Reimbursed medical treatment in Germany for UK citizens! Apply now!

Please be advised that SilaMed's information about the medical treatment in Germany of the foreign patients, reimbursement of costs in the UK as well as the travel insurance for medical treatment are based on the data provided by the official sites of NHS, the European Commission and the Federal Ministry for Economic Affairs and Energy.   

Please note that SilaMed cannot provide any medical advice, diagnosis or treatment, and does not make recommendations in choosing a German medical provider – that is a decision that remains entirely up to you.

Planned Treatment Abroad (Germany) After Brexit

NHS-Funded Planned Treatment (S2 Scheme):

UK citizens can still receive NHS funding for pre-arranged medical treatment in Germany (and other EU or EEA countries) through the S2 funding route. This scheme allows eligible patients to get treatment from public healthcare providers abroad with NHS covering the costs, as long as prior authorization is obtained . The S2 route only covers treatment in the German state healthcare system (public hospitals or clinics) – private treatments are not covered . You must apply and get NHS approval before travelling; if you undergo treatment without prior approval, you will usually be responsible for the full cost  .

Eligibility and NHS Approval Process:

To use the S2 scheme, you need to be ordinarily resident in the UK (entitled to NHS care) and meet specific criteria. Key requirements include  :

• NHS Availability & Undue Delay:

The treatment you seek in Germany must be a type that is routinely provided by the NHS in your case, but your local NHS cannot provide it in a medically acceptable timeframe (this is known as “undue delay”) . Essentially, you must demonstrate a clinical need that cannot be met quickly enough at home.

• State Healthcare Provider:

The German hospital or clinic must be part of the public healthcare system and agree to accept the S2 form as payment. The treatment must be available to German residents under their statutory health scheme (not a purely private service) .

• Medical Referral:

You will need documentation from a doctor. Typically, a German specialist (or other EU/EEA clinician) must provide a letter after evaluating you, confirming your diagnosis, the necessity of the treatment, and the timeframe in which you need it . (A supporting letter from a UK consultant or GP can also help.) The German provider should also supply an estimate of costs and proposed treatment dates, and must confirm they will treat you under the S2 arrangement .

• Residency and GP Referral:

You must prove you are a UK resident eligible for NHS care (e.g. provide your NHS or National Insurance number and proof of address) . Usually, you should have been seen by your NHS GP or specialist about the condition, and have a referral if the treatment abroad is hospital-based .

To apply, you fill out an S2 application form (available from NHS England) and submit it with the supporting documents before you undergo treatment . Applications can be emailed to the NHS European Cross-Border Healthcare Team for processing, and it may take around 20 working days to get a decision . If approved, you’ll receive an S2 certificate (payment guarantee form) issued by NHS Business Services Authority, which you then give to the German healthcare provider . The S2 acts as a promise that the NHS will cover the treatment cost as per the German public healthcare rates.

Costs and Reimbursement under S2:

When using an approved S2, your treatment in Germany is provided on the same terms as for a German resident . This means you should not be charged for anything a German patient wouldn’t pay for. In Germany, many standard treatments are covered entirely by statutory insurance, but patients may owe certain co-payments (for example, a German patient pays about €10 per day for a hospital stay) . If the German system requires a patient contribution, you would be responsible for the same co-payment during your treatment . You should not be asked to pay the full bill upfront – the German insurer or health authority bills the NHS for the covered portion, and you only pay any required patient share .

After returning to the UK, you can claim reimbursement for any co-payments you had to pay for S2-approved treatment. The NHS will refund eligible out-of-pocket charges related to the authorized treatment (usually up to the equivalent NHS cost for that treatment, known as the NHS tariff)  . For example, if you paid a €50 statutory co-pay in Germany, you can submit those receipts to reclaim that amount. However, private add-ons or upgrades (like paying for a private room or any treatment outside the state system) are excluded and will not be reimbursed . Also note, the NHS does not cover travel, accommodation, or non-medical expenses for treatment abroad , so you would bear those costs yourself.

