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S2 Scheme

For further information contact the The Department for Work and Pensions:

Phone: 0191 218 1999

e-mail: overseas.healthcare@dwp.gsi.gov.uk

EU Cross-border Healthcare Directive

The European Cross-border healthcare Directive was passed by Europe in 2011. The Scottish Government and the other UK administrations are working to transpose the Directive into domestic legislation by October 25, 2013. 

The Directive formally sets out the fundamental right to healthcare services across the European Economic Area for all EEA citizens, although this right has been in place for many years. The provisions under the EU Directive are similar the S2 route, but there are some important differences:

How it works

The EU Directive provides a legal framework for people who wish to obtain healthcare under Article 56 of the Treaty of the Functioning of the European Union. It gives you the right to access healthcare services in another EEA country as long as the treatment is medically necessary and is also available under the NHS. It covers treatment provided in both state-run hospitals and by independent healthcare 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 that you are aware of all of the possible treatment options within the NHS, which may be more convenient to you than going overseas.

As with the S2 route, if "undue delay" applies in your particular case, you must be granted authorisation. For more information and to ensure you that you do not have any difficulties when claiming reimbursement, you should contact your NHS Board.

Entitlements and Rules - UK residents

Subject to certain conditions, you are entitled to medical treatment in another EEA country. To get NHS-funded treatment in another EEA country, you must be ordinarily resident in the UK and entitled to NHS treatment and services. 

What treatment am I entitled to?

You can only get reimbursements under the EU Directive for treatments that are funded by your NHS Board. Your Board decides whether an individual treatment is available on the NHS. 

What is undue delay?

You must be allowed to have treatment abroad if you cannot have the same treatment on the NHS within a medically acceptable period. This applies both to the S2 Route and the EU Directive.

The waiting time is based on your medical needs and the evidence that exists for your condition. It also has to take into account your health and the likely course of your medical condition at the time of the decision.

Decisions on undue delay must be based on a medical assessment. This assessment must be kept under review while you're waiting for treatment. Offering treatment within a national waiting time target does not necessarily avoid undue delay.

Appeal and review

Local health commissioners should have systems in place to deal with requests for treatment abroad. They are required to give such requests serious consideration, taking into account your circumstances.

If you're unhappy with your local health commissioner's decision, you should appeal in writing to your NHS Board.  Each Board has an appeal procedure, and you should appeal within the timeframe set by your Board. 


The cost of your treatment abroad will usually be reimbursed up to the cost of the equivalent treatment on the NHS.  This means if the treatment abroad is more expensive than under the NHS, you may have to pay the additional costs.  But if the treatment is cheaper, you cannot profit from it.

However, on a discretionary basis, the S2 route can be used for more expensive treatments, including treatments not available on the NHS. 

Where possible, speak to your NHS Board about your options and reimbursement arrangements before you travel for healthcare in Europe.