Healthcare abroad.

[Brian Kirby]

There was a post on here last week, from someone who had moved permanently to, I think France, and had found they could not register under the French health service and was having to pay privately for all their treatment.  I can't now find the post, but it prompted me to do a bit of hunting.

The problem seems real enough and anyone contemplating a permanent move away from UK, or who has moved and not yet discovered this trap, may be interested, or may be able to help.

This will only affect persons under state retirement age, who have taken early retirement, i.e. who are not working abroad.  Under these circumstances, it seems there is a real problem transferring your UK health benefits to another Euro-state's health service. 

If you are over state retirement age you are dealt with as retired, and your rights can be be transferred.  You will need to get a form E121 from the DWP and present this to the local social security office where you now live (that is the principle, local rules will govern the detail).  Your rights should then be transferred and you will be entitled to whatever level of state healthcare that country provides.  You will probably also need to take out private local top up insurance for items the state system doesn't cover.  If so, this kind of cover will be readily available as most of your neighbours will already have it.

If you are working in your Euro-state you will be contributing (not on the black are you, surely!) to the system and will automatically get cover.

If you are registered disabled, you should be able to get cover in your Euro-state until your UK eligibility for invalidity benefit would expire.  I don't have the details, but if this might apply to you do check both the UK and Euro ends.  Under these circumstances, it seems you will need a form E106 from DWP, but issue of this is time limited, so if you are already in Euro-land, and aren't already registered into the state healthcare system, don't wait around.

However, back to the beginning, if you are early retired and living in Euroland do make urgent enquiries.  Some aspects of the rules are administered by HMRC (H M Revenue and Customs), but they, understandably are more interested in the payments side of things as they are now responsible for National Insurance contributions.  However, it seems you must turn to them to confirm your NI record.  The DWP is split, with the Pensions Service dealing with the state pensions matters but not, apparently, with the matter of eligibility or transfer of rights, other than your state pension rights, to other countries.  Somewhere within DWP, therefore, lie the rules governing if, and how, you can transfer your UK healthcare rights to another Euro-state. 

However, I could find no guidance on this on the net, I could not view an E106, and I could not find any guidance notes on eligibility or procedure.  DWP don't seem to have a general e-mail query address, don't make their 'phone number that visible, but do seem to encourage contact by post.  I did eventually find a phone number, and got through to a very helpful chap who agreed he could see what the problem might be, but didn't know the answer and, after a side conference with his colleagues, didn't know who would know either!

Part of the problem lies with your EHIC (E111 as was) since, after you've been living outside UK for over 6 months, you are deemed to have left this country.  As soon as you have lived in your Euro-state for more than the said 6 months, you are supposed to change your residency to that country and, when you do that, it seems you loose your UK state health cover, which is deemed to be provided by the state in which you now reside.  Thus, your UK issued EHIC is liable to be rejected if presented.

Add to this that most UK travel insurance policies are based upon your using the EHIC, so that the insurer's risk is generally limited to the costs the reciprocal EHIC agreement doesn't cover.  Thus, if your EHIC is rejected, you may find the insurer says he won't pay the full costs.

In this way, you can apparently arrive in a situation where you have no valid EHIC, no valid top up insurance, no Euroland state health care, and no euroland private top up insurance either.  That, it would seem, can leave you individually liable for all your health costs on a wholly private basis.  Not too bad for the ingrowing toenail, maybe, but if things really get sticky, the costs could be huge!

If anyone knows I've got this wrong anywhere, please do correct. 

However, if the above profile fits you, do make urgent enquiries and, if it turns out I've caused unnecessary anxiety, I apologise in advance.  However, with the responsibilities split between government departments, the lack of clear general guidance, and the unclear response to my queries, I rather fear there is ample scope for cock up and confusion, which is not what you want to hit if the chips go down.

The only light I could find, was that if you are one of a couple, and you or your partner are over state retirement age, the other partner can be treated as dependent and so gain cover on the eligible partner's entitlement.  However, the eligible partner must have transferred their rights for this to work.  One or other, therefore, will need to obtain the necessary E121.

[derek500]

Good post Brian.

 

Here in Spain it depends in what autonomous region you live.

 

In the Comunidad Valenciana where I live, residents have free use of the local health service.

 

I know in Andalucia they don't. I believe in Murcia they soon will.

