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What is The EU directive on Cross Border healthcare?

Posted in: Maria's Blog
Author: Maria Cecilia Tacchi
Tags: , , ,

I bet you haven’t heard about this, the EU directive on cross border healthcare.

This is a little known directive that gives all EU nationals the right  to obtain healthcare services in any EU state, as long as they are entitled to the same services in their own country, and as long as they are not able to obtain such services within a reasonable amount of time at home.

There is another way of also accessing programmed care abroad, The S2 (formerly E112), I have NO idea why the EU felt they had to open another  route for care, but they did.

This could mean (in both routes) that if somebody is able to get a hospital in the UK to do the surgery before the appointment  in Spain, and they don’t have relatives here to help with their after care but  have in the UK, they could be entitled to have the surgery there.


This of course is not publicised, as nobody wants hordes of citizens from other countries filling up their hospitals..
But this directive exists since 2011, but the deadline to implement it was October 2013.

The EU directive on cross border healthcare has many complex and detailed rules and regulations. However, it is possible to summarise the rules for both citizens and countries.

Rules for Citizens
Residency: To be entitled to cross border healthcare, you must be a resident of a country within the European Economic Area (EEA).
Local provision: In order for cross border healthcare to be funded, it must be available in your home state as part of the standard healthcare package available to all citizens. Local commissioners will set out what treatment is covered under each state system.
Undue delay: Cross border healthcare must be funded if there is undue delay in providing the same treatment locally. The European Court of Justice defined undue delay as a waiting time that “exceeds the period which is acceptable in the light of an objective medical assessment”. This means that such judgements should be based on medical assessments, not just on arbitrary time based targets.
Reimbursement: The cost of cross border healthcare will only be reimbursed up to the cost of the treatment in the home state. States are not obliged to pay for costs in excess of the cost of treatment in the home state and you are not allowed to profit from having cheaper treatment in another state. The costs of travel and accommodation are not generally reimbursed.

I know these look like many requirements, but it could mean hope for older expats living here with no relatives and a surgery in the horizon.

Here is a very good guide on the directive it is written from the perspective of someone living in the UK, but can be applied to any EU citizen

What are the differences between both routes?

There are some major differences between the two application routes.

Payment conditions


The UK will cover the cost of your treatment. However, you may have to pay a contribution towards healthcare costs, depending on what the common practice is in the country of your choice. However, you may be able to claim back some or all of the co-payment when you return to the UK. To apply for a refund of the co-payment, you will need to contact the Overseas Healthcare Team on 0191 218 1999 or overseas.healthcare@dwp.gsi.gov.uk.

EU Directive

You will normally have to pay treatment costs upfront and get reimbursement from NHS England. Reimbursement will be limited to the cost of the same treatment under the NHS.

Treating sector


Since this is based on agreements between governments, it is only valid for state sector treatment.

EU Directive

Treatment can be in the state or private sector as the NHS will directly reimburse the fees you have paid.

Limit to funding and reimbursements


There is no limit to how much can be paid to the treating institution, even if the cost is more than the treatment would have been under the NHS. However, some countries require a patient contribution, which you would have to pay up front.

EU Directive

You’ll have to pay the cost upfront and seek reimbursement when you’re back in the UK. However, you can only claim back as much as the treatment would have cost in the UK. If the treatment is more expensive, you’ll have to cover the additional costs. If the treatment was cheaper than under the NHS, you will not be able to profit from it and ask for the difference in return from the NHS.


The Extranjeria department in Mijas has already done many of them, so this is proof that the directive works.

Remember that after surgery, specially orthopedic, the rehabilitation period is long, and if you don’t have a support network here, it might be impossible to do so, in that case this might be ideal if you do have a support network in the UK.

Please note: The information provided is based upon our understanding of current legislation. It is not legal advice but is provided freely to enable you to be properly informed. We recommend that if you are considering taking action, you should seek professional advice.

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