The Government has promised the European Health Insurance Card (EHIC) won’t be a casualty of Brexit. But how does the card work – and what pitfalls await the unwary and unprepared?
What is an EHIC?
The European Health Insurance Card replaced the old E111 certificate in 2005. This free card gives you the right to access state-provided healthcare during a temporary stay in any of the other 27 EU countries, as well as Switzerland and the European Economic Area (EEA) nations of Norway, Iceland and plucky Liechtenstein.
The benefits include GP visits and in-patient hospital stays. Most countries have a health system that is similar to the NHS, except that you may be expected to pay a small proportion of the cost of treatment – for example, to see a GP. You may also have to pay upfront for care, and then claim back when you return home. The NHS provides good online information on the policies and charges in each of the partner countries.
Do I still need travel insurance for Europe?
Some people regard the EHIC as providing all the cover they need. They are happy to forego travel insurance benefits such as emergency airlifts, delay and cancellation protection and cover against loss or theft. But the NHS points out: “The EHIC is not an alternative to travel insurance and will not cover any private medical healthcare or costs.”
When seeking treatment, it is essential to make sure you are treated in the public health system, not as a private patient. Because the two categories are often co-sited on the same premises, take care (if your condition allows) to ensure that you are being treated as an EHIC patient.
In the past, some British travellers seeking treatment in Spain and elsewhere have been asked to sign forms that signal their agreement to private care, at a possible cost of thousands of pounds.
I heard the EHIC does not cover emergency treatment?
So did I; it was in a tweet put out, and subsequently deleted, by ABTA, the travel association. It read: ”An EHIC card for example won’t protect you if you need emergency treatment in Europe.” In fact, an EHIC card is exactly what you need for emergency treatment in Europe. In contrast, the EHIC won’t cover you if you travel abroad specifically for medical treatment.
Does the EHIC cover everywhere in Europe?
No. Key omissions include the Channel Islands, the Isle of Man, Monaco, San Marino and the Vatican. If these places figure in your travel plans, then you should seriously consider travel insurance.
While the former Yugoslavian republics of Macedonia, Montenegro and Serbia are outside the EU and the EEA, the UK has reciprocal health-care agreements that work like the EHIC.
Further afield, there are similar bilateral arrangements with other countries, such as Australia and New Zealand, for which the EHIC is not required. Note, however, that these treaties do not cover the journey between the UK and Australasia.
How do I get an EHIC?
Carefully. If you search online and don’t pay attention, you can get directed to one of several official-looking sites that charge a fee (£34.50 in the case of EHIC Direct) for doing very little; ehic.org.uk is the website you want. This is the fastest way to apply, but if you prefer you can call 0300 330 1350.
The card is valid for five years. You can apply for a replacement after four years and six months, which may be convenient and is certainly a better idea than letting the old one run out while you are abroad.
What if I lose the EHIC?
If it happens while you are in the UK, just apply for a new one. If you lose it abroad and need treatment, call the Overseas Healthcare Team on +44 191 218 1999 and ask for a Provisional Replacement Certificate (PRC). You’ll need to provide your National Insurance number, as well as the email address (or, quaintly, the fax number) for the specific department of the hospital or clinic where you are receiving treatment.
“This will give you the same cover as an EHIC until you return home,” says the NHS.
The PRC is also an alternative if you haven’t actually got around to applying for an EHIC. The card is simply a shorthand for telling medical professional abroad: “This person qualifies for reciprocal health care.”
My travel insurer says that I must carry a valid EHIC when on holiday in the EU. Why?
Because if you are being treated under EHIC terms, the cost exposure that your insurer faces is drastically reduced. Most travel insurers recognise that there may be extreme circumstances in which you are unable to insist on being treated in the public system, but they want to incentivise you to act in their interests. Some will apply a significant excess (ie refuse to pay the full value of the claim) if you do not help keep costs down by using an EHIC card.
What happens to the EHIC after Brexit?
No one knows, but the prospects for continuation look more optimistic than they did. In the Brexit White Paper, the government said it "wants UK and EU nationals to continue to be able to use the European Health Insurance Card (EHIC) to receive healthcare should they need it while on holiday".
The former Brexit Secretary, David Davis, said that if agreement on a continuation of the system with the EU cannot be agreed, then the UK would provide one “unilaterally”.
What about treatment for kidney patients?
As The Independent revealed, medical charities have warned that 29,000 kidney dialysis patients who can currently get the treatment they need while abroad would face costs of more than £800 a week if the card goes, effectively putting holidays and rest breaks out of reach for people on ordinary incomes. As it is a pre-existing condition, insurance companies will not cover the treatment.
A House of Lords report by the European Union Committee said that in the event of no successor to the EHIC card: “The many people with long-term conditions, including kidney patients, and people with disabilities, will be particularly affected, given the prohibitive costs of travel insurance that they face.”
The committee concluded: “It is not in the UK’s interest for reciprocal healthcare arrangements to cease. Because of higher insurance costs – and in the case of dialysis patients, people living with rare diseases, and disabled people, the difficulty of obtaining travel insurance at all – without EHIC or an equivalent arrangement it will become much more expensive for UK citizens with chronic conditions to travel to the EU post-Brexit, for holidays, recuperation or treatment.”
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