When making plans to travel overseas, most people are advised to apply for health insurance that will cover them in case of an emergency during the course of their stay. This makes it possible for them to seek the medical attention they need in a foreign land, without having to worry about an astronomical bill.Even if you move to a different nation as an expat, you will probably be asked to get your healthcare options in place without any delay. This is because many countries across the globe have made the healthcare of their residents and citizens a top priority. The intricacies of the system may vary from one place to another; it is therefore important for you to understand what you are entitled to and what is expected of you.
Healthcare in the UK
For many years, British healthcare has been a topic of controversy because of the mixed reviews it has been receiving from service users. The findings of several international surveys have also been inconclusive in terms of rating the quality of healthcare in this country. Yet, it is fairly safe to say that the UK’s healthcare system is at least at par with most other developed nations.
Public healthcare across Great Britain is provided by the National Health Service (NHS). This state entity has a comprehensive network of medical facilities, professionals, and services which include hospitals, General Practitioners, dentists, optometrists, pharmacists, and ambulances. It has been credited as one of the most inclusive and robust healthcare systems in the world.
The NHS was founded in 1948 and its main objective was to ensure that good quality medical services were made available to everyone who resided in the country, regardless of their age, gender, nationality, social status and income bracket. The service aimed at providing decent medical care without any cost at the point of use to anyone who lived in the country, including foreigners. To be eligible for free NHS treatment, people simply had to be legal residents, pay their taxes and make a certain number of contributions towards the nation’s healthcare program.
Statistics show that the NHS system currently handles about a million patients in each 36-hour period on average. People are given various options for a wide range of services, which include routine physical tests, antenatal checkups, emergency care, medical care for chronic illnesses, organ transplants, surgeries and even end-of-life care. However, responsibility for healthcare in Scotland has been devolved to the Scottish Government, for Northern Ireland it is handled by the Northern Ireland Assembly, and for Wales it falls under the Welsh Assembly.
In 2014, the NHS was declared the most impressive public healthcare system compared to 10 other developed nations. The UK got a higher ranking than some of the most well developed countries in the Western world, such as the US, Canada, Australia, New Zealand, Germany, the Netherlands, Sweden, Norway, Switzerland and France. The main reason for the high rank was the system’s efficacy, effectiveness, patient centered care, safe care, coordinated care, and cost-related matters. In terms of quality, the UK came in at second place.
At present, almost 64.6 million of the people living in the UK are covered under the NHS, and of this population, 54.3 million are in England. However, the system also offers several benefits to British expats who have settled down overseas. In fact, the UK is one of the nations that have the maximum number of reciprocal health agreements with other countries.
What is a reciprocal health agreement?
When you move to another nation as an expat, you are not necessarily entitled to use their public healthcare system. In many places around the world, foreigners are required to apply for private health insurance in order to cover any medical expenses that may crop up while they reside overseas.
In some cases, the governments of certain nations sign reciprocal health agreements with each other. This helps their residents get access to the subsidized public healthcare system even if they are in certain foreign countries, which in turn helps curb their medical expenses to a great extent.
It is important to note that making use of reciprocal health services is not the same as using public healthcare in your home country. For example, you may not be covered for a preexisting medical condition or any other health problem that does not require immediate medical attention. Other services like pharmaceuticals when not a hospital in-patient, medical evacuations, and the use of ambulance services are also excluded from most reciprocal agreements. The cost of repatriation to one’s home country for medical reasons is also generally not included in these agreements. However, the exact terms and conditions will probably vary, depending upon the place you reside in.
Reciprocal Health Agreements for British Expats
According to recent reports, thousands more British expat pensioners are signed up for reciprocal agreements compared to seniors from across Europe who live in the UK. These figures were obtained following a request from the BBC Freedom of Information and they indicate that there are still 145,000 British retirees across the European Economic Area (EEA), who are currently registered with the NHS as well as the healthcare system in their host country. On the other hand, the number of elderly EEA nationals that have been registered to use the NHS is only 40,000 or so.
