Which services am I entitled to free of charge if I am insured?
- Screening tests
- Medical treatment
Which services do I have to pay for even as an insured person (partial or supplementary fee)?
Which services are not available under health insurance?
What are my options when using healthcare services?
- The right to choose a doctor
- The right to request a second opinion
- Retrieving patient history, and disallowing it
- At the doctor’s
- In the pharmacy
- The right to information
- Settlement declaration (information on the social security funding available for services)
What should I pay attention to when visiting a doctor?
Who controls the use of services?
Under health insurance, the insured person is entitled to the following screening tests for the prevention and early detection of diseases:
- screening tests for checking the healthy development of the newborn and for the early detection of any malformations;
- children aged between 0 and 6 years are entitled to
- age-appropriate metabolic, sensory and intellectual functioning tests, as well as full physical screening,
- examinations to detect dental malformations and to record overall dental condition,
- tests for age-appropriate development and emotional state,
- screening tests for the prevention and early detection of diseases induced by environmental risk factors;
- 6–18-year-olds and full-time school students over 18 years of age, in addition to the above, are also entitled to screening tests performed within the frameworks of school and youth healthcare;
- the 18+ age group is entitled to
- screening tests for the diseases induced by age- and sex-appropriate risk factors, specified in the Decree of the Minister responsible for health insurance, and at the frequency specified therein,
- screening tests for the prevention and early detection of diseases induced by environmental risk factors, not including examinations to determine occupational fitness for work carried out by an occupational health service doctor and any further specialist outpatient care required,
- dental screening tests once a year;
- regardless of age:
- sports health examinations, except for the sports health care of professional athletes,
- tests for the early detection of the likely consequences or complications of the disease.
Please note that the insured person will also have to pay HUF 1,700 for lung screening if the lung screening is NOT part of the compulsory screening, or not part of the age-related screening as described above, or not part of the professional suitability tests for students in vocational training institutions and higher education institutions.
Services used for medical treatment
The Health Insurance Fund provides primary, specialist and other healthcare services to insured persons. You can read more about these by clicking on the menu on the left.
Basic healthcare services
Primary healthcare service ensures that patients receive long-term, personalised, continuous health care in or near their place of residence, regardless of their gender, age or the nature of their illness.
The task of primary health care:
- so-called preventive care for the prevention and early detection of diseases,
- monitoring individuals’ health, providing health information, health education, health development, and supporting health planning,
- medical treatment and care of the patient, even in the patient’s home if necessary, or home care and rehabilitation on the advice of a specialist,
- referring the patient to a specialist.
Specialist healthcare services
- specialist outpatient care,
- specialist dental care, and
- specialist inpatient care.
Other healthcare services
- Obstetric care,
- Medical rehabilitation,
- Patient transportation
- Mobile specialist care
Which services do I have to pay for even as an insured person? (partial or supplementary fee)
During the use of healthcare services, the insured person must also pay a supplementary or partial fee in the following cases.
During the use of services subsidized by health insurance, the patient must pay a PARTIAL FEE for the services in the following cases:
- interventions to alter external sex characteristics, except where the aim is to develop, due to malformations, the external characteristics of the genetically determined sex,
- types of dentures determined to restore chewing ability,
- orthodontic appliances under the age of 18.
The insured person is entitled to the following services for a SUPPLEMENTARY FEE:
- other comfort services provided on the patient’s own initiative within the frameworks of healthcare services, and
- if it is justified by the patient’s condition, care (including medication and meals) provided on the basis of a doctor’s referral in the case of staying in a nursing department.
The rules for the calculation of the partial and supplementary fee and, in several cases, the exact amount of the fee are set out in Annex 1 to the Government Decree 284/1997 (XII. 23.) on usage fees of certain healthcare services subject to usage fee, and no valid deviation from that is possible.
The list of services that can be used for a usage fee at the provider must be displaced in a clearly visible place in the healthcare institution, with the fees indicated. The patients must be informed about the fees for the reimbursable services that are justified and that they request before the service provided for a compensation fee is started.
