In short
- There are two routes: the EU Directive (you pay, then claim) and the S2 form (approval first, care in the public system).
- Only care your health system covers at home is refunded, at most what it would cost at home: not cosmetic treatment, travel or agents' fees.
- Only treatment in the EU or EEA counts: Hungary, Poland, Spain, Czechia and Croatia, not Turkey or Mexico.
- Ask your own insurer or national contact point in writing before you book, and keep every invoice.
If you live in an EU or EEA country, your public health insurance may pay back part of planned treatment you have in another EU country. This guide explains the two routes and who to ask, with each point linked to the official page it comes from. It is not medical or financial advice: only your own insurer can tell you what it will pay for your treatment, and whether a treatment is right for you is for a doctor who has examined you to say.
1. Two routes
- The Cross-border Healthcare Directive (Directive 2011/24/EU) sets out when you can have care in another EU country and be reimbursed by your home country (European Commission). You pay the provider yourself and claim afterwards (HSE).
- The S2 form is a prior authorisation from your public health insurer, which you send to the insurer in the country of treatment; your insurer may then pay the provider for you (Your Europe). With an S2 you pay only the patient fee charged in that country (Kela).
2. Which destinations count
The Directive covers the EU countries plus Iceland, Liechtenstein and Norway (HSE, oesterreich.gv.at). Of our destinations, that means Hungary, Poland, Spain, Czechia and Croatia. Treatment in Turkey, Mexico, Thailand or any other country outside Europe is not covered by either route (NHS).
3. The Directive route: pay first, claim afterwards
- Only care covered at home. The care must be something your public system would have covered at home (Helsenorge, Zorginstituut Nederland).
- At most the cost at home. You get back no more than the same care would cost your home system, and never more than you paid (HSE, Styrelsen for Patientsikkerhed). The difference is yours to pay.
- Prior authorisation for some care. It may be required for care with an overnight stay, very serious or complex procedures, or expensive equipment; without it where it is required, you may not be reimbursed (Your Europe).
- Keep the paperwork. In Sweden you must keep the original receipts (1177); in Finland you claim within 6 months of paying (Kela). Ask your insurer which documents it needs before you go.
4. The S2 route: approval first
You apply before you travel, and the decision is your insurer's. In Ireland, Finland and England it is for treatment that is not available at home, or not within the time normally needed (HSE, Kela, NHS). The care is given under the other country's state scheme, not as a private patient: the NHS S2 route does not cover private treatment, and the Irish scheme needs a recognised public institution that accepts the S2 form (NHS, HSE). Do not book before the decision.
5. What is not refunded
- Treatment your system does not pay for at home. Because only care insured at home is refunded, a purely cosmetic operation or a hair transplant is not refunded abroad either (Zorginstituut Nederland, Kela). Treating its complications may cost you too: see If something goes wrong.
- Travel and accommodation are your responsibility (Your Europe).
- Fees paid to an agent or intermediary that organises treatment are not refunded in Ireland (HSE). See Before you book on agents.
6. Dental work
It depends on what your system covers for adults at home. In the Netherlands, the basic insurance covers surgical dental care, X-rays and removable dentures, and implants only for a serious disorder of the mouth (Rijksoverheid). In Sweden, Försäkringskassan can tell you in advance whether and how much you would get back (1177); in Finland, ask Kela for a prior information notice well before you book (Kela). The true cost tool counts what is left for you to pay.
7. Who to ask in your country
Each country has a national contact point that explains the rules; questions about what you will be paid can only be answered by your own insurer at home (Your Europe). The contact points below are from the EU's list (European Commission).
| Where you live | Ask first | National contact point |
|---|---|---|
| Ireland | Directive: a referral from a GP or a public consultant; prior notification is optional for inpatient or day-case care (HSE). S2: the Treatment Abroad Scheme, through a public hospital consultant (HSE) | HSE Cross Border Directive |
| France | Your health insurance fund: care with a night in hospital or costly specialised equipment needs prior authorisation; claim with the "Soins reçus à l'étranger" form, S3125 (Cleiss) | Cleiss |
| Germany | Your Krankenkasse: hospital treatment needs its approval first (§13 SGB V) | EU-Patienten.de |
| Belgium | Your mutualité or ziekenfonds, which gives prior authorisations for planned care abroad (INAMI) | Belgian contact point |
| Netherlands | Your zorgverzekeraar, for permission beforehand; your eigen risico (deductible) applies abroad too (Zorginstituut Nederland) | CAK |
| Denmark | Your region: hospital care with at least one night needs its approval; you pay first (Styrelsen for Patientsikkerhed) | Danish Patient Safety Authority |
| Austria | Your health insurer: hospital stays and high-tech outpatient care need its approval first (oesterreich.gv.at) | Kontaktstelle Patientenmobilität |
| Finland | Kela: prior information notice (form SV 134e) or prior authorisation (Kela) | EU-healthcare.fi |
| Sweden | Försäkringskassan: prior approval (förhandstillstånd) or an advance decision (förhandsbesked) (1177) | Försäkringskassan |
| Norway | Helfo: refund afterwards, or prior notification for specialised hospital care (Helsenorge) | Helsenorge |
8. Switzerland and the United Kingdom
- Switzerland. Basic insurance may pay for planned treatment abroad only in particular cases, after your doctor applies to the insurer's medical adviser and the insurer agrees (FOPH). Ask your insurer in writing before you book.
- United Kingdom. The EU Directive route is closed: you can only claim for treatment that started or was approved before 11pm on 31 December 2020. The S2 route remains, with prior authorisation from NHS England (NHS). It is for people ordinarily resident in England, for state treatment that is routinely available on the NHS but cannot be given in a medically acceptable time (NHS).
Before you book, ask your insurer or contact point in writing which route applies, get any authorisation or S2 form before you travel, and work through Before you book: the checklist.