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Which medical specialties are included in the healthcare services offered by specialists to outpatients within the GHS?

Medical outpatient specialties covered by the GHS

How do beneficiaries secure access to an outpatient specialist (OS) and what do they pay each time?

Beneficiaries have access to an OS of their choice to receive healthcare services by the OS as an outpatient either with a referral by another healthcare provider or directly.

In case of direct access to an OS, without a referral, the beneficiary will pay a Personal Contribution 1, i.e. the amount of 25 euros.

In case of access to an OS via a referral the beneficiary will pay the Co-payment amounting to 6 euros.
Every diagnostic radiology test performed by a radiologist after a referral by a PD or an OS will be charged with a co-payment amounting to 10 euros.
Tests by specialists in cytology and pathological anatomy will not be charged with a co-payment.

It is noted that direct access to the Special Group of Outpatient Specialists (SGOS) for diagnostic tests without a referral will not be covered by the GHS.

Which healthcare providers can refer you to an OS?

Beneficiaries can have access to an OS after being referred by the following providers:

Personal doctor
another Outpatient Specialist
Hospital as inpatient healthcare provider

For how many visits is the referral to an OS valid?

By a personal doctor – Normal Referral: it is valid for two [2] visits in total and six (6) months, Long-term Referral: it is valid for 12 visits in total and twelve (12) months, Special Referral: it is valid for one acivity/examination and 30 days.
By a specialist doctor - Normal Referral: it is valid for two [2] visits in total and six (6) months, Special Referral: it is valid for one activity/examination and 30 days.
By a hospital – it is valid for two (2) visits in total to the attending doctor of the beneficiary and six [6] months.

To which healthcare providers can an OS refer a beneficiary?

An OS refers beneficiaries to other healthcare providers as follows:

another OS belonging to a specialty covered by the GHS
Special Group of Outpatient Specialists (SGOS) for diagnostic tests. The following specialties belong to the SGOS:

diagnostic radiology
nuclear medicine
cytology
histopathology

Laboratory
Hospital for inpatient healthcare services (GHS 2nd Stage, June 2020)
Accident & Emergency Department (GHS 2nd Stage, June 2020)
Nurse, midwife, and allied health professionals (GHS 2nd Stage, June 2020)
Palliative healthcare centre (GHS 2nd Stage, June 2020)
Rehabilitation centre (GHS 2nd Stage, June 2020)

In addition, an OS may prescribe the required pharmaceutical products.

For how many visits is a referral by an OS to the SGOS for diagnostic tests valid?

The said referral by an OS to an OS of the SGOS is valid for one visit and one month.

What is the procedure for the specialty of nuclear medicine?

Nuclear medicine performs diagnostic tests as well as therapeutic treatments and therefore it belongs to the Special Group of Outpatient Specialists only as regards the diagnostic tests that are performed after a referral by an OS. When the beneficiary is referred by a PD, the referral ıs valid for three (3) visits as normally and not for a specific diagnostic test.

What happens in case a beneficiary visits an OS directly without securing a referral?

In general, direct access to an OS is not fully reimbursed by the HIO and beneficiaries are asked to pay a Personal Contribution 1 (25 euros).

Are there any cases of direct access to an OS when beneficiaries do not pay an additional amount of money?

Female beneficiaries who have attained the age of 15 will have direct access to gynaecologists/ obstetricians without paying a Personal Contribution 1 (i.e. 25 euros) but by paying the 6 euro co-payment that applies also in case of access to an OS by referral.

Are visits of beneficiaries with chronic diseases to OSs reimbursed by the HIO?

Visits to OS by beneficiaries with chronic diseases will be reimbursed by the HIO provided they have a referral by the personal doctor. Referrals by PDs to OS for beneficiaries with chronic diseases will include a larger number of visits than regular referrals (i.e. 12 visits instead of 3) and will be valid for a longer period (i.e. 12 months instead of 3).

How are OS selected by beneficiaries?

The choice of an OS is an exclusive right of the beneficiaries who can contact directly a contracted with the HIO, OS, in order to arrange an appointment.

Will beneficiaries be able to change the OS whom they originally contacted?

Beneficiaries are able to change the OS whom they originally contacted. The total number of visits to an OS that are reimbursed by the HIO for the specific case remains the same.

How are outpatient specialists reimbursed?

See FAQs on Reimbursement of providers

Are there minimum requirements that must be fulfilled by OS when concluding contracts with the HIO?

Healthcare providers who wish to contract with the HIO as outpatient specialists for the provision of healthcare services to outpatients, must meet certain minimum requirements regarding qualifications, insurance coverage, infrastructure and equipment as these are stipulated by the GHS Law and the relevant Regulations.

Is participation of an OS in multidisciplinary groups covered by the GHS?

The HIO does not reimburse the participation of OS or other healthcare providers in multidisciplinary groups.

What are the working hours of OS?

OS provide their services in accordance with the working hours they choose. OS and their staff must be in a position to arrange theır visits’ schedule in accordance with the beneficiaries’ needs, e.g. special arrangements should be made for emergencies and/or complicated cases but also for beneficiaries with chronic diseases whose condition has worsened.

Are there any rules for the replacement of an OS in case he/she is absent?

In case of absence, an OS must make available to the beneficiaries he/she is treating a telephone number in order to contact him/her or his/her replacement.

Does the GHS cover home visits by OS?

The GHS does not cover home visits by OS to beneficiaries. Home visits that are covered by the GHS are home visits made by PDs to permanently bedridden patients (6 visits per year per permanently bedridden patient) as well as home healthcare services by nurses (that will be included in the second stage, in June 2020).

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