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Title:Pravici zavarovanih oseb v obveznem zdravstvenem zavarovanju do zdravstvenih storitev med potovanjem in bivanjem v tujini in do zdravljenja v tujini
Authors:ID Pirih, Petra (Author)
ID Cvetko, Aleksej (Mentor) More about this mentor... New window
Files:.pdf MAG_Pirih_Petra_2010.pdf (1,21 MB)
MD5: CD3B9F7AC07150CA4C6F3720FF659A49
PID: 20.500.12556/dkum/97e3106a-cc31-4407-bba4-4f22ea41e5df
 
Language:Slovenian
Work type:Master's thesis
Organization:PF - Faculty of Law
Abstract:V magistrski nalogi sta obravnavani dve pravici zavarovanih oseb v obveznem zdravstvenem zavarovanju, in sicer pravica do zdravstvenih storitev med potovanjem in bivanjem v tujini in pravica do zdravljenja v tujini. Pravica do zdravstvenih storitev med potovanjem in bivanjem v tujini zagotavlja zavarovanim osebam plačilo zdravstvenih storitev, ki jih med potovanjem in bivanjem v tujini uveljavljajo v obsegu in na način, določenim z Zakonom o zdravstvenem varstvu in zdravstvenem zavarovanju, s Pravili obveznega zdravstvenega zavarovanja, s pravnim redom Evropske unije ali z meddržavno pogodbo. Njihove pravice so odvisne tako od tega, v kateri državi jih uveljavljajo, kot od namena bivanja v tujini. Z analizo navedene pravice je predstavljeno, v katerih primerih, do katerih zdravstvenih storitev in v kakšnem obsegu so zavarovane osebe med potovanjem in bivanjem v tujini upravičene v breme sredstev obveznega zdravstvenega zavarovanja, in na kakšen način jih uveljavljajo. Predstavljena in analizirana je tudi pravica do povračila stroškov zdravstvenih storitev v tujini, kadar morajo zavarovane osebe le-te zaradi različnih razlogov kriti same, in ugotovljeno, ali in kako na pravico do povračila stroškov zdravljenja vpliva sklenjeno in uveljavljeno turistično zdravstveno zavarovanje z asistenco v tujini pri eni izmed zavarovalnic. Pravica do zdravljenja v tujini pa zavarovanim osebam omogoča, da namenoma odidejo v tujino in tam v breme sredstev obveznega zdravstvenega zavarovanja prejmejo ustrezno zdravljenje oziroma storitev. Ker gre pri navedeni pravici za zdravljenje pri tujemu izvajalcu zdravstvenih storitev, s katerim Zavod za zdravstveno zavarovanje Slovenije nima sklenjene pogodbe, predstavljajo stroški takšnega zdravljenja dodatno finančno breme za zdravstveno blagajno z omejenimi sredstvi. Zdravljenje v tujini se zato omejuje s sistemom predhodne odobritve, za kar pa morajo biti izpolnjeni določeni pogoji. Z analizo navedene pravice je predstavljeno, v katerih primerih so zavarovane osebe upravičene do zdravljenja v tujini in v okviru tega do katerih zdravstvenih storitev, ter postopek uveljavljanja in pravnega varstva pravice. Ker je Slovenija od maja 2004 dalje polnopravna članica Evropske unije in tako tudi njo zavezuje evropski pravni red, pa je posebej, skozi določbe Unije in z analizo pomembnejših sodb Sodišča Evropske unije, predstavljena tudi pravica do zdravljenja v drugi državi članici Evropske unije.
Keywords:obvezno zdravstveno zavarovanje, pravica do zdravstvenih storitev med potovanjem in bivanjem v tujini, pravica do povračila stroškov zdravstvenih storitev v tujini, zdravstveno zavarovanje na potovanjih v tujini z asistenco, pravica do zdravljenja v tujini, pravica do zdravljenja v drugi državi članici Evropske unije, čezmejno zdravstveno varstvo
Place of publishing:Maribor
Publisher:[P. Pirih]
Year of publishing:2010
PID:20.500.12556/DKUM-14280 New window
UDC:34(043.2)
COBISS.SI-ID:4110123 New window
NUK URN:URN:SI:UM:DK:3YNUJUWU
Publication date in DKUM:06.07.2010
Views:4841
Downloads:668
Metadata:XML DC-XML DC-RDF
Categories:PF
:
PIRIH, Petra, 2010, Pravici zavarovanih oseb v obveznem zdravstvenem zavarovanju do zdravstvenih storitev med potovanjem in bivanjem v tujini in do zdravljenja v tujini [online]. Master’s thesis. Maribor : P. Pirih. [Accessed 3 April 2025]. Retrieved from: https://dk.um.si/IzpisGradiva.php?lang=eng&id=14280
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Secondary language

Language:English
Title:The rights of insured persons in compulsory health insurance to medical services during travels and stays abroad and to medical treatment abroad
Abstract:The master's thesis deals with two rights of insured persons in compulsory health insurance; these are the right to medical services during travels and stays abroad and the right to medical treatment abroad. The right to medical services during travels and stays abroad covers the payment of medical services which are claimed during travels and stays abroad by insured persons; these are covered by the Healthcare and Health Insurance Act, Rules of Compulsory Health Insurance, the Judicial Law of the European Union or International treaty. Their rights depend on the country where they are claimed as well as the purpose of the stay in that particular country. The analysis of the rights shows in which cases, which medical services and in which extent the insured persons staying or travelling abroad can claim the funds from the compulsory healthcare insurance and how they can claim them. The right to reclaim the expenses of medical services abroad, where the persons in question have to cover the expenses by themselves for different reasons, is also presented and analysed, together with the findings if and how the signed claimed tourist health insurance with assistance abroad in one of the insurance companies influences the right to reclaim the expenses. The right to medical treatment abroad enables the insured persons to intentionally go abroad and claim, to the expense of the compulsory healthcare insurance, as well as receive the suitable medical services. Because the right in question deals with medical services performed by a foreign provider who is not in contract with the Health Insurance Institute of Slovenia, these expenses present an additional financial burden for the healthcare fund, which is limited; this is why medical treatments abroad are limited with the system of preliminary approval for which certain conditions have to be met. The analysis of the right in question presents in which cases the insured persons have the right to medical treatment abroad and according to these, which medical services the persons are entitled to and what the procedure of claiming these and the legal protection of these rights are. Because Slovenia has been a full member of the European Union since 2004 and is thus obliged to the European legal system, the right to medical treatment in countries of the European Union through the legislation of the European Union and more important judgements of the European Union Law Court are also presented.
Keywords:compulsory health insurance, right to medical services during travels and stays abroad, right to reclaim the expenses of medical services abroad, travel health insurance with assistance, right to medical treatment abroad, right to medical treatment in countries of the European Union, cross-border health care


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