[terry1956]

Hi there, this is a very grey area in deed. I know people in france ( ex brits) who do get state benifits, heath cover etc. They are the same age as myself, ie 50. I nowever will nto get any handouts, not that I have need. The NHS have been trying for sometime to cut ties with people who leave the UK, But one can leave for one year with cover, I think that the fault lays alot with the local doctors who just don,t want older people on their lists, s once you lost your UK doctor it maybe very hard to get back into the system.

This is an area that is always on the move,and one reason we have delayed moving to from the uk at this time, But with the new roads taxes and waste taxes etc, and the fact that the only good pub in the area is closing we my be on the move sooner then later.

terry

[Randonneur]

I am in the French Health system and because I have leaukemia I get 100% health cover 70% for Optical and supposedly 70% for Dental, but I have been to the dentist twice and been fully refunded. When we arrived in Dec 2000 I was 56 and on Incapacity Benefit and it was just transferred to my State Pension at 60. My husband however, was 55 and was classed as my dependant and he received up to 70% refund on medical, Optical and Dental expenses, the balance is covered by what the French call Mutual Insurance, which he pays 50 euros per month, there is a cheaper one as well.

 

A friend of ours, here, was 40 when she arrived and decided to pay her National Health contributions as advised by the Uk Department that deals with this. Therefore, she is now in the French system and is still able to get all that she is entitled to under any reciprocal agreement.

 

We are very fortunate in the Charente as our local CPAM (social security office) has a young lady that deal solely with expats and is very helpful.

 

I would advise anyone who is thinking of retiring here to go into the CPAM office in their region and make all necessary enquiries before taking the plunge.

 

I cannot praise the French Health service here enough, they have been wonderful to myself and my Husband. The only fly in the ointment is having an eyetest. There is a waiting list of about 5 months because you have to see a registered opthalmic doctor and not the optician. Opticians only fit you for your glasses or contact lenses.

 

[terry1956]

I hope you are ok, and getting about.

terry

[Randonneur]

yes, no problem Terry, I was diagnosed in 1992 so it is not new, just something I have to live with, they can treat but not cure, just got another 6 months reprieve so the world's our oyster. It just makes you think a little more and not take life too seriously. There are a lot of people in this world with more problems than me.

[Brian Kirby]

I case it may help anyone affected, I received the following reply to my question to the DoH.

I think it is very comprehensive and well written and a credit to the DoH.  Looking at the name of the signatory, who says the EC can't work!

Dear Mr Kirby,

(I have edited out part of this e-mail that related to overseas visitors to UK)

Under the current Regulations, anyone who spends more than 3 months living outside the UK is no longer automatically entitled to free NHS hospital treatment in England. This includes people in receipt of UK state retirement pensions. Whether you remain entitled depends on where outside the UK you live, and how long you live there.

A UK state pensioner living not less than six months in the UK and not more than six months in another EEA member state each year is exempt from charges for NHS hospital treatment in England while living in the UK, as long as they are not registered as resident in the other EEA member state.  This exemption extends to the spouse and children (under the age of 16, or 19 if in further education) of such a person as long as they are living in the UK with you on a permanent basis for your period of residence in the UK.

A UK state pensioner who is registered as resident in another EEA member state and has activated their E121 form is only exempt from charges for NHS hospital treatment in England that is needed promptly for a condition that arose after their arrival in the UK. You will also need to have lived lawfully in the UK for at least 10 years continuously at some point in the past. This exemption extends to the spouse and children (under the age of 16, or 19 if in further education) of such a person as long as they are staying in the UK with you on a permanent basis for the period of your visit.

A UK state pensioner living more than 3 months of the year outside the UK in a non-EEA country is exempt from charges for NHS hospital treatment in England that is needed promptly for a condition that arose after their arrival in the UK. You will also need to have lived lawfully in the UK for at least 10 years continuously at some point in the past. This applies whether you spend a few months each year living in a non-EEA country and the rest in the UK or whether you are living there permanently and only return to the UK for short visits. This exemption extends to your spouse and children (under the age of 16, or 19 if in further education) as long as they are staying in the UK with you on a permanent basis for the period of your visit here.

If you go anywhere abroad for more than three months, either for a one-off extended holiday for a few months or to live permanently for several years, but then return to the UK to take up permanent residence here again, then you will be entitled to receive free NHS hospital treatment from the day you return. So will your spouse and children (under the age of 16, or 19 if in further education) if they are also living with you permanently in the UK again.

If you decide to move to another EEA country permanently and you are receiving a UK social security pension (for example, retirement pension, incapacity benefit paid at the long-term rate, or a widow’s benefit or bereavement allowance) you may be entitled to a UK-issued form E121 to cover you for healthcare in Spain.

