Find out how access to healthcare is regulated in the EU.
The global Covid-19 pandemic highlighted the sanitary risks that characterize our society. When faced with such risks, it is fundamental to have the possibility to access care and treatment. This becomes true especially in the context of international travel. In fact, in foreign Countries, we might not be as familiar with the regulations to get access to healthcare as we are in our own Country. In the European Union, these revolve around the EHIC Card and the S1 Form.
Health Cover in the EU
Before discussing in detail the functionalities and characteristics of the EHIC Card and the S1 Form, it is necessary to analyze how the EU regulates the access to healthcare for its citizens.
EU citizens that temporarily stay in another member State, which is not their State of residence, for whatever reason, have the right to receive all medical treatment that cannot wait until their return to their home Country. Art. 19 of the Regulation (EC) no. 883/2004 of the European Parliament and of the Council of 29 April 2004, in fact, establishes that:
“[…] an insured person and the members of his/her family staying in a Member State other than the competent Member State shall be entitled to the benefits in kind which become necessary on medical grounds during their stay, taking into account the nature of the benefits and the expected length of the stay. These benefits shall be provided on behalf of the competent institution by the institution of the place of stay, in accordance with the provisions of the legislation it applies, as though the persons concerned were insured under the said legislation”.
If Regulation (EC) no. 883/2004 clearly ascertains this principle, there are still two things to better define. The first one, is its territorial jurisdiction. In fact, not only this principle applies to the 27 EU Member States; on the contrary, Iceland, Liechtenstein, Norway and Switzerland are also counted as EU countries for the purposes of EU social security coordination rules and are therefore covered by this Regulation.
The other thing to define is the practical application of this principle. To understand that, we must refer to Art. 25 of the Regulation (EC) no. 987/2009 of the European Parliament and of the Council of 16 September 2009:
“For the purposes of the application of Article 19 of the basic Regulation, the insured person shall present to the health care provider in the Member State of stay a document issued by the competent institution indicating his entitlement to benefits in kind […]”.
The EHIC Card (European Health Insurance Card) plays this part.
The EHIC Card
The EHIC Card is the document which grants access to medically necessary, state-provided healthcare during a temporary stay in any of the 27 EU Countries, Iceland, Liechtenstein, Norway and Switzerland. As the Regulation (EC) no. 987/2009 requires, it proves that the owner is insured in an EU Country.
Such card is issued by the national institution responsible for the provision of health insurance.
What the EHIC Card covers
As previously stated, the EHIC Card grants access to medically necessary, state-provided healthcare in all EU Countries (and those who are considered as such for the sake of this matter). Therefore, the first thing to notice is that we are in the scope of public healthcare. It does not cover, instead, any private healthcare, which is why it does not serve as an alternative to travel insurance.
In addition, we must consider the notion of the healthcare necessity. The European Commission itself clarified that this concept is flexible, and one needs to evaluate it on a case-by-case basis. However, it mainly derives from two criteria. First, there is a medical criterion, that takes into account the seriousness of the health situation. It is clear how all emergency care falls into this criterion, while preventive care, like vaccination, may not.
Then, there is the duration of the stay abroad. Evidently, a 6-month stay implies that many treatments cannot wait until the end of such stay, as could be the case, on the contrary, for a 2-week vacation.
It is also important to remember that each Country has a different healthcare system. What is free of charges in a Country might not be free of charges in another one.
Those who cannot get a EHIC Card before temporarily staying in another EU Country, will still get medical treatment, should it be necessary. However, they will have to pay for it in advance, and claim reimbursement once they get back home, according to the procedure established by their Country of residence.
EHIC Card in the UK
After Brexit happened, a lot of confusion rose around the participation of the UK in European common policies. This includes the EHIC Card, and especially its validity for UK citizens temporarily staying in the Union, and vice-versa.
As of today, the situation is as follows:
- UK citizens can continue to use their pre-Brexit issued EHIC Cards to access necessary healthcare in Europe until the expiry date indicated on their documents. After that, they will not be able to renew them (there are a few exceptions regarding citizens who have the rights to do so under the Withdrawal Agreement between the UK and the EU).
- EU citizens can continue to use their EHIC Cards to access necessary healthcare during temporary stay in the UK. This particular regulation, however, only considers citizens from Switzerland and Norway as EU citizens. It excludes, instead, citizens from Iceland and Liechtenstein.
Under certain circumstances, specific categories of EU citizens, during their stay in another Member State, have the right to an even more comprehensive health cover than the one granted by the EHIC Card. One of these categories are posted workers.
Posted workers can benefit from a full health cover in the foreign Country where they carry out their activities, as people insured in such Country do, through presentation of the S1 Form. The S1 Form grants access to all state-provided healthcare, regardless of the concept of its necessity.
Once again, it is the public health Authority of each Member State that issues the S1 Forms to eligible individuals.
It is important to remember that, posted workers in possession of an S1 Form must present it to the Healthcare Authority in the Country where they temporarily work, as soon as their arrival.