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The S2 funding route

The S2 route may entitle you to NHS-funded state healthcare treatment in another European Economic Area (EEA) country or Switzerland.

But there are certain qualifying criteria that need to be met, as set out below.

Eligibility criteria

In order to approve your S2 application, NHS England will 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 requested treatment would normally be provided on the NHS to an individual in your circumstances.
  • You have provided written evidence that you have had a full clinical assessment by a clinician in either the UK, any EEA country, or Switzerland. The clinician's statement must clearly state why the treatment you seek is needed in your circumstances, and what the clinician considers to be a medically justifiable time period within which you should be treated again, based on your circumstances. The clinician should support this statement by giving objective reasons.
  • The requested treatment is available under the treating country's state healthcare scheme.
  • Taking into consideration the information provided by the clinician, NHS England has determined that the same or equivalent treatment cannot be provided to you on the NHS within a time period that's medically justifiable.
  • The requested treatment is not experimental or part of a drug trial.
  • The requested treatment is not emergency treatment.

Tip: If your supporting documentation is in a different language, you'll need to provide an English translation.

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 your application under the S2 route is approved, your treatment will be provided under the same conditions of care and payment that would apply to residents of the country you'll be treated in.

This could mean you have to pay a percentage of the costs personally (a co-payment charge).

In some countries, patients cover 25% of the costs of their state-provided treatment. The state covers the other 75%.

If you received treatment under such a healthcare system, you'd be expected to pay the same co-payment charge as a patient from that country.

For example, for an operation that costs £8,000, of which you're expected to pay a standard patient co-payment charge of 25%, you'll pay £2,000. The NHS will pay the remaining £6,000 to the healthcare provider treating you.

You may be able to claim back some or all of your contribution when you return to the UK.

To apply for a refund of your contribution, you'll need to contact Overseas Healthcare Services on 0191 218 1999.

In some countries, as in the UK, healthcare is completely free. This means an approved S2 will cover 100% of the costs of your healthcare, so you would not be required to pay any treatment costs.

NHS England will not reimburse travel or accommodation costs.

Healthcare during the transition period if you’re travelling to have planned treatment

There will be no changes to healthcare access for UK nationals in the EU, Iceland, Liechtenstein, Norway and Switzerland before 31 December 2020.

You can still apply for the S2 funding route as you did before.

If you’ve requested authorisation for your treatment by 31 December 2020, it can go ahead once it’s authorised, even if the date of the treatment is from 1 January 2021.

Planned treatment from 1 January 2021

You can still access planned treatment abroad under the S2 route from 1 January 2021, if you’re either:

  • a UK State Pensioner living in the EU before 31 December 2020
  • a ‘frontier worker’ (someone who works in one state and lives in another) before 31 December 2020, for as long as you continue to be a frontier worker in the host state
  • an EU national living in the UK before 31 December 2020

How to apply

Information:

Due to the coronavirus (COVID-19) outbreak, there may be delays in receiving and processing S2 applications sent by post.

Please send your documentation by email as this will be easier to process.

Email: england.europeanhealthcare@nhs.net

Please email your documents as a PDF attachment. Please do not email embedded documents.

For your healthcare to be funded under the S2 route, you'll need to apply for funding (PDF, 105kb) prior to treatment.

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 resubmit the application.

An application should include:

  • evidence demonstrating that the eligibility criteria are met
  • full details of the type of treatment and the proposed provider (including admission and discharge dates, and estimated costs)
  • your National Insurance number or NHS number, as appropriate

Send your completed form and accompanying documents to the following address:

European Cross Border Healthcare Team
NHS England
Fosse House
6 Smith Way
Grove Park
Enderby
Leicester
LE19 1SX

Or email: england.europeanhealthcare@nhs.net.

NHS England is not obliged to approve an S2 application that does not satisfy the eligibility criteria. But it has the discretion to do so in exceptional circumstances.

NHS England will not approve an S2 application retrospectively, unless there are exceptional circumstances.

If NHS England approves your application, you'll be issued with an S2 guarantee form, which you'll need to present to the relevant healthcare provider abroad.

For more information, contact NHS England.

Maternity

S2 applications relating to maternity are processed differently. For more information, see giving birth outside the UK.

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 wasn't provided as part of the original application that you believe may impact the rejection decision.

Request an appeal

You should request a formal appeal if you don't agree with the rejection decision, but don't have any additional information or evidence.

Email NHS England on england.europeanhealthcare@nhs.net and quote the reference number included with the application outcome.

Concerns and complaints

Raise a concern

If you’re unhappy with the review or appeal outcome, you can also raise a concern with the European Cross Border Healthcare (ECBH) team directly or via the NHSE Customer Contact Centre. You would typically do this if you do not agree with a decision or you have experienced a problem with the processing of your application, for example an inappropriate delay.

Raise a complaint

You can also raise a complaint with the NHS England Customer Contact Centre if you want to complain about something, for example:

  • a process not being followed
  • communication issues with the team
  • behaviours or attitudes of the team or team members
  • a policy issue in relation to your application

You cannot complain about the decision or outcome of the application. This would be considered as a review, appeal or concern and will be referred back to the ECBH team.

Page last reviewed: 30 January 2020
Next review due: 30 January 2023