The Planned Treatment Scheme (S2 funding route)

The Planned Treatment Scheme (S2 funding route) may entitle you to NHS funding for planned state healthcare treatment in an EU country or Switzerland, Norway, Iceland or Liechtenstein if you’re eligible.

The S2 funding route applies to public healthcare providers only – It does not cover private treatment. You must get approval first before travelling to receive planned treatment, as there are eligibility criteria that need to be met.

Eligibility criteria

To be eligible for S2 funding the following criteria must be met.

• Prior approval – applications must be authorised before treatment.
• State healthcare – the treatment must be available to you under the providing country’s state healthcare scheme (not as a private patient).
• Entitlement on NHS – the treatment must be routinely available to you under the NHS in your medical circumstances.
• Undue delay – the NHS must confirm that it cannot provide the specified, or equivalent, treatment(s), in a medically acceptable timeframe, for your condition or diagnosis (referred to as undue delay). The relevant NHS commissioner is contacted by the European Cross Border Healthcare (ECBH) team to provide this information.
• Medical support for diagnosis and treatment – there must be written support from an EU or Switzerland, Norway, Iceland or Liechtenstein clinician, which following their full medical assessment, supports the diagnosis, need for treatment and medical timeframe needed for the treatment. This can be supported by a UK clinician.
• Provider support for dates and costs – there must be written support from an EU or Switzerland, Norway, Iceland or Liechtenstein clinician or healthcare provider of the planned treatment dates and estimated costs.
• Residency – you must be ordinarily resident in England and entitled to treatment on the NHS.

You must be registered with an NHS GP. You must have seen your NHS GP for a consultation or assessment about the condition you are seeking funding for, where relevant.

A GP assessment or referral will only be needed if you’re being seen for treatment by a secondary care service (hospital or community care). You will not need a GP referral for treatments in primary care (such as dental or ophthalmology). A referral to NHS services from a dental or ophthalmic provider is only needed if applicable to your application.

You must check with the EU or Switzerland, Norway, Iceland or Liechtenstein provider that they will accept an S2 form to fund the treatment(s) and are providing the treatment package through state funded healthcare. The Provider Declaration form explains the requirements for the treatment provider.

S2s cannot be considered for the clinical trial or experimental part of any treatment package.

You should not pay for eligible treatment costs, apart from the co-payment (see below).

S2s cannot be issued or approved if the treatment costs have already been paid for (unless the payments relate to the co-payment charge).

NHS England has no authority to approve applications if the funding criteria are not met.

Only treatment costs can be assessed for funding. Travel and accommodation costs will not be included, including those for people or carers who may be accompanying you. Translation costs are also not covered.

NHS England will determine whether:

• the same or equivalent treatment can be provided to you on the NHS within a time period that is medically justifiable (undue delay)
• the requested treatment would be routinely commissioned by the NHS and available to you on the NHS, in your medical circumstances

It is recommended you have your EHIC or GHIC with you whenever you visit an EU country or Switzerland, Norway, Iceland or Liechtenstein in case you need healthcare unrelated to your approved S2.

Your EHIC or GHIC is not a substitute for travel insurance. It may not cover all health costs and never covers repatriation costs. Make sure you have travel insurance as well as your card.

Find out more about applying for healthcare cover abroad (GHIC and EHIC)

Planned treatments in Switzerland

To be eligible for planned treatment in Switzerland you must also either:

• have UK, Irish, Swiss or EU nationality (or have dual nationality including one of these)
• be a stateless person or refugee (living in the UK)
• be the family member or survivor of someone who holds one of these nationalities or statuses

Find out more about healthcare for UK nationals visiting the EU, Iceland, Liechtenstein, Norway or Switzerland from GOV.UK

How to apply

For your healthcare to be funded under the S2 route, you'll need to complete and submit the S2 (planned treatment) application form to apply for funding (PDF, 145kb), for approval before the treatment.

For further information, read the S2 (planned treatment) route application guidance notes (PDF, 154kb).

