Direct billing in the event of a hospital stay

Request for direct billing in the event of a hospital stay
Hospital bills are often expensive. The Joint Sickness Insurance Scheme (JSIS) can help you cope with this kind of unavoidable expense by advancing the money to pay the bill. On receipt of a request for direct billing, it will pay the bill direct to the hospital, under certain conditions.

Who can make a request for direct billing?
All members of the JSIS with primary cover, i.e. officials, members of the temporary and contract staff, pensioners and recipients of an unemployment allowance. This scheme is not available to children and spouses who are generally covered on a top-up basis after their medical expenses are reimbursed in the first instance by a national sickness insurance scheme.

What sort of expenses are eligible?
Direct billing applies only to expenditure on stays in a hospital or clinic (including stays of only one day) for treatment which is eligible for reimbursement under the sickness insurance rules (surgery, childbirth, etc.). Cosmetic surgery and youth enhancement or body sculpting are excluded. Direct billing may also be requested if you have high or repetitive medical costs. This is deemed to be the case if your monthly expenditure on medication or consultations exceeds 20% of your basic salary or pension.

How do I make a request for direct billing?
Once your hospital stay has been arranged, fill in the direct billing request form and send it to your settlements office, together with any supporting documents required (prior authorisation, medical prescription). When you are admitted to hospital, specify that the bill is to be sent direct to the JSIS.

After your stay in hospital
The hospital will send the bill for your stay direct to your settlements office and may send you a breakdown of charges (not to be confused with a bill). Statement of expenses The PMO will pay the bill direct to the hospital and will send you a statement, which will indicate the amount reimbursed (80% or 85% of the expenditure incurred) and your contribution (15% or 20%). This amount constitutes a debt which will automatically be cleared by means of your future medical expenses. Your future reimbursements will not be paid to your account but will be deducted from your debt. Once it is cleared, medical expenses will once again be paid to your account. If you are admitted to hospital as an emergency the procedure is the same. Please inform your relatives of the procedure to be followed.
 * N.B.: If the hospital sends a reminder don’t pay the bill; forward the reminder as quickly as possible to your settlements office.

The PMO pays €400 000 direct to hospitals every day. If you have top-up insurance, send the company the JSIS statement of expenses so that they can reimburse you the amount of your contribution.

For some treatments, prior authorisation is required.

Futher reading

 * Direct billing and advances (MyIntraComm)
 * Hospitalisation (see also Surgery - MyIntraComm) expenses are reimbursed at a rate of 80% or 85%.