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FAQs on the upper limit for prescription charges


When is the new regulation to be introduced?
According to the current arrangements, the necessary regulation specifying an upper limit for prescription charges equivalent to 2% of income is to be put in place by 1 January 2008.

From when will the new upper limit regulation be valid?

The regulation should be valid from 1 January 2008.

Will the planned regulation apply to all patient contributions?
The new regulation will apply only to prescription charges.

I pay other health care costs and also paid towards my health cure. Will these payments be credited towards the prescription charge upper limit?
No. The new regulation applies to prescription charges only.

Does the prescription charge upper limit apply to everyone or is it only for chronically ill people on low incomes?
The prescription charge upper limit regulation applies to everyone who is not exempted from paying prescription charges.

Is the limit calculated on a current basis or retrospectively?
It will be determined whether you have reached the limit in the current year. Once you have reached the limit, you will no longer need to pay prescription charges in the rest of that calendar year.

Does the new upper limit regulation apply to all medications I buy from a pharmacy?
The upper limit regulation applies only to medications supplied on prescription for which you pay a prescription charge. Any medications for which you do not pay a prescription charge do not count.

My medications are prescribed from me by a private consultant: what happens in my case?
If you pay a prescription charge for a medication prescribed by a private consultant because this medication is covered by your health insurance provider, the charge you pay will added to your prescription charge account and used to determine when you reach your prescription charge upper limit.

What happens in the case of prescriptions for medications issued to members of my family?
Your dependents (spouse, children) will not have an individual upper limit. This means that any prescription charges that they pay or you pay for them will be credited to your account.

I am care-dependent, am unable to leave my house (nursing home) and my doctor comes to me. How will my doctor know that I am exempt from paying prescription charges?
Even if your doctor makes house calls, he/she will be aware that you are exempt from paying prescription charges from your records (as is currently the case) and will issue you free prescriptions. The situation will thus remain essentially the same when the new regulation is introduced. As a rule, it will be in the interest of the doctor to subsequently log the details of house calls he has made in the e-card system, so that the system will be updated with regard to prescriptions he/she has issued to you. Of course, if your doctor does not do this, the system will not know when and if you become exempt, but as this will not be in your doctor’s interest, we do not expect this situation to arise.

Will my doctor or pharmacist be informed of my income or the number of prescription charges I have paid? Is data protection guaranteed?
Your doctor will only be informed that you are exempt from paying prescription charges. Your doctor will not be told the reason for this (i.e. what your income is or how many prescription charges you have paid). The same will apply to your pharmacist.

In order to know when I am exempt, my health insurance provider will need to know how many prescription charges I have paid. Will my prescription charge account thus also show information on the medications I use?
No. Your prescription charge account will only show how many prescription charges you have paid. No information on the actual medications you are using will be documented. Your prescription charge account will only list data and amounts paid; information on the pharmacy or medications you use will not be stored. The information will only be used for the purposes of internal data processing and this data will be treated as confidential. This data may not be revealed to other persons.

Will my e-card be used in order to determine when I have reached my prescription charge upper limit?
Your e-card enables your doctor to receive information about whether you are exempt from paying prescription charges.

What information is stored on my e-card?
None: your e-card is merely a kind of key card that enables the user to access data - it does not itself store any data.

How is the upper limit calculated?
It is calculated using the figures for most recent annual contributory basis and/or any other contribution(s) that the social security authority is aware of.

Will my upper limit be calculated on the basis of my net or gross income?
Your upper limit will be calculated on the basis of your net income. This will be calculated using the most recent available figures for your annual contributory basis.

I would like to be exempted with immediate effect from January 2008 - is this possible under the new upper limit regulation?
No. If you think you are entitled to exemption from payment of prescription charges because you are socially vulnerable, you should contact your health insurance provider.

Will information on my income be stored on my e-card?

No.

How will my insurance provider know what my income is? Will the data transfer method used be protected?
There are special regulations that apply to the transfer of data and these ensure that this conforms to the requirements of the data protection code. The data that will need to be used is already available to the social security authority (e.g. information on contributions you have made or the pension paid to you).

