TempoLife › Features › Hospitals, emergency care and waiting lists › cross-border
Falling ill abroad, and planned treatment in another country
Three different EU mechanisms get confused with each other constantly: the card for unplanned care, the authorised route for planned care, and the pay-and-claim directive.
This page explains how the system works. It is not a diagnosis, it cannot tell you how urgent your own situation is, and it is not a directory: it carries no clinic addresses, opening hours or visiting times, because those change and a wrong one sends you to a closed door. If someone may be seriously ill or injured, call the emergency number — 112 across the region, 113 for medical emergencies in Norway — and if you are unsure, call your country’s advice line rather than deciding from a web page.
The card is for what happens to you, not for what you go for
The European Health Insurance Card covers medically necessary state-provided care during a temporary stay in another EU or EEA country or Switzerland, so that you are not forced to travel home to be treated. It is not travel insurance and it is not a discount card. Three limits catch people out. It applies to public providers, so a private clinic that treats you is a private bill. It covers what is necessary before your planned return, judged by the treating clinician, which is a different test from "anything that went wrong". And it does not cover repatriation — flying a sick or injured person home is the single largest cost in this area and it needs commercial insurance. Carry both, and carry the card in a form you can actually show.
Two routes for planned treatment, and they behave differently
If you intend to be treated in another country, there are two mechanisms and choosing the wrong one is expensive. The S2 route, under the EU social security coordination regulation, requires authorisation from your own health insurance body before you travel; with it, you are treated as if you were insured in the country of treatment, which usually means the public system pays and you pay only what a local would. The directive route needs no prior authorisation for most outpatient care: you arrange the treatment, pay the provider yourself, and claim reimbursement afterwards up to what the same treatment would have cost your own system — which can be much less than you paid. Treatment requiring an overnight stay or highly specialised equipment can still require prior authorisation even under the directive.
What to do before you go
Ask your own national contact point rather than the foreign clinic; every member state has one, and its job is exactly this question. Get the prior authorisation in writing if the route needs one, and ask specifically whether your treatment is on the list that requires it. Establish what your own system pays for the procedure, because under the directive that figure is your ceiling and it is the number that determines whether the trip makes financial sense. Ask whether travel and accommodation are covered — usually they are not. And ask who provides the follow-up, because a complication that appears after you fly home is treated at home and the surgeon is not.
| Route | What it covers | What you do |
|---|---|---|
| European Health Insurance Card | Medically necessary state care during a temporary stay in another EU or EEA country or Switzerland, on the same terms as a local resident | Show the card at a public provider; you pay whatever a local would pay |
| S2 authorisation | Planned treatment in another member state, arranged in advance, paid as if you were insured there | Apply to your own health insurance body before travelling; approval is required |
| Directive 2011/24/EU | Planned cross-border care you arrange yourself, reimbursed afterwards up to what your own country would have paid | Pay the provider, keep everything, claim from your national contact point on return |
Coming home with a record
The practical failure in cross-border care is documentation. Ask for a discharge summary, the operative note, the imaging on a disc or a transferable link, the histology if there was any, and a list of medicines with generic names rather than brand names, because a brand that exists in one country may not exist in another. Get it in English if you cannot get it in your own language. The European electronic exchange of patient summaries and prescriptions is expanding but is not yet a substitute for carrying the paper. The records page covers what your national portal will and will not hold.
After Brexit and outside the EU
The card scheme covers the EU and EEA plus Switzerland; arrangements with the United Kingdom exist under the post-withdrawal agreements and are their own case, so check them rather than assume the card behaves identically. Outside that area there is no coordination mechanism at all and the only protection is commercial travel insurance — which is also, everywhere, the only thing that pays for getting you home. If you take one action from this page, make it that one.
Sources: Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare · Regulation (EC) No 883/2004 on the coordination of social security systems · European Commission — the European Health Insurance Card · checked 2026-09-08
Frequently asked questions
Does the European Health Insurance Card make treatment free?
No. It gives you state-provided medically necessary care on the same terms as a local resident, so you pay what they pay — nothing in some countries, the ordinary visit fee in others. It does not cover private providers, planned treatment you travelled for, or repatriation.
What is the difference between S2 and the cross-border directive?
S2 is prior authorisation from your own insurer for planned treatment abroad, after which you are treated as if insured in that country. The directive route needs no authorisation for most outpatient care but works on pay-and-claim: you pay the provider and are reimbursed up to what your own system would have paid, which may be less.
Who covers flying me home?
Nobody in the public schemes. Repatriation is excluded from the European Health Insurance Card and from the planned-treatment routes, and it is the most expensive thing that happens to a traveller. It is what travel insurance is for.
Where do I ask about this?
Your own country’s national contact point for cross-border healthcare, which every member state operates. It is the body whose job is to tell you which route applies, whether prior authorisation is needed and what your own system would pay.
Related pages
Emergency department, out-of-hours or your own doctor?
Five doors into the same health service, what each is actually for, and the two questions that pick the right one in about ten seconds.
How the emergency department decides who goes first
The five-level ladder, the target times that go with each colour, why arrival order is irrelevant, and what to do when you get worse in the waiting room.
Calling an ambulance: what the dispatcher asks, and why
The questions in the order they come, why you must not hang up, what to do in the minutes before the crew arrives, and when they will send something other than an ambulance.
Stroke, heart attack and sepsis: the conditions with a clock
The three emergencies where the treatment that works expires, the signs that should end the discussion, and why the ambulance beats the car even when the car is faster.
Which emergency department for a child
Where the paediatric emergency care actually is in this region, the age rules that override everything, and the signs that make a child’s illness a same-hour problem.
Every country, every number
The hub: emergency and advice numbers for the whole region, the access rules and all the country pages.
The four questions a hospital always asks
Age, weight, what you take and when it started. TempoLife keeps the medicine log, the symptom timeline and the measurements in one place, so the answers exist before anyone asks for them.