The EU directive route to access healthcare in Europe is similar to the S2 route, but there are some important differences.
If you fulfil the eligibility criteria, the EU directive route may entitle you to buy healthcare in another European Economic Area (EEA) country – but not Switzerland – and to apply for a reimbursement from the NHS.
However, unless there are exceptional circumstances, you are only entitled to funding for treatments that are the same or equivalent to treatments that would be available to you on the NHS. For more details, see the section about eligibility criteria, below.
The EU directive route is available for either state-funded or private treatment abroad. In most cases you will have to pay the costs upfront. You can make a claim for reimbursement when you return, up to the amount the treatment would have cost on the NHS in England.
However, you will bear the financial risk of any additional costs that may arise. Any NHS charges that would have applied to the treatment on the NHS, such as prescription charges, will be deducted from the reimbursement.
NHS England will not reimburse travel or accommodation costs.
Be aware that you will need to obtain prior authorisation from NHS England for some treatments. They will confirm whether you are entitled to the treatment and the level of reimbursement you can expect.
NHS England 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. Learn what types of services require prior authorisation (PDF, 72kb) – this is not a definitive list.
NHS England does not approve an application under the EU directive route retrospectively when you should have applied for prior authorisation but failed to do so, unless there are exceptional circumstances.
For more information and to ensure you don't have any difficulties when claiming money back, contact NHS England via email on email@example.com before making any arrangements abroad.
Eligibility criteria and how to apply for reimbursement
If you apply for reimbursement after treatment or authorisation in advance of treatment, you will need to complete an application form (PDF, 105kb). To avoid any difficulty, you should read the application guidance notes (PDF, 80kb).
Make sure you use the latest form, as provided on this site, to submit your application. If you use an outdated form you may be asked to supply further information or to resubmit the application.
Whether you are applying for a reimbursement after treatment or authorisation in advance of treatment, you'll need to include full details of the type of treatment and the healthcare provider.
This should include:
- admission and discharge dates
- estimated costs
- original receipts and proof of payment
If your receipts and supporting documentation are in a different language, you will need to provide English translations for them. All applications should include your National Insurance or NHS Number, as appropriate.
It can take up to 20 working days for an application to be processed and a decision to be made. It may take longer if your application is not complete and additional information is required.
If you have already had the treatment and your application under the EU directive route is approved, the reimbursement itself can take an additional 30 working days to be processed.
In order to approve your EU directive application, NHS England will also need to be satisfied that the following eligibility criteria are met:
- You are ordinarily resident in England and entitled to treatment on the NHS.
- The treatment is the same as or equivalent to a treatment that would be made available to you on the NHS. Only in exceptional circumstances will NHS England approve other forms of treatment – you will need prior authorisation for this.
- The healthcare provider is based in another EEA country and provides the treatment.
- The treatment is necessary to treat or diagnose a medical condition.
- You have provided a letter from an EEA clinician – a clinician based in the UK or another EEA country – as evidence that you've had a full clinical assessment. The letter needs to describe your condition and diagnosis, and confirm the medical need for the treatment. The letter must clearly state why the treatment received will be, or was, needed.
If your application is for a treatment that requires prior authorisation, NHS England may still refuse your application if:
- you are likely to be exposed to unacceptable patient-safety risk
- the general public are likely to be exposed to a substantial safety hazard as a result of the treatment
- there are serious and specific concerns about the healthcare provider in relation to their standards and guidelines on quality of care and patient safety
- the treatment can be provided on the NHS in a medically justifiable time period
If you want to apply for treatment that requires prior authorisation, the letter provided by the EEA clinician must clearly state why the treatment is needed in your circumstances, and what the clinician considers to be a medically justifiable time period within which you should be treated. The clinician should support his statement by giving objective reasons.
NHS England will take the clinician's statement into consideration and will determine whether the same or equivalent treatment can be provided on the NHS within a time period that is medically justifiable.
If you make an application for prior authorisation of treatment under the EU directive route, NHS England will, in the first instance, determine whether or not you meet the requirements of the S2 route.
If you satisfy the criteria for approval under the S2 route, you will be granted authorisation via that route, unless you specifically request to use the directive route – for example, to access the private sector abroad.
The S2 route is considered more attractive because you do not have to pay the healthcare costs upfront – except for co-payments – and you may be covered for costs that exceed the NHS equivalent.
For more information, contact NHS England on 0300 311 2233 or email firstname.lastname@example.org.
Respect the way 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 are 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.
An agreement to fund your treatment abroad by the NHS does not mean the NHS is liable for the treatment you receive.
Review and appeal
Request a review
If you're unhappy with the outcome of your application, 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 and you believe it may impact the rejection decision.
Request an appeal
You should request a formal appeal if you do not agree with the rejection decision, but do not have any additional information or evidence.
Email NHS England on email@example.com and quote the reference number included with the application outcome.
Page last reviewed: 13 February 2019
Next review due: 13 February 2022