Nhs Funding For Treatment In The European Economic Area (Eea) Application Form Page 10
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10Part 11: Application Check List
(you must complete this section prior to submitting your form)
2 x Proof of residence for permanent address (covering treatment period).
1.
One must be a bank statement (showing day to day transactions), along with
one other official document linked to your residency e.g. utility bill / council tax bill
or tenancy / rental agreement. Please contact us for further advice, if required.
2.
Clinicians letter supporting medical need (English translation required).
3.
S2 only – written confirmation from the provider of the treatment(s) of the:
agreed treatment(s), dates and the estimated costs.
Invoices and receipts / proof of payment, for items included in Part 4
4.
(Section g) (English translation(s) required).
5.
Evidence of exemption from patient charges (if applicable).
6.
All sections of the application form completed.
7.
Signatures (patient / applicant).
8.
Security Question and Answer: Q: _________________________________
(please provide for phone call
A:__________________________________
ID verification
Supporting Documentation
This team only requires the original receipts / Proof of Payment documents, as
outlined in section 4(g). All other supporting documentation can be copies.
We cannot accept responsibility for documents lost in transit.
Translations should be signed / dated / stamped.
Please note that this application will not be processed until all of the necessary
supporting information has been received. Incomplete applications will
therefore be put on hold, and not processed, until complete.
Please send your completed form and accompanying documents to the following address:
European Cross Border Healthcare Team
NHS England
Fosse House, 6 Smith Way
Grove Park, Enderby
Leicester, LE19 1SX
Or email:
england.europeanhealthcare@nhs.net
Please note: It can take up to 20 working days for a fully completed application to be processed
and a decision to be made. You will be informed of the outcome of your application once a
decision has been reached. If approved, the reimbursement can take up to a further 30 working
days to be processed.
10. EEA application form (04 /15)
Page 10 of 10
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