Planned healthcare in the EU/EEA and Switzerland

Two possibilities – different consequences for the patient

As a person insured with an EU-social security system, you are able to benefit from the coverage of planned treatment costs in another EU/EEA country and Switzerland by your statutory health insurance service, both under the Regulations (EC) 883/2004 and 987/2009 on the coordination of social security systems and the Directive 2011/24/EU.

Under EU law, these two possibilities have different consequences for patients in terms of legal basis, scope, competent authorities, approval conditions, reimbursement costs, payment procedure and formalities, as well as the amount of the patient’s own co-payment. Make sure you are always well informed about any financial and other implications.

Option 1 – with an S2 form

With an S2 form, your health insurance institution covers the costs of the treatment in another EU country directly.
If you choose this option, you can only access publicly provided healthcare, and you will always need to apply to your national health insurance institution for prior authorisation (known as an S2 form) before you go for treatment abroad. Your health insurer is obliged to give prior authorisation if the treatment you’re applying for is included in your health insurance cover, but can’t be provided to you in your own country within a time limit, which is medically justifiable.

If you’ve obtained an S2 form, your treatment costs will be covered according to the rules in the country where you’re treated. This will be dealt with by the relevant institutions in your home country and the country of treatment. In principle, you will not have to pay for the treatment.

S2 forms are issued by your health insurance authority. Once completed, you should send it to the health insurance authority in the country where you plan to go for treatment. Search for the relevant health insurance authority in your country, or find out more about other standard forms for social security rights related to healthcare in the EU.

If people who are insured in the country where you are treated have to pay for that specific treatment, you will also have to pay and be subsequently reimbursed according to the conditions and reimbursement rates in that country.

Option 2 – claim reimbursement after treatment

You may also pay for your planned medical treatment yourself and be able to get some or all of your costs reimbursed once you get home. This system applies to both public and private healthcare providers in another EU country.

You will be reimbursed according to the reimbursement rates applied for the same treatment in the country where you’re insured. If you’re insured in a country that doesn’t have a reimbursement scheme, then your national health insurance body will reimburse you according to a tariff based on the cost of that treatment to the national healthcare system.

Depending on the type of treatment you need and the rules in your country, you might also need prior authorisation from your health insurer. However, the form for prior authorisation under this option is established nationally. Prior authorisation is required by many EU countries for care involving an overnight hospital stay or expensive medical equipment. No prior authorisation can be required for, e.g. a medical consultation.

Ask your health insurer or your National Contact Point whether you need prior authorisation. You can also find links to lists of treatments subject to prior authorisation in your country here. Your application must be granted if you would otherwise have to wait too long for treatment at home. When considering your application, your health insurance body also has an obligation to assess whether it is possible to issue you with an S2 form.

Option 1 with an S2 form will usually be more beneficial to you where the persons who are insured in the country where you are treated do not have to pay for the same treatment or where the reimbursement rules of your home country are more favourable than the rules in the country where the treatment takes place. In the latter case, you will be entitled to a top-up from your health insurer. However, only Option 2 is possible, if you need private healthcare.

Read more about expenses and reimbursements for your planned medical treatment.

You may have additional rights to treatment abroad based on the national law or bilateral/multilateral Social Security Agreements of your state of affiliation. We recommend that you contact your statutory health insurance service for further information before you make any final decisions.

You may find useful tips on organizing planned treatment abroad here.