Planned Medical Treatment in the EU, EEA/EFTA and Switzerland - The S2 Funding Route

You may be entitled to NHS funding for planned state healthcare treatment in an EU country, Norway, Iceland, Liechtenstein, or Switzerland with an S2 certificate.

The S2 funding route applies to public health care providers only – it does not cover private treatment. If you are travelling with the intention of receiving planned treatment you must submit an S2 application and obtain approval from your Local Health Board (LHB) before you travel. Certain eligibility criteria need to be met before this funding can be approved.

Countries that are covered

• The EU countries are: Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden.
• Switzerland, Norway, Iceland and Liechtenstein are covered by the S2 scheme.
• For Switzerland you will also need to provide additional information for your nationality status
• The treatment “Provider” must be in the EU or Switzerland / Norway / Iceland / Liechtenstein.
• Northern Ireland, Scotland and Wales are not included as they are part of the UK.

If you do not have formalised evidence of your settled status in the UK, please find more information to see if you need to apply through the Windrush Scheme.

Switzerland

For Switzerland you will also need to provide additional information for your nationality/status. To be eligible for planned treatment in Switzerland you must hold:

• Patient Status:
• UK, Irish, Swiss or EU nationality (or have dual nationality including one of these).
• Or are a stateless person or refugee (living in the UK).
• Or are the family member or survivor of someone who holds one of these nationalities or statuses.

Applicants are able to prove their nationality through an official document e.g., a passport or a birth certificate.

   Or:

• Family Member Status: Applicants can also prove their eligibility if they are related to a family member who has UK / Irish / EU or Swiss nationality or if they are related to a stateless person or refugee living in the UK. This can either be a spouse, civil partner or child. Both the nationality of the family member and the family connection must be evidenced e.g., through a birth certificate.
• Refugees: Can prove their status through documentation showing their leave to remain for example a UK Biometric residence permit, a UK issued Refugee Travel Document or Home Office paperwork.
• Stateless persons: Can prove their status through, for example, a UK issued Stateless Person's Document, a UK Biometric residence permit or Home Office paperwork).

This list is not exhaustive, and applicants may be able to prove their eligibility for planned treatment in Switzerland with official documentation not described here.

 

Eligibility Criteria for Wales

The eligibility criteria for Wales include:

• Prior Approval: Applications must be authorised before treatment is received. Retrospective applications for an S2 will not be considered.
• State Healthcare: The treatment must be available to the patient under the providing country’s state healthcare scheme and not as a private patient. Written confirmation that the treatment is state provided must be obtained from the provider.
• Entitlement on NHS: The treatment must be routinely available to the patient under the NHS in their medical circumstances.
• Undue Delay: The NHS must confirm that it cannot provide the specified, or equivalent, treatment(s), in a medically acceptable timeframe, for the patient’s condition/diagnosis (referred to as Undue Delay). The relevant LHB will contact the local clinical team to provide this information.
• Medical support for diagnosis and treatment: There must be written support from an EU or Switzerland/Norway/Iceland/Liechtenstein clinician, which following their full medical assessment, supports the diagnosis, need for treatment and medical timeframe necessary for the treatment.
• Provider support for dates and costs: There must be written support from an EU or Switzerland /Norway/Iceland/Liechtenstein clinician / provider of the planned treatment dates, which should include the start and end date of treatment and a full breakdown of the estimated costs.
• Residency: The patient must be ordinarily resident in Wales.

Ordinarily Resident

A person is ordinarily resident if they are living in the UK:

• lawfully
• voluntarily
• for settled purposes as part of the regular order of their life for the time being,

whether for a long or short duration.

• People that are subject to immigration control must also have indefinite leave

to remain in the UK to be considered ordinarily resident.

    A person is not ordinarily resident just because they have British nationality, hold a British passport, are registered with a GP, have an NHS number, own a property in the UK or have paid / are paying NI contributions and taxes in the UK.

It is important to note the following points:

• The patient / applicant must obtain, from the EU, Norway, Iceland, Liechtenstein, or Switzerland provider, confirmation that they will accept an S2 to fund the treatment(s) and are providing the treatment package through state funded healthcare. The Treatment Provider Declaration form explains this in detail. This form is in English only as it is to be filled in by the provider.
• S2s cannot be considered for the clinical trial or experimental part of any treatment package.
• The patient should not pay for eligible treatment costs, apart from any co-payment.
• S2s cannot be issued / approved if the treatment costs have already been paid for (unless the payments relate to a co-payment charge).
• NHS Wales has no authority to approve applications if the funding criteria are not met.
• Only treatment costs can be assessed for funding. Travel, accommodation, and other costs will not be included, including those for people / carers who may be accompanying the patient. Translation costs are also not covered.
• S2s will only be issued for planned treatment dates, which may span a treatment period of up to 3 months.
• Should there be a change to the date of treatment, a request will need to be submitted to NHS Wales to obtain an S2 amendment.
• Extensions / continuation applications can be made and will be assessed on a case-by-case basis.
• Do not apply for your planned treatment S2 more than 3 months in advance of the treatment date, as applications are not normally assessed until 12 weeks prior to a treatment date. This is to ensure that the eligibility evidence is current.
• The treating clinician’s evidence/letter must be on official letterhead and should not be more than 6 months older than the treatment start date. The provider declaration form should also be returned. There is a check list at the end of the application form to ensure all required supporting evidence is submitted.
• An S2 can only cover one treatment provider and one treatment package per application. If you need more than one treatment package or treatment at more than one provider, then you will need to submit separate S2 applications for each provider.

What the S2 will cover

The S2 is a guarantee of payment refunded through UK reciprocal healthcare arrangements, which the UK government will pay directly to the treating country after treatment has been received.