Please note that a healthcare provider financed by the Health Insurance Fund may not charge the insured person for healthcare services provided under health insurance other than as detailed above.
Which services are not available under healthcare insurance?
The following services are not available under healthcare insurance:
- occupational hygiene screening tests, check-ups and further outpatient specialist services initiated as part of/within the frameworks of these,
- primary occupational health services, provided that they are not necessary because of the occupational disease or accident at work of the insured person using the service, and any further specialist outpatient service initiated as part of/within the frameworks of these,
- specialist medical opinion on the patient’s state of mind during the guardianship procedure, as well as statutory medical examinations and expert opinions, unless the examination and expert opinion are carried out for the purpose of establishing entitlement to social security or social allowance and benefits, or health insurance benefits, and further specialist outpatient services initiated as part of/within the frameworks of these,
- services necessitated by an accident occurring during particularly dangerous, extreme sports or leisure activities, and further specialist outpatient services initiated as part of/within the frameworks of these. In this respect, an accident is defined as a single external impact on the human body which occurs suddenly or within a relatively short period of time, independently of the will of the injured person, and causes injury, poisoning or other damage to health (physical or mental), or death,
- sports health care for professional athletes and further specialist outpatient services initiated as part of/within the frameworks of this,
- non-medical health care provided for purely aesthetic or recreational purposes, and healthcare services provided to avert its consequences or restore the original condition, and further specialist outpatient services initiated as part of/within the frameworks of these,
- surgical sterilization for non-medical reasons and healthcare services provided to avert its consequences or restore the original condition, and further specialist outpatient services initiated as part of/within the frameworks of these,
- care that does not fundamentally affect health in a positive direction and has not been scientifically proven to be effective, and healthcare services provided to avert its consequences or restore the original condition, and further specialist outpatient services initiated as part of/within the frameworks of these,
- the use of procedures, medicines and medical devices that are professionally accepted in Hungary but not yet included in funding/subsidization, the so-called pre-authorisation use of medicines, or the use of an accepted health service other than the accepted way, except for benefits eligible under equity and further specialist outpatient services initiated as part of/within the frameworks of these,
- care provided exclusively in the context of medical research, and further specialist outpatient services initiated as part of/within the frameworks of this,
- accommodation and meals provided in a healthcare institution for the accompanying person of the patient, except for a disabled patient (a parent/legal guardian or close relative of a patient under the age of 14 who is with the child at the time of treatment is not considered an accompanying person and is therefore not liable to pay),
- driver fitness tests, and further specialist outpatient services initiated as part of/within the frameworks of these,
- medical fitness tests for possessing firearms, and further specialist outpatient services initiated as part of/within the frameworks of these,
- detoxification in case of being under the influence of alcohol or drugs, and further specialist outpatient services initiated as part of/within the frameworks of this,
- blood tests performed to detect alcohol or drug levels, and further specialist outpatient services initiated as part of/within the frameworks of these,
- issuing medical records, and further specialist outpatient services initiated as part of/within the frameworks of this,
- the immunization of the patient with non-compulsory vaccination, and further specialist outpatient services initiated as part of/within the frameworks of this (except for free vaccination).
It is good to know that a HUF 2,000 usage fee must be paid for immunization with non-compulsory vaccination (such as vaccinations before travelling abroad), however, there is no need to pay for medical treatment in the case of vaccinations against pneumococcal bacteria, human papillomavirus and influenza. Furthermore, the doctor may not charge a fee for the administration of the vaccination against meningococcal C virus for 0–2 year olds, which is included in a priority support category of the social security support.
The rules for the calculation of the compensation fees of certain benefits not covered by health insurance and, in several cases, their exact amounts are set out in Annex 2 to the Government Decree 284/1997 (XII. 23.) on usage fees of certain healthcare services subject to usage fee. The compensation fees for tests related to the SARS-CoV2 virus are also included in this Annex.
