100% benefit – the person pays a co-payment of 3.5 euros and the amount exceeding the price limit or the price in the price agreement. The Health Insurance Fund will reimburse 100% of the difference between the price limit or the price agreement and the co-payment.
the person was given a reimbursable prescription for a medicinal product which costs 10 euros. The price limit of the active substance is set at 8 euros. The discounted price for the person consists of:
- the person’s co-payment: 3.5 euros
- the amount exceeding the price limit: 10 euros – 8 euros = 2 euros
- the Health Insurance Fund reimburses 100% of the difference between the price limit or the price agreement and the co-payment.
The person has to pay 3.5 euros + 2 euros = 5.5 euros for the medicinal product.
90% benefit – the person pays a co-payment of 3.5 euros, 10% of the difference between the price limit or the price agreement and the co-payment, and the amount exceeding the price limit or the price agreement. The Health Insurance Fund will reimburse 90% of the difference between the price limit or the price agreement and the co-payment.
the person was given a reimbursable prescription for two medicinal products which cost 10 euros. The price limit of the active substance is set at 8 euros.
The discounted price for the person consists of:
- the person’s co-payment: 3.5 euros
- the amount exceeding the price limit: 10 euros – 8 euros = 2 euros, 2 euros × 2 products = 4 euros
- the Health Insurance Fund reimburses 90% of the difference between the price limit or the price agreement and the co-payment, so the person’s share (10%) is (8 euros × 2 products – 3.5 euros) × 10% = 1.25 euros
The person has to pay 3.5+ 4 euros + 1.25 euros = 8.75 euros for the medicinal products.
75% benefit – the person pays a co-payment of 3.5 euros, 25% of the difference between the price limit or the price agreement and the co-payment, and the amount exceeding the price limit or the price agreement. The Health Insurance Fund will reimburse 75% of the difference between the price limit or the price agreement and the co-payment.
the person was given a reimbursable prescription for a medicinal product which costs 10 euros. The price limit of the active substance is set at 8 euros. The discounted price for the person consists of:
- the person’s co-payment: 3.5 euros
- the amount exceeding the price limit: 10 euros – 8 euros = 2 euros
- the Health Insurance Fund reimburses 75% of the difference between the price limit or the price agreement and the co-payment, so the person’s share (25%) is (8 euros – 3.5 euros) × 25% = 1.13 euros.
The person has to pay 3.5 euros + 2 euros + 1.12 euros = 6.63 euros for the medicinal product.
50% benefit – the person pays a co-payment of 3.5 euros, 50% of the difference between the price limit or the price agreement and the co-payment, and the amount exceeding the price limit or the price agreement. The Health Insurance Fund will reimburse 50% of the difference between the price limit or the price agreement and the co-payment.
the person was given a reimbursable prescription for a medicinal product which costs 40 euros. The price limit of the active substance is set at 35 euros. The discounted price for the person consists of:
- the person’s co-payment: 3.5 euros
- the amount exceeding the price limit: 40 euros – 35 euros = 5 euros
- the Health Insurance Fund reimburses 50% of the difference between the price limit or the price agreement and the co-payment, so the person’s share (50%) is (35 euros – 3.5 euros) × 50% = 15.75 euros.