The E112 Form:
The E112 form entitles you to treatment in the state-funded sector in another EEA country and Switzerland. Treatment will be provided under the same conditions of care and payment as residents of that country. This could mean you have to pay a percentage of the costs up front.

If you received treatment under that healthcare system, you would be expected to pay the same co-payment charge as a patient from that country. You may be able to seek reimbursement for this cost when you are back in the UK, if you find that you are not able to do so in the other country (and limited to the equivalent cost on the NHS).

Equally, in some countries care is completely free at the point of delivery, as in the UK. This means the E112 will cover 100% of the costs of your care, so you would not be required to pay any treatment costs upfront. 

The system works with the NHS paying the treating country’s contribution. If the amount paid by the NHS to the treating institution on your behalf is less than the treatment would have cost to provide locally in the UK, and you have had to pay co-payment charges, you can claim the reimbursement of these charges up to the cost of providing the care locally by the NHS.

For example, if you go abroad for an operation costing £8,000, and are expected to pay a standard patient co-payment charge of 25%, you will pay £2,000. The NHS will pay the remaining £6,000 to the treating institution.

If the cost of treating you at home would have been £7,500 you could then claim back the extra £1,500 budgeted by the NHS to help cover the co-payment charge that you have paid.
Since the treatment is £500 more expensive than on the NHS, you would have to pay this portion yourself, and could not be reimbursed for it.

How to apply for an E112
You must apply to your local health commissioner for their written agreement to recommend funding for treatment. In making this decision, your local commissioner will need to be satisfied that:

• A UK NHS consultant has recommended in writing that you be treated in the other EU country, and that a full clinical assessment has been carried out to demonstrate that the treatment will meet your specific needs.
• The costs of sending you abroad for treatment are justified against the health commissioner’s responsibilities for spending money efficiently and fairly, in the interest of all the patients they look after.
• The treatment is available under the other country’s state health scheme.
• You are entitled to treatment under the NHS.

If it is agreed that you should go abroad for treatment, the appropriate paperwork should be passed to the Overseas Healthcare Team in Newcastle. They will consider the issue of the E112 form. If issued, you will need to take this form with you to the other member state where you are going for treatment.
Overseas Healthcare Team Tel: 0191 218 1999.

Article 49
Route Article 49, which is named after the relevant section of the European Community (EC) treaty, may allow you to obtain a reimbursement of the costs of planned medical treatment you receive in another EEA country. Your treatment must be one that is available through the NHS. However, there is no guarantee that you will receive funding.

Your local NHS commissioner can only issue a reimbursement for up to the cost of being treated locally under the NHS. Unlike using an E112 form, you can receive this financial contribution towards either private or state-provided treatment.

You will have to pay for the total cost of treatment upfront, and can normally only apply for reimbursement after your treatment has been completed and paid for. Even if your treatment abroad is cheaper than it would be under the NHS, you cannot be reimbursed more than you have paid for your medical treatment.

If you wish to apply under Article 49, you should consult your local health commissioner. They can work out the cost of local treatment under the NHS, and therefore the maximum amount you can claim as a reimbursement.

Comparison the E112 and Article 49
There are some major differences between the two application routes. In conjunction with your local health commissioner you should decide which route is most suitable:

Payment conditions

• E112: You will be treated as if you are a member of the treating country’s health system, e.g. the patient may need to pay a contribution towards healthcare costs which they may be able to seek reimbursement for when they are back in the UK if they are not able to do so in the other country (and limited to the equivalent cost on the NHS). The NHS will pay the treating country back their contribution.
• Article 49: You will be treated as if you are a member of your home member state, and therefore, you will have to pay treatment costs up front and seek reimbursement from your local NHS health commissioner.

Treating sector

• E112: Since this is based on agreements between governments it is only valid for State sector treatment.
• Article 49: This can be either State or private sector treatment as the NHS will be directly reimbursing you the fees you have paid.
  What happens next
• E112: the appropriate paperwork from your local commissioner should be sent to the Overseas Healthcare Team in Newcastle and they will consider issue of the E112 form and will post it to you. You will need to present the form to the hospital authorities abroad on admission.

Limit to amount that will be paid

• E112: There is no limit to how much will be paid to the treating institution, even if the cost is more than the treatment would have cost at home. The amount paid will match the treating country’s contribution, and may extend to reimbursing you a portion of your contribution.
• Article 49: The amount reimbursed to patient will be limited to what it would have cost to treat them under their local health care system.

Reimbursements

• E112: The patient only pays any co-payments (this is where, in some countries, a patient is required to pay a certain percentage of state-provided treatment).The patient may then be able to seek reimbursement for this cost when they are back in the UK if they are not able to do so in the other country (and limited to the equivalent cost on the NHS).
• Article 49: The patient pays total costs upfront and is reimbursed up to what the treatment would have cost at home. If the cost of foreign treatment is less than what treatment would cost under the NHS the patient will not get the excess.