European business travelers and holiday vacationers can rely on the European Health Insurance Card to take care of the medical and healthcare needs whenever they visit EHIC-participating nations. This little card is what gives them the peace of mind against unforeseen medical expenses that can easily run in the thousands of dollars while on a temporary stay in these countries.
Before the turn of the new millennia, more and more individuals and their respective families are traveling to countries that, in the past, they could only imagine via the postcards that their friends send them. A lot has changed since then. Advances in aviation technology has resulted in lower air fares. The global economic outlook has brightened leading to the easing of travel restrictions. And while the threat of global terrorism has somehow dampened the traveling spirit of some, many more are confident about the increased security measures imposed by the countries of the world.
Unfortunately, this increased traveling has spurred new challenges both to the tourists themselves and the governments that play host to them. One of these challenges is the provision of quality health care that is highly accessible, judiciously equitable, and practically affordable to everyone, including visitors and tourists.
Such is the idea behind the European Health Insurance Card.
A Closer Look at EHIC (E111)
The European Health Insurance Card can be best viewed as an agreement between and among nations of the European Union as well as the European Free Trade Association. It guarantees free healthcare to the residents or nationals of each of these member countries when they do visit other member nations either for business or leisure. In some instances, the health service may have to be paid but at a significantly reduced price. The important thing to understand about the European Health Insurance Card is that it gives visitors the right to the state- or publicly-funded health care services that are normally only applicable to the residents and nationals of the host country.
It is therefore, crucial to understand that the health care services will actually vary from country to country. So, it is not unusual to obtain free medical treatments for a particular health condition, illness, injury, or disease from one country but not in another. Some countries may provide free ambulance services but others may require you to shoulder these expenses. There are also countries that provide free dental treatments while in other nations, dental treatments may not be covered by their national health insurance programs. The point is that whenever you visit a particular country, you must abide by their laws, rules, regulations, as well as policies in the same manner as everyone does. You cannot invoke your rights as if you were in your home country.
The EHIC is an agreement between nations that, if their nationals visit other participating countries, they will be obliged to provide the same medical, dental, and emergency treatments as well as other health care services that these countries provide to their respective nationals. This means that British nationals visiting France or Germany, for example, will be able to access the healthcare procedures and treatments that French or German national are able to receive from their government.
This is inherently rooted in the Single Market scheme of the European Economic Area which technically comprises of the EU and the EFTA organizations.
Countries that Participate in the E111 Scheme
Currently, there are 32 countries that adhere to the principles of the European Health Insurance System. Collectively, these are members of the European Economic Area. However, since Switzerland has voted in a referendum not to be affiliated with the EEA, the EHIC is officially recognized as the health insurance card that is accepted in the EEA plus Switzerland.
The EEA includes, with the exception of Switzerland, the following countries:
- Czech Republic
- Republic of Cyprus
- The Netherlands
- United Kingdom
It should be understood that Iceland, Liechtenstein, and Norway are not members of the European Union. These countries, together with Switzerland, are members of the European Free Trade Association. The rest of the countries in the list are members of the European Union, including the United Kingdom, despite the results of the Brexit referendum in June 2016.
Switzerland was initially a member of the EEA. However, because of a constitutionally mandated referendum, the Swiss population officially rejected the country’s inclusion in the EEA. It is nevertheless, a founding member of the EFTA which was formed in 1960 together with the United Kingdom, Denmark, Portugal, Sweden, Norway, and Austria. Of the 7 original members of the EFTA, only Norway and Switzerland remains, strengthened by the inclusion of Liechtenstein and Iceland. The other 5 original members chose to join the European Economic Community, the progenitor of the European Union, instead. While Switzerland is not a member of the EU, it has multiple bilateral agreements with individuals EU states. Plus, it is also a member of the EFTA. This allows it to become a signatory and participating country in the European Health Insurance System.
The EHIC is also applicable to the overseas territories of EU member nations such as Martinique, French Guiana, Guadeloupe, and the Reunion Islands. While these territories accept the EHIC, the benefits may be limited. Greenland and the Faroe Islands also have existing EHIC agreements even though these states are not EEA members.
E111 and the Origins of E111 (EHIC)
In the past, European travelers always had to carry an A4-sized piece of travel document known as the E111 Form. Whether they had to go on a skiing expedition high in the Alps, explore the gastronomic cuisines of the different regions of Italy, or bask in the sun or even engage in truly thrilling water sports in the Mediterranean-lined coasts of Europe, it was imperative that the E111 Form went with them together with their other travel documents. The E111 essentially contained all the pertinent information about the holder of the document, including his name, his nationality, his address, his date of birth, and even his dependents, should there be any.
