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Seeking medical treatment in Europe

What is the EU directive route?

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

The directive grants a fundamental right to purchase healthcare services across the European Economic Area (EEA) for all EEA citizens, and the right to apply for reimbursement from their home system.

The EU directive route to accessing healthcare in Europe is similar to the S2 route, 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 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 you are aware of all the possible treatment options within the NHS, which may be more convenient for you than going abroad. 

Find out what types of services require prior authorisation (PDF, 72kb) – please note this is not 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.

Find out more about the general rules.

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

How to apply

You will need to complete the application form (PDF, 102kb) if you seek prior authorisation for treatment or want to apply for funding or reimbursement. When applying for reimbursement, original receipts and proof of payment must be supplied.

Note: Please ensure you use the latest available form (as provided on this site) before submitting your application. Applicants who use an outdated form may be asked to supply further information or resubmit their application.


Under the EU directive route you are only entitled to funding for treatments in the EEA that you would normally receive under the NHS. If you are unsure whether or not you're entitled to funding for a particular treatment, please contact NHS England or your local clinical commissioning group (CCG).

Within England, different aspects of healthcare are commissioned by different organisations. Your entitlement to funding will depend on the services that are commissioned for patients in your area and any criteria that apply.

Clinical commissioning groups (CCGs)

CCGs commission:

  • most hospital services, excluding dental services, antenatal and newborn screening services, and specialised services
  • community health services provided outside of acute hospitals, such as rehabilitation services

To find out more about what your CCG commissions, contact your local CCG. You can also find out how your local CCG performs.

NHS England

NHS England commissions: 

  • specialised and highly specialised services – one of the eligibility criteria for a specialised service in another EEA country is prior authorisation ahead of treatment: find out what types of services require prior authorisation (PDF, 72kb) (this is not a definitive list)
  • primary care services – such as GP, dental, community pharmacy, and high street optometry services
  • other dental services

For more information, contact NHS England on 0300 311 22 33 or

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 you would not be entitled to receive under the NHS. If you're unsure about whether or not you are entitled to funding for a particular treatment, contact NHS England.

Respect the way in which the foreign system works

Although the NHS may approve funding for your treatment abroad, the country you want to go to is not obliged to accept you as a patient. If you're refused treatment in an EEA member state, they will have to explain their decision to refuse treatment.

You cannot expect to receive treatment in preference to a patient already within the country's state healthcare system. This means you may have to observe local waiting times or the country's guidance on particular treatments.

Note: an agreement to fund your treatment abroad by the NHS does not mean the NHS is liable for the treatment you receive.


The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

TankiR said on 01 August 2015

So costs of state-run (public) or private hospital treatment abroad can be refunded up to the price of the equivalent NHS procedure.

How does one ascertain how much the NHS assigns for any particular operation or treatment?

Is there any possibility to get a partial refund for private treatment obtained inside UK, or is this specifically excluded?

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Naomi R said on 02 April 2014


Having failed to receive any response to my email request I thought I would try communicating here.

I receive a regular supply of oxygen cylinders at home in the UK to treat my Cluster Headache. I have found the cost of securing an oxygen supply in Europe through “Oxygen Worldwide” totally prohibitive. Can you tell me if I would be entitled to claim the costs of this through the Cross Border Directive Route and if so, how would I go about it?

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poubelle said on 20 October 2013

needing an immediate and unexpected hip replacement in Feb, I googled a clinic in Abbeville, France, specialising in hips and knees, and had a replacement 10 days later, with a 2 week stay there, including physio daily. I quoted Art56 to the PCT, and they were excellent--"never had an Art56 before"!, rushed through all the authorisations AND paid the medical costs, leaving me with travel/hotel costs.
Marvellous results, no infection ("infection less than 0.02%") and was walking without sticks by early May. Would certainly do it again. It is possible to take a room companion if wished--possibly an idea if non French speaking, but staff charming, humane etc

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Rob Dickman DH said on 19 February 2013

At the current time, all reimbursement applications under the Cross-border Directive route are determined locally by Primary Care Trusts (Health Boards in Wales, Scotland and NI).

In England, from 1 April 2013, the NHS Commissioning Board will take over this function. In the meantime, any specific questions may be routed to the Department of Health at the mailbox address above:

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Cross Border Healthcare Policy Team said on 19 February 2013

My understanding is that Bromley PCT now forms part of NHS South East London, so any request for reimbursment should be sent there. The contact details are:

NHS South East London
1 Lower Marsh

Main reception: 0203 049 4444

If you require any further advice, please email the Department of Health at:

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wolfemurray said on 08 February 2013

I would be very interested to know if Eva CCC managed to get reimbursed for her husband's knee surgery (comment from 24.1.12). I believe that health authorities can be fined 10 million Euro for refusing payments. From October 2013 the directive will start to be enforced and things will get interesting...

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upforitwizard said on 31 January 2013

Hi what has happened to you is not new and will be happening more and more. According the EU directive a system must be fully implemented by October this year, the only government to go public is the Scottish who has a web site
I know a gentlemen who tried to get money from a Welsh health trust and got buried by bureaucracy. I have a gentlemen who is going for robotic surgery and will be asking for funding so we will use the legislation to fight his case.
I must add we took the Welsh Government to court in 2007 for a treatment to be made available and won so here we go again.

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Eva CCC said on 24 January 2012

I would like to know if you could help me out finding right way to seek reimbursement. My husband had a knee problem and needed surgery but he has decided to have it done in Poland instead of UK. He had his surgery 4 months ago and since last 2 months we are trying to get to our local PCT commissioner to file claim forms. The trouble is that my husband's orthopaedic specialist who confirmed need of surgery refered us to our GP and GP does not know what to do next. We showed him NHS Guidance for Cross Border Healthcare & Patient Mobility, but he states that due to some kind of NHS restructurization he does not know where to refer us next because PCT in our Bromley council area no longer exist. We do have all documentation to confirm need of surgery, history of illness etc just need to know where shall we go with it?

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Page last reviewed: 11/09/2015

Next review due: 11/09/2017

EU directive eligibility criteria

You'll need to meet the following criteria to be eligible for funding under the EU directive:

  • you must be ordinarily resident in England
  • you can't apply for funding outside the EEA
  • evidence of your medical need must be provided
  • the treatment must also be available to you under the NHS
  • some treatments require prior authorisation
  • reimbursement will be limited to the cost of the same treatment under the NHS


The risks of treatment abroad

There are many issues to consider before having surgery or dental treatment abroad

Is treatment abroad for you?

Use this checklist to help you feel confident you're making the right decision