Within the EU

Reciprocal Healthcare Arrangements within the EU

The majority of existing agreements are still in place following the UK’s exit from the EU. This mean that:

  • UK residents can continue to access emergency healthcare when visiting EU countries. This can be obtained using a UK Global Health Insurance Card (GHIC) issued by the UK Government.
  • UK pensioners with an S1 certificate issued before 31 December 2020 can receive full access to healthcare in the country they retire to and can return to the UK for treatment if they wish. EU residents holding an EU member state issued S1 certificate can access healthcare in the UK in the same way.
  • UK posted workers (for more than two years) and frontier workers (those that live in one country and work in another) with an S1 certificate issued before 31 December 2020 can receive free healthcare in the EU country they work in. This also applies to EU workers in the UK with an S1 certificate.  
  • UK residents and their family members can continue to access planned healthcare and maternity treatment in an EU member state via an S2 certificate.
  • The EU directive route can no longer be used by UK residents following the UK’s exit from the EU, unless an application was in progress on 31 December 2020 or where treatment was accessed before 11pm on 31 December 2020.

The UK Government will pay the EU Member State for treatment of UK patients in that country who hold an EHIC, S1 or S2 certificate. Some countries require payment in advance and patients can claim these costs back from the UK Government.

EU patients who receive treatment in the UK and hold an EHIC, S1 or S2 certificate will have those costs paid to the UK Government by that country.

For information on travelling abroad for healthcare, contact the relevant Health Board area below:

Aneurin Bevan UHB 
Telephone: 01633 623432
email: abb.ipfr@wales.nhs.uk 

Betsi Cadwaladr UHB 
Telephone: 03000 855145 (Phone calls are diverted to an answering machine, which is checked twice a day)
Email: Bcu.Overseasvisitorqueries@wales.nhs.uk

Cardiff and Vale UHB                              
Cardiff and Vale IPFR (Individual Patient Funding Requests) Commissioning Team 02921 836535
Email: CAV.IPFR@wales.nhs.co.uk 

Cwm Taf Morgannwg UHB 
Commissioning Team: 01443 744800
Email: Cwmtaf.IPFR@wales.nhs.uk 

Hywel Dda UHB 
Telephone: 01437 834485
Email: hdd.ipfr@wales.nhs.uk  

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

Swansea Bay UHB                              
Planning Office - S2 Route 01639 683615 or 01639 683389 

New Global Health Insurance Card (GHIC)

GHIC gives UK residents travelling in the EU access to emergency and medically necessary healthcare, including medically necessary treatment for a pre-existing or chronic condition. The GHIC and EHIC cannot be used for any planned medical treatment.

This GHIC replaces EHIC, which remains valid in the EU until its expiry date.

You can apply for a new GHIC free of charge: Healthcare Cover Abroad - EHIC and GHIC.  

If you need medical treatment and do not have your EHIC or GHIC, you will need to apply for a Provisional Replacement Certificate (PRC) to evidence your entitlement.

All UK travellers to the EU are strongly advised to obtain travel insurance in addition to the GHIC and EHIC as these may not cover all costs resulting from medically necessary treatment e.g. repatriation.  You could be charged for some of all of the healthcare you receive.

Click here for information on Foreign Travel Insurance on the UK Government pages.

You should check what is covered by your GHIC or EHIC for the country you are visiting: European Health Insurance Card.


Withdrawal Agreement

If you are covered by the EU Withdrawal Agreement your healthcare rights remain as they were prior to 31 December 2020.


New UK EHIC under the Withdrawal Agreement

Individuals covered by the Withdrawal Agreement can apply for the new UK EHIC to use in EU Countries, Norway, Iceland, Liechtenstein and Switzerland from 1 January 2021.

Click here for information on eligibility: Healthcare Cover Abroad - EHIC and GHIC.


Long Term Healthcare Coverage – S1 Certificate

From 1 January 2021, if you move to an EU country (or move from an EU country to the UK), you and your family can still access healthcare whilst in that country via an S1 certificate if eligible. This applies to individuals who are frontier workers, other cross-border workers such as mariners and some posted workers.

