisoning; treatment of bone fracture or dislocation and other injuries requiring the intervention of a doctor; medication from the so called positive list in line with the list of interchangeable medication on prescription for treating the above diseases and conditions; 8 of 10

9 3. Health care of women: contraceptives, termination of pregnancy, medical care during pregnancy and at childbirth. (2) Vulnerable persons with special needs and exceptionally other applicants have the right to a larger scope of health services approved and defined by the commission from the third paragraph of the previous Article of this Act. (3) Minors are entitled to health care under the same terms as Slovene citizens. (4) Medical examinations of applicants can be required in the interest of protecting public health in Slovenia." 1.2 persons granted the IP (refugee or subsidiary protection) status: It is set out in the fifth indent of the first paragraph of Article 89 of the IPA, that "a person with granted the international protection status has a right to:... health care;" In the Article 94 (Health care of persons with granted international protection) of the IPA is defined: "(1) The persons with granted international protection are mandatory insured under this title, if not mandatory insured under other title. (2) Children with granted international protection are entitled to health services under the same conditions as children, set by health care and health insurance regulations." a) For the persons with granted the IP status, the application to the Health Insurance Institute of Slovenia is made by the Ministry of the Interior's Integration Section, if the person is not already included into the mandatory health insurance under other title (e.g. employment relationship). The person is later provided with the Slovenian Health Insurance Card, based on which he/she can enforce the required health services he/she is entitled to. 2. The IP seekers can enforce the required health services they are entitled to on the basis of the Applicant's Card, defined by the 1 paragraph of Article 112. of the IPA as "a document confirming the IP seeker's status and at the same time a permit to stay in the Republic of Slovenia until the enforcement of the decision throughout the IP procedure." The IP seekers usually do not go to one of the Community Health Care Centres or other health institution by themselves (although they are entitled to) since it is more practical that the required physician comes to the Asylum Home and they are also communication issues present. They usually communicate their health problems to the senior staff nurse of the Asylum Home. She speaks quite a few languages (inter alia English, Arabic and Serbo-Croatian) which provides the satisfactory level of communication with lots of IP seekers, accommodated into the Asylum Home. If necessary, the adequate translator is arranged. The arrival of the adequate physician to the Asylum Home is then arranged (and a translator, when necessary), or the IP seeker is accompanied and transferred by car to an appropriate Heath Institution. 9 of 10

10 Spain Yes Persons who have been granted international protection are part of the public health insurance system in the same conditions as the Spanish citizens. (as stated in the article 36.1 of the Spanish asylum Act 0f 2009). The Spanish asylum act lays down, in its article 18, the rights and obligations of the asylum seekers. Among the rights entitled by the asylum seeker, it is the health care, so they are also part of the public health insurance system like the Spanish citizens. Sweden Yes In Sweden asylum seekers are entitled to a free medical examination. They are entitled to emergency or urgent medical and dental care. The local county council decides on what kind of care that includes. This is performed by the regular health authorities and paid for the Swedish Migration Board. Everyone with a permanent residence permit (including persons that have been granted asylum or subsidiary protection) has the same right to health care as everyone living in the country (including citizens) and is registered in the normal health care system. United Kingdom Yes 1. In the UK, provision of basic medical care and treatment is provided through the National Health Service (NHS) and the equivalent Health and Social Care (HSC) in Northern Ireland primarily for people resident in the UK. The NHS and HSC are state funded and do not forma a 'health insurance scheme'. 2. Persons who are applying for or have been granted asylum in the UK and persons who have been granted subsidiary protection (through humanitarian protection) are entitled to free care at the NHS and HSC. Norway Yes All registered asylum seekers in Norway are covered by the universal national health insurance system as long as they do not have an obligation to leave the country after a final rejection of their application. This is also the situation for family members, and for all those who have been granted a residence permit, regardless of basis. Adults who have an obligation to leave the country after having had their asylum application rejected will only have the right to emergency medical assistance, and should in principle themselves pay the costs of any medical treatment. Non-government organisations have established a clinic in Oslo to provide medical assistance to persons in this situation, and will probably not charge more than a symbolic fee. ************************ 10 of 10