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.   

As a UK citizen you have a right to seek medical treatment in Germany under the Cross Border Healthcare Directive (including EU countries, Norway, Liechtenstein, Iceland) and for the cost of this treatment to be reimbursed by the NHS England.

Unfortunately there are still very few UK citizens who really know and understand their rights under the EU Directive for the treatment elsewhere within the EU member states. Actually most UK patients are not aware that they may apply for the medical treatment in Germany and reimburse the costs for the medical treatment directly by the NHS.

You must comply with certain requirements to qualify for NHS funding of your treatment in Germany.

What to do before going to Germany for medical treatment?

If you're thinking about having medical treatment in Germany, it's important to understand how it works and the risks involved. If you don't follow the correct procedures, you may end up being responsible for the full cost of the treatment.

Contact NHS!

The general rules for UK residents

Subject to certain conditions, you're entitled to medical treatment in Germany. The most important condition in order to get NHS-funded treatment in Germany is that you must be resident in the UK and entitled to NHS services. 

You can only get reimbursements under the EU Directive for treatments in Germany that are funded by the NHS. If you are unsure whether the treatment you are seeking in Germany is funded by the NHS, please contact NHS England for further information.

Funding options

There are two ways to access NHS-funded healthcare in Germany:

• S2 route (or E112) – this is a direct arrangement between the NHS and the state healthcare providers in Germany. Prior approval is required.
   
• EU directive on cross-border healthcare (or Article 56) 

Generally, you'll have to pay the costs of treatment in Germany and then claim reimbursement from the NHS when you return. Depending on the treatment, it may be necessary for you to obtain authorization from NHS England before receiving treatment.

I. What is the S2 route?

The S2 (formerly E112) route entitles you to state-funded treatment in Germany.

Treatment will be provided under the same conditions of care and payment as for residents of Germany. This could mean you have to pay a percentage of the costs personally. However, you may be able to claim back some or all of the co-payment when you return to the UK. 

In Germany care is completely free, as in the UK. This means the S2 will cover 100% of the costs of your care, so you would not be required to pay any treatment costs upfront. 

Note: Treatment covered by an S2 cannot be experimental or a drug trial.

S2 eligibility criteria          

To be eligible for the S2 route, you must:

• be ordinarily resident in England
• be receiving treatment in the state sector
• be able to prove the German hospital will accept an S2 
• provide a letter of support from your consultant in the UK
• provide an estimation of cost from Germany
• provide the proposed dates of treatment  in Germany

How to apply

To be issued with an S2 form, you will need to apply for funding prior to treatment. Please ensure you are using the latest available form (as provided on NHS site) before submitting your application. Applicants using an outdated form may be asked to supply further information or resubmit their application.
 

NHS England will decide whether or not to approve your application and will need to be satisfied that:

• a NHS consultant has recommended in writing that you be treated in Germany, and a full clinical assessment has been carried out to show the treatment will meet your specific needs
• the costs of sending you to Germany for treatment are justified – the health commissioner is responsible for spending money efficiently and fairly in the interests of all the patients they look after the treatment is available under the German state health scheme
• you're entitled to treatment under the NHS

If NHS England approves your application, you will be issued with an S2 form. You will need to take this form with you to Germany where you will be receiving treatment. For more information, contact NHS England.

Maternity

S2s to cover maternity care in Germany country are processed differently. For more information, see NHS section Giving birth outside the UK.

Please note: It can take up to 20 working days for a fully completed application to be processed by NHS and a decision to be made. You will be informed of the outcome of your application once a decision has been reached. If approved, the reimbursement can take up to a further 30 working days to be processed.

II. What is the EU directive route?

The EU directive on cross-border healthcare was passed in 2011.

The directive grants a fundamental right to purchase healthcare services across the European Economic Area (EEA) for all EEA citizens, and the right to apply for reimbursement from their home system. The EU directive route to accessing healthcare in Europe is similar to the S2 route, but there are some important differences.

EU directive eligibility criteria for your treatment in Germany

You'll need to meet the following criteria to be eligible for funding under the EU directive:

• you must be ordinarily resident in England
• evidence of your medical need must be provided
• the treatment must also be available to you under the NHS
• some treatments require prior authorisation
• reimbursement for your German treatment will be limited to the cost of the same treatment under the NHS

How it works

The EU directive gives you the right to purchase healthcare services in Germany and apply for reimbursement from the NHS, as long as the treatment is medically necessary and would be made available to you under the NHS. It covers both treatment given in German state-run hospitals and German private service providers.

