The European Health Insurance Card - make sure you follow the rules

By Alan Taylor - 19/05/2008

What is the European Health Insurance Card?

If you fall sick or have an accident when on holiday in an EEA (European Economic Area) country how do you obtain medical treatment? Many of you will know the message that has been put across for years that under the EU social security rules you can receive medical treatment which becomes necessary during a holiday or a temporary stay in another EU country.

 

But are you up to date on how to do this and to claim any refund which may be due to you? If you fall sick don’t reach for your old form E111 because this became obsolete in January 2006. What you now need is a European Health Insurance Card (EHIC). 

 

The EHIC is issued in much the same way and serves the same purpose as the old E111 but unlike the E111 each member of your family should have their own card. Information about the EHIC is on the Department of Health’s website at www.dh.gov.uk/travellers where you can apply for an EHIC online and download the information you need under “Country-by-country guide to entitlement.” You can also obtain an application pack with a T7 booklet “Health advice for travellers” from a Post office and apply for an EHIC by phone on  0845 606 2030 or by post. Applying on line is the quickest way to obtain an EHIC.
 
What treatment can I receive and how do I obtain it?

The EHIC is your passport to healthcare under the EU rules but you must know how to use it. So, you have your EHIC and you fall sick or have an accident but what treatment will be available and how do you get it? Under the rules you can receive any treatment which becomes necessary during your visit from the state health service in the country you are visiting. 

 

Treatment for a pre-existing condition is covered provided you did not go specifically to the other country for treatment. The system works only if you follow the rules and contact a doctor or hospital linked to the state health system. Full details are given in the information note which can be downloaded and in the T7 booklet “Health advice for travellers” which you will be given with your EHIC. Before you start your holiday make sure you read the section for the country where you will be on holiday and keep the booklet with you when you are there.  

Will I have to pay for medical treatment which becomes necessary during my holiday and can I claim a refund of the costs?

If medical treatment becomes necessary during your holiday it will be provided by the state health authorities under the same rules that apply to residents of that country. This means you may receive free treatment or you may have to pay all or part of the cost then claim a refund of the cost or part of it later.

 

If you have to pay the full cost of treatment from a doctor or as an out-patient at a hospital you may be able to claim a refund of the part of the cost which is refundable under the rules of the country in which you receive treatment. You can apply for a refund when you are in the other country. If any part of the cost is not refundable this is called a “patient contribution” or a “co payment”.

Each country has different rules but it may be useful, as an example, to look at what happens in France. If you see a doctor in France who works within the French state health system or you receive treatment as an out-patient at a hospital you will be charged the cost of the treatment and you can claim a refund of about 70% of the cost.

 

The other 30% of the cost is a patient contribution and this amount will not be refunded under the French rules. For hospital in patient treatment the respective figures are 75% and 25% and the hospital receive the 75% amount from the sickness authority. It is better to claim your refund when you are still in France. However, if you cannot make a claim in France or you choose to wait until you return to the UK you can either:

 

•    make a claim through your travel insurance policy. You will lose the amount of any excess on the policy but you may receive a refund of the balance of the costs including the amount of any patient contribution you have made; or

 

•     make a claim to the Department for Work and Pensions (DWP) by phoning their call centre on 0191 218 1999 and they will tell you what to do. This will take longer than the insurance company route because the DWP will contact the French health authorities who will decide the amount of any refund; this will be paid to you on their behalf by the DWP. If you claim in this way you cannot receive a refund under French rules of the 30% of the cost which is the amount of the patient contribution for the cost of treatment from a doctor or as an in-patient or out-patient at a French hospital.

 

Will the NHS refund any of the patient contribution which I paid?

Under a recent revised interpretation of the EU healthcare rules for unexpected medical costs paid when on holiday the NHS may be able to refund the patient contribution or part of it, which you paid for in-patient hospital treatment in the other country and which is not refundable under the other country’s rules. This refund rule does not apply where you have received treatment from a doctor or as an out-patient at a hospital in the other country or if you went there for planned medical treatment.

 

Where the cost of the hospital treatment in the other country minus any amount which you have to pay as your contribution towards the cost of the treatment under that country’s rules is less than what would have been the cost for the same treatment in an NHS hospital you can claim a refund of the amount you have paid as your contribution to the cost of the treatment.

 

However, the refund will be limited to the difference between the cost of treating you in an NHS hospital and the cost of the treatment in the other country minus your contribution to that cost. The most you can get back is the amount you paid but depending on the difference in costs you may not receive a refund or it may only be part of the amount you paid. If you need advice about this type of refund speak to the DWP call centre mentioned earlier.

Here are some examples based on treatment as an in-patient in a hospital in France which cost £1,000. The hospital will be paid 75% of the cost (£750) by the French sickness insurance fund and you will have to pay 25% (£250) as the patient contribution which is not refundable under French law. The NHS will now consider a refund application for the patient contribution as follow:

Example 1

If the treatment you received in France would have cost the NHS £700 you will not receive a refund because the cost to the NHS is less than £750 which is the cost of the treatment in France minus the amount of your contribution.

Example 2

If the treatment you received in France would have cost the NHS £950 you will receive a refund of £200 which is the difference between the cost to the NHS treatment and the cost of the treatment in France minus the amount of your contribution, that is, £750.

Example 3

If the treatment you received in France would have cost the NHS £1,100 the difference between the cost to the NHS and the cost of the treatment in France minus your contribution is £350. You will receive a refund of £250 which is the amount you paid in France as your contribution to the cost of the treatment.

 

How should I make a claim for a refund of medical costs?

Deciding on the best way to claim a refund is not straightforward because much depends on the amount of the hospital costs, whether the costs include a non refundable patient contribution,  the amount of the excess on your travel policy and whether you paid a patient contribution for hospital in-patient treatment, part of which my be refunded by the NHS rather than the French authorities as mentioned earlier.

 

The conclusion to this is that when you need medical treatment you will not go far wrong if you follow the advice on the Department of Health’s website and in the T7 booklet. Unfortunately, the route for claiming a refund of medical costs is not quite so straightforward.