Payment participation system

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

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. 225/2018 (2018) and regulation no. 1251/2018 (2019) on payment participation system in healthcare costs.

See how much you have to pay as an insured person from March 2018 and here from January 2019. The amounts in the text below is for the year 2019.

The maximum payment is 26.100 kr. but for pensioners, people with disability and children the maximum is 17.400 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 26.100 kr. (17.400 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 26.100 kr. in a month. When the maximum payment is reached, they pay up to 4.350 kr. per month as a rule when seeking medical care.

Pensioners never pay a higher fee than 17.400 kr. in a month. When the maximum payment is reached, they pay up to 2.900 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.

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 from 2-17 years old who do not have a referral will pay 2/3 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.

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