An application should include:

• evidence demonstrating that the eligibility criteria are met
• proof of residency
• written evidence of a full clinical assessment by a clinician in any EU country, Norway, Iceland, Liechtenstein or Switzerland. This assessment must clearly state why you need the treatment, and the time period in which you need this treatment, based on your circumstances. The clinician should support this statement by giving objective reasons. You may also provide supplementary written evidence from a UK based clinician to support your application
• confirmation that the proposed treatment provider will provide the treatment through their state funded healthcare system and can accept the S2 – the completed form should be completed and sent with your application - complete the provider declaration form (PDF, 141kb)
• full details of the type of treatment and the proposed provider – including admission and discharge dates, and estimated costs including any required patient contribution (a co-payment charge)
• your National Insurance number or NHS number, as appropriate
• if you're applying for an S2 for treatment in Switzerland - evidence that you have satisfied the nationality criteria, by providing proof of your UK, Swiss or EU nationality, or your status as a refugee or stateless person, or your status as a dependant of someone with one of those nationalities or statuses

If your supporting documentation is in a different language, you will need to provide an English translation. Translations do not have to be completed by an official translator. See the guidance notes for more information.

It can take up to 20 working days for a complete application to be processed and an entitlement decision to be made. It may take longer if your application is not complete and more information is needed.

Make sure you use the latest form, provided on this site, to submit your application. If you use an outdated form, you may be asked to supply further information or resubmit the application.

Where possible, submit applications by email. Send your completed application by email to: england.europeanhealthcare@nhs.net

Email your supporting documents as separate PDF attachments. Do not email embedded documents.

If you are unable to apply by email, send your completed form and accompanying documents to the following address:

European Cross Border Healthcare Team
NHS England
County Hall
Leicester Road
Glenfield
Leicester
LE3 8RA

Allow enough time for postal applications to be received and processed.

For more information about the Planned Treatment Scheme contact NHS England.

If NHS England approves your application, you'll be issued with an S2 certificate (payment guarantee form) by the NHS Business Services Authority. You'll need to give this to the relevant healthcare provider abroad.

Maternity

S2 applications relating to maternity are processed differently. For more information, see giving birth outside the UK.

UK issued S1 holders

If you live in an EU country, Norway, Iceland, Liechtenstein or Switzerland, are eligible and have a registered S1 form, you need to apply through the health authority in the country where you live. Do not apply to NHS England.

S2 costs and the co-payment charge

If your application under the S2 route is approved, your treatment will be provided under the same conditions of care and payment that would apply to residents of the country you'll be treated in.

This could mean you have to pay a percentage of the costs yourself (a co-payment charge).

For example, in some countries, patients cover 25% of the costs of their state-provided treatment. The state covers the other 75%. If you had treatment under such a healthcare system, you would be expected to pay the same co-payment charge as a patient who lives in that country.

In some countries, as in the UK, state healthcare is completely free. This means an approved S2 will cover 100% of the costs of your healthcare, so you would not need to pay any treatment costs.

You should therefore not be asked to pay for any treatment costs upfront, unless it’s for the co-payment charge. S2s cannot be issued or approved if the treatment costs have already been paid for (unless the payments are for the co-payment charge).

Make sure you’ve asked for an itemised estimate of all treatment costs including any expected co-payment before submitting your completed application for funding.

If your supporting documentation is in a different language, you’ll need to provide an English translation. Translations do not have to be completed by an official translator. See the guidance notes for more information.

You’ll be able to claim back any eligible co-payment when you return to the UK. Private healthcare costs, such as room upgrades, cannot be reimbursed. Make sure you’re aware of any costs you’ll need to pay before you have the treatment.

For more information or to apply for a reimbursement of a co-payment, contact Overseas Healthcare Services on 0191 218 1999 or complete the online form on the NHS Business Services Authority website.

NHS England will not reimburse travel or accommodation costs.

Request a review or appeal

If you're unhappy with the outcome of your application, you can request a review or an appeal.

You can request a review of the decision if you have more information or evidence that was not provided as part of the original application that you believe may affect the rejection decision.

You can request a formal appeal if you do not agree with the rejection decision, but do not have any more information or evidence.

Email NHS England on england.europeanhealthcare@nhs.net and quote the reference number included with the application outcome.

Concerns and complaints

Raise a concern

If you're unhappy with the review or appeal outcome, you can also raise a concern with the European Cross Border Healthcare (ECBH) team directly or via the NHS England Customer Contact Centre.

You would typically do this if you do not agree with a decision or you have experienced a problem with the processing of your application, for example an inappropriate delay.

Raise a complaint

You can also raise a complaint with the NHS England Customer Contact Centre if you want to complain about something, for example:

• if you believe the correct process is or was not being followed
• if you have concerns about how your application was handled, such as communication issues with the ECBH team or behaviours or attitudes of the team or team members
• if you want to complain about a policy issue in relation to your application

You cannot complain about the decision or outcome of the application. This would be considered as a review, appeal or concern and will be referred back to the ECBH team.