In most cases, you will have to pay the costs upfront. You can claim reimbursement when you return, up to the amount the treatment would have cost under the NHS.

Prior authorisation may be required in some cases. This will confirm whether you are entitled to the treatment in Germany and the level of reimbursement you can expect.

Find out by NHS what types of services require prior authorisation for the treatment in Germany.

You must be allowed to have treatment in Germany if you cannot have the same treatment on the NHS within a medically acceptable period. As with the S2 route, if "undue delay" applies in your particular case, you must be granted authorisation. Find out more about the general rules directly by NHS.

For more information and to ensure you don't have any difficulties when claiming back your money, contact NHS England before making any arrangements for Germany.

Entitlements for the EU Directive route for treatment in Germany

Under the EU directive route you are only entitled to funding for treatments in Germany that you would normally receive under the NHS. If you are unsure whether or not you're entitled to funding for a particular treatment, please contact NHS England or your local clinical commissioning group (CCG).

Within England, different aspects of healthcare are commissioned by different organisations. Your entitlement to funding will depend on the services that are commissioned for patients in your area and any criteria that apply.

Clinical commissioning groups (CCGs)

CCGs commission:

• most hospital services, excluding dental services, antenatal and newborn screening services, and specialised services
• community health services provided outside of acute hospitals, such as rehabilitation services

To find out more about what your CCG commissions, contact your local CCG. You can also find out how your local CCG performs.

NHS England

NHS England commissions: 

• specialised and highly specialised services – one of the eligibility criteria for a specialised service in Germany is prior authorisation ahead of treatment: find out what types of services require prior authorisation
• primary care services – such as GP, dental, community pharmacy, and high street optometry services
• other dental services

For more information, contact NHS England on 0300 311 22 33 or england.contactus@nhs.net

How to apply

You will need to complete the application form that can be provided by NHS if you seek prior authorisation for treatment or want to apply for funding or reimbursement. When applying for reimbursement, original receipts and proof of payment must be supplied.

Note: Please ensure you use the latest available form before submitting your application. Applicants who use an outdated form may be asked to supply further information or resubmit their application

Note: an agreement to fund your treatment abroad by the NHS does not mean the NHS is liable for the treatment you receive.

 
Compare funding routes

There are some major differences between the two application routes.

1. Payment conditions

• S2 Route
  The UK will cover the cost of your German treatment, but you may have to pay a contribution towards healthcare costs, depending on what the common practice is in Germany. However, you may be able to claim back some or all of the co-payment when you return to the UK.
   
• EU directive
  You will normally have to pay treatment costs upfront and then apply for a reimbursement from NHS England. Reimbursement will be limited to the cost of the same treatment under NHS.

2. Treating sector

• S2 Route
  Since this is based on agreements between governments, it is only valid for state sector treatment.
• EU directive
  Treatment can be in the state or private sector, as the NHS will directly reimburse the fees you have paid.

3. Application process

• S2 Route
  Fill in the application form provided by NHS and send it to NHS England. Make sure you are using the latest available form before submitting your application. Applicants using an outdated form may be asked to supply further information or resubmit their application.
  Once they have received your application form, NHS England will decide whether or not you are eligible for funding via this route. If you are, you will be issued with a S2 form, which you will need to present to the health service provider in Germany, such as the hospital or dentist, when you're admitted.
  For more information, contact NHS England: England.europeanhealthcare@nhs.net.
• EU directive 
  Again, fill in the application form provided bandy NHS and post it to NHS England. You'll need to supply original receipts and proof of payment. If you are considering going to Germany and claiming reimbursement after treatment, we recommend you contact NHS England at England.europeanhealthcare@nhs.net to confirm your eligibility.
  Some services are subject to prior authorisation – you will therefore be required to apply for funding before going to Germany for treatment. Find out what types of services require prior authorisation by NHS.  

4. Limit to funding and reimbursements

• S2 Route
  There is no limit to how much can be paid to the German institution treating you, even if the cost is more than the treatment would have been under the NHS. However, some medical institutions in Germany require a patient contribution that you have to pay upfront.
• EU directive
  You'll have to pay the cost upfront and seek reimbursement when you're back in the UK. However, you can only claim for the amount treatment would have cost in the UK. If the treatment is more expensive, you'll have to cover the additional costs. If the treatment was cheaper than under the NHS, you will not be able to profit from it and ask for the difference in return from the NHS.
   

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.