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Linda Briggs Cross Border Healthcare
Cross Border Healthcare


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NHS Cross Border Healthcare

As a resident of the UK and an NHS patient
you are entitled to seek medical treatment in Europe or Switzerland. (Until we come out of Europe, then we are likely to lose this option)

There are two ways to access this sort of NHS funded healthcare, however, conditions apply to both routes:


1.         The S2 route (previously E112)
This is a direct payment arrangement between the NHS and the state health provider in the country that you have chosen and must be arranged before your treatment.

2.         Article 56
This is the EU Directive on cross-border healthcare. Generally you will pay the cost of your treatment and then claim for its reimbursement from the NHS when you return. You do not always need to obtain authorisation from NHS England before receiving treatment, but it is highly recommended and can avoid problems and rejected applications later

Both the S2 route and Article 56 require you to complete this application form.
apply for funding (PDF, 100kb)

Print a copy, complete it and send to the address at the end of the form.  If you are unsure which funding option to choose, tick the box ‘I’m unsure which route to apply under’.

Warning: You can not use your European Health Insurance Card (EHIC)
Your European Health Insurance Card (EHIC) does not cover going abroad for medical treatment; it is for emergency treatment that becomes necessary while you are abroad.

EU cross border healthcare

In more detail -
The S2 route

The S2 route entitles you to state-funded treatment in another European Economic Area (EEA) country or Switzerland.  Treatment will be provided under the same conditions of care and payment as for residents of that country.  This may mean you have to pay some of the costs before your treatment.

For example, in some countries, patients cover 25% of the costs of their state-provided treatment.  This is known as a 'co-payment charge'.  The state covers the other 75%.  If you received treatment under this healthcare system, you would be expected to pay the same co-payment charge as a patient from that country.

An example of this would be, for an operation that costs £8,000 of which you are expected to pay a standard patient co-payment charge of 25%, you will pay £2,000.  NHS England will pay the remaining £6,000 to the institution treating you.

You may be able to claim this back when you return to the UK.  To apply for a refund of the co-payment, you will need to
contact the Overseas Healthcare Team on 0191 218 1999 or

Some countries provide completely free health care and so the total cost will be covered by the S2 route.

To be eligible for the S2 route you must:

  • be a resident in England.
  • be receiving treatment from the NHS.
  • be able to prove that your chosen hospital will accept an S2.
  • provide a letter of support from your UK consultant.
  • provide an estimation of cost.
  • provide the proposed dates of treatment.

You must be allowed to have treatment abroad if you cannot have the same treatment on the NHS within a medically acceptable period.  As with the Article 56 route, if 'undue delay' applies in your particular case, you must be granted authorisation.

How to apply
Click on this link and complete the form prior to treatment apply for funding (PDF, 100kb)

NHS England will decide whether or not to approve your application and will need to be satisfied that:

  • A UK NHS consultant has recommended in writing that you be treated in the other EEA country, and that a full clinical assessment has been carried out to demonstrate that the treatment will meet your specific needs.
  • The costs of sending you abroad for treatment are justified. The Health Commissioner is responsible for spending money efficiently and fairly, in the interest of all the patients they look after.
  • The treatment is available under the other country’s state health scheme.
  • It is not an experimental treatment or a drug trial.
  • You're entitled to treatment under the NHS.

If NHS England approves your application, you will be issued with an S2 form. You will need to take this form with you to the other member state in which you will be receiving treatment.

EU cross border healthcare

In more detail - The Article 56

Article 56 of the EU Directive on cross-border healthcare 2011

Article 56 gives you the right to purchase healthcare services in another EEA country and to apply for reimbursement from the NHS, the treatment must be medically necessary and you would have received it from the NHS.

It covers both, treatment given in NHS hospitals and by private service providers.

You will have to pay the costs up front and claim for reimbursement when you return, up to the amount the treatment would have cost under the NHS.

Prior authorisation is mandatory in some cases.
Please click the link supplied  by the NHS for their list 
types of services require prior authorisation (PDF, 72kb) .  However, we highly recommend prior authorisation in all cases, to ensure that you are fully aware of the amount that you will be reimbursed and your entitlements.

You must be allowed to have treatment abroad if you cannot have the same treatment on the NHS within a medically acceptable period. As with the S2 route, if 'undue delay' applies in your particular case, you must be granted authorisation.

How to apply
Whether you are seeking prior authorisation for a treatment, or to applying for funding or reimbursement, you will need to complete the
application form (PDF, 100kb). (This is the same form as for S2)

When applying for reimbursement, original receipts and proof of payment must be supplied.

Travel costs
NHS England does not refund travel or accommodation costs for healthcare funded via the S2 or Article 56 routes.

Appeal and review
If you're unhappy with the outcome of your application for treatment abroad, you can request a review of the decision.  If you would like the decision to be reviewed, please e mail, quoting your unique reference number (provided when you were informed of the outcome of your application).


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