Treating countries however provide treatment under the same conditions of care and payment that would apply to their residents. This could mean that you have to pay a percentage of the costs of your treatment personally (a co-payment charge; see further below) in advance of your treatment.

You should not be asked to pay, and should not pay, for the full cost of your treatment upfront.

The S2 will not cover any costs that are for private healthcare and are not covered as part of the public healthcare system in the country you are travelling to (for example for room upgrades etc). 

This is why it is important to ensure the provider confirms that they will accept an S2, and that the treatment will be provided under their state healthcare scheme. Please therefore ensure that you have written evidence from the provider of the treatments and a full breakdown of costs the S2 is covering, otherwise you could potentially be asked to pay the costs yourself, for which you may then be liable.  The provider declaration form should be used to confirm the criteria when in discussion with the provider prior to submitting your application.

S2 Costs and the Co-payment charge

If your application under the S2 route is approved, your treatment will be provided under the same conditions of care and payment that would apply to residents of the country you'll be treated in.

This could mean you have to pay a percentage of the costs personally (a co-payment charge).

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

In some countries, as in the UK, state healthcare is completely free. This means an approved S2 will cover 100% of the costs of your healthcare, so you would not be required to pay any treatment costs.

You should therefore not be asked to pay for any treatment costs upfront, unless it relates to the co-payment charge.  S2s cannot be issued / approved if the treatment costs have already been paid for (unless the payments relate to the co-payment charge).

Ensure you have requested an itemised estimate of all treatment costs including any expected co-payment prior to submitting your completed application for funding. If your supporting documentation is in a different language, you will need to provide an English translation. Translations do not have to be completed by an official translator; please see the guidance notes for more information.

You will be able to claim back any eligible co-payment when you return to the UK. Private healthcare costs, such as room upgrades, are not eligible for reimbursement. Please ensure you are aware of any costs you are liable to pay before treatment takes place.

For more information or to apply for a reimbursement of a co-payment, you'll need to contact Overseas Healthcare Services on 0191 218 1999 or complete the form found here: Contact Overseas Healthcare Services | NHSBSA

NHS Wales will not reimburse travel or accommodation costs.

Making an Application for S2

Welsh residents should contact their (LHB) in their area of Wales for further guidance and to make an application. LHBs are the first port of call for assessing S2 applications for Wales.

Aneurin Bevan University Health Board 
Telephone: 01633 623432
Email: abb.ipfr@wales.nhs.uk

Betsi Cadwaladr University Health Board 
Telephone: 03000 855145
Email: BCU.IPFR@wales.nhs.uk

Cardiff and Vale University Health Board                            
Individual Patient Funding Requests (IPFR) Commissioning Team Telephone: 02921 836535
Email: CAV.IPFR@wales.nhs.uk            

Cwm Taf Morgannwg University Health Board 
Commissioning Team Telephone: 01443 744800
Email: Cwmtaf.IPFR@wales.nhs.uk

Hywel Dda University Health Board
Telephone: 01437 834485
Email: hdd.ipfr@wales.nhs.uk

Powys Teaching Health Board
Telephone: 01874 712694
Email: Monitoring@powyslhb@nhs.net

Swansea Bay University Health Board                            
Planning Office Telephone:  01639 683615 or 01639 683389
Email: Planning.office@wales.nhs.uk       

It can take up to 20 working days for a fully completed application to be processed by the LHB and a decision to be made. You will be informed of the outcome of your application once a decision has been reached.

The NHS Business Services Authority (NHS BSA) assess applications for standard and maternity S2 certificates and are responsible for issuing to UK residents. 

If your application under the S2 route is approved, you will be issued with an S2 guarantee form, which you will need to present to the relevant healthcare provider abroad.  Your treatment will be provided under the same conditions of care and payment that would apply to residents of the country you will be treated in. You may need to pay a percentage of the costs personally, known as co-payment charge although you may be able to claim some or all of this when you return to the UK. You should not be asked to pay, and should not pay, for the full cost of your treatment upfront. You will not be reimbursed for travel and accommodation costs under S2.

If a co-payment charge is made, the NHS Business Services Authority will be able to advise if you are eligible for a refund of these charges (please note that NHSW is unable to give advice in respect of refunds). All other eligible treatment costs should be covered by the S2 and should not be paid directly by you. Please note that only co-payment charges can be refunded.

For example, in some countries, patients cover 25% of the cost of their state-provided treatment, whilst the state covers the other 75%, so the expectation for an operation that costs £8,000 is that you’ll pay £2,000. This would be paid directly to the provider, by you, prior to receiving treatment and you can request a refund of eligible costs from NHS BSA. The NHS would pay the remaining £6,000 via the reciprocal arrangements in place. 

Private healthcare costs, such as room upgrades, are not eligible costs and are not reimbursable. All costs should be agreed prior to receiving treatment to ensure that you are aware of costs you are responsible for. If your supporting documentation is in a different language, you'll need to provide an English translation.

For reimbursement of all eligible patient contributions, please contact NHS BSA via telephone 0191 218 1999 or from outside the UK +44 191 218 1999 Monday to Friday, 8am to 6pm.

Request a Review or Appeal of your S2 Application

If you are unhappy with the outcome of your application, you can request a review or an appeal.

You can request a review of the decision if you have additional information or evidence that was not provided as part of the original application that you believe may impact the rejection decision.

You can request a formal appeal if you do not agree with the rejection decision, but do not have any additional information or evidence.

To request a review or appeal, please contact your LHB quoting the reference number included with the application outcome.

 

Last Updated: 11/01/2024 14:16:15