Republika Srpska Health Fund clarifies out-of-entity treatment financing

The Health Insurance Fund of Republika Srpska has clarified the procedures for financing medical treatment outside of the entity. This coverage is applied when necessary healthcare services cannot be provided within domestic medical institutions.

The process begins when the University Clinical Center of Republika Srpska, acting as a tertiary healthcare provider, submits a proposal to refer a patient for treatment elsewhere. Based on this proposal, a professional commission from the Fund determines the medical necessity and approves financing for institutions that have a contract with the Fund, such as those in Serbia.

Under this system, insured individuals in Serbia are generally only required to pay a participation fee unless they are exempt. Exempt groups who receive full coverage include children under 18, individuals over 65, war invalids, pensioners with the lowest pensions, and patients with malignant diseases or other severe conditions.

If treatment options in Serbia are exhausted, the Fund may finance treatment in other foreign countries. In such cases, the Fund pays the medical institution directly based on a pre-calculation. The Fund emphasizes that patients should not pay for services upfront and seek reimbursement later, as the established legal path is designed to provide systemic protection for the insured.