How is the upper limit for prescription charges calculated for persons receiving a pension?
It will be calculated on the basis of the net pension you receive in the current calendar year, less any special payments.

What will happen if I earn less in the current calendar year than in the previous year?
In this case, simply contact your insurance provider and request that your upper limit should be recalculated on the basis of your current income.

I have more than one paid employment. How will my prescription charge upper limit be calculated?
Your upper limit will be calculated using the figures available for your total contributory basis.

I draw dietary allowances, mileage allowances etc. How will these be counted towards my prescription charge upper limit?
These will be relevant only if they form part of your general contributory basis.

In addition to my earned income/pension, I also receive a company pension, rental or leasing income and interest. Will these be taken into account when calculating my prescription charge upper limit?
According to the agreed text of the guidelines on exemption from prescription charges, company pensions or other income for which no social security contributions are to be paid will not be taken into consideration for automatic calculation of the prescription charge upper limit.

What happens if I reach my prescription charge upper limit in the current year?
When using your e-card, your doctor will be informed that you are exempt from payment of prescription charges.

Is it possible that I might have to continue to pay prescription charges even after I have reached my prescription charge upper limit for the year?
As your prescription charges will only be documented when your health insurer calculates the cost of medications issued to you and this takes a certain time, it is possible that you may have to initially continue to pay prescription charges even after you have reached your prescription charge upper limit for that year.

What will happen if I pay too many prescription charges in a particular year?
The overpaid prescription charges will be credited to you in the following calendar year so you will more quickly reach your upper limit.

How will my upper limit be calculated if I had no paid employment in the period in question?
In such periods, your upper limit will be calculated on the basis of your income (such as any unemployment benefit you receive), insofar as this is known to the social security authority.

I use very few medications, but my wife, who does not have her own income, must regularly use medications. What effect will this have on my prescription charge upper limit?
As a dependent, there will be no individual upper limit calculated for the wife. The prescriptions she uses will be taken into consideration when calculating when the insured person’s upper limit is reached.

How can I find out what my prescription charge upper limit is for the year?
There are currently no plans to provide individuals with information on their prescription charge upper limit, but this may be implemented in the course of 2008 (citizen card).

Will my health insurer inform me when I reach my prescription charge upper limit?
There are currently no plans to inform individuals when they reach their upper limit. However, the system ensures that your doctor will be informed that you are exempt from payment of prescription charges because you have reached your upper limit.

How will my doctor know that I have reached my prescription charge upper limit?
Your doctor will be informed through the e-card system that you are exempt from payment of prescription charges and will note this on your prescription.

What must my pharmacist do once I have been exempted from payment of prescription charges?
Nothing. When your e-card is scanned at your doctor’s and this shows that you are exempt from prescription charges, your prescription will be issued by your doctor as before (with a second stamp showing you are exempt). Your pharmacist will see from this you should not be charged for the prescription.

My son participated in an internship programme last year. He had no paid employment for the rest of the year. What effect will this have on the prescription charge upper limit?
If your son was registered as a dependent by the social security system at the time the first prescription for the calendar year in question was issued, no individual upper limit will be set for him. The prescription charges paid by him will be taken into account to determine whether and when his father/mother reaches their upper limit.

Will there be anything different when I visit the doctor because of the new regulation?
No.

Will the existing exemptions continue when the new regulation is introduced?
Yes.

I intend to start work for the first time this year. How will my prescription charge upper limit be calculated?
If there is no information on your contributory basis for the year in question, we will use a provisional value to calculate your upper limit.

Last year, I had a good income, but my earnings are very low this year. What effect will this have on my prescription charge upper limit?
In this case, you can apply to your health insurer to have your upper limit reduced. You will need to inform your insurer of your current income situation in your application.

I was exempted in a particular year, but had a high income for that year. Will I have to make a repayment?
No. But your high income will mean that you will have a higher upper exemption limit for the following year.

In recent years, I was covered by my husband’s insurance, but I have now begun to work. What effect will this have on my prescription charge upper limit?
Until we have data on your contributory basis in the system, your upper limit will be calculated using a provisional value.

