Medical billing
EU cross-border healthcare — Directive 2011/24/EU reimbursement, the EHIC and the S2
SupranationalEURead off primary law
European Union (cross-border healthcare)
- Rule id
- medical.eu-crossborder
- Version
- 1.0.0
- In force from
- October 25, 2013
- Last read against its sources
- August 5, 2026
- Countries bound
- 27 countries
In plain language
What this regime says.
A patient insured in one EU member state who is treated in another has a right to reimbursement from their own state, up to what the treatment would have cost at home. A separate route — the European Health Insurance Card — covers care that becomes necessary during a temporary stay, on the same terms as a local patient.
Who is covered
People insured in an EU member state. The card route extends to Iceland, Liechtenstein, Norway and Switzerland; the Directive does not.
What you get
Reimbursement up to the home-state cost of the same treatment, capped at what you actually paid; treatment on local terms during a temporary stay; a reasoned decision on any refusal; and a national contact point in both states.
Where claims go wrong
- Not claiming at all. This is the most under-used right in European healthcare.
- Claiming from the wrong body. Reimbursement under the Directive comes from your own state, not from the hospital or the host state.
- Missing the national deadline for the claim while arguing with the provider about the invoice.
- Assuming prior authorisation was needed. Article 8 limits when it may be required, and a blanket authorisation requirement is not lawful.
Authority
Every citation,
with its pinpoint.
A claim that cites “EU law” gets filed. A claim that cites Article 7(1)(c) gets answered. These are the exact coordinates this entry rests on.
- Directive 2011/24/EU, Arts. 6, 7 and 8Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients' rights in cross-border healthcareURL verified 2026-08-05Art. 6 — national contact points; Art. 7 — the state of affiliation must reimburse the costs of cross-border healthcare up to the level it would have assumed had the healthcare been provided in its territory, without exceeding the actual costs; Art. 8 — prior authorisation may be required only in the limited cases listed and must not constitute a means of arbitrary discrimination or an unjustified obstacle
- Regulation (EC) No 883/2004, Arts. 19 and 20Regulation (EC) No 883/2004 on the coordination of social security systemsURL verified 2026-08-05Art. 19 — an insured person staying in another member state is entitled to the benefits in kind that become necessary on medical grounds during the stay, provided on behalf of the competent institution and under the same conditions as for people insured locally (this is what the European Health Insurance Card evidences); Art. 20 — authorised planned treatment in another member state, evidenced by the S2 document
Sources
Where a figure is indexed, converted or published by a regulator rather than fixed in the instrument, the provenance is recorded separately. Anything marked as a modelled estimate is exactly that — a model, not a statutory number.
- National contact points for cross-border healthcare, one in each member stateEuropean Commission, Directorate-General for Health and Food Safetyretrieved 2026-08-05
What it imposes
Clocks, defences and the ladder.
A rule module builds these while it evaluates, because a limitation period depends on which forum is open to you. What follows is the structure this regime produces — deliberately with no dates and no figures, because those belong to your facts rather than to the law.
What it entitles you to, beyond money
- Reimbursement up to the home-state cost of the same treatmentDirective 2011/24/EU, Art. 7. Claim from your own state's institution, not from the provider or the host state. The amount is what the treatment would have cost at home, capped at what you actually paid, and only your own institution can compute it — which is why no figure is stated here.
- Treatment on local terms during a temporary stayRegulation (EC) No 883/2004, Art. 19. Where care became necessary during a stay and you held a valid card, you were entitled to the same terms as a locally insured person. Being billed privately in those circumstances is a matter for the host state's liaison body and for your own institution.
- Information and assistance from a national contact pointDirective 2011/24/EU, Art. 6. Every member state operates one, in both the treating and the insuring state, and they exist precisely to answer this question.