Services needed because of an accident occurring during a sport or leisure activity, which is particularly dangerous from the point of view of healthcare financing and which is considered an extreme sport, are not available under compulsory health insurance. At the same time, the costs of life-saving interventions of urgent need, in cases of accidents occurring during extreme sports and leisure activities, are also covered by the health insurer. Life-threatening conditions and illnesses that fall under the scope of urgent need are defined in detail in Decree 52/2006 (XII. 28.) of the Ministry of Health on certain healthcare services falling under the scope of urgent need.
Particularly dangerous, extreme sports, fun leisure activities:
- water skiing,
- jet skiing,
- white-water rafting,
- mountain climbing and rock climbing from grade 5,
- high-mountain expedition,
- base jumping, bungee jumping,
- wall climbing,
- demolition derby, rally,
- hot-air ballooning,
- single-handed and offshore sailing,
- hang gliding, skydiving, paragliding, aerobatics.
What are my options when using healthcare services?
When using healthcare services, you can exercise various rights related to health insurance:
The right to choose a doctor
The patient has the right to choose a doctor, within the framework of which he/she has the right to choose another doctor instead of the doctor assigned to the patient’s care according to the working schedule of the health care institution, provided that the professional content of the care justified by the insured person’s state of health and the urgency of the care do not preclude this.
The choice of doctor must be put in writing in three copies, signed by both the insured person and the chosen doctor, with one copy remaining with the patient.
The declaration of the choice of doctor must specify
- the means of communication,
- the arrangements for the service provided with the chosen doctor’s assistance,
- the provisions for amending and withdrawing the contents of the declaration.
The right to request a second opinion
In case you debate the test results or the proposed therapy, you can ask for one further specialist opinion.
Retrieving patient history, and disallowing it
For more efficient and economical treatment, it is possible for the general practitioner, the treating physician or the pharmacist to electronically retrieve certain data from the register kept by the National Health Insurance Fund (Nemzeti Egészségbiztosítási Alapkezelő, hereinafter: NEAK). The general practitioner and the treating physician can ask for information on healthcare services provided under health insurance, while the pharmacist can ask for data related to medicines dispensed with a price reimbursement.
You can object to the data request, or you can re-authorise the request by withdrawing the previous ban—in this case, make sure to send the completed objection form to NEAK. To view the details of the NEAK department nearest to you, please enter the postcode of your place of residence or place of stay:
Retrieving patient history at the doctor’s:
Please note that your general practitioner and your treating physician (the doctor providing outpatient and inpatient treatment) are both entitled to retrieve information on the medical services used by you, so that they can make a decision about your treatment in the light of the care you have received earlier. It also allows the general practitioner and your treating physician to find out when, where and what type of health care you have received.
It is important that you can object in writing (to NEAK) to the retrieval of data concerning you, or you can ask for your previous ban to be withdrawn, on the details of which your treating doctor will inform you in writing or orally.
Please note that the data retrieved this way may only be used in connection with the patient’s treatment, and the doctor is not entitled to forward or transfer it to any other person.
Retrieving patient history in the pharmacy
In order to promote effective and safe medication and develop cost-effective medical therapy, the pharmacist may know the name, amount and dispensing date of the medicine used with social security support within one year. This query facility is provided to the pharmacy in electronic form by NEAK.
The pharmacist is not entitled to get information about medicines used to treat mental and behavioural disorders or sexually transmitted diseases.
Please note that the pharmacist can only retrieve this information if the prescription ordered with social security support is dispensed personally by the insured person. The patients must also approve the retrieval of medication by a separate signature, and they can ask the pharmacist to provide information on the data received during the query.
It is important to note that you can also object to the retrieval of data concerning you by your pharmacist or by NEAK, or, if necessary, you can ask to withdraw a previous ban.
If your objection is made to the pharmacist, the pharmacist must immediately forward it to NEAK.
Please note that the data retrieved this way may only be used in connection with the patient’s treatment, and the pharmacist is not entitled to forward or transfer it to any other person.