The E111 assured travelers that they will be able to obtain necessary medical treatment for any injuries or even any health condition that may develop while they are in the host country. For example, you may break a leg if you fall during one of your ski jumping tricks. You can be stung by a jelly fish while snorkeling or simply swimming in beaches. You can even get sunburned or, worse, heat stroke if the temperature simply is too much for your body to bear. Food poisoning can also be a concern especially if you are not sure about the hygienic and sanitary conditions upon which your food was cooked from. Even drinking water can bring you stomach upset leading to diarrhea which can affect your ability to complete your travels and enjoy your holiday. In these instances, you will need to seek medical help. But since you are in a foreign country, doing so will represent a huge healthcare investment as medical care for foreigners typically don’t come cheap.
That is why travelers always had to carry with them the E111 Form. It is the key to obtain free or lower-cost treatments for such medical conditions that occur while traveling.
Unfortunately, during these travels, it is not uncommon that the A4 paper gets crumpled, torn, soaked and mutilated, and its print become highly illegible that health care authorities wishing to examine the document further for validity simply are left with no choice but to either accept the E111 at face value or deny the coverage it is supposed to provide.
There was another issue to the E111 Form. Because the health insurance document already covers the entire family, there is only a single copy. If you are traveling alone, then it should never really be a problem. It is also not a problem if you can guarantee that you will be traveling with your family as a group every time and all the time. This means that everyone goes where the family goes. So, if you go to the public town square, everyone in your family must go with you. The problem therefore is when one or several members of your family decide to go their separate ways. For instance, you would like to visit the famous entertainment centers of a particular city while your spouse wants to go shopping. Your little kids wants to stay at the children’s amusement park while your older children, maybe teenagers, would want to spend time at the beach. You technically have 4 different locations to cover. And if one of your family members figure in an accident or even gets suddenly sick, he or she will not be able to obtain free or reduced cost health care services simply because they don’t have a copy of the E111 Form. While E111 countries do provide emergency medical services regardless of whether you have E111 or not, you will need the E111 Form to continue with the treatment as well as to avail of other auxiliary services. If you don’t have the E111, you may have to pay for these services.
That’s why, in 2004, the different governments in Europe finally decided to scrap the E111 and introduce a more revolutionary, a more comprehensive, and a more functional health insurance document – the EHIC. It took the European governments almost 2 years to completely phase out the E111, achieving full phase-out status by the first day of the year in 2006.
There are a lot of advantages to using the EHIC instead of the E111. First and foremost, it is plastic, the size of a credit card. As such, there is no problem regarding its storage as you don’t have to fold it several times just so it will fit in your wallet or your purse. There is also less risk of it getting damaged. It can get wet and still be legible. One of the best advantages of the EHIC is that each member of your family has his or her EHI Card. This means your partner can go shopping on her own, you kids can go play, and your teens can go swimming, while you’re having your own kind of fun and everyone will be confident that they can receive quality and affordable care.
The European Health Insurance Card has truly revolutionize the way European travelers access healthcare services in their host countries.
How E111 Works
When traveling to any of the countries and territories listed above, you are entitled to receive free or reduced-price health care and medical and dental treatments should you be in need of one. To avail of these services, it is imperative to present your EHIC as well as proof of identification, usually your passport, just to verify the information contained in the EHIC. Know that the EHI Card does not bear your picture so health care authorities will not be able to ascertain whether you are the legitimate owner of the EHIC. That’s why health care professionals will ask of a validating document.
When you present your EHIC, you are subject to the terms and conditions of the health care system of the country you are presently staying or visiting. For example, if you are a French national and you are visiting the United Kingdom or any other EHIC participating country, you will be subject to the rules, policies, and regulations that exist in the UK, not in France. So, you will receive the same treatments as any other Briton does.
As the EHIC is essentially a contract between and among governments, it is only applicable to services provided by these governments. As such, if you seek health treatments or procedures as well as other care services from a private institution or professional, you may actually end up with a hefty medical bill as you will be made to pay for such services obtained.
It is equally crucial to understand that EHIC will only cover health conditions that are incurred while staying or on a visit to any particular member country. If you visited the country for the sole reason of obtaining a healthcare treatment or if you purposely go on an overseas holiday to give birth to your child, these will not entitle you to the guarantees of the European Health Insurance System.
However, if you have a longstanding medical or health condition such as chronic obstructive pulmonary diseases like asthma, diabetes, or even cardiovascular conditions that require routine medical care, your insurer can coordinate with their counterparts in the host country so that services like hemodialysis and oxygen therapy can be appropriated for you. It is also imperative that the health care institution that will administer or provide these treatments are duly recognized or accredited by the host country’s national health insurance system. Otherwise, you may find yourself having to worry about thousands of dollars’ worth of medical bills.
