A Guide to having your Medical Treatment Abroad. Planning your treatment and the Rules Applied.
When going to another country specifically for planned medical treatment, different rules apply than those for getting necessary care whilst abroad on a trip. It's important to note that your European Health Insurance Card (EHIC) does not cover going abroad for planned treatment.Forms and articles
The S2 (previously E112)
Comparing the S2 (or E112) and Article 56
Giving birth outside the UK
You should firstly discuss your plans with your doctor before you make any travel or medical arrangements. They will refer you to your local health commissioner who will discuss the options available to you and will confirm the following:
- Which treatments they are prepared to fund, and what level of funding would be available.
- Exactly how much you will be reimbursed.
- That you fully understand the conditions under which you will be treated abroad.
- Any programme of after-care or follow-up treatment you might require upon your return to the UK.
If going to an EEA country, there are two routes for obtaining NHS funding. You can use the S2 form (previously E112) issued by the Overseas Healthcare Team (Newcastle - (see below)) or, alternatively, you can go under Article 56 of the Treaty on the Functioning of the European Union (previously Article 49 of the EC Treaty). Your local commissioner can advise you on which option is better for the type of treatment you require. Each option works in a slightly different way.
What is a local health commissioner?
- In England: primary care Trusts, practice –based commissioners and GP’s
- In Wales: local health boards and Health Commission Wales
- In Scotland: the NHS board of the patient’s residence
- In Northern Ireland: health and social services boards
The S2 (previously E112)
The S2 (or E112) form entitles you to treatment in the state-funded sector in another EEA country and Switzerland. Treatment will be provided under the same conditions of care and payment as residents of that country. This could mean you have to pay a percentage of the costs upfront.
For example, in some countries, patients cover 25% of the costs of their state-provided treatment, known as a 'co-payment charge'. The state would cover the other 75%. If you received treatment under that healthcare system, you would be expected to pay the same co-payment charge as a patient from that country. You may be able to seek reimbursement for this cost when you are back in the UK if you are not able to do so in the other country.
Equally, in some countries care is completely free at the point of delivery, as in the UK. This means the S2 (or E112) will cover 100% of the costs of your care, so you would not be required to pay any treatment costs upfront.
The system works with the NHS paying the treating country’s contribution. If the amount paid by the NHS to the treating institution on your behalf is less than the treatment would have cost to provide locally in the UK, and you have had to pay co-payment charges, you can claim the reimbursement of these charges up to the cost of providing the care locally by the NHS.
For example, if you go abroad for an operation costing £8,000, and are 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 treating institution.
If the cost of treating you at home would have been £7,500 you could then claim back the extra £1,500 budgeted by the NHS to help cover the co-payment charge that you have paid.
Since the treatment is £500 more expensive than on the NHS, you would have to pay this portion yourself, and could not be reimbursed for it.
How to apply for an S2 (or E112)
You will need to apply to your local health commissioner for their written agreement to recommend funding for treatment. In making this decision, your local commissioner will need to be satisfied that:
- A UK NHS consultant has recommended in writing that you be treated in the other EU 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 against the health commissioner’s responsibilities 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 are entitled to treatment under the NHS.
If your commissioner agrees that you should go abroad for treatment, the appropriate paperwork should be passed to the Overseas Healthcare Team in Newcastle. They will consider the issue of the S2 (or E112) form. If issued, you will need to take this form with you to the other member state where you are going for treatment. For more information phone 0191 218 1999.
Route Article 56 (previously Article 49), named after the relevant section of the Treaty on the Functioning of the Euopean Union (TFEU, or the Lisbon Treaty), may allow you to obtain a reimbursement of the costs of planned medical treatment you receive in another EEA country. Your treatment must be one that is available through the NHS. However, there is no guarantee that you will receive funding.
Your local NHS commissioner can only issue a reimbursement for up to the cost of being treated locally under the NHS. Unlike using form S2 or the E112 form, you can receive this financial contribution towards either private or state-provided treatment.
Be aware that you will have to pay for the total cost of treatment upfront, and can normally only apply for reimbursement after your treatment has been completed and paid for. Even if your treatment abroad is cheaper than it would be under the NHS, you cannot be reimbursed more than you have paid for your medical treatment.
If you wish to apply under Article 56, you should consult your local health commissioner. They can work out the cost of local treatment under the NHS, and therefore the maximum amount you can claim as a reimbursement.