If you have taken early retirement, and are not getting a UK social security pension, you may nevertheless be eligible, for a limited period only, to a form E106 to cover you for healthcare in EEA countries and Switzerland.

You will need to address your enquiry to the Department for Work and Pensions, who are, in general, responsible for issuing the Form E106 or 121 to early retirers and social security pensioners. The address to contact is:

The Department for Work & Pensions
The Pension Service
International Pension Centre
Medical Benefits Section
Tyne view Park
Whitley Road
Newcastle-upon-Tyne
NE98 1BA

Tel: 0191 218 7547 (or + 0044 191 218 7547 from abroad)
Fax: 0191 218 7343 (or + 0044 191 218 7343 from abroad)

For further queries about forms E106 and E121, please contact the Department for Work and Pensions directly.

Finally, the medical services available under the State scheme in the country you are moving to may differ from those available in the UK.  Treatment will be provided on the same terms as it is available to local residents in the country you are relocating to.  You will need to contact the health authorities in the specific country for details of services provided.

I am sorry about such a lengthy reply but I hope this clarifies the regulations.

Yours sincerely,

Cristina Saez
Department of Health

I hope this helps clear up any doubts.

[terry1956]

Randonneur, good man. get out there and do it, and if you see an old hymer with two pug dogs in it and an odd looking old fool, say hello.

we can open something up and talk about France,

terry

[terry1956]

Hi BRIAN. sorry but your letter from the DOH, just deals with people over 65 for men and 60 for women and their children, it does not answer the question for people who do not fit into that group, like me.

It also states that one losts the right to heath care, and then states that one can rejoin after being away for a number of years, this is so grey as to be useless.

 

terry

[Randonneur]

Bon soir Terry,

 

It was Mme Randonneur who wrote the post. Him indoors is frightened of putting his fingers on the keyboard. But thanks for the kind thoughts and look forward to opening a bottle or two, hubbie doesn't drink wine only G & T's.

 

 

[Brian Kirby]

terry1956 - 2007-03-12 7:58 PM Hi BRIAN. sorry but your letter from the DOH, just deals with people over 65 for men and 60 for women and their children, it does not answer the question for people who do not fit into that group, like me. It also states that one losts the right to heath care, and then states that one can rejoin after being away for a number of years, this is so grey as to be useless. terry

Terry

I think this bit does, does it not?

"If you have taken early retirement, and are not getting a UK social security pension, you may nevertheless be eligible, for a limited period only, to a form E106 to cover you for healthcare in EEA countries and Switzerland.

You will need to address your enquiry to the Department for Work and Pensions, who are, in general, responsible for issuing the Form E106 or 121 to early retirers and social security pensioners. The address to contact is:

The Department for Work & Pensions
The Pension Service
International Pension Centre
Medical Benefits Section
Tyne view Park
Whitley Road
Newcastle-upon-Tyne
NE98 1BA

Tel: 0191 218 7547 (or + 0044 191 218 7547 from abroad)
Fax: 0191 218 7343 (or + 0044 191 218 7343 from abroad)

For further queries about forms E106 and E121, please contact the Department for Work and Pensions directly.

Finally, the medical services available under the State scheme in the country you are moving to may differ from those available in the UK.  Treatment will be provided on the same terms as it is available to local residents in the country you are relocating to.  You will need to contact the health authorities in the specific country for details of services provided."

But in any case my purpose was to raise the warning, not to try to provide the answers.  Each individual's case will differ, and trying to offer any kind of advice where individual circumstances differ so widely would at best cause confusion and at worst might cause actual hardship.

Therefore, as suggested, if unclear, check with DWP as above.

As to when you loose your rights through absence, and how you can reinstate these, I'd suggest you have another read.  I think it is set out reasonably clearly, given its complexity.  If you can't make sense of it I think it may be worth taking some advice, just in case there is something you haven't understood that becomes critical for you in future.  Forewarned is forearmed!

[terry1956]

BRIAN, my partner works within the NHS (part time now days), in a senior position, she knows the rules, and the ways of the NHS backwords, But the system is falling to bits and the good old NHS is looking at ways to cut numbers, also to bear in mind for younger people is the 10 year rule for pensions. Its a mine field out there, but my plan is to leave the UK for a few years then come back as an asylum seeker, I will get 1st go within the NHS, a house, car, phone, and all the hand outs.

 

its odd, that our queen is the head of a few countries, yet try getting into one of them to live. all very odd.

 

terry