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Healthcare in the European Union: what you need to know

Healthcare in the European Union: what you need to know

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As a European citizen, covered by the health service of a Member State, you have the right to receive medical treatment in all the other EU Member States. The costs of treatment will be covered by your home country’s health authorities.

The costs of medical treatment in another EU country can be covered through:

  • Direct healthcare: your home country’s health service will pay directly the State health service of the treating country
  • Indirect healthcare: you will pay the cost of your care upfront to the public, private or private ‘under contract’ healthcare facilities or professionals of the treating country and you will then claim reimbursement from your home country’s health authority.

The general principles of the two EU legal instruments can be applied in specific ways in each EU country and may be accompanied by additional national rules.

Direct healthcare: the Regulations

You may receive treatment in another EU country, the EEA and Switzerland under the same conditions as those country’s citizens, through the direct healthcare scheme (Social Security Regulations (EC) No 883/2004 and 987/2009).

Your public health service will cover directly the cost of the cross-border healthcare you receive from public or contracted private healthcare facilities or professionals (direct healthcare). You will not be reimbursed for any co-payments.

This scheme does not apply to the healthcare provided by non-contracted private providers (or to the private services offered by contracted providers).

If you are temporarily in another Member State, taking into account the nature of the care and the expected duration of your stay, you will have direct access to necessary care by presenting your European Health Insurance Card (EHIC) or its replacement certificate.

The EHIC or its replacement certificate only cover medically necessary care.

If you intend to seek planned medical care abroad, under a specific treatment plan, hence prescribed in advance, you must obtain prior authorisation from your national health service/health insurance scheme.

For more information, see:

Authorisation for planned healthcare abroad is subject to two conditions:

  1. The treatment is appropriate and aimed at safeguarding the patient’s health
  2. the requested treatment is available under your home country’s national health service/health insurance scheme but cannot be provided in your country within a medically justifiable time period, in light of your health status and the probable course of your illness.

The authorisation is granted by issuing the S2 form, which must be submitted to the competent public health authorities or to the public or contracted health facilities/professionals.

Travel expenses may also be covered and, in some cases, the costs of an accompanying person.

Indirect healthcare: the Directive

You can receive treatment in other EU countries, Iceland, Norway and Liechtenstein by paying upfront for the treatment abroad and then claiming reimbursement from your home country, under the conditions described below (Directive 2011/24/EU of 9 March 2011 implemented by Legislative Decree No 38 of 4 March 2014):

  • under this scheme, you will pay the costs of treatment abroad upfront, subject to authorisation in specified cases, and you may subsequently claim reimbursement from your national health service
  • you will be reimbursed the cost that your home country’s healthcare service would have incurred, had the treatment been provided in its territory, without exceeding the actual costs of healthcare received. However, Member States may decide to reimburse the full cost of the cross-border treatment, even if it exceeds the costs they would have assumed had the healthcare been provided in their territory.

Reimbursable treatment is that provided by your home country’s healthcare service, except for:

  • long-term care (the purpose of which is to support people in need of assistance in carrying out routine, everyday tasks)
  • allocation of and access to organs for the purpose of organ transplants
  • public vaccination programmes against infectious diseases

For overriding reasons of general interest, Member States may limit the access of incoming patients to treatment in their territory and the application of the rules on reimbursement to outgoing patients.

Member States may also introduce a system of prior authorisation for cross-border healthcare which:

  • involves overnight hospital accommodation or requires the use of highly specialised and cost-intensive medical infrastructure or medical equipment
  • involves treatments presenting a particular risk for the patient or the population
  • is provided by public or private healthcare providers that, in the specific case, could give rise to serious and specific concerns relating to the quality or safety of the care.

Italian and EU citizens registered with the Italian Health Service who intend to avail themselves of indirect healthcare are required to apply for prior authorisation limited to the services provided for by Ministerial Decree 50 of 16 April 2018.

If you request authorisation for cross-border treatment under the indirect scheme (Directive) but the conditions for direct treatment are met, you will be authorised under the Regulations. In this case, if you prefer, you can expressly request application of the Directive.

Contact your National Contact Point

Relevant legislation

Social Security Regulation (EC) No 883/2004 of 29 April 2004
Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems - OJ L 166, 30.4.2004.

Social Security Regulation (EC) No 987 of 16 September 2009
Regulation (EC) No 987/2009 of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems - OJ L 284 30.10.2009

Directive 2011/24/EU of 9 March 2011
Council Directive 2011/24 of 9 March 2011 on the application of patients’ rights in cross-border healthcare – (OJ L 088, 4.4.2011)

Legislative Decree No 38 of 4 March 2014
Implementing Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare and Directive 2012/52/EU laying down measures to facilitate the recognition of medical prescriptions issued in another Member State.

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