Comparing the S2 (or E112) and Article 56
There are some major differences between the two application routes. In conjunction with your local health commissioner you should decide which route is most suitable:
- S2 or E112: the UK covers the cost of treatment. However, the patient may need to pay a contribution towards healthcare costs which they may be able to seek reimbursement for when they are back in the UK if they are not able to do so in the other country.
- Article 56: treated as if you’re a member of your home member state, therefore you will have to pay treatment costs up front and seek reimbursement from your local NHS health commissioner.
- S2 or E112: since this is based on agreements between governments it is only valid for state sector treatment.
- Article 56: can be state or private sector treatment as the NHS will be directly reimbursing you the fees you have paid.
What happens next
- S2 or E112: the appropriate paperwork from your local commissioner should be sent to the Overseas Healthcare Team in Newcastle and they will consider issue of the E112 form and will post it to you.You will need to present the form to the hospital authorities abroad on admission. For more information and advice phone 0191 218 1999.
Limit to amount that will be paid
- S2 or E112: no limit to how much will be paid to the treating institution, even if the cost is more than the treatment would have cost at home. The amount paid will match the treating country’s contribution, and may extend to reimbursing you a portion of your contribution.
- Article 56: amount reimbursed to patient is limited to what it would have cost to treat them under their local health care system. If the cost of foreign treatment is less than what treatment would cost under the NHS, the patient will not get the excess.
- S2 or E112: patient only pays any co-payments (this is where, in some countries, a patient is required to pay a certain percentage of state-provided treatment).The patient may then be able to seek reimbursement for this cost when they are back in the UK if they are not able to do so in the other country.
- Article 56: patient pays total costs upfront and is reimbursed up to what the treatment would have cost at home. If the cost of foreign treatment is less than what treatment would cost under the NHS the patient will not get the excess.
Current EU regulations and recent caselaw has established that:
NHS patients are entitled, subject to certain conditions, to receive care in another EU country
Local commissioners should have a system in place to deal with requests for treatment abroad and should always give such requests serious consideration, taking into account the individual’s circumstances.
If undue delay applies to NHS care, a PCT cannot refuse a request for treatment abroad
Decisions on whether undue delay applies should be based on a clinical assessment of the individual’s circumstances.
Patients can only receive reimbursements for treatment that their PCT funds
It is the patient’s home health service that is responsible for deciding what care an individual can receive. Even if a treatment is funded elsewhere in the UK, if a patient seeks care abroad that they wouldn’t have been entitled to from their local commissioner, they must pay for it themselves and they are not entitled to any reimbursement.
If you are unhappy with the decision or recommendation (in the case of S2's or E112’s) of your local health commissioner, there should be a local appeals procedure.
TIP: If you choose to go abroad for healthcare, it is strongly advisable to take out insurance before you receive such treatment to ensure any unforseen emergencies are covered.
You will only be entitled to receive payment towards your travel and subsistence costs if they are similar to those treatments had they been provided in the UK. These payments must not be greater than the cost of support would be had you been treated by the NHS.
Giving birth outside the UK
If you are going to another EEA country (or Switzerland) specifically to give birth, you will need a European Health Insurance Card (EHIC) for routine medical care and a S2(or E112) form to cover the birth itself.
As well as having an EHIC, it's recommended that you have travel insurance as the EHIC may not cover you for every situation.
To get an S2 (or E112) you need to write to the Overseas Healthcare Team (Newcastle) or the Department of Health, Social Services and Public Safety in Northern Ireland, explaining why you want care outside the UK and enclosing the following information:
- A MATB1 certificate or a letter from your UK GP or midwife, showing your expected date of delivery (EDD).
- Your NHS number or National Insurance number and
- Your date of birth, your full UK address and dates of travel.
Indicate whether or not you will be returning to the UK as well as letting them know if you have already left the UK for another EEA country.
Applicants resident in England, Scotland or Wales
If you are a resident in England, Scotland or Wales, you will need to send your application to:
Overseas Healthcare Team (Newcastle)
Tyne & Wear
Phone 0191 218 1999 (Monday to Friday 8am-5pm)
(Note: Medical Benefits administer the E112 system on behalf of the Department of Health)
Applicants resident in Northern Ireland
If you are a resident in Northern Ireland, you will need to send your application to:
Department of Health, Social Services and Public Safety
General Medical Services Branch Room D3
Upper Newtownards Road
Belfast BT4 3SQ
Tel: 028 9052 2890
Fax: 028 9076 5624