Brexit: Reciprocal Healthcare Arrangements

Thursday 26th September 2019 Written Statements

[The Minister for Health (Edward Argar)]

Today I am notifying the House about an announcement that the Government have made about transitional healthcare arrangements across the EU if we are unable to secure a deal.

The UK is leaving the European Union (EU) on 31 October 2019, with or without a deal. The UK Government are working hard to secure a deal that covers healthcare arrangements, but it is important that people understand what will happen if the UK leaves without a deal and what support the Government have put in place for that scenario.

Our priority is to maintain reciprocal healthcare arrangements with member states (MS) when we leave the EU. That is why the UK Government have proposed consistently to all MS that existing reciprocal healthcare arrangements (under regulation 883) continue until 31 December 2020 in a no-deal scenario. These arrangements safeguard healthcare for the hundreds of thousands of UK-insured persons who live in Europe or require medical treatment while holidaying in Europe. They also ensure that EU citizens can receive healthcare in UK, whether they are here on holiday, or to live and work.

Regulation 883

Current EU reciprocal healthcare arrangements (Reg (EC) No 883/2004) support large numbers of UK nationals living in, working in, or visiting the EEA or Switzerland to access healthcare. The arrangements require equal treatment between EU/EFTA citizens when accessing healthcare in other MS. Any EU citizen (or economically active third country national) resident in the UK who moves to the EEA or Switzerland can access state-provided healthcare by paying the same taxes as nationals of that country or people who are eligible for state healthcare.

In addition, the UK reimburses other MS for the state-funded element of healthcare for certain groups known as “UK-insured” who do not need to pay local taxes:

(a) S1—the UK covers the healthcare costs of S1 holders, which include state pensioners, people with disability benefits, certain workers and their dependents living in the EU.

(b) European health insurance card (EHIC)—the UK funds “needs-arising” healthcare when UK residents visit the EU temporarily (for tourism, study or work).

(c) S2—the UK Government fund UK-insured individuals who travel to receive pre-authorised planned treatment in the EU (e.g. maternity).

The UK administers reciprocal healthcare, including paying for overseas medical costs, on behalf of England, Scotland, Wales, Northern Ireland and Gibraltar.

Arrangements with member states

Arrangements are already in place with a number of MS, and the UK Government are still seeking further reciprocal agreements ahead of leaving the EU on 31 October. The Government are currently undertaking technical discussions with countries such as Belgium who have already passed domestic legislation that will support reciprocal healthcare with the UK after Brexit.

The UK Government stand ready to reciprocate all arrangements with MS, and have the necessary legislation in place, under the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 and the European Union (Withdrawal) Act 2018.

Ireland

Under the common travel area (CTA). British citizens living in Ireland will be able to access healthcare in Ireland on the same basis as Irish citizens which means that they may need to make a financial contribution. The UK Government are in detailed discussions with the Irish Government to reach an arrangement which would enable current reciprocal healthcare arrangements to continue. British and Irish citizens who live in Ireland will also continue to have access to free-of-charge healthcare while visiting the UK. This is regardless of the circumstances in which the UK leaves the EU.

Spain

Healthcare access in Spain will remain the same after exit day, whatever the Brexit scenario. This is because the UK and Spain have each taken steps to ensure that people living in each country can continue to access healthcare as they do now until at least 31 December 2020, using their S1 forms. UK EHIC holders in Spain, and those who have planned treatment in Spain using an S2 form will also be able to continue to access healthcare in the same way when they are in Spain until at least 31 December 2020. The UK Government are now seeking to work closely with Spain to agree how this will work in practice. The Spanish Government’s guidance on access to Spanish healthcare and Brexit can be found here:

www.lamoncloa.gob.es/lang/en/brexit/Paginas/index.aspx.

Switzerland

The UK has reached an agreement with the Swiss Confederation to ensure that the rights of UK nationals living in Switzerland and Swiss nationals living in the UK are preserved in a no-deal scenario after the UK leaves the EU on 31 October. This means that UK-insured individuals who reside in Switzerland at the time of Brexit will still be able to access healthcare using their S1 form, as they do now.

