Icelandic health insurer estimates overseas treatment costs exceeded ISK 100 million

Costs covered by Iceland Health Insurance for treatment outside the European Economic Area exceeded ISK 100 million last year, according to its chief executive, who told mbl.is that the claims are difficult to administer and verify.

“In the larger context, this has not been a very large cost item, but it is complicated and difficult to manage in every respect,” said Sigurður H. Helgason, chief executive of Iceland Health Insurance.

He said he did not have the exact figure to hand but estimated that the cost had exceeded ISK 100 million in the past year.

Changes to Iceland’s health insurance legislation approved by parliament last spring mean that people travelling outside the EEA from 1 January will no longer be insured against medical costs resulting from illness or accidents. The authorities have advised travellers to check their coverage with insurance companies and through payment card insurance.

Within Europe, reimbursements are based on clear rules and cooperation with partners across the continent. These partners help verify whether a provider is legitimate and whether charges are reasonable compared with the cost of the same service in the country concerned.

Outside that system, Iceland Health Insurance has few connections, making it difficult to establish whether costs are reasonable, Sigurður said.

Coverage limited to providers in public insurance systems

Sigurður said comparable health insurance systems generally do not provide the same rights as Iceland’s system, and that very few cover healthcare costs everywhere in the world.

He also clarified that the legislative change does not simply apply to state-run hospitals within the EEA. Rather, it excludes healthcare providers that are not part of the public health insurance system in the country where treatment is provided.

European healthcare systems vary, with some relying heavily on public providers and others on private providers. Iceland Health Insurance will cover costs when a provider delivers services covered by the relevant country’s health insurance system and there is a reimbursement agreement in place.

However, treatment at a private hospital that has no working relationship with the public health insurance system, such as a private hospital in Spain, will no longer be reimbursed.

Individual emergency cases can be reviewed

Sigurður said exceptional cases would still be assessed. If someone suffers an accident or heart attack and is taken to a private hospital, Iceland Health Insurance will review the case separately under its existing authority to do so.

Several questions have arisen over how the legislative changes will be implemented, and they are being reviewed by Iceland Health Insurance and the ministry. Additional guidance for the public may be issued.