Part IV Powers of the Secretary of State

Regulations as to certain charges

75BF1Reimbursement of the cost of services provided in another EEA state

1

A Health Board must reimburse the cost of eligible services incurred by or on behalf of an eligible person on or after 23rd August 2010, but this is subject to the limits applicable under subsections (3) and (4), to subsections (6) and (7) and to any deduction applicable under section 75D.

2

Eligible services are services provided by an authorised provider in an EEA state other than the UK, which are necessary to treat or diagnose a medical condition of the eligible person and are—

a

services, not being specified services, that are the same as or equivalent to those that the Health Board in whose area the eligible person resides would make or have made available under this Act in the circumstances of the person's case;

b

specified services for which the Health Board in whose area the eligible person resides has given authorisation under section 75C; or

c

services—

i

which are neither the same as nor equivalent to services that the Health Board would make available under this Act in the circumstances of the person's case; and

ii

for which the Health Board has given authorisation under section 75C.

3

In respect of services other than dental services, a Health Board may limit the amount payable by way of reimbursement under subsection (1) to the amount that the same or equivalent services would have cost the Health Board in whose area the eligible person resides if those services had been provided under this Act otherwise than in accordance with this section and section 75C.

4

In respect of dental services a Health Board may limit the amount payable by way of reimbursement under subsection (1) to the amount that would have been payable in respect of the same or equivalent services if those services had been provided under this Act otherwise than in accordance with this section and section 75C.

5

Where the same or equivalent services referred to in subsection (4) would have required approval from the Dental Practice Board, the Health Board—

a

may require the eligible person to submit evidence as to the clinical necessity of the dental services; and

b

may decline to reimburse the costs of any services which were not clinically necessary.

6

The duty in subsection (1) does not apply where the cost of the eligible services was incurred in connection with an arrangement which was entered into by or on behalf of the eligible person in the course of business and under which the applicant for reimbursement has gained or might be expected to gain any financial benefit.

7

This section and section 75C do not apply in circumstances where Articles 20 and 27(3) of Regulation (EC) 883/2004 apply.

8

In this section and sections 75C and 75D—

  • “authorised provider” in relation to services provided in an EEA state other than the United Kingdom means a person who is lawfully providing services;

  • “eligible person” means a person who is ordinarily resident in Scotland;

  • “eligible services” has the meaning given in subsection (2) of this section;

  • “services” includes any goods, including drugs, medicines and appliances which are used or supplied in connection with the provision of a service, but does not include accommodation other than hospital accommodation; and

  • “specified services” means those services comprising—

    1. a

      services which would require a stay in hospital accommodation for at least one night;

    2. b

      medical treatment that involves general anaesthesia, epidural anaesthesia or intravenously administered sedation;

    3. c

      dental treatment that involves general anaesthesia or intravenously administered sedation;

    4. d

      services whose provision involves the use of specialised or cost-intensive medical infrastructure or medical equipment.