Where to take it next
- Claim reimbursement from your own state's health insurance institutionAttach the itemised invoice, proof of payment and the medical justification. Ask which national deadline applies to the claim and get the answer in writing — this is the step people miss, and the deadlines are national and often short.Claim directtypically 60 days
- National contact point in your own state, and in the treating stateEstablished under Article 6 of the Directive. They advise on the procedure, the tariffs used and the prior-authorisation position, and can tell you quickly whether a refusal is well founded.Regulatortypically 30 daysofficial page
- Appeal a refusal of reimbursement or of prior authorisationArticle 9 of the Directive requires administrative decisions on cross-border healthcare to be properly reasoned and open to challenge, including judicial review. A refusal without reasons is itself a ground of complaint.Internal appealtypically 90 days
- SOLVIT, and then the national ombudsmanSOLVIT resolves cross-border problems caused by a public authority misapplying EU law, free and usually within ten weeks. It is the right forum where the obstacle is your own institution's treatment of the Directive rather than the merits of your claim.Ombudsmantypically 70 daysofficial page
Documents
What this regime can produce.
Every one of these is a document you send yourself, in your own name. Duesday never writes to anybody on your behalf and is never anyone’s agent.
The same claim type elsewhere
France — dépassements d'honoraires, secteur 1 and 2, and the OPTAMFRNational — FranceCode de la santé publique, art. R. 4127-53Confidence: mediumGermany — the GOÄ and GOZ private billing schedules and their multiplier limitsDENational — GermanyGebührenordnung für Ärzte (GOÄ), §§ 2, 5 and 12Confidence: mediumIreland — public hospital charges, medical cards and the HSE complaints routeIENational — IrelandHealth Act 1970 (as amended)Confidence: lowItaly — Servizio Sanitario Nazionale, the ticket and the URP routeITNational — ItalyLegge 23 dicembre 1978, n. 833Confidence: lowNetherlands — NZa tariffs, the eigen risico and the SKGZ dispute routeNLNational — NetherlandsWet marktordening gezondheidszorg (Wmg), art. 35Confidence: mediumSpain — Sistema Nacional de Salud coverage and the right to economic informationESNational — SpainLey 41/2002, de autonomía del pacienteConfidence: lowUnited Kingdom — NHS charging, overseas visitor invoices and private healthcareGBNational — United KingdomNational Health Service Act 2006, s. 1(4)Confidence: mediumArizona surprise out-of-network bill dispute resolution (A.R.S. § 20-3111 et seq.)US-AZSub-national — United StatesA.R.S. § 20-3111 et seq.Confidence: medium
Other rights in the same countries
Austria — ÖBB FahrgastrechteATNational — AustriaRegulation (EU) 2021/782 as applied in AustriaConfidence: lowAustria — rental deposit (Allgemeines Bürgerliches Gesetzbuch (ABGB) § 16b, and the Mietrechtsgesetz (MRG))ATNational — AustriaAllgemeines Bürgerliches Gesetzbuch (ABGB) § 16b, and the Mietrechtsgesetz (MRG)Confidence: lowBelgium — action en réparation collective (Code de droit économique, Book XVII)BENational — BelgiumCode de droit économique / Wetboek van economisch recht, Livre XVII, Titre 2 (arts. XVII.35 et seq.)Confidence: lowBelgium — rental deposit (Regional housing codes: Vlaams Woninghuurdecreet, Décret wallon relatif au bail d’habitation, Code bruxellois du Logement)BENational — BelgiumRegional housing codes: Vlaams Woninghuurdecreet, Décret wallon relatif au bail d’habitation, Code bruxellois du LogementConfidence: lowBelgium — SNCB/NMBS compensation for delays and for repeated delays on season ticketsBENational — BelgiumRegulation (EU) 2021/782 as applied in BelgiumConfidence: lowBulgaria — rental deposit (Закон за задълженията и договорите (Obligations and Contracts Act), наем)BGNational — BulgariaЗакон за задълженията и договорите (Obligations and Contracts Act), наемConfidence: lowCroatia — rental deposit (Zakon o najmu stanova and the Zakon o obveznim odnosima)HRNational — CroatiaZakon o najmu stanova and the Zakon o obveznim odnosimaConfidence: lowCyprus — rental deposit (Rent Control Law of 1983 (23/1983) for controlled tenancies, and the general law of contract)CYNational — CyprusRent Control Law of 1983 (23/1983) for controlled tenancies, and the general law of contractConfidence: low
Does this one reach your facts?
The engine runs every regime that could apply at once and reconciles them, rather than making you guess which page to read.
Not a law firm. Not legal advice. You send it yourself. This page describes a law; it is not advice about your situation and no outcome is promised.