Moreover, UK nationals travelling to Switzerland, before the UK leaves the EU will continue to be covered by their UK issued EHIC for the duration of their stay. This includes visits which started before Brexit and end after the UK’s withdrawal from the EU. If a visit starts after the UK leaves the EU, EHIC may no longer be valid.

Norway, Iceland and Liechtenstein

The UK has reached an agreement with the EEA-EFTA states (Iceland, the Principality of Liechtenstein, and the kingdom of Norway) to ensure the rights of UK nationals living in these countries, and that nationals of Iceland, Liechtenstein and Norway living in the UK, by 1 November are preserved after the UK leaves the EU on 31 October 2019. This means that UK-insured individuals in these countries at the time of the UK’s exit will be able to access healthcare using their S1 form, as they do now, after 31 October.

Moreover, UK nationals travelling to Iceland, Liechtenstein or Norway before the UK leaves the EU will continue to be able to rely on their UK issued EHIC for the duration of their stay. This includes visits which started before Brexit but end after the UK has left the EU. If a visit starts after the UK has left the EU, EHIC may no longer be valid.

Other EU countries

Updated information has been published on gov.uk and nhs.uk on the situation for each MS, including what arrangements have been put in place. These pages will be kept updated as further assurances from MS are received.

Those living in the EU whose healthcare is funded by the UK should not delay in reviewing their circumstances in order to secure their future healthcare needs. It is important that people review their own needs now and consider options carefully by checking the guide for the country they live in. People can also sign up to email alerts to check these country guides regularly as the situation may change as the UK gets closer to leaving the EU.

Preparing for leaving the EU

The UK’s offer to EU citizens resident in the UK is clear. We offer complete assurance to EU citizens who are living in the UK on or before 31 October 2019, that they will be able to access free healthcare on the NHS after we leave the EU on 31 October. Should EU countries not agree to our offer to continue the existing reciprocal healthcare arrangements until December 2020, visitors from those EU countries will be charged for NHS care.

Beyond the bilateral arrangements, it is difficult to predict what exact arrangements will be in place for UK nationals in other MS as we continue to hold our technical discussions with them. This is because of the varying nature of each country’s healthcare system. In view of this uncertainty, UK-insured individuals living in the EU should be ready for possible permanent changes to how they access healthcare.

Everyone living in the EU is strongly encouraged to think about their own healthcare needs and circumstances and consider the steps they need to take to be assured of continuing healthcare coverage. The Government have produced detailed advice for each country which can be accessed here: www.gov.uk/uk-nationals-livinq-eu

Specifically, individuals should consider: whether they need to register as a resident under local rules; the documentation they need to have in place; taking steps to understand how the local healthcare system operates and how their healthcare cover may change; and, if appropriate, purchasing private insurance.

Contingency arrangements

While we continue to promote our offer to all MS to continue existing reciprocal healthcare arrangements until at least 31 December 2020, the Government recognise that as we leave the EU, arrangements may not be straightforward and people may experience some challenges. As such, while countries and individuals put arrangements in place, we have taken a number of steps to support and protect UK-insured individuals living in the EU.

Not all UK-insured individuals will need to access these UK arrangements, as we may negotiate some further arrangements and many countries have put in place comprehensive arrangements already for UK-insured individuals and others may follow suit. However, coverage does vary, and the UK Government want to ensure that all UK-insured individuals are in a good position to assess their options and prepare for what comes next.

Specifically:

(1) We have provided information online and are sending a letter to S1 holders living in EU and EFTA MS, encouraging individuals to consider their circumstances and options and to take the necessary steps to ensure they have appropriate coverage in place. The steps necessary will vary depending on individual’s circumstances and by country.