The right to information
The patient has the right to be informed about his/her state of health in a way that he/she can understand, in addition to the information related to the processing of his/her personal data. Based on that, the doctor is obliged to provide full information about the disease, possible complications, treatment methods, his/her right to decide on these, the benefits and their possible compensation fees, as well as about other NEAK publications and information material.
Settlement declaration (information on the social security funding available for benefits)
Following the treatment, the healthcare provider will provide the patient with a so-called settlement declaration about the services used within the frameworks of specialist outpatient care, dental care, and inpatient care, if the patient requests that. In this settlement declaration, the provider shall give information on the service received by the patient (in plain language, in Hungarian, including financing codes), the fee payable for the care, which is a condition for receiving the care, the maximum amount of financing that can be claimed from the health insurance fund for the care received, and, in the case of inpatient care, the number of days of care.
In order to improve a sick person’s quality of life, it is possible to provide equity-based support, taking into account the specific situation of the individual. On the basis of the principles of social risk sharing and equity, and within the frameworks provided by the Health Insurance Fund, NEAK may take over the fees for certain medical services, or part of them, on an equitable basis, if compensation is requested in advance (by means of a request for equity) and the service is to be used at a financed healthcare provider.
You can find more information on the services available on grounds of equity here.
What should I pay attention to when visiting a doctor?
- Please remember to take your social security card and, if you are over 14 years of age, your photo identification document (such as your ID card) with you, as you will need to show them to receive medical treatment. We recommend that you take your social security card with you even if you have a permanent identity card (e-card) with a storage element, as its usability for social security purposes depends on the technical conditions available at each institution. Before you receive the care, the doctor will check that you are on the NEAK register of people entitled to care. If the legal relationship check does not show a “green light” or a “yellow light”, you will be informed about that at the doctor’s office. It is important to note that if the legal relationship check shows a “red light”, the doctor cannot refuse to perform the care merely on the grounds of the legal relationship registry, however, the legal relationship must be clarified, so the doctor can contact the competent county government office or, in the case of Pest County and the capital, the Government Office of Budapest. Please enter the postcode of your place of residence or that of your place of stay to see the contact details of the government office (the department responsible for the health insurance fund functions) competent for your place of residence or place of stay:
- Keep the medical documents you receive and take them with you each time you go for medical treatment, as they can be used as a reference for further medical examinations.
- Check which services are provided free of charge and which are subject to a fee.
- It is good to know that any examinations can be refused.
- Tell your doctor about any previous medical conditions (such as drug sensitivities) to facilitate safe and professional treatment.
The Healthcare Services Space (Egészségügyi Ellátási Szolgáltatási Tér, hereinafter EESZT) is an online platform accessible by logging in to the Client Gateway (Ügyfélkapu) and entering your social security number, where you can find your digital healthcare documents created in healthcare institutions after joining EESZT. You can view your medical records, outpatient records and final reports, and download them at any time.
In addition to the above, in the EESZT
- you can retrieve the electronic prescriptions written to you and those you have already dispensed,
- you can view and print your e-Referrals (both the valid and already used referrals can be retrieved, for a given period, through the platform),
- under “Services” in your Event Catalogue, you will see all the events when you have received health care in outpatient and inpatient specialist care institutions or in general practitioner services,
- you can also exercise digital self-determination concerning the data in the EESZT.
Who controls the use of services?
Please note that the eligibility for receiving social security supported care is checked by the health insurer. As part of that, it compiles all the health services that the patient has received with social security support. For the purposes of making a compilation, it may also initiate a data reconciliation with the patient—who is obliged to cooperate—regarding personal and health data, in the place of residence or place of stay, furthermore, it may carry out an on-the-spot check. In addition to the representative of the health insurer, only the insured person concerned and the person authorised by him/her may take part in the data reconciliation.
If the patient concerned disputes the use of a healthcare service included in the compilation set out by the health insurer during the data reconciliation or the on-the-spot check, the health insurer shall also check the documentation available at the healthcare provider who ordered or provided the healthcare service in question.