There are currently two routes through which you can access healthcare in another Member State – the “S2 route” based on the coordination of social security in the EEA and Switzerland, and the Directive route based on your individual rights under EU free market principles.
The S2 Route
The S2 replaced the E112 in May 2010 when new EU Regulations came into force. E112 was the name of the administrative form that someone received to prove they had authorization for planned medical treatment in another Member State of the European Economic Area and Switzerland. The E112 was issued under Article 22, Regulation (EEC) 1408/71, which was set out in 1971 and upheld by the European Court of Justice in 1998. [1] The S2 is issued in accordance with Articles 20 and 27(3) of Regulation (EC) 883/2004 and proves entitlement for planned treatment in another EU Member State.
Under the S2 route
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You must seek prior authorization for your treatment from your local healthcare commissioner.
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Only state funded healthcare will be paid for.
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Treatment costs will be paid directly by the Department of Health (except for any patient contributions or co-payments).
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Treatment cost is not limited to the equivalent UK tariff (i.e. the amount that the NHS would have paid for the treatment), except in co-funding Member States.
The S2 route involves a direct arrangement between the NHS and the state healthcare provider in the country of your choice. This means that you will not have to pay for all of your treatment upfront. Although if your chosen country has a co-funding scheme, you may have to pay this contribution and then claim it back.
To use this route, you must apply for prior authorization and, if the treatment is approved, you will be issued with an S2 form. These applications are dealt with by your local commissioner and S2 forms are issued by the Department of Health Overseas Healthcare Team in Newcastle.
Under the S2 route, if treatment in your chosen country is fully funded by the state, then the NHS will pay in full, even if this costs more than the NHS tariff. However, if you have to pay a co-funding contribution up front, you will only be reimbursed up to the equivalent UK tariff for the treatment and so you may lose out.
The Directive Route
Under the EU Directive:
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You may not need prior authorization from your healthcare commissioner.
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Treatment in both state and private healthcare facilities is covered.
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You pay for your treatment upfront and reclaim the costs later from the NHS.
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Any refund on treatment costs are limited to the equivalent UK tariff, (i.e. what the NHS normally pays for this treatment)
The ‘Directive route’ is based on an individual exercising his or her rights to obtain health services on the open market within the EU, under article 56 of the Lisbon Treaty. It has been called the ‘Article 56 route’ previously. You will normally have to pay for all of your treatment upfront and claim reimbursement from the NHS when you return.
Treatment under the Directive route only needs prior authorisation if the treatment:
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Involves overnight hospital accommodation for the patient in question for at least one night,
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or requires highly specialised or cost-intensive medical infrastructure or medical equipment,
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or involves treatment that carries a particular risk,
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or involves a healthcare provider about which there are quality or safety concerns. This does not include healthcare subject to EU legislation that ensures a minimum level of safety and quality throughout the EU.
‘Non-hospital’ treatments, such as dentistry, opticians’ services and other therapies do not require prior authorisation. However, they must be normally funded by your local health service to qualify and the treatment must be medically necessary. It is well worth applying for prior authorisation anyway, so that you know exactly what will be reimbursed on your return.
[1] http://www.publications.parliament.uk/pa/ld200809/ldselect/ldeucom/30/3004.htm
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