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Changes to the E111

How the new European Health Insurance Card will affect your health care options

April 2004

Members living or working abroad in the European Economic Area may have heard about the forthcoming introduction of a new EU Health Insurance Card. Some countries will start these cards from 1 June 2004 and all will have them by 2006.

As the world's largest international expatriate health insurer BUPA International reports on the new scheme and how it will affect existing members and anyone considering living or working abroad within the EEA.

What is the new EU Health Insurance Card?

Members of EU national health schemes travelling within the European Economic Area (EEA) currently benefit from the E111 system, which allows visitors to other member countries to use the public health care sector on the same terms as a local resident.

From 1 June 2004, the E111 system will work with the new EU Health Insurance Card scheme, replacing current paper forms.

What are the main differences between the E111 and its replacement, the EU Health Insurance Card?

The extended rules will maintain most elements of the existing E111:

• The scheme only covers short-term stays.
• The card will not give access to local 'private' treatment, except in those countries where locals themselves have access under the public scheme.
• Expats resident in other EU countries will not be covered by schemes from their 'home' countries.

There are also important changes to be aware of:

• E111 forms included the whole family but in future each member of a family will need to have their own EU Health Insurance Card, once these are issued nationally.
• The scheme will be extended to provide all covered visitors with not only emergency care but also necessary care. This means non-emergency care will be provided if it is appropriate to a patient's condition and intended length of stay.

Which countries will this affect?

The E111 system applies to the whole of the European Economic Area (EEA) which consists of the 15 member states of the European Community - including the UK and Ireland - as well as Iceland, Lichtenstein and Norway. Switzerland is not included. In May 2004 ten new countries will join the EU and in theory will immediately adopt the same system.

What kind of treatment will be covered by the EU Health Insurance Card?

As with the existing E111, any emergency treatment you may need while visiting member countries will be covered. In addition, the extended scheme will allow for 'necessary' treatment.

'Necessary' treatment consists of medical treatment which is appropriate to your condition and length of stay. You will not qualify for treatment for something that you are already on the waiting list for in your home country, or if the treatment you need can reasonably wait until you get home after your planned visit.

If I have a new EU Health Insurance Card, do I also need private travel insurance?

The UK government recommends everyone should have the E111 to which they are entitled but stresses that everyone should also take out suitable private cover for their travel abroad. This is because the E111 system, whether using forms or cards, is necessarily limited to public scheme rights which can be unfamiliar and incomplete.

To avoid the confusion of trying to work out the public healthcare system of the country you are visiting in advance, especially if you are visiting more than one in a trip, it is more reassuring to have health insurance that also gives 'private treatment' options and repatriation cover in the countries to be visited.

It is also highly recommended to take travel insurance to cover loss of baggage, passport and any delays or liabilities that may occur.

How do these changes affect expats?

As with the current E111 system, expats who become resident in other EU countries will not be covered from their home country and so will not be able to use a card issued from there.

Depending on their country of origin and the public entitlements of the country of residence, expats often prefer to take out an international health insurance policy to provide healthcare peace of mind. With an international health insurance policy expats will be covered everywhere (within the region specified on their policy) and medical expenses will be settled in a straightforward manner.

It is important to note that the EU Health Insurance Card scheme will not be a replacement for buying travel insurance, or international medical insurance outside the EEA. Nor will it cover expats as they travel from country to country, unless they qualify for a new card issued by their EEA country of residence.

BUPA International is the largest international expatriate health insurer in the world. As part of the BUPA group which covers 8 million members world-wide, BUPA International was the first to make available a flexible structure of benefits to provide comprehensive cover for hospital treatment and specialist fees anywhere in the world.

BUPA International offers an exceptional level of protection and support for people who are living or working outside their home country. Peace of mind is ensured by the 24 hour multi-lingual helpline, open 365 days a year, and a team that has the experience and training to take control of any emergency situation. Benefits of direct settlement of bills, fast claims turnaround and local knowledge on a global scale ensure BUPA International can be relied upon to take away stress at often difficult times.

Does the EU Health Insurance Card mean I will get exactly the same healthcare treatment in other countries within the EEA as I would do at home?

No. Standards, methods and costs of healthcare vary enormously within the EEA. Some countries have excellent standards, but in countries where even the locals have difficulty accessing the public healthcare scheme, visitors will be no better served.

Even if you require and receive 'emergency' or 'necessary' healthcare while abroad, in some countries patients are expected to pay for this at the time. Generally you will be able to get most of that reimbursed later, but if for some reason your E111 form or card has not been shown to the doctors or you inadvertently get treatment in the wrong part of the hospital or even end up in a private hospital, you will not be able to get reimbursed. (In the UK, the NHS will never reimburse a patient for non-E111 treatment when they get home).

To avoid any confusion and to enable you to be treated faster, it is safer to be covered for every eventuality with your own private health insurance policy.

Does the new scheme mean I can travel abroad purely to receive medical treatment?

No, not generally if the purpose of travel is to receive public-paid treatment - there are separate systems for that. For example, in the UK any travel for hospital treatment has to be pre-authorised by the NHS, which has its own rules.

The extended E111 system intends that people with European public health cover should not be discouraged from EEA travel just because they might need incidental treatment.

When exactly does the new EU Health Insurance Card come into effect?

It is expected that 12 EU countries (including Ireland) will introduce the cards in 2004, and the remaining countries (including the UK) will phase them in by 2006. Existing paper forms are likely to be acceptable for some time.

The new rules extending cover to non-emergency 'necessary' care will apply everywhere from 1 June 2004.

From the same date hospitals and doctors in the EU must accept E111's (existing forms or new cards) as a qualification for public treatment under the scheme without asking for further proof.

What will the new card look like?

The new EU Health Insurance Cards will be blue and share one of two common formats. They will not initially be electronic in most countries, and will show no confidential information.

I'm an existing BUPA International member, what action do I need to take?

No action is needed until the cards are introduced in the country where you are resident.

Everyone should already have an E111 form if they qualify for one. If you are an expat resident in the EEA, you may qualify for an E111 form or card from your country of residence.

If you are a frequent traveller with BUPA International cover it will still be advisable to obtain an E111 form or card as long as your travel pattern retains residence in the UK or another EEA country.

However, in all cases your existing BUPA International policy will continue to give you all the medical health and care cover you need.