Post-Brexit Changes:

Following Brexit, the UK’s participation in the EU’s general cross-border healthcare directive ended. UK residents can no longer use the EU Directive route for new planned treatments in Europe. (This was the program that let patients pay upfront for treatment in an EU country and then claim reimbursement from their home health service.) The NHS confirms that you cannot apply for reimbursement under the EU directive for any treatment that started or was approved after 11 pm on 31 December 2020 . In practice, this means the S2 scheme is now the only route for NHS-funded pre-planned treatment in Germany post-Brexit. The S2 process itself remains similar to before – the UK’s agreement with the EU (and separate deals with EEA countries and Switzerland) preserved this reciprocal healthcare arrangement . Always check the latest NHS guidance, as eligibility criteria or application forms can be updated. Before pursuing treatment abroad, discuss it with your GP and ensure you have written approval in hand; otherwise, you will likely be liable for all costs if you go ahead without the S2.

Emergency or Necessary Treatment During Travel

Coverage for Urgent Treatment with GHIC/EHIC:

If you are visiting Germany on holiday, for work, or other temporary stay, and you unexpectedly need healthcare (for example, emergency treatment or care for an illness/injury that arises during your trip), you can use a UK Global Health Insurance Card (GHIC) or a valid European Health Insurance Card (EHIC) to access treatment. Germany, like other EU countries, accepts the GHIC/EHIC as proof of entitlement to public healthcare for visitors. Even after Brexit, UK-issued EHICs or the new GHIC give UK citizens the right to “medically necessary” state-provided healthcare in Germany under the same conditions as German nationals . “Medically necessary treatment” means any urgent or unplanned care that can’t reasonably wait until you return to the UK – for example, treatment for accidents, sudden illness, or flare-ups of pre-existing conditions while abroad .

Using the GHIC/EHIC in Germany:

Always carry your GHIC (or EHIC) and photo ID when traveling. If you require medical attention, present your card at the hospital, clinic, or doctor’s office before you receive treatment. Ensure that the provider treats public health insurance patients (look for signs like “Alle Kassen” or ask if they accept the EHIC/GHIC) – the card only covers care in the public system, not private clinics . With the GHIC/EHIC, you should be treated as if you are insured under Germany’s statutory health scheme (gesetzliche Krankenversicherung). In practice, this means the cost of your necessary treatment is mostly covered by the German health system, with only standard patient charges, if any, to pay. Germans pay small user fees for certain services, so you should expect the same minimal charges as a local patient. For example, hospital inpatients are charged €10 per day and prescription medications require a small co-pay (usually €5–10 per item) under German law . If you receive those services, you would pay those fixed fees directly to the hospital or pharmacy, but you will not be billed for the full treatment cost – the rest is settled via the German insurer and the NHS agreement.

Crucially, a GHIC/EHIC is not a substitute for travel insurance. While it covers most medically necessary care in public facilities, it won’t pay for private healthcare or services not covered by the German state system, nor extras like mountain rescue, medical repatriation to the UK, or stolen property . Always take out comprehensive travel insurance, which can cover those situations or any co-payments you might incur. The UK government and NHS advise having travel insurance even when you carry a GHIC, to ensure you’re fully protected.

What if you don’t have your card? If you forgot your GHIC/EHIC or it hasn’t arrived yet, you can still get healthcare – you’re entitled to treatment, but you may need to obtain a Provisional Replacement Certificate (PRC). A PRC serves as a temporary proof of your UK coverage. To get a PRC, you (or someone on your behalf) can contact NHS Overseas Services while you’re at the German medical facility, and they will fax or email a certificate to the provider . This PRC gives you the same cover as the GHIC/EHIC for that visit . If you cannot obtain a PRC immediately, you might have to pay for treatment upfront – but be sure to keep all invoices and receipts so you can claim a refund later. Once a PRC is provided (even after you’ve paid), the German insurer or NHS might arrange to cover the costs or reimburse you. Always ask the hospital if they can wait for a PRC or invoice you later, rather than charging you on the spot.

