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Travelling to Europe for medical treatment

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 Applicants who use an outdated form may be asked to supply further information or resubmit their application.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.

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