Before you visit any of these countries, it is essential that you learn their health care system and how EHIC can be used within the framework of the country’s health program. For example, there are countries where ambulance services are free while in other countries, you may have to pay for them. There are also countries where the prescription medicines are provided free of charge while others may require you to pay a small fee as patient participation.
So, before you seek treatment, you have to:
- Make sure the provider – hospital, clinic, doctor, dentist, or pharmacy – is recognized by the host country’s public health program;
- Show your EHIC as well as your passport;
- Ask whether you will receive treatments for free or will pay a certain amount; and
- Ask what treatments or services are covered by the EHIC.
Once you have received the treatment, make sure to obtain the following:
- Official receipts, if there was some form of payment involved;
- Official prescriptions;
- Official medical report; and
- Other pertinent documentation of the treatment you received.
You will need these documents to claim a refund right at the host country’s office that handles EHIC reimbursements. In the past, you can claim reimbursement upon your return to your home country. However, recent changes to the provisions of the EHIS already allows you to make the claim right in the country where you obtained such treatments and services.
In case you renewed your EHIC but haven’t received it prior to your overseas travels, you can request for a Provisional Certificate which can be sent directly to the public health care institution or provider where you will obtain treatments. This guarantees that you have a valid EHIC but that the physical card has not reached you in time for your travel abroad.
The EHIC is a very useful card. That is why it is imperative that you bring it with you whenever visiting the countries listed above.
What E111 (EHIC) Covers
Your E111 card generally covers the following, subject to the laws and policies related to the public health care program of the host country.
- Treatments for illnesses or health conditions that develop during your stay in the host country
- Treatments for injuries sustained because of accidents or some other traumatic events that you experienced while in the host country
- Routine care for pre-existing health conditions or illnesses, such as diabetes, asthma, and cardiovascular conditions, provided arrangements for such treatments have been made in advance
- Routine care for maternity cases provided you did not purposely visit the host country to give birth
- Emergency care for premature labor and delivery among pregnant women
- Treatments for emergency oral and dental conditions
- Prescription medications
- Other procedures, treatments, and services deemed necessary and under the existing laws and regulations of the public health care system of a specific country.
It should be made clear that while EHIC guarantees these provisions, the actual implementation may vary from state to state. As was already discussed, some countries provide these services absolute free while others may provide them at a discounted price. There are also countries that ask for a patient contribution fee to avail of these services.
What EHIC Does Not Cover
It is safe to say that whatever is not listed above will not be covered by EHIC. In case this is not yet clear, then the following is a simplification of what are not covered by EHIC.
- Treatments provided by a private hospital, medical center, clinic, doctor, or dentist
- Unnecessary treatments such as those that can wait until you return to your home country
- Optional health care services or procedures not covered by the national health insurance of the host country
- Treatments obtained through medical tourism, whereby the purpose of visiting the country is to seek such treatments
- Cost of repatriation
- Flight delays and cancellations
- Damaged or lost personal belongings
EHIC and Travel Insurance
The foregoing discussion shows that EHIC is not a replacement for travel insurance. In fact, it is complementary to a travel insurance because the things that are not covered by EHIC will be covered by the travel insurance. Additionally, many travel insurance companies no longer issue such policies unless the individual has a valid EHIC.
Obtaining and Keeping the Validity of EHIC
In the past, obtaining an EHIC required you to visit the agency that provides EHIC. From there, you can fill up an application form and then submit it for processing. For individuals who lived far from these offices, they went to the Post Office to obtain an EHIC application form, fill it up, and then submit it for processing. In both instances, one primary issue was the bureaucratic red tape that has come to be synonymous with government services. As such, it will usually take a considerable length of time to apply for the EHIC. This is notwithstanding the effort you have to put in going to the office, wait in line for a considerably long period of time, and make the submission yourself. And when there are issues in your application, it will often take additional time to sort out the errors.
With the growth of the internet, many EHIC applications are now processed online. And while government agencies can also provide such online services, they are not as efficient as privately-run companies that provide EHIC applications and renewals. For instance, MyEHIC has been shown to provide its clients with a comprehensive EHIC application and renewal service through its online portal. Clients can even make necessary annotations online and are given prompt notification of the status of their application. Several months prior to the expiry of the EHIC, which has a validity of 5 years, MyEHIC already sends out notifications to its clients that there EHIC is already 6 months away from being expired. Clients can then decide whether to renew it at once or to wait for the deadline.
Online services such as those provided by MyEHIC also allow clients to apply for their family members. This is especially useful if there are children below 16 years of age in the family. This guarantees everyone in the family gets his or her European Health Insurance Card.
The EHIC of Tomorrow
The European Health Insurance Card safeguards your future by making sure you have access to quality affordable care when traveling to the 32 countries that have agreed to open their health care services to the nationals and residents of each member nation. It is a fundamental travel companion to any European wishing to explore other European countries.