Funding Options

If you're thinking about having medical treatment abroad, it's important to understand how it works and the risks involved. If you don't follow the correct procedures, you may end up being responsible for the full cost of treatment.

For example, your European Health Insurance Card (EHIC) does not cover going abroad for medical treatment. The EHIC is for emergency treatment that becomes necessary while you're abroad.

NHS patients have the right to seek treatment in another European Economic (EEA) country.  However, conditions may apply in some cases.

There are two ways to access NHS-funded healthcare in other EEA countries, through the S2 Route or The EU Directive Route.

The S2 Route

The S2 (formerly E112) 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 could mean you have to pay a percentage of the costs personally.

For example, in some countries, patients cover 25% of the costs of their state-provided treatment, 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. For example, for an operation that costs £8,000 of which you're expected to pay a standard patient co-payment charge of 25%, you will pay £2,000. The NHS will pay the remaining £6,000 to the institution treating you. However, you may be able to claim back some or all of the co-payment when you return to the UK.

In some countries, as in the UK, care is completely free. This means the S2 will cover 100% of the costs of your care, so you would not be required to pay any treatment costs upfront. Please note that the treatment covered by an S2 cannot be experimental treatment or a drug trial.

How to apply

To be issued with an S2 form, you will need to contact your Health Board to apply for funding prior to treatment. Your Health Board 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 Board 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.
  • You're entitled to treatment under the NHS.

If the Health Board 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.


S2s to cover maternity care in another EEA country are processed differently. For more information see our section Giving birth outside the UK.

The EU Directive Route

The EU Directive on cross-border healthcare was passed in 2011.

The EU Directive grants a fundamental right to purchase healthcare services across the European Economic Area for all EEA citizens. The EU Directive route to accessing healthcare in Europe is similar to the S2 route (see above), but there are some important differences.

How it works

The EU Directive gives you the right to purchase healthcare services in another EEA country and apply for reimbursement from the NHS, as long as the treatment is medically necessary and would be made available to you under the NHS.

It covers both treatment given in state-run hospitals and by private service providers.

In most cases, you will have to pay the costs upfront. You can claim reimbursement when you return, up to the amount the treatment would have cost under the NHS.

Prior authorisation may be required in some cases. This will confirm whether you are entitled to the treatment and the level of reimbursement you can expect. It will also ensure that you are aware of all the possible treatment options within the NHS, which may be more convenient for you than going abroad. Click here to find out what types of services require prior authorisation. Please note that this is not necessarily a definitive list.

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.

For more information and to ensure you don’t have any difficulties when claiming back your money, contact your Health Board before making any arrangements abroad.

How to apply

If you seek prior authorisation for a treatment or to apply for funding or reimbursement, you will need to complete the relevant paperwork required by your Health Board. When applying for reimbursement, original receipts and proof of payment must be supplied.

What isn't covered by the EU Directive?

The EU Directive doesn’t cover treatments outside the EEA. For example, if you want to have a particular drug treatment or surgery in the US because the NHS doesn't provide it, you’ll have to fund this yourself.

It also doesn’t cover treatments that you would not be entitled to receive under the NHS. If you are unsure whether or not you are entitled to funding for a particular treatment, please contact your local Health Board.

Compare Funding Routes

There are some major differences between the two application routes.

Payment conditions
The UK will cover the cost of your treatment. However, you may have to pay a contribution towards healthcare costs, depending on what the common practice is in the country of your choice. However, you may be able to claim back some or all of the co-payment 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

EU Directive
You will normally have to pay treatment costs upfront and get reimbursement from your Health Board. Reimbursement will be limited to the cost of the same treatment under the NHS.

Treating sector
Since this is based on agreements between governments, it is only valid for state sector treatment.

EU Directive
Treatment can be in the state or private sector as the NHS will directly reimburse the fees you have paid.

Application process
Contact your Health Board for an application form, complete and return it. Once they have received your application form, your Health Board will decide whether or not you are eligible for funding via this route. If you are, you will be issued with an S2 form, which you will need to present to the health service provider abroad, such as the hospital or dentist, when you're admitted.

EU Directive 
Fill in a re-imbursement form from your Health Board. You'll need to supply original receipts and proof of payment. If you are considering going abroad and claiming reimbursement following treatment, we recommend that you contact your Health Board to confirm your eligibility. Some services are subject to prior authorisation and you will therefore be required to apply for funding before going abroad for treatment.

Limit to funding and reimbursements
There is no limit to how much can be paid to the treating institution, even if the cost is more than the treatment would have been under the NHS. However, some countries require a patient contribution, which you would have to pay up front.

EU Directive
You’ll have to pay the cost up front and seek reimbursement when you're back in the UK. However, you can only claim back as much as the treatment would have cost in the UK. If the treatment is more expensive, you’ll have to cover the additional costs. If the treatment was cheaper than under the NHS, you will not be able to profit from it and ask for the difference in return from the NHS.

Last Updated: 01/04/2017 09:00:00
The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website