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EHIC Card Italy and S1 Form for health cover in the EU

Find out how access to healthcare is regulated in the EU.

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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

What is a European health card? 

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”.

Which countries are covered by the EHIC card? 

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.

What is 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.

EHIC card application: How do I apply for a EHIC card online?  

The EHIC card is issued by the national institution responsible for the provision of health insurance. Depending on the applicable procedures in your specific country, you may be able to apply for it online.  

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 Italy  

The card, also known as National Health Card (“Tessera Sanitaria nazionale”) allows you to get the free medical assistance of family doctor and receive the necessary medical treatment from the NHS. 

How do I get EHIC in Italy?  

In Italy, you will have to get registered with the National Health System (NHS) to be able to apply for your EHIC card. To register with the NHS, it is necessary to go to the relevant “ASL” office with your application documents (i.e. valid passport, tax code, residence permit application receipt, etc.). 

Is healthcare free in Italy for foreigners? 

Only some categories of foreigners are entitled to register with the NSH for free. Among these:   

  • Those who hold a stay permit as subordinate workers or self-employed, or asylum-seekers, or citizenship applicants;  
  • Dependent family members of the above-mentioned citizens.

If you are not entitled to free healthcare, you can still decide to register voluntarily with the NHS by paying an annual lump-sum contribution, calculated on the basis of your income.   

If you are unsure about your case, feel free to contact us for a consultation. 

Do I need to renew my EHIC card?

For Italian citizens, the EHIC card is valid for six years, unless otherwise specified by the regional health authority. Before its expiry, the authorities will automatically send out a new card.  

For foreigners, the EHIC Card is usually valid for the same period as the residence permit, after which it can be renewed if the conditions apply. 

How do I replace my lost EHIC card?

You can apply for an EHIC replacement certificate if your card was incorrect, or if you have not yet received it, or if the original card was stolen or lost after your received it. In this case, you will have to make also a police report to submit with the application for replacement.  

The new EHIC card will be delivered about 30 days from the request but, in case of urgency, the authorities can also issue a provisional replacement certificate.  

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.

Is EHIC valid in UK?

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.

S1 Form

What is an S1 form?  

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.

How do I get an S1 form? 

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.

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Regulatory Framework

Regulation (EC) no. 883/2004 of the European Parliament and of the Council of 29 April 2004

Reference (Italian only)

Regulation (EC) no. 987/2009 of the European Parliament and of the Council of 16 September 2009

Reference (Italian only)

Explanatory notes on modernised social security coordination Regulations (EC) No 883/2004 & No 987/2009

Reference (Italian only)

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