It is easy to get treatment abroad. Many Europeans are keen to know whether the cost of treatment abroad can be met. This website explains what to do and which costs can be met, answers the most frequently-asked questions and provides links to the relevant national authorities for matters of national law. To avoid unpleasant surprises, get the information you need before you go.
If you are covered by a legal social security scheme in a member State of the European Economic Area or Switzerland, you may be entitled to have the costs met for treatment abroad. It does not matter what nationality you have, provided you are legally resident in one of these countries.
On this site, for ease of reference, we use the term “treatment”. The social security rules are more specific and talk of "benefits in kind". These specifically include medical and dental care, medicine and hospitalisation and direct payments to reimburse the cost of these services. The defining characteristic of benefits in kind is that they are intended to cover treatment you receive by covering or reimbursing your expenses.
In principle, your treatment costs will be covered only if the law in the State where you are insured recognises the treatment. For example, the cost of spa cures is covered in some countries but not in others. Find out from your insurance institution before you travel.
There are two separate procedures.
For hospital treatment, your health insurance institution will almost always require you to seek authorisation. The cost will then be covered according to the rules of the State where you receive the treatment. If those terms are less favourable than the terms offered by your own health insurance, the difference will be refunded to you. Please note that the entitlement to additional reimbursement is not recognised in the case of Switzerland.
For non-hospital treatment, if you obtain authorisation, the guarantees will be the same. You can also dispense with authorisation and travel directly to the State where you wish to receive treatment and claim for reimbursement on your return. The cost of your treatment will then be covered according to the rules of the State where your health insurance institution is based. Without authorisation, treatment costs are not covered in the case of Switzerland.
There is currently no definition under EU law of "hospital treatment" or "non-hospital treatment". If in doubt, check with your health insurance institution.
The authorisation for costs to be met
The S2 form is a standard European portable document, identical in all countries and all languages.
Ask your health insurance institution.
This is the form where your health insurance institution certifies that it will cover the cost of the treatment you want to get abroad. It gives your details as the person whose costs are to be covered, the duration of this cover and, if possible, the establishment providing the treatment.
A distinction is made between hospital treatment and medical treatment given in a doctor's surgery or at your home (non-hospital treatment). The Court of Justice has acknowledged that countries need to be able to forecast the demand for and infrastructure of hospital care, especially its geographical distribution. They must guarantee patients adequate and permanent access to a balanced range of good-quality hospital treatment, while at the same time keeping down costs by ensuring that money and human and technical resources are not wasted.
To what extent can costs be met
The obligation to cover your costs concerns only costs relating to treatment received in the State of treatment, i.e. for hospital treatment, the cost of the treatment proper, and unavoidable accommodation and meals in the hospital.
However, if the rules of the State where you are insured allow cover for other costs, such as travel from your home to the place of treatment, and/or the accommodation expenses of the person accompanying you, and if you have obtained authorisation, then reimbursement of those costs cannot be refused on the grounds that the treatment was given in another State. You have the same rights as if the treatment were given in the State where you are insured.
To find out which costs can be reimbursed in your case, contact your health insurance institution.
No. For example, if your first request for authorisation was rejected, but authorisation was given subsequently, you are entitled to receive direct reimbursement by your health insurance institution of the amount that would normally have been reimbursed if the cover had been confirmed at the outset (Vanbraekel judgement , 12 July 2001, C -368/98, point 34).
Another example: if you did not wait for the outcome of a legal appeal against a refusal of cover, this fact by itself does not justify a refusal to reimburse your costs (Leichtle judgement, 18 March 2004, C-8/02, point 59).
Waiting lists are not in themselves against EU law, but your health insurance institution cannot refuse you authorisation for treatment abroad for that reason alone. It must take into account your specific medical condition and prove that the envisaged wait is acceptable, given an objective medical assessment of your clinical needs. Moreover, waiting lists must be managed flexibly and dynamically so that you can be moved up the list if your condition deteriorates.
Refusal of cover
No. If the time you would have to wait for treatment in the country where you are insured is unacceptable for medical reasons, the institution cannot refuse to cover your treatment on the grounds of costs alone.
You should be able to appeal under national law. The Commission provides information on how to enforce your rights via Solvit.