I have a good income, but my wife has a low income; we thus both have insurance that covers our child. How will the medications used by my child be treated?
The prescription charges will be credited to that parent of whom the child is considered a dependent for insurance purposes. If both you and your wife are insured with the same insurance provider and it is not possible to definitely assign the dependency of the child to one or the other, the paid charges will be credited to the prescription charge account of the mother.

I am paying voluntary health insurance contributions. How will my prescription charge upper limit be calculated?
Your upper limit will be determined from the contributory basis that has been calculated as a result of the voluntary contributions you pay.

Will the information folder be sent to insured persons as well?
No. Folders will only be sent to doctors and consultants who work under contract with the social security organisations and to all public pharmacies. The folder will also be supplied through their local organisation to pensioners and some self-help groups. However, copies of the folder will be provided in the branches of the health insurance providers, where insured persons will be able to read them.

How will collective prescriptions for care homes be dealt with under the new prescription charge upper limit regulations?
If prescription charges are paid for a collective prescription that can be allocated to individual insured persons and these prescriptions result in a settlement between the pharmacy and the relevant health insurance provider, these charges will be added to the prescription charge account of the insured persons in question.

How will medical products (such as oxygen) that are delivered to my home be dealt with?
Please contact your health insurance provider for more information on this aspect.

Will prescriptions issued by private consultants count towards my prescription charge upper limit?
If your private consultant is authorised to issue prescriptions that will be covered by your health insurer, these will be treated in the normal way for the purposes of calculation of your prescription charge upper limit. Otherwise, your consultant will need to issue a private prescription. Providing this private prescription is for drugs or products on the approved list of your health insurer, you can take this private prescription to your insurance provider, who will convert it into one covered by your health insurance, which you can then take to your pharmacy.

May private consultants also use my e-card to determine whether I am exempt from prescription charges?
No. Private consultants are only authorised to access database information on patients if they are performing a screening examination. Outside screening examinations, private consultants do not have the option of accessing this information.

How can an insured person who only uses private consultants prove that he/she is entitled to exemption from payment of prescription charges?
In this case, the insured person must ask their insurance provider for written confirmation that they are exempt; they can then submit this confirmation to their doctor.

When will the information folders be supplied to the persons concerned?
By early February 2008 at the latest.

Will a doctor with an in-house pharmacy be able to draw inferences about my income?
No, because patients normally do not visit one doctor only.

Will my prescription charge upper limit remain the same for the whole year?
For persons in paid employment and persons receiving benefits (excluding those in receipt of retirement/other forms of pension): No, as soon as more recent figures from the previous year become available, your upper limit will be recalculated.
For persons in receipt of retirement/other forms of pension only: Assuming that your financial situation does not change, your prescription charge upper limit will generally remain the same. However, it may be necessary to recalculate your upper limit if you become entitled to another pension or you take up paid employment while receiving your pension. Note: It is possible that that although you have already been exempted, this exemption will be withdrawn or, alternatively, that you become exempt with immediate effect, and that any prescription charges you have paid in the year in question are credited to you in the following year.

What is the effective date for determining whether a prescription charge should be added to a specific prescription charge account?
The relevant date is that on which the prescription is presented to a pharmacy (at which point in time the charge will also be paid). We look at whether the patient was personally insured or was insured as the dependent of another person on that date, and thus add the charge to the account of the appropriate person.
Note: Your insurance status can change several times in one year (if you work as an intern, for example).

Will my prescription charges still be tax-deductible?
There will be no change in this respect (relevant in this case are the actual costs of medical treatment, such as paid prescription charges).

What will happen if my doctor erroneously issues me with a prescription that is exempt? Will I subsequently have to pay the charge?
No. You will not be held liable for any errors made by your doctor.
Note: In the case of certain notifiable diseases, the legal stipulations require that the relevant patient is automatically exempted from payment of the prescription charge for prescriptions that relate to the disease.

I am insured with the KFA. Does to the prescription charge upper limit regulation also apply to me?
If you are insured with the KFA, you are not covered by the prescription charge upper limit regulation even if you hold an e-card. The legal stipulations in the general social security regulations (ASVG) do not apply to persons insured with the KFA. An exception is the KFA Vienna. This organisation will be participating in the prescription charge upper limit system and has adapted its regulations accordingly.