Healthcare abroad: an introduction

So where in the world can I fall ill without a painfull bill?

If you have ever complained about the service provided by our NHS then you may be even more disappointed when you move abroad. With a couple of honourable exceptions such as France, many holiday home hotspots offer a much more restricted and often 'pay up front' healthcare system than back here in the UK.

For those who go abroad for short periods, the UK-issued European Health Insurance Card (EHIC) is designed to help get you access to reduced, or sometimes free, state-provided medical treatment in all member states of the European Economic Area (EEA) if you fall ill or have an accident.

The card also covers pre-existing conditions. The doctor you see in the other European member state needs to consider if the treatment which you require is necessary, as only necessary medical treatment which is covered by the card.

Apply for an EHIC online at www.dh.gov.uk/travellers. The card may not cover all the things that you would expect to receive free of charge from the NHS, and there might be extra costs you hadn’t bargained for, like paying for a translator if you don’t know the language. The Department of Health advises you to take out travel insurance to cover these costs.

However, this is simply a safety-net system for those who are ordinarily resident in the UK, and is not designed for people who are going to live abroad (unless you are on a short-term contract and still employed by a UK company). Ordinary residence in the UK is not determined by simply Income Tax or National Insurance in the UK, but whether you spend the majority of your time living in the UK “for a fixed and legal purpose”.

Once you have permanently moved away from the UK you are no longer entitled to medical treatment under normal NHS rules. If you are starting work for an employer based in another member state (or you are setting up as self-employed) you should register for state healthcare in that country. In these circumstances, your new country of residence will be responsible for the cost of your healthcare – and this section of the website is designed to reveal the different rules and systems available around the globe.

There are circumstances, however, in which the UK can continue to pay your healthcare costs if you move to another European member state to live. This may be either be because you are:

• In receipt of your UK state pension: contact the Department for Work and Pensions (DWP) to apply for form E121.

• Below retirement age but not working; contact the DWP to apply for form E106. Rules for qualifying are complicated, but if successful, the form maybe valid for up to two-and-a-half years and is dependent on the recent past payment of UK National Insurance contributions.

• You are working for a UK company and paying National Insurance and Income Tax to the UK. Contact Her Majesty’s Revenue and Customs on 0845 915 4811 to enquire about a Form E101 or E106.

When the E106 expires, you will either have to start paying into the national insurance scheme of your new country, or take out private insurance. But remember that, in France the rules have recently changed so that you may not be entitled to state healthcare paid for by France until you’ve been resident for five years, so private insurance would be your only option. Obviously, this could be harder to obtain if you have a serious pre-existing condition.)