The EU directive route

The EU directive provides a route for you to get healthcare in Europe, which may be paid for by the NHS.

If you're eligible, it may entitle you to buy healthcare in a European Economic Area (EEA) country – but not Switzerland – and apply for reimbursement from the NHS.

If you get money back, the amount will be up to the cost of equivalent treatment on the NHS – you may not get the full amount back.

The EU directive route is similar to the S2 route. The important differences are:

• the EU directive route is available for either state-funded or private treatment (the S2 route is only for state-funded treatment)
• under the EU directive route you'll have to pay the costs upfront, then claim back eligible costs from the NHS as soon as possible when you return to the UK

Alternatively, you may be able to get money back for unplanned medically necessary state-funded treatment using the European Health Insurance Card (EHIC) route. The amount you’re refunded may be different using EHIC. Please consider both options before you select a route to submit your application.

If you accessed your treatment before 11pm on 31 December 2020, you can still apply for funding through the EU directive route.

Please complete and submit your application for funding as soon as possible following treatment to avoid delays.

Requesting prior approval for specialised treatments

If your treatment is on the specialised list (see the list of specialised treatments on the NHS England website), you must have requested prior authorisation ("approval") from NHS England before 11pm on 31 December 2020.

If it's approved, you can have the treatment even if the date of the treatment is from 1 January 2021. In those circumstances, treatment until 31 December 2024 will be funded, unless a date beyond that is approved by the NHS.

Unless there are exceptional circumstances, you're only entitled to funding for treatments that are the same or equivalent to those available to you on the NHS.

You can make a claim for money back when you return, up to the amount the treatment would have cost on the NHS in England.

What you cannot claim back

You'll need to pay for:

• any additional costs that may arise
• travel or accommodation costs

Any charges that you'd usually pay for treatment on the NHS, such as prescription charges, will be taken off the money you get back.

When you apply, make sure you:

• read the EU directive funding application guidance notes (PDF, 171kb)
• use an up-to-date application form, as provided on this page
• include all the necessary documents

Complete the EU directive funding application form (PDF, 201kb).

For all applications you must complete the form in full and provide details of the type of treatment and the healthcare provider, including:

• your National Insurance or NHS Number
• admission and discharge dates
• estimated costs
• original receipts and proof of payment
• English translations of any receipts and supporting documentation that are in a different language

How to send your application

Please send all your supporting documentation by email as this is quicker to process. This includes:

• your completed application form
• proof of residence
• medical documents

Scan your documents and email them as PDF attachments to the European Cross Border Healthcare Team.

Email: england.europeanhealthcare@nhs.net

If you're using a mobile phone, you can make PDF versions of documents by either:

• using your phone camera's scan setting
• selecting "print" after you've taken a picture of the document, then save it as a PDF

Where possible, organise documents into one PDF for each category. For example, an application form PDF, proofs of residence as one PDF, medical documentation as one PDF.

Send all PDF documents together in one email.

Do not email embedded documents or photographs (jpg/jpeg files).

Once we've received your application, we'll give you an EU reference number. Please include this whenever you contact us.

Send your original paper receipts and paper invoices by post to:

European Cross Border Healthcare Team
NHS England
County Hall
Leicester Road
Glenfield
Leicester
LE3 8RA

Make sure you include your EU reference number with your paper documents.

How long it takes

It can take up to 20 working days to process an application and decide if you're eligible for reimbursement. It may take longer if the application is incomplete and we need to request more information.

If you've already had the treatment and your application under the EU directive route is approved, it can take an additional 30 working days to process the reimbursement.

Who can apply?

Your EU directive application must meet NHS England's eligibility criteria:

• you're 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'll need prior approval 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've 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

Reasons for refusing an application

If your application is for a treatment that requires prior approval, NHS England may still refuse your application if:

• you're 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 approval, 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 this 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.

Although the NHS may approve funding for your treatment in an EEA country, the country you want to go to is not obliged to accept you as a patient. You may be refused treatment by the EEA member state.

You cannot expect to receive treatment in preference to a patient already within the country's state healthcare system. This means that if you're accepted for treatment, 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.

If you're unhappy with the outcome of your application, you can request a review or an appeal.

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 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 england.europeanhealthcare@nhs.net and quote the reference number included with the application outcome.

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 you can email NHSE on england.contactus@nhs.net.

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.