Continental Cover

The European Health Insurance Card (EHIC) replaced the E111 in 2005.  It gives holders access to healthcare within the European Economic Area (EEA) and Switzerland.

In this article, we look at what is and is not covered by the EHIC and other ‘E’ forms and what international private medical insurance (IPMI) can offer as an alternative.

What is the European Health Insurance Card?

The EHIC covers treatment need during a trip due to either illness or accident.  This includes treatment for chronic conditions, pre-existing conditions and routine maternity care (although conditions apply – this should be investigated through the NHS and Department of Health).

The card gives access to free or low-cost emergency medical treatment, which will be delivered under the state health system (ie public health treatment) in the country that you are visiting.

The card is available to residents of EEA countries and Switzerland for use within all other EEA countries and Switzerland.  The EEA is made up of the European Union (EU) plus Iceland, Liechtenstein and Norway.  You are entitled to a UK-issued EHIC if you are “ordinarily resident” in the UK.  This is defined as: “lawfully living in the UK for a settled purpose as part of the regular order of his or her life for the time being.”

Other ‘E’ forms

While the EHIC provides access to emergency healthcare while on holiday, there are a number of other forms that give UK residents access to healthcare within Europe.  These are:

E112: designed to help alleviate waiting times on the NHS by offering you the option to have NHS funded treatment abroad.  You will be selected by your local NHS Trust or Primary Care Trust (PCT) based on your suitability to travel and respond to treatment.  Treatment will be arranged with a clinic abroad, called a Designated European Provider, usually within 3-5 weeks.  All treatment, travel and accommodation costs will be covered by the NHS, although travel will usually be with a group of 5-25 people.  You can take someone with them, for example a friend or relative, but this person must pay for their travel and accommodation.

E121: will cover your healthcare costs if you are a UK State pensioner living in Spain when you access the Spanish sickness insurance system (Spanish public healthcare).  The forms are issued by the UK Department of Work and Pensions (DWP)

E106: will cover your medical costs if you are ordinarily resident in the UK and are moving to Spain, either to take early retirement or to look for work (ie non-State pensioners).  The form gives temporary cover for two years.  After this time, you can apply for an E121, if eligible, or you must pay into the state healthcare insurance scheme or take out an IPMI plan.

Complications

Fathoming out what you are and are not eligible for can be complicated.  For starters, variations exist for people who are ordinarily resident in the UK and working in another EEA country, or working in another EEA country for a UK employer, or self-employed for a short time in another EEA country, or employed and working in two or more EEA countries, and so the list goes on.

The downfalls of EHIC

Although a card that covers healthcare in Europe sounds like a simple concept, there are some complex restrictions and eligibility requirements.

The card is not normally available if you are living in (rather than visiting) another country.  However, if you are normally resident in the UK and move to another EEA country (or Switzerland) but still pay compulsory UK national insurance (NI) contributions you are entitled to a UK-issued card.  If you are not paying NI contributions in the UK, you will not be eligible for a UK-issued EHIC and may need to pay in to the state health insurance scheme of the country you are living in or take out PMI.

The card will only provide access to treatment that is: 1) state-provided (public); and 2) emergency.  This means that you will not have any choice over where or how you will be treated and may not be able to get treatment for things like minor injuries or illnesses if they are not considered an emergency.

Because state healthcare systems vary across Europe, the healthcare may not be of the same standard as that offered by the NHS and you may have to pay for some of your treatment.

The card will never pay for emergency evacuation or repatriation back to your home country, including the costs of flying a body back if you die while abroad.

It will also not cover treatment if that treatment is the purpose of the trip.

Finally, the card is only valid within EEA countries and Switzerland, so what about the rest of Europe?

Complications of other ‘E’ forms

E112: does not give you a choice of provider and there can still be waiting times.  Treatment will be provided by state/public hospitals and you will not have access to private rooms, which you may have under an IPMI plan.

E121: has a complex application process.  If you are a pensioners moving to Spain you must apply for an E121 from the DWP and then, once granted, register it with the authorities who run the sickness insurance scheme in Spain.  They will issue a health card to use when getting treatment.  If this is not done you must pay for your treatment.

If, for any reason, you become ineligible for your UK benefit or you get a Spanish pension, you will no longer be able to get health care cover from the UK under your E121.

There may be a delay in issuing an E121 while a residence permit is issued.  During this period, it may not be possible to access the Spanish healthcare system free of charge.

If you are a pensioner who lives in the UK but spends over three months of the year in Spain you are not eligible for an E121, and, under current legislations, are also not eligible for free of charge NHS treatment.

E106: this form gives cover for two years in Spain only.  After that time or outside of Spain, you must pay for treatment or seek alternative cover.

The advantages of IPMI

The Department of Health advises UK residents to take out comprehensive private insurance for treatment not covered by the EHIC or any other ‘E’ form. 

IPMI plans have a number of advantages over these European public health provisions:

Simplicity: once a plan is taken out, it will give you the same cover wherever it is used, for the duration of the cover.

The same cover for the whole of Europe: most IPMI providers will give you a choice of area of cover that means a plan can be used in a number of countries.  For example, at InterGlobal we offer Europe as an area of cover, meaning you could get private medical treatment in any European country.  This avoids potential confusion over what is and is not available under the state healthcare system in any given country.

Choice: you can be treated at whatever public or private hospital or clinic you choose within your area of cover, provided the insurer does not have any restrictive hospital lists.

Comprehensive cover: most IPMI providers will offer you a choice in the level of cover, usually ranging from in-patient and emergency only, through to cover for most medical eventualities, including out-patient treatment.

Emergency evacuation: most IPMI plans will pay for you to be evacuated by air ambulance if there is no adequate medical treatment available in your location.  Although this is not a major problem in most European countries, some more remote areas, for example the Alps, might require air evacuation.

Repatriation of mortal remains: similarly, most IPMI plans will pay for your body to be flown back to your home country if the worst happens and you die abroad.

Security: FSA regulation in the UK means that UK-based providers must comply with stringent regulations, designed to protect the customer.

Cover when travelling for treatment: IPMI plans give you choice, meaning that even if you wish to travel to a different country purely for the purpose of receiving medical treatment, the costs of the treatment will be covered by the plan (provided it is within the area of cover and benefits, conditions and exclusions of the plan).

Cover for dental treatment, optical treatment and wellness tests: the variety of treatment that will be covered by an IPMI plan has the potential to be much greater than that offered free of charge on any state healthcare system.  For example, plans may include cover for emergency or routine dental treatment, optical treatment or wellness (preventative) tests.

Non-medical cover: some IPMI plans will cover things like the costs of a flight to visit a critically ill relative, legal expenses or travel insurance.

Taking no chances

When living or travelling in Europe, you want to know that you can access good quality healthcare wherever you are.

Any decision about your healthcare provision needs to be made as a result of thorough research.  When it comes to public healthcare in Europe, the NHS, Department of Health and Department of Work and Pensions give information on cover available to UK residents through the EHIC and other ‘E’ forms.

However, the myriad advantages of IPMI also justify a full investigation of the plans on offer if you are moving to or travelling in Europe.  Make sure you have the peace of mind and protection that you need.

Andrew Sandilands

Compliance Officer

InterGlobal

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