The EU Directive
In 2011 the European Parliament introduced the European Directive on cross-border healthcare in order to better define the rights of EU citizens when seeking treatment in EU states other than their own. In essence, the directive means that an EU citizen has the right to medical treatment in any member state and to be treated on the same basis as they would in their home state.
The directive covers planned healthcare as opposed to emergency treatment which is usually covered through the European Health Insurance Card (EHIC) system.
The general rules for UK residents
It is usually more convenient to undertake treatment locally in your home country. However, if there is an undue delay in getting the treatment locally, the directive allows you to travel to another EU to obtain the treatment and to have the cost of treatment reimbursed by your own country’s healthcare system, providing the following rules are applied:
- EEA residency – to obtain treatment under the provision of the Directive you must be a resident of a country within the European Economic Area (EEA), including Norway, Lichtenstein and Iceland.
- Local availability – the treatment cannot not be funded by your home state’s health service unless it is already available in your home country.
- Reimbursement of costs – you will normally have to pay for your treatment costs beforehand and then apply for reimbursement from your own country’s healthcare system. Your home state is not obliged to pay for the cost of treatment beyond what it would have cost at home. Travel and accommodation costs will not normally be reimbursed and the patient will be responsible for ensuring that appropriate aftercare arrangements are in place after they have returned home.
- Refusal of treatment – a state may refuse to accept a patient from another country, providing they are able to explain their decision.
- Equality of provision – a patient from another EEA state cannot be given preference over patients already within the home state system.
What treatment am I entitled to?
You can only get reimbursements under the EU Directive for treatments that are funded by the NHS. If you are unsure whether the treatment you are seeking is funded by the NHS, please contact your health board for further information.
What is undue delay?
You must be allowed to have treatment abroad if you cannot have the same treatment on the NHS within a medically acceptable period. This applies both to the S2 route and the EU Directive.
The waiting time is based on your medical needs and the evidence that exists for your condition (such as NICE guidance). It also has to take into account your health and the likely course of your medical condition at the time of the decision.
Decisions on undue delay must be based on a medical assessment. This assessment must be kept under review while you're waiting for treatment. Therefore, any claim of undue delay must be supported by your clinician.
Offering treatment within a national waiting time target does not necessarily avoid undue delay.
Patients will only be entitled to reimbursement of travel expenses if they were entitled to such reimbursement within NHS Wales. The level of reimbursement will only be the same as the travel costs between home and your local health provider.
Appeal and review
If you're unhappy with the outcome of your application for treatment abroad, you can request a review of the decision. If you would like the decision to be reviewed, please contact your Health Board, quoting your unique reference number (provided when you were informed of the outcome of your application).