(2) For UK-insured individuals who may find themselves in a particularly vulnerable situation because they fall ill before the UK leaves and require treatment that spans exit day, we have made specific transitional provisions. If an individual requires healthcare treatment before the UK leaves the EU and the treatment will continue until after Brexit, the UK Government will pay for this course of treatment for up to one year (or the authorised period in relation to an S2) or the period of treatment if shorter. This will apply for those receiving healthcare as an S1, S2 or as an EHIC holder.

(3) The UK Government will fund the healthcare of existing UK-insured individuals living or working in the EU, on the same basis as now, for a further six months from the point of Brexit. This provision is aimed at providing individuals time to make alternative arrangements for their future healthcare cover, including registering for healthcare in their country of residence.

The UK-funded protection may be required if the EU or MS refuse to enter into arrangements with the UK or refuse to offer comprehensive protections to UK-insured through domestic legislation.

In addition, some MS do not fund healthcare for those who are going through the healthcare registration process. To give as much protection as possible to UK-insured individuals, after the six months is over, the UK Government will continue to fund healthcare for the length of the registration period if that MS does not fund healthcare for that period (up to one year) and the individual has taken steps to register in-line with local timeframes and no later than six months from exit day. This will ensure there is appropriate coverage should there be delays or overly lengthy registration processes. If a UK-insured individual leaves their country of residence to travel to another country, they will have to take out full travel insurance as their EHIC will not be valid.

(4) The UK will also continue to cover those travelling to the EU, whose visits commenced prior to Brexit day until they return to the UK, up to a period of six months.

(5) Students may find themselves in a particularly challenging position if they are already studying abroad. All students are encouraged to take out comprehensive travel insurance and to investigate local healthcare schemes that they may be eligible for. However, given the circumstances, the UK Government have agreed to continue existing cover of healthcare costs for students for the duration of their course, should they be already studying in a MS at the point that the UK leaves the EU and on the basis of evidence from their Institution. More information on support for students can be found here: www.gov.uk/guidance/studying-in-the-european-union-after-brexit.

(6) In exceptional circumstances, the UK Government have put in place provisions to provide bespoke support to people who find themselves in a challenging position due to a change in their healthcare cover after Brexit. This scheme will run from 1 November 2019 for at least a year with strict criteria and will only support those with very limited financial means.

The overall contingency package will be most relevant in MS whose domestic legislation does not protect UK-insured individuals during the registration period, exposing them to gaps in healthcare coverage and potentially high costs. We are seeking to agree with MS that they will accept our payments for healthcare cover if the UK leaves the EU without a deal. Where a MS does accept these payments, this would mean UK-insured individuals could continue accessing healthcare as now, beyond deciding whether to register with the local scheme or return to the UK within six months of Brexit. If a MS does not agree to this, then the UK Government will step in to pay healthcare costs directly. To access this support after the UK leaves the EU, UK-insured individuals will need to contact the NHS business services authority (NHS-BSA) to provide them with the healthcare provider’s details, so that the BSA can arrange for the healthcare provider to invoice the UK Government directly.

Individuals should not delay taking action to put appropriate permanent arrangements in place for when the UK leaves the EU on account of this additional support, particularly as for some EU countries the timeframe for UK-insured individuals to register with their domestic health system is far shorter than six months.

Planned treatment

The UK Government will fund planned treatment within MS (S2 scheme) if authorisation for that treatment has been applied for before Brexit and later granted or authorised before Brexit, even if that treatment is scheduled to start after Brexit. The UK Government will pay for these treatments if the provider agrees to honour their commitment.

Returning to the UK

After the UK leaves the EU some people may decide to return the UK. UK nationals living in the EU whose healthcare is currently funded by the UK will be able to access free NHS care when temporarily visiting England, Scotland and Wales. UK nationals living in the EU will be eligible for NHS care if they move permanently back to the UK (including Northern Ireland) and meet the ordinarily resident test. Accident and emergency services and services that are deemed urgent or immediately necessary will always be provided free at the point of delivery first in the UK, with entitlement to NHS care determined afterwards. More information can be found here: www.gov.uk/guidance/using-the-nhs-when-you-return-to-live-in-the-uk.

[HCWS1832]