If you have moved from UK to Norway, Iceland, Liechtenstein or Switzerland before 1 January 2020, you also may be entitled to healthcare whilst in that country.

You entitlement depends on whether you want to live abroad permanently or work outside the UK for a set period and whether you have worked or paid contributions or  whether you receive certain benefits, such as a pension.

If you are citizen of Norway, Iceland, Liechtenstein or Switzerland and were living in the UK on or before 31 December 2020, your S1 is still valid because of the Citizen's Rights Agreement with those countries.

If you lived in Wales on 31 December 2020, your S1 is still valid.

Further details including how to apply for an S1 can be found here: Healthcare Cover.


Planned Medical Treatment in the EU and Switzerland – S2 Funding Route

You may be entitled to NHS funding for planned healthcare treatment within the EU and Switzerland with an S2 certificate. Certain eligibility criteria need to be met before this funding is approved.

The criteria for Wales include:

  • You must be ordinarily resident in Wales.
  • Treatment “Provider” must be in the EU or Switzerland (but does not include Northern Ireland, Scotland and England and Wales). 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.

Note this scheme does not necessarily cover planned treatment in Norway, Liechtenstein or Iceland. Please contact your Local Health Board before you apply.

  • The treatment provider may be either private or state providers. The treatment must however be available under the providing country’s state healthcare scheme (i.e. could be provided by a private or state provider, but it must be available within the state healthcare system). 
  • Applications must be authorised before treatment is received.
  • The NHS must confirm that it cannot provide the treatments or equivalent, in a medically accepted timeframe, for the patient’s condition / diagnosis (referred to as Undue Delay)
  • There must be written support from a UK, EU or Switzerland clinician which, following their full medical assessment, supports the diagnosis, treatment and medical timeframe necessary for the treatment that the patient is seeking funding for.
  • There must be written support from an EU or Switzerland clinician / provider of the planned treatment dates and estimated costs.
  • The patient / applicant must check with the EU or Switzerland provider that they will accept an S2 form to fund the treatment(s).
  • S2 cannot be considered for the clinical trial or experimental part of any treatment package.
  • The patient does not pay for eligible treatment costs (apart from any required co-payment cost which would be charged to a person insured within that system, which the patient must pay).
  • S2 cannot be issued / approved if any of the treatment costs have already been paid for (unless the payment relates to the co-payment charge).

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

The NHS Business Services Authority 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 will not be reimbursed for travel and accommodation costs under S2.

You may be able to request an S2 if you are an EU national and have been living in the UK prior to1 January 2021.

Since 1 January 2021, EU citizens who move to the UK for more than six months need to pay the Immigration Health Surcharge as part of their visa application. This may be reimbursed in certain circumstances i.e. a Member State covers their healthcare costs in full. See Travelling to the UK from other RoW countries below.


Ordinary 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 in order to be considered ordinarily resident.


Healthcare in Wales after 1 January 2021

If you are an EU citizen who lived lawfully in Wales before 31 December 2020, you can use the NHS in Wales and access NHS services free of charge provided you have successfully applied to the EU Settlement Scheme for settled or pre-settled status, applied and hold a Certificate of Application whilst awaiting determination, or have made an appeal awaiting determination.

Additional support and guidance: EU Settlement Scheme.


Agreement with Ireland after 1 January 2021

The Commons Travel Area arrangement between Ireland and the UK mean that Irish citizens living in the UK and UK citizens living in Ireland continue to access NHS healthcare free of charge in the country they live in.

Healthcare in Ireland.  


Studying in the UK

If you are a citizen of the EU, Norway, Iceland, Liechtenstein and Switzerland and began studying at an accredited high education institute in the UK on or before 31 December 2020, you can use your EHIC for medical necessary healthcare until the end of the course. 

If the course extended beyond 30 June 2021, you can apply for the EU Settlement Scheme for you or your family are from the EU, Iceland, Norway, Liechtenstein and Switzerland and were living in the UK by 31 December 2020.

Where the course began after 1 January 2021 and is lasts for more than six months, the Immigration Health Surcharge must be paid when applying for your student visa.

Last Updated: 13/04/2022 07:49:13