Health benefits

Health benefits HCFA TEAM February 16, 2023

Digital KEPA

From 2022, the disability certification process by the KEPAs has been completely overhauled. The process is now done digitally with a single application and results in a single disability medical certificate, giving access to all benefits. Based on the new legislation, the disability assessment at KEPAs has been simplified and digitised, while the obligation to pay a fee has been abolished for all categories of applicants.

To apply to the digital KEPAs visit the website https://epan.gov.gr/e_kepa.

For any additional information or clarification on Digital KEPA, you can contact the 1555 helpline or submit an online enquiry at 1555.gov.gr

To download the Official Gazette 146, article 103, p. 34 (Law 4961/2022) with the relevant decisions press here

KEPA Percentage of disability

The benefits and privileges of Cystic Fibrosis sufferers depend on the Disability Percentage assigned to each patient by the Health Committees of the Disability Certification Centres (KEPA). The above Committees are required to take into account the Unified Table of Disability Rates, which determines, for all insurance institutions and the State, the disability rates corresponding to each condition.

Based on current legislation patients with Cystic Fibrosis are entitled to a disability rate of 67% or more or 80% or more depending on the level of severity of the disease. Excluding a small percentage of atypical forms of Cystic Fibrosis, which include patients whose only symptom is infertility due to azoospermia.

If the Commission decides to award a lower rate or a rate that is not in accordance with the two rates above, an immediate appeal and request for reconsideration should be made.

Download the 3-page excerpt (Government Gazette 1506 B/4-5-2012, Government Gazette 5987B’/31-12-2018) on Cystic Fibrosis here.

See the table of disability rates for all conditions here.

Disability rate of 67% or more

Disability rate of 67% and above is entitled to for 2 years patients with Cystic Fibrosis who have symptoms from the respiratory system, who are receiving treatment to treat the symptoms of the disease.

Disability rate of 80% or more

Disability rate of 80% is entitled to for life patients with Cystic Fibrosis whose bronchial tree is now permanently colonised by microbial strains such as pseudomonas, haemophilus or Staphylococcus aureus, and the course of the disease will not improve due to the presence of bronchiectasis despite the continuous and painful treatment they receive.

Pharmaceutical Care

The prescription of medicines and preparations needed by patients with Cystic Fibrosis for the treatment of their disease and its complications can be done for all patients (insured and uninsured) by the attending physicians of the Cystic Fibrosis Units or by any physician certified in the Electronic Prescribing System (E-Prescription System), either a public or a private physician.

Patients with Cystic Fibrosis, as well as solid or fluid organ and tissue transplant recipients, are entitled to zero (0%) on all medications. Also, high-cost medicines are given free of charge to all Cystic Fibrosis patients, usually by the EOPYY pharmacies.

Under the EOPYY’s drug reimbursement system, drugs included in the “positive list” and reimbursed by insurance funds have a dual price: the insurance price and the retail price. The pharmacist must provide the insured person of the EOPYY with the pharmaceutical product for which the retail price coincides with the insurance price and is the cheapest. If the insured person chooses a pharmaceutical product for which the retail price is higher than the insurance price, then the resulting difference in the amount is shared 50% by the insured person and 50% by EOPYY.

Zero participation in medicines: Government Gazette 2883/26-10-2012, p. 44549

High-cost medicines: Law 3816/2010 – Government Gazette 6/26-1-2010, article 12, par. 2

EOPYY reimbursement system for medicines: FEK 692/26-3-2013

Medical Care for Uninsured Unemployed Uninsured

Unemployed young people of young age up to 29 years old are covered by IKA insurance for sickness benefits in kind, after applying to the IKA branches of their place of residence. These unemployed persons will have to present, when submitting their application for inclusion in the programme, a certificate from the DYPA (formerly OAED) that they have been registered as unemployed for at least two months before submitting their application, that they are still unemployed and that they hold an unemployment card renewed every three months. They must also be uninsured, not studying and, once they have taken up a job, they must register with the IKA branch of their place of residence. The sickness booklet issued is valid for six months and is renewed upon presentation of a new certificate from the OAED that they are still unemployed. More on the website of the DYPA here.

