Privileges – Benefits HCFA-TEAM February 16, 2023

Privileges – Benefits

Digital KEPA (Disability Certification Centre)

From 2022, the KEPAs’ disability certification process has been completely overhauled. The process will now be digital, with a single application, and will result in a single medical disability certificate giving access to all benefits. Under the new legislation, the disability assessment process at the KEPAs has been simplified and digitised, and the requirement to pay a fee has been removed for all categories of applicants.

To apply for the digital KEPAs, please visit https://epan.gov.gr/e_kepa.

For additional information or clarification on the digital CERs, you can contact the 1555 Helpline or submit an online enquiry at 1555.gov.gr.

To download Gov. 146, Article 103, p. 34 (Law 4961/2022) with the relevant decisions, click here.

Determination of Disability Percentage

The benefits and privileges of CF patients depend on the disability percentage assigned to each patient by the Health Committees of the Disability Certification Centres (CDCs). These committees must take into account the Unified Table of Disability Rates, which establishes the disability rates for each condition for all insurance institutions and the State.

According to the current legislation, patients with cystic fibrosis are entitled to a disability rate of 67% or more or 80% or more, depending on the severity of the disease. A small percentage of atypical forms of CF are excluded, including 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 line with the above two rates, an appeal and request for reconsideration should be made immediately.

Download the 3-page extract (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.

67% and above Percentage of disability

People with CF who have respiratory symptoms and are receiving treatment to manage their symptoms are entitled to a disability rate of 67% or more for 2 years.

80% and above Percentage of disability

Patients with cystic fibrosis whose bronchial tree has become permanently colonised by microbial strains such as Pseudomonas, Haemophilus or Staphylococcus, and whose disease does not improve due to the presence of bronchiectasis despite continuous and painful treatment, are entitled to a lifetime disability rate of 80%.

Pharmaceutical Treatment

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

CF patients and recipients of solid or liquid organ and tissue transplants are entitled to a zero (0%) co-payment on all medicines. In addition, high-cost medicines are provided free of charge to all CF patients, usually by EOPYY pharmacies.

Under the EOPYY drug reimbursement system, drugs included in the “positive list” and reimbursed by the insurance funds have a double price: the insurance price and the retail price. The pharmacist is obliged to provide the EOPY insured person with the pharmaceutical product whose retail price is the same as the insurance price and which is the cheapest. If the insured person chooses a medicine whose retail price is higher than the insurance price, the resulting price difference will be shared 50% by the insured person and 50% by the 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, paragraph 2

EOPYY drug reimbursement system: Government Gazette 692/26-3-2013

Medical care for the Uninsured Unemployed

Unemployed young people up to the age of 29 are covered by the IKA for sickness benefits in kind, on application to the IKA branches in their place of residence. When submitting their application, these unemployed persons must provide a certificate from the DYPA (formerly OAED) certifying that they have been registered as unemployed for at least two months prior to submitting their application, that they are still unemployed and that they hold an unemployment card that is renewed every three months. They must also be uninsured, not be in training and, once they have started work, must declare this to the IKA branch in their place of residence. The health card issued is valid for six months and is renewed on presentation of a new certificate from the OAED stating that they are still unemployed. For more information, see the DYPA website here.

Ability to choose a hospital from Adolescents up to 16 years old

Following a decision by EOPYY (here), young people up to the age of 16 can, if they wish, can choose a paediatrician and paediatric hospitals for their treatment.

EOPYY Uniform Regulation on Health Benefits

The Uniform Regulation on Health Benefits (EKPY) of the National Health Services Organisation (EOPYY) includes all the long-awaited provisions for patients with CF that the Hellenic CF Association has been requesting since 2014 through a series of letters and meetings with all relevant bodies. According to the EKPY (Government Gazette 4898/1-11-2018, Government Gazette 6544/B/12-12-2022), CF patients covered by the National Health Services Organisation (EOPYY) are entitled to the following free services

Paraclinical Examinations

Zero participation in the cost of diagnostic tests and procedures and laboratory tests performed in private diagnostic centers and clinics contracted with EOPYY.

Nebulizers and Consumables

The new generation eflow nebuliser and its consumables are provided free of charge to CF patients by the Greek National Health Services Organisation (EOPYY). The replacement time for the nebuliser is four (4) years, while the replacement time for the consumables is six (6) months.

Physiotherapies

Up to ten (10) physiotherapy sessions per month and per year will be reimbursed with no contribution to the cost of physiotherapy, if carried out in private providers contracted by EOPYY. Physiotherapy can be provided in public PHC facilities, physiotherapy laboratories of public PHC facilities, state hospitals, CFPFs and contracted physiotherapy laboratories, physiotherapy and rehabilitation laboratories, physiotherapy laboratories of private clinics and with home visits for full physiotherapy procedures by contracted physiotherapists.

Food Supplements - Therapeutic Nutrition

The reimbursement of nutritional formulations is provided for CF patients who receive the special nutritional formulations in accordance with the nutritional indicators with the relevant opinion valid for six (6) months from the date of its issue. The EOPYY may determine the quantity of each formulation that it will reimburse by special decision of the Board of Directors, which will be communicated to doctors and providers through its website. All patients with cystic fibrosis are excluded from the 10% contribution to the cost of special therapeutic diet formulations.

Disposable Sanitary Materials for Intravenous Treatment

The necessary medical equipment to carry out intravenous treatment at home, as certified by the attending physician, is reimbursed, specifically for serum infusion systems, needles, syringes, IV catheters, serum stands, leucoplast, and gauzes. Cystic Fibrosis patients now have zero participation in the value of commercially available medical consumables.

Hospitalization Transplantation Expenses Abroad

EOPYY covers 100% of the costs of hospitalisation/transplantation outside Greece. Coverage of transplantation costs requires a full and detailed justification of the impossibility of performing the transplantation in Greece at the critical time for the patient’s case, as well as the approval of the National Transplantation Organisation (EOM).

Patient Transportation Costs

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

The patient and one accompanying person are entitled to this reimbursement. EOPYY will reimburse the cost of transport for one accompanying person, which is compulsory for children and adolescents under 18 years of age, and for adults if deemed necessary by the attending doctor.

If the journey is made by private car or taxi, the reimbursement is based on the distance travelled. In exceptional cases and after consulting the AHS, the EOPYY may, by decision of the Board, reimburse the cost of an air ticket for the patient and his/her companion.

Supporting documents for the reimbursement of travel expenses
  • Reasoned certificate from the attending physician on the impossibility of treating the condition or performing the examination or necessary paraclinical examinations at the patient’s place of residence.
  • Copies of examinations or discharge certificates in the case of hospitalisation of the patient.
  • Proof of payment of tickets or petrol receipts and proof of payment of tolls on the day of travel and return. If the journey was to a town in a neighbouring county where there is no toll, the petrol receipt must be presented.