Ian Youngman, author of the upcoming report “Brexit and Insurance” writes the first in a series of articles on the subject. In this article, he explains the role of the European Health Insurance Card and dispels the confusion that surrounds its use.
The European Health Insurance Card is a free card that gives EU citizens access to medically necessary, state-provided healthcare during a temporary stay in any of the 28 EU countries, Iceland, Lichtenstein, Norway and Switzerland, under the same conditions and at the same cost (free in some countries) as people insured in that country.
The European Health Insurance Card:
- Is not an alternative to travel insurance. It does not cover private healthcare or costs such as a return flight to a home country or lost/stolen property,
- Does not cover costs if travelling for the express purpose of obtaining medical treatment,
- Does not guarantee free services. As each country’s healthcare system is different, services that cost nothing at home might not be free in another country.
The responsibility of issuing the EHIC is not a person’s state of residence, but with the state where a person is paying to or benefiting from the Social Security System. This affects people receiving pensions from their EU home country rather than their country of residency. A resident of Spain, receiving a pension from the UK, should apply for the EHIC card in the UK.
How many people have an EHIC card?
200 million Europeans already have the European Health Insurance Card (EHIC), according to the latest figures from the European Commission. This represents more than half of the insured population in the EU. 500 million have the right to EHIC access.
What does it entitle you to?
EHIC allows people to get necessary treatment when travelling within the European Union plus Switzerland, Liechtenstein, Norway and Iceland.
The EHIC, available free of charge, confirms that a person is entitled to receive medical treatment that becomes necessary on a temporary stay abroad from the host country’s public healthcare system on the same terms and at the same cost as nationals of that country.
Hospitals that provide public health services are obliged to recognise the EHIC. In the vast majority of cases, patients presenting the EHIC receive the necessary healthcare and are reimbursed without any problems. However, there have been cases of refusals, in general due to a lack of awareness on the part of healthcare providers. Therefore, both the European Commission and the member countries continue to raise awareness on how the card works, both among health practitioners and citizens.
In the event that the EHIC is not accepted, patients should contact the relevant health authority in the country they are visiting. The emergency contact numbers are easily accessible via the EHIC application for smart phones and tablets. In case of further refusal, patients should request support from their home country’s health authorities. Finally, if they still encounter problems, they can contact the European Commission, which can investigate the claims and raise the issue with the authorities of the country concerned. The Commission investigates such cases and when necessary, infringement procedures will be opened against any countries not applying EU law on the use of the EHIC.
Confusion over medical tourism numbers
The huge amount of travel within Europe and the millions who get treatment while in another country, go some way to explaining why country and hospital figures of international patients are often several multiples of actual medical tourists: the two get confused, sometimes accidentally, sometimes not.
Restrictions on EHIC use
Non-EU nationals cannot use their European Health Insurance Card for medical treatment in Denmark.
Croatian nationals cannot use their European Health Insurance Card in Switzerland.
The card does not help with rescue and repatriation. If people need free transport back home after falling seriously ill or after having an accident while visiting another EU country, they will need separate insurance cover.
It does not cover people for private healthcare or the cost of planned treatment in another EU country.
Use by UK citizens
The European Health Insurance Card (EHIC) was used 215,000 times in 2015 by UK citizens. 27 million UK citizens have an EHIC card, according to the Department of Health.
The NHS claimed £145million from other nations’ healthcare systems under the EHIC scheme over the last five years. But the NHS paid out £736 million over the same period under the arrangement.
In 2016 the UK claimed back £31million from other EU countries, while paying out £130million.
The number of EU citizens using the EHIC card to claim free healthcare in the UK has risen from 3,854 a year to 18,167 in just five years.
The government is failing to get back money from foreign governments that they owe for their nationals using the NHS.
Countries can claim back health costs from other member states when their citizens use medical services overseas.
The biggest pay-outs go to France which claimed £221million over the last five years – 11 times as much as the UK got back from the French.
Germany claimed £85million back, while Ireland got £55million back from the UK over the period.
EHIC and medical tourism
The EHIC does not intend to, and is not allowed to be used for circumstances where a person is travelling between countries to get medical treatment.
The future
After March 2019 and Brexit, the EHIC may or may not survive in the UK, or may survive in principle but not in practice, so UK outbound and inbound travellers could have no EHIC.
Even if EHIC survives, it is not a substitute for travel insurance so this could be an opportunity for travel insurers to offer more cover and roll back what seems to be an increasing trend of travelling without any insurance.
©2026 All rights reserved LaingBuisson