Ability for Teenagers up to 16 years old to choose a hospital

Following a decision by the Greek National Health Insurance Fund(here), adolescents, up to the age of 16, can choose a paediatrician and paediatric hospitals for their treatment, if they wish.

Uniform Health Care Regulation EOPYY

The Uniform Health Care Services Regulation (EKPY) of the National Health Care Services Organisation (EOPYY) contains all the much desired provisions concerning patients with Cystic Fibrosis, which the Panhellenic Cystic Fibrosis Association has been demanding since 2014 through a series of letters and meetings with all the competent bodies. Based on the ESRP (FEK 4898/1-11-2018, FEK 6544/B/12-12-2022) patients with Cystic Fibrosis who are insured by the National Health Insurance Fund (EOPYY ) are entitled to the following benefits free of charge. Also based on an order of the General Staff of National Defence (see here), the provisions of the Unified Health Care Benefits Regulation (EHIC) of the EOPYY for civil servants are also applicable to the insured of the funds of the Ministry of National Defence.

Paraclinical examinations

Provided by zero participation the cost of diagnostic examinations and procedures and laboratory tests performed in private diagnostic centres, clinics, etc. contracted with EOPYY.

Neutralizers

The new generation eflow nebulizer and its consumables are provided free of charge by the EOPYY to patients with Cystic Fibrosis. The replacement time for the nebulizer is four (4) years, while the replacement time for the consumables is six (6) months.

Natural therapies

Compensated up to ten (10) physiotherapy sessions per month per year with zero participation in the cost of physical therapies, when they are carried out by private providers contracted with EOPYY. Physiotherapies can be carried out in public PHC facilities, in the physiotherapy laboratories of public PHC facilities, state hospitals, KEFIAPs and in contracted physiotherapy laboratories, physiotherapy and rehabilitation laboratories, physiotherapy laboratories of private clinics, and with home visits for complete physiotherapy operations by contracted physiotherapists.

Special Dietary Formulations

Reimbursement of nutritional formulations is provided for Cystic Fibrosis patients who receive the special nutritional formulations according to the nutritional indicators with the relevant opinion valid for six (6) months from the date of its issuance. EOPYY may determine the quantity of each formulation that it reimburses by special decision of the Board of Directors which is communicated to physicians and providers through its website. From the 10% contribution to the cost of special therapeutic feeding formulations all patients with cystic fibrosis are excluded.

Consumable Health Care Materials

Reimbursement is made for the necessary sanitary equipment for home intravenous therapy, as certified by the attending physician, in particular for serum infusion systems, needles, syringes, venipuncture catheters, serum stands, albuminous plasters and gauze. Cystic fibrosis patients now have zero involvement in the value of the consumable health material they purchase commercially.

Hospitalisation/transplantation costs abroad

The EOPYY covers 100% of the hospitalisation/transplantation costs outside Greece. The coverage of transplantation costs requires a full and detailed justification regarding the impossibility of carrying out the transplant in Greece at the critical time for the patient’s case, as well as the approval of the National Transplantation Organisation (NTO).

Patient transport costs

Insured persons who have had to travel outside their place of residence for a health problem that is not treated in a health facility near their place of residence are reimbursed by EOPYY for the cost of their travel by public transport (bus, boat, train).

The patient and one accompanying person are entitled to the allowance. The EOPYY reimburses the cost of an accompanying person’s travel expenses, obligatory for children and adolescents up to 18 years of age and for adults, if deemed necessary by the attending physician.

If the journey is made by private car or taxi, the compensation is paid on the basis of the kilometric distance travelled. In exceptional cases and following an opinion of the AHS, the EOPYY by decision of the Board may reimburse the value of an air ticket for the patient and his/her companion.

Supporting documents for reimbursement of travel expenses

  • Reasoned certificate of the attending physician for the impossibility of treating the condition or conducting the examination or the necessary paraclinical examinations at the patient’s place of residence.
  • Copies of the tests or the discharge certificate in case of hospitalisation of the patient.
  • Proof of payment of the ticket price or petrol receipts, as well as a toll receipt, on the day of travel and return. If the journey was made to a town in a neighbouring county where there are no tolls, then the petrol receipt must be presented.