There are 2 ways patients from EU countries can pay for treatment in another member state:
S2/E112 form route or the Cross Border Healthcare Directive (The Directive) route
Under S2 all costs are covered – regardless if they would have been cheaper in the home state. Patients will essentially be treated as a citizen of the treating country, in regards to paying for healthcare.
The S2/E112 route is a payment agreement between your home country and the NHS.
The directive will only cover the costs of the treatment up to the amount it would have cost in the home state.
The Directive route is a payment agreement between yourself and the treating country – where you usually pay the costs upfront and them claim back money that should be reimbursed.
Surgery would cost you £5000 in country A, where you live. It will cost you £10,000 in country B where you are receiving the treatment. S2/E112: The full cost of the surgery will be covered.
The Directive: You will only be covered up to £5000 by the national health provider. You will have to cover the remaining £5000 yourself (through private insurance or your own money).
If your home country requires a co-payment (where patients pay a percentage of their treatment) then you may still incur a cost, even if covered by your home country’s health cover.
Using the S2/E112 you will be treated as a citizen of the country you are receiving treatment in, so will need to pay the co-payment charge upfront. If the cost of the surgery is less than it would have cost in your home country, then you may be reimbursed for the cost of the co-payment, up to the total cost of surgery in your home state.
If you need to undergo an operation that costs £8000, but that country has a co-payment charge of 25%, youll have to pay £2000 while the NHS will pay £6000.
Using The Directive route, you will only be reimbursed for the cost of the treatment as it would have been in your home country.
S2/E112 always requires prior authorisation from the state healthcare provider of your home country. You cannot claim for costs you have already incurred using this method.
The Directive route only requires authorisation if the treatment sought:
- Involves overnight hospital accommodation for at least one night; or
- Requires use of highly specialised and cost intensive medical infrastructure or medical equipment; or
- Presents a particular risk for the patient or the population; or
- Is provided by a healthcare provider that, on a case-by-case basis, could give rise to serious and specific concerns relating to the quality or safety of the care, with the exception of healthcare which is subject to Union legislation ensuring a minimum level of safety and quality throughout the Union.
Prior authorisation: Undue delay
Generally, patients may not be refused prior authorisation when the healthcare cannot be provided to you in your home state within a time limit that is medically justifiable. * Treatment must be available in home state and there must be an undue delay.
When both conditions are met, treatment may only be refused authorization under exceptional circumstances (e.g. if the treatment sought would pose a safety hazard to you or the general population).
Public or private treatment?
S2/E112 only allows for treatment from state hospitals – excluding any treatment from private healthcare providers. The Directive allows for treatment from both private and public providers but you should check you are covered before engaging private healthcare.
If you feel your authorisation has been incorrectly rejected or you have not been reimbursed correctly then you should complain to your country’s health insurance provider. If they stand by the original decision they should inform of how you can appeal the decision or what legal action you can take.
National Contact Points
If you are eligible to NHS treatment in the UK and are seeking treatment abroad you should contact the NHS, at:
firstname.lastname@example.org or Tel 0300 311 2233
The contact points for Wales, Scotland and Northern Ireland can be found here:
If you are entitled to treatment in another EU country or Switzerland and are seeking treatment in the UK, you can receive advice from your country’s contact point. The list of points can be found here: