Comprehensive Sickness Insurance in the UK: How do you prove past healthcare coverage by another Member State’s social security system?

As the UK’s withdrawal from the European Union approaches, EEA nationals and their family members have been applying for permanent residence in increasing numbers.

In 2016, over 90,000 applications for permanent residence were submitted by family members and in 2017 this more than doubled to almost 215,000 applications (Home Office, Immigration statistics, October to December 2017).

However, the rate of rejection of applications was relatively high: in 2016 29% of applications were either refused or declared inadmissible, whereas in 2017 the rate of rejection was lower at 21%.

Unfortunately, we do not have reliable statistics to determine what proportion of these refusals is due to applicants not having held comprehensive sickness insurance during their period of residence in the UK.

Despite having made a specific request to the Home Office to publish this information, our request was turned down because the “requested data is not recorded for our statistical purposes thus; (sic) we cannot provide information on any of the above questions” (Home Office response to the EU Right Clinic’s FOIA request No 35185, 7 May 2015).

However, we know from the evidence submitted to the Brexit Committee of the House of Commons that the absence of comprehensive sickness insurance constitutes one of the main reasons for the Home Office to reject applications for residence documentation by EEA nationals and their family members (Exiting the European Union Committee, The Government’s negotiating objectives: the rights of UK and EU citizens (HC 2016-17, 1071) para 67).

So how can EEA nationals and their family members prove they have held comprehensive sickness insurance during their residence in the UK when they apply for permanent residence?

The Home Office’s Modernised Guidance “EEA nationals qualified persons”  sets out what documents are needed for permanent residence applications:

For applications for a document certifying permanent residence or a permanent residence card

They must provide one of the following documents or a combination of these documents covering their 5 continuous year’s residence in the UK:

•  a comprehensive private medical insurance policy document

•  a valid European Health Insurance Card (EHIC) issued by an EEA member state other than the UK (or its predecessor form E111)

•  form S1 (or its predecessor forms E109 or E121)

•  form S2 (or its predecessor form E112)

•  form S3

The definition of CSI [comprehensive sickness insurance] does not include:

•  cash back health schemes, such as:

o dental

o optical

o prescription charges

•  travel insurance policies

•  access to the UK’s NHS”

However, these documents are not the only way that EU citizens and their family members can prove they held comprehensive sickness insurance.

**Please note that, in practice, the Home Office’s practice means it does not always accept past coverage by another Member State’s healthcare system as evidence of comprehensive sickness insurance. You may therefore need to be prepared to appeal against any refusal by the Home Office to accept evidence of past coverage. In all cases we invite you to submit a copy of this blog post in your application**.

Another way to prove comprehensive sickness insurance includes past coverage under your home country’s social security system.

This will often benefit students who came to study in the UK and who remained covered by their home country’s social security system, but it might include others, such as those in receipt of an exportable benefit from another EU country or EEA state.

Past coverage under your home country’s social security system can be proved in a number of different ways that differ according to national practices:

•  Italian citizens who came to the UK to study and did not register with AIRE (Anagrafe Italiani residenti all’estero): they can prove this by obtaining a letter confirming their former healthcare coverage from their local healthcare institution (azienda sanitaria locale), if possible with a print-out confirming the dates when they held an Italian Healthcare Insurance Card (Tessera Europea di Assicurazione Malattia).

•  Bulgarian and Romanian citizens may be issued Structure Electronic Document S041 by their social security institution back home which confirms that their citizens remained covered by their home country’s social security system for a specified period of time and therefore were entitled to receive healthcare in the UK at the expense of their home country during that period of time – if you have been issued SED S041, you should download our practice note on SED S041 and include a copy in support of your application for permanent residence.

•  Dutch citizens may also be issued with the old Form E104 , which is a certificate showing periods of previous coverage by their home country’s social security system for a specified period of time and therefore were entitled to receive healthcare in the UK at the expense of their home country during that period of time – if you have been issued Form E104, you should download our practice note on Form E 104 and include a copy in support of your application for permanent residence. [link to document]

Separately, some EEA citizens may be able to invoke the existence of reciprocal arrangements concluded by the UK with individual Member States. The basis for this claim is the ruling by the Court of Appeal in Ahmad v Secretary of State for the Home Department [2014] EWCA Civ 988 in which Arden LJ held “[53] … It is common ground that if there were reciprocal arrangements with the EEA national’s own state that would be sufficient to constitute comprehensive insurance cover.” This would only benefit the following categories:

•  German citizens who can invoke Article 2 of the Agreement between the Government of the United Kingdom of Great Britain and Northern Ireland and the Government of the Federal Republic of Germany concerning the Waiving of the Reimbursement of the Costs of Benefits in Kind provided for Sickness, Maternity, Accidents at Work and Occupational Diseases, of Unemployment Benefits and of the Costs of Administrative and Medical Controls (Bonn, 29 April 1977), which waives any costs arising from medical treatment provided under the NHS to German citizens in the UK:

“(1) Reimbursement by the competent institutions of the Contracting Parties of the costs of benefits in kind for sickness, maternity, accidents at work and occupational diseases in accordance with paragraph 1 of Article 36 and paragraph 1 of Article 63 of Regulation (EEC) No. 1408/71 [now paragraph 1 of Article 35 and paragraph 1 of Article 41 of Regulation 883/2004] and of the costs of administrative and medical controls in accordance with paragraph 1 of Article 105 of Regulation (EEC) No. 574/72 [now paragraph 1 of Regulation 987/2009] shall mutually be waived.”

•  In addition, some EEA nationals who arrived in the UK before their country joined the EU/EEA may be able to rely on the more favourable provisions of reciprocal arrangements that are contained in bilateral social security conventions that effectively waives the requirement to hold comprehensive sickness insurance. This results from the so-called “Rönfeldt principle” laid down in the case law of the EU Court of Justice in Case C‑227/89 Rönfeldt EU:C:1991:52 and subsequent cases. This only benefits specific nationalities:

o   French nationals who were lawfully living in the UK before 1 January 1973 when the UK joined the EEC;

o   Portuguese and Spanish nationals who were lawfully living in the UK before 1 January 1986 when Portugal and Spain joined the EEC;

o   Icelandic and Norwegian nationals who were lawfully living in the UK before 1 January 1994 when Iceland and Norway joined the EEA;

o   Austrian and Finnish nationals who were lawfully living in the UK before 1 January 1995 when Austria and Finland joined the EU;

o  Czech and Slovenian nationals who were lawfully living in the UK before 1 May 2004 when the Czech Republic and Slovenia joined the EU.

In all cases, applicants should not forget to supply an English translation of any document which have been issued in another language.

The EU Rights Clinic is a partnership between ECAS and the University of Kent in Brussels. It helps EU citizens and their family members overcome problems they encounter when moving within the EU.

The EU Rights is grateful for the financial support it has received from the European Programme for Integration and Migration under its sub-fund on EU mobility.

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