To be more specific, at least 70,000 British retirees are eligible to use the healthcare system in Spain but fewer than 80 Spanish senior citizens are covered by the NHS. Similarly, around 43,000 British pensioners have been registered to use the healthcare service in France; this is a very high figure compared to the 201 senior French citizens that are covered by the NHS. It is possible to explain these figures, at least to some extent, by the fact that more British citizens are likely to opt for retirement in countries like Spain and France, than the other way around.
In 2014-2015, Great Britain paid a sum of £674.4 million to other EEA nations in order to cover the health costs of expat British pensioners. In that same period it could claim back only £49.7 million as payment for the EEA citizens’ that got treatment in the UK.
In the near future, Brexit may put an end to reciprocal health agreements between the UK and other countries in the European Union. In theory, there is a chance that the authorities may make it mandatory for all the British and European expat pensioners to get private health insurance in their country of residence. This would be very costly for elderly expats. Nevertheless, some of the EEA nations such as Switzerland have negotiated access to reciprocal healthcare arrangements. Many political experts believe that reciprocal healthcare setups will be maintained in some form.
In order to register for state-run healthcare at a reduced cost in a country that has a reciprocal agreement with the UK, you will need to have your European Health Insurance Card (EHIC). In several places, this card covers you for the treatment of preexisting medical problems and even maternity care.
The UK’s Reciprocal Health Agreements
Since the UK is currently a part of the European Union, citizens of all member nations enjoy reciprocal healthcare benefits. Moreover, Great Britain has entered into reciprocal health agreements with all the EEA Nations. To view a list of these countries and to get a clear understanding of how the refund claims work for each place, visit the NHS website.
Additionally, the UK also has healthcare agreements with a number of non-EU and non-EEA countries, so that their citizens can make use of low-cost or free treatment when living in the following destinations:
• Bosnia and Herzegovina
• British Virgin Islands
• Falkland Islands
• Isle of Man
• New Zealand
• St. Helena
• Turks and Caicos Islands
For more details on medical contact numbers, the documents that are required, the treatments covered and the services you need to pay for in each of the nations listed above, visit the NHS website.
European countries that do not have any reciprocal health agreements with the UK are:
• San Marino
• The Channel Islands (including Alderney, Guernsey and Sark)
• The Vatican
In 2016, the UK terminated their reciprocal healthcare agreements with a number of nations. You may have been entitled to healthcare at reduced or no costs here in the past, but you will no longer have access to the public health system going forward. It is therefore now important for British nationals to ensure that they have private health cover when traveling to:
Making Use of Reciprocal Healthcare Agreements
Not all countries have an entity like the NHS and the health services for every place are likely to follow a unique structure. Do keep in mind that the health system in every nation works differently and your entitlements will therefore change from one place to another. You could have to pay for certain treatments that were completely free of charge in the UK in spite of having an EHIC.
If you have misplaced your card you need to call the Department of Health Overseas Healthcare Team on +44 191 218 1999, in order to obtain a Provisional Replacement Certificate.
If you decide to utilize state healthcare when overseas, make sure that you have all the required paperwork and choose the right facility.
There are numerous things that you will have to keep in mind when you decide to move overseas, and healthcare should definitely be on your checklist of important considerations. Depending on the country you choose to settle down in, you may no longer be eligible to use the NHS, since it is a residence-based healthcare system. Notify your General Practitioner (GP) to have yourself and your family removed from the NHS register.
Also make sure that you calculate the amount you are likely to pay for additional healthcare costs (including insurance) and factor it into your moving budget.
At times, British citizens are not entitled to use their UK-issued EHIC to access healthcare across Europe. However, there are a number of exceptions so speak with an agent or an attorney to know if you are eligible.
Before hopping on to the plane for your new destination, find out about the healthcare services in that country and the process for getting yourself as well as your family members registered. In all probability, you will only be entitled to free public healthcare if you have your residency paperwork in place and are making national contributions. The eligibility procedure for countries that have a reciprocal healthcare agreement with the UK could be completely different. Get all the details on which treatments are free or at reduced costs and which ones you will be required to pay for in full. It is best to consult a professional in order to get more accurate and reliable information on the use of healthcare services for British expats overseas.