THE TWO MAIN OPTIONS & REIMBURSEMENT

“UK patients may go abroad for treatment within the European Union (EU) if a commissioning body commissions care abroad or if a patient asks to go abroad for care” Department of Health 2011

If you’re thinking about going abroad for surgery or any other form of medical treatment (including giving birth), the NHS may offer you financial and aftercare support. Many people are unaware of the fact that, whatever your reasons for going abroad, you may well be entitled to medical care at a reduced cost or sometimes free of charge.

Your entitlement will vary based on whether you’re going to a European Economic Area country (EEA) or another country in the world. If you are going abroad specifically for medical treatment different rules apply than those for getting necessary emergency care whilst you are away on a holiday or a business trip.

Information about European Economic Area (EEA) Countries

Information about NON European Economic Area (EEA) Countries

Current EU Regulations

Please note that your European Health Insurance Card (EHIC) does NOT cover going abroad for PREPLANNED surgery or and other treatment.

However NHS patients are entitled, subject to certain conditions, to receive care in another European Union (EU) country. This means that your local Health Commissioner should have a system in place to deal with requests for surgery and other forms of medical treatment abroad and should always give such requests serious consideration.

You must always remember that if there is UNDUE DELAY no Primary Care Trust is allowed to refuse a request for treatment abroad. You must also bear in mind that any decisions made, with regard to whether there is ‘undue delay’ or not, should be based on a clinical assessment of your individual circumstances.

USING THE FORM S2 (E112) OPTION

This option is based on agreements between Governments and it is only valid for state sector treatment. There is currently NO limit with regard to how much will be paid to the treating institution…even if the cost is more than the treatment would have cost in the United Kingdom. The amount paid will match the treating country’s contribution and may also include reimbursing you for some of your contribution.

If you use this option the NHS will cover the cost of treatment. You may need to pay a contribution towards your healthcare costs abroad that you may be able to have partly or fully reimbursed when you are back in the UK if you are not able to do so in the other country.

You may also pay ‘co-payments’. That is, you may be asked to pay a percentage of the cost of the state-provided treatment. If this happens you may then be able to seek reimbursement for this cost when you return to the UK – if you are not able to do so in the other country.

USING THE ‘ARTICLE 56’ OPTION

The ‘Article 56’ option can include state or private sector treatment and the NHS will be directly reimbursing you the fees that you have paid. However, the amount reimbursed to you will be LIMITED to what it would have cost to treat you under your local NHS health care system. Also please note that, if the cost of your foreign treatment is LESS than the cost of the treatment in the NHS, you will NOT receive any excess amount.

If you choose or are offered the ‘Article 56’ option you will pay for the TOTAL COST of your surgical procedure, or any other medical treatment upfront, and you should then be reimbursed – but your reimbursement will only be up to the cost of the treatment in the UK. If the cost of foreign treatment is LESS than what treatment would have cost under the NHS you will NOT receive the excess amount.

Your local Health Commissioner can advise you on which option is better for the type of treatment that you want. Please note that each option works in a slightly different way.

There are NO formal arrangements in place if you go to a non EEA country for surgery or treatment. Therefore, if this is your intention, you should speak to your local Health Commissioner and ask if they would be willing to fund your surgery or treatment and/or if they have any specific arrangements in place with regard to your preferred country.

For further information about the ‘Article 56’ option you may like to use the following link.

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_115256

A Department of Health publication clearly states that Primary Care Trusts “cannot insist on a patient obtaining prior authorisation where this is not justified…there may well be occasions where patients return from an EEA country where they have incurred treatment costs and then seek to claim reimbursement from the PCT – less any applicable NHS charges. The principal considerations are whether there is a proven clinical need for the treatment and whether the patient would have been entitled to the same or similar treatment on the NHS”

You will only receive a REIMBURSEMENT for the cost of any surgical procedure, or any other medical treatment, if your PCT has agreed to fund it so (if you need to be reimbursed for some of the costs) it is stressed that you should not make any arrangements until you have received written approval from the NHS.

Your ‘home health service’ is responsible for deciding the care that you can receive. You should know that (even if a treatment is funded elsewhere in the UK) if you seek care abroad that has not been approved by your local Health Commissioner, you will have to pay for it yourself and you will not be entitled to any reimbursement. However, if you are unhappy with any decision or recommendation (in the case of S2′s or E112’s) there should be a local appeals procedure that can be used.

Also please note that, if you make a decision to go abroad for healthcare (funded or not) it is strongly recommended that you should to take out a specific insurance policy, before you make any travel or medical arrangements, to ensure that any unforeseen problems and/or emergencies are properly covered.