1. Beneficiary access to an Outpatient Specialist (OS)
Beneficiaries are entitled to visit 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 (without referral) as described below:
A. Access with a referral
Beneficiaries may have access to an OS provided that they are referred by the following healthcare providers:
- personal doctor
- hospital as inpatient healthcare provider
B. Direct access (without referral)
Apart from access to OS with referrals by another healthcare provider as described above, beneficiaries may visit an OS of their choice directly. In general, when beneficiaries visit an OS without referral they will be asked to pay a Personal Contribution 1
An exception to the above rule is the direct access to gynaecologists and obstetricians by female beneficiaries who have attained the age of fifteen (15). In these cases, beneficiaries will not pay a Personal Contribution 1
C. Right to choose an OS
The choice of an OS is in every case an exclusive right of the beneficiary. The referral refers to a doctor’s specialty (e.g. Cardiology) and does not refer by name to any doctor and the choice of the doctor is left up to the beneficiary who communicates directly with the OS of his choice (who is contracted with the HIO) in order to book an appointment.
D. Right to change an OS
Beneficiaries are entitled to change the OS whom they visited initially. In any case, the total number of visits to an OS for which a referral is valid remains the same. That is to say, if the beneficiary secures a referral for a specialty from his/her Personal Doctor, then he/she has the right, if he/she so wishes to visit three different doctors of that same specialty for which the referral was issued.