Emergency Treatment Costs and Reimbursement:

In many cases, if you use your GHIC/EHIC properly, you won’t need to pay anything at the time for urgent care (besides nominal fees) – the billing is handled between the German health insurer and the UK’s NHS system. However, the exact process can vary. In some instances or some healthcare settings, you might be asked to pay the bill upfront (especially if you did not show a GHIC or if the provider isn’t set up to directly bill overseas insurances) . Germany’s system typically bills insurers directly for hospital care, but for outpatient doctor visits and prescriptions, it’s possible you could be asked to pay and claim refund later (as is common in countries like France, for example). If you are charged out-of-pocket for any state-provided medical treatment in Germany, you have the right to claim reimbursement from the NHS upon your return to the UK . The NHS Business Services Authority will assess your claim to ensure the treatment was medically necessary and should have been covered by the GHIC/EHIC arrangement .

When you pay upfront, German providers should charge you the same rate they charge their public insurance fund. Keep all paperwork given to you – doctor’s notes, invoices, payment receipts, discharge summaries – as you’ll need these for a refund claim . The NHS will refund all eligible costs that a German resident wouldn’t have had to pay. In other words, you’ll get back the portion of the bill that would have been covered by German statutory insurance, but not any patient co-payment that German law requires locals to pay . For example, if you paid €100 for a treatment and a German resident would normally have €80 covered by insurance and €20 as a co-pay, the NHS can reimburse you ~€80 (converted to GBP) while the remaining €20 is your own cost – because German patients also pay that part . This principle ensures fairness: the GHIC/EHIC gives you the same coverage as locals, not more. (Notably, in the case of a pre-approved S2 planned treatment, the NHS does refund the co-payment in many cases, but for routine emergency care via GHIC/EHIC, patient co-payments are not refundable .)

In summary, urgent or unplanned medical care in Germany is accessible to UK travelers through the GHIC/EHIC system. This remained in place after Brexit due to a new UK–EU agreement on reciprocal healthcare. Always use your GHIC/EHIC at the point of care to minimize charges. If you do end up paying, the NHS can reimburse you for covered services as long as you follow the proper claims process (outlined below). Remember that seeking necessary treatment with a GHIC/EHIC will not impact you negatively with the NHS – it’s part of the service, and you won’t have to pay anything to the NHS for using the card abroad. Your focus should be on getting the care you need without delay, and then sorting out any paperwork afterward.

NHS Reimbursement Process and Limitations

Whether you received planned treatment in Germany (with prior NHS approval) or had to get emergency treatment during a visit, you may need to claim money back from the NHS for costs you paid. The reimbursement process differs slightly for planned S2 treatments versus unplanned care, but there are common principles. Below is an overview of how to claim, what costs are covered, and important restrictions to be aware of:

1. How to Submit a Claim to the NHS:

• Planned Treatment (S2) Co-Payments:

If you used the S2 scheme for a pre-approved treatment in Germany and had to pay any co-payment or patient contribution, you can claim this back after you return. The NHS Business Services Authority (BSA) handles these refunds. You will need to complete a special S2 refund claim form and send it to Overseas Healthcare Services (part of the NHSBSA) . Make sure to include evidence of the costs you paid, such as original invoices from the German provider and proof of payment (receipts or bank statements) showing that you paid those bills . If the invoices are not in English, provide a translation (you can do this yourself or have someone translate, as long as it’s accurate and signed) . Submit each separate treatment episode as a separate claim with its own form and signed declaration. The NHS will review the claim to verify that the charges were indeed for the treatment authorized under your S2 certificate . Once validated, the refund for eligible costs will be paid to you (usually into your bank account). Contact NHS Overseas Healthcare Services by phone or online if you need help with the form .

