Payment participation system

A new payment participation system was taken into force on the 1st of May 2017.

See how much you have to pay as an insured person here and here.

The goal is to lower the expenses of those who need a lot of health care and have paid a large amount of money for that service.

No one will pay more than a certain maximum amount for each month for healthcare. These amounts are specified in a new regulation no. 314/2017 on payment participation system in healthcare costs.

The maximum payment is 24.600 kr. but for pensioners, people with disability and children the maximum is 16.400 kr. Siblings, 17 years old and younger, who are registered with the same legal residence according to the National registry are considered as one person in the payment system.

When calculating what a person is paying for healthcare at any given time, it is examined how much he has collected in the maximum payment and which payment should be based on the tariff.

If the cost according to the tariff for medical service exceeds the maximum the person must pay every month, the Icelandic Health Insurance will pay the difference.

In determining a person's payment participation, the status at the beginning of the month and the amount paid for health services in that month are taken into account. If these aggregate payments are lower than 24.600 kr. (16.400 for pensioners and children), the person takes part in the costs until such amount is reached. This means that individuals, other than pensioners and children, never pay a higher fee than 24.600 kr. in a month. When the maximum payment is reached, they pay up to 4.100 kr. per month as a rule when seeking medical care.

Pensioners never pay a higher fee than 16.400 kr. in a month. When the maximum payment is reached, they pay up to 2.733 kr. per month as a rule when seeking medical care.  

Patient’s fee is calculated in a database operated by the Icelandic Health Insurance.

Information on payment participation is available to each person/family in the Benefits portal.

See how much you have to pay as an insured person here and here.

Payments for the following categories are included in the Payment Participation System

Health care center (Heilsugæsla)

Hospital treatment

Visits to specialists in hospitals

Visits to specialists outside of hospitals

Tests and other health researches

Radiation, X-rays and image analysis

Psychiatric services for children according with an agreement with IHI

Payments for therapy

Physiotherapy

Speech Therapy

Occupational therapy

Treatment for skin diseases

References to a specialist

Children under the age of 18 years old, referred by a healthcare practitioner, do not pay a fee for a visit to a specialist. Children who do not have a referral will pay 30% of the service fee until the payment threshold (maximum monthly payment) is reached.

However, children with homecare assessment and children under the age of two years old will not need a reference, it’s free of charge.

The referral system includes specialized medical services, laboratory tests, radiology analysis that a specialist considers necessary in connection to diagnosis or treatment.

A healthcare practitioner who issues a reference determines its validity. Validity period will be in accordance with the professional assessment of the doctor at any given time, but generally not longer than one year at a time. However, the reference for children with chronic illness or disability may be valid for up to ten years.

See how much you have to pay as an insured person here and here.

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