• Emergency/Urgent Treatment Costs:

If you had to pay for medically necessary treatment while visiting Germany (for example, you didn’t have your GHIC with you, or you were billed in error), you can claim a refund from the NHS for those costs. Download and fill out the NHS overseas refund claim form (available from the NHS or NHSBSA website) . In the form, you’ll detail the treatment and costs incurred. Attach all original bills and receipts from the German hospital/doctor/pharmacy . It’s also helpful to include any supporting documents that prove the care was state-funded – for instance, a letter from the provider or a discharge paper indicating you were treated in a public facility. You should also provide copies of your GHIC/EHIC (if you have one) and any correspondence about a Provisional Replacement Certificate if obtained. Send the completed claim form and documents to NHS Overseas Healthcare Services (the address or email will be on the form/website) . If you had travel insurance that covered some of the cost, note that as well; the NHS might reimburse your insurer directly for the portion they covered, or they will coordinate so you’re not paid twice. The claims team will evaluate whether the treatment should have been free or reduced cost under the GHIC agreement . If yes, they will reimburse you for the eligible amount (see next section for how amounts are determined). It’s important to keep copies of everything you send and to submit claims promptly. While there isn’t a hard deadline mentioned in guidance, it’s best not to delay – aim to file the claim as soon as you have all necessary documents, ideally within a few months of treatment.

2. Reimbursement Amounts and Limitations:

• Planned (S2) Treatment Costs:

Under the S2 scheme, the bulk of the treatment cost is covered directly by the NHS – you typically won’t pay anything to the foreign hospital except possibly the nominal charges mentioned. If you did pay a statutory co-payment, the NHS can refund you up to the full amount of that co-payment, provided it does not exceed the cost that the NHS would normally pay for the same treatment in the UK . In most cases, German public healthcare costs are comparable to NHS tariffs, so the co-payment you paid (if any) is usually fully reimbursable. For example, if your German treatment would have cost the NHS £5,000 but Germany covered all but a €100 patient fee, the NHS will likely refund that €100 (converted to pounds). The phrase “up to the cost of the NHS tariff” means if the German patient charge is extremely high or includes elements not usually provided on the NHS, they might cap the refund at what the treatment would cost the NHS. In practice, any required patient share for standard treatment is paid back to you . Remember that the NHS will not reimburse anything you spent on private care or services outside the agreed treatment. If you opted for something not covered by your S2 (e.g. an additional procedure or an upgrade), those costs come out of your own pocket . Also, as noted, peripheral expenses (flights, hotels, local transportation) are not covered by the NHS – plan those costs into your budget if you travel for treatment .

• Emergency Treatment Costs:

Reimbursements for ad-hoc treatment in Germany are calculated based on what the care would have cost a German resident. The NHS will refund you in GBP, using the exchange rate applicable at the time of treatment, for the portion of your bill that the German state health system would ordinarily cover . The local co-payment (patient contribution) is not refunded because that’s an amount German patients must pay themselves as well . For instance, if you paid a €30 doctor’s bill and, by German rules, €20 of that would be reimbursed by a German insurer and €10 is the standard patient fee, the NHS will give you back €20 (converted to pounds). If Germany provides full coverage for an item (say, emergency surgery costs), and you were charged in error, you’d get the full amount back. The NHS will not reimburse above what the treatment would have cost under Germany’s public system, nor will they cover private hospital rates. This means if you accidentally went to a private clinic and paid £500 for a service that’s free in a public hospital, the NHS cannot refund you anything, because the agreement only covers public care . Similarly, if you were charged incorrectly (more than the official rate), the refund will be based on the correct rate. In summary, you can expect to get back everything you’re entitled to under the GHIC arrangement, but nothing more. It’s also worth noting that routine patient charges in Germany (like the prescription fees) are usually small, so many minor expenses won’t be refundable simply because they fall under patient responsibility. The GHIC ensures you don’t pay large treatment costs, and the NHS refund process takes care of situations where you had to pay upfront or were overcharged.

3. Restrictions and Important Notes:

• State-Only, No Private Care:

NHS reimbursements apply only to treatment received within the public healthcare system. Private medical treatment is excluded from all these schemes . If you choose to see a private doctor or use a private hospital in Germany, you must pay the full cost – neither GHIC/EHIC nor the S2 will cover private fees, and the NHS will not pay you back. Make sure the providers you visit are part of the statutory system (in Germany, doctors who see public patients usually display a sign for Kassenpatienten). In the context of planned treatment, S2 cannot be used for private clinics, and even if a public hospital offers an optional private-service package, those costs (like a private room or surgeon of choice) will not be refunded . The UK government will only pay for the standard care that a German insured patient would get .

• Need for Prior Authorization (Planned Care):

For non-emergency treatment, NHS England approval is mandatory before you go abroad. You cannot retroactively apply for S2 funding after getting treated. If you did not follow the S2 process (for example, you went to Germany on your own for surgery without informing NHS England), you generally won’t be able to claim any reimbursement from the NHS. The only exception was under the old EU directive route, which as mentioned is no longer available for new cases after Brexit. All current official guidance emphasizes that you must get the S2 form issued in advance to have NHS cover for planned overseas care . UK citizens should be aware that just because a treatment might be cheaper or faster in Germany does not mean the NHS will pay for it; you must meet the strict criteria and go through the application steps. Conversely, if you do get approval, ensure you stick to the treatment as approved (dates and procedures) – changes or additional treatments would require a revised S2 or new approval.

• Time Limits and Documentation:

While the guidance doesn’t specify a firm deadline for making reimbursement claims, it’s wise to file your claim as soon as possible after treatment – delays could complicate currency conversions or verification of your documents. Keep copies of all documents you send. If anything is missing (like no proof of payment), the NHS may come back to you for clarification, which will delay your refund. Also note that if you didn’t actually pay any money out-of-pocket, you cannot claim “reimbursement” (since there’s nothing for the NHS to refund you) . For example, if the hospital accepted your GHIC and you paid nothing, you can’t later ask the NHS to pay you (any cross-border billing is handled government-to-government in that case). Reimbursements go to whoever incurred the cost – if your travel insurance paid the German provider directly, the NHS might reimburse the insurer rather than you, or adjust the amount to avoid double paying . The process is intended to make you whole for expenses you shouldn’t have had to bear, not to profit or cover costs that were never your liability.

• GHIC/EHIC Validity:

After Brexit, UK residents should obtain the new GHIC (free of charge from the NHS) to ensure continued cover in Europe. If you still have a UK-issued EHIC from before Brexit, it remains valid until its expiry date . Both cards are functionally equivalent for EU countries like Germany . One subtle distinction: some UK nationals living abroad or with certain statuses can get a “UK EHIC” (under the Withdrawal Agreement) which also covers EEA/Switzerland, but for the average UK traveler, the GHIC is the right card. Be aware that the GHIC/EHIC covers EU countries and Switzerland; it does not cover other nations worldwide (despite “Global” in the name). For destinations outside the EU/Switzerland, reciprocal deals are separate or non-existent, so never assume you have coverage without checking . For Germany specifically, GHIC/EHIC is the key to accessing care easily.

In conclusion, UK citizens can indeed still get reimbursement from the NHS for treatment in Germany after Brexit, but it’s crucial to follow the official procedures. For planned treatments, that means securing S2 approval beforehand and abiding by the requirements. For unplanned treatments, carry your GHIC, use public healthcare providers, and save your receipts. The latest NHS and government guidance stresses continuity of emergency healthcare rights in the EU (via the GHIC)  and the continued availability of the S2 scheme for planned care . Post-Brexit changes have mostly affected the prior EU directive route, which is no longer in operation  – otherwise, reciprocal healthcare between the UK and Germany remains strong. Always consult official NHS sources or gov.uk before your trip for up-to-date information, as policies can evolve. With the proper preparation, UK patients can confidently access necessary medical treatment in Germany, and either have the costs covered upfront or claim eligible refunds from the NHS afterward, preserving healthcare continuity across borders.