French Health care for British Ex-pats

I have been following the saga about the right to healthcare in France for British ex-pats.

The whole subject has certainly created a stir and caused some sleepless nights in a few households.

I was only told about it by a friend fairly recently. Until that point in time over a convivial glass of wine at a BBQ I was blissfully unaware of the volcano that was erupting.

Luckily, I turned to This French Life which is always on the ball with following important news and information for ex pats and picked up on this article that Craig had written.

Craig says that it all started with some loosely written and erroneous press coverage with the bombshell that Sarkosy has withdrawn health cover for anyone under retirement age that is not contributing to the French system.

As you can probably imagine, with two young children and personally growing older by the day, it came as a bit of a surprise. After all, we are all part of Europe aren't we?

Further press coverage seemed to change the landscape and it did indeed look as though we were doomed to die in horrible discomfort whilst the empty wards shouted 'Non'! at us as we clawed at the hospital entrance, desperate for medical assistance.

TFL updated us all on some new information and it started to become a little clearer but none the less still confusing.

I had not written about here on Perigord Vacance for two reasons. The first is I am too busy for my own good at the moment and could not find the time to write at length on the subject.
Secondly, The whole subject seemed so complicated that I did not want to add any personal spin that would muddy the water still further.

I then received an email from John Kelly, a regular reader of PV, who asked why I had not covered it? 'After all my blog was read by many ex pats and potential ex pats and it could help to raise awareness'.

I received another email from John , who had written a hypothetical question to Alan Johnston, the minister for Health and with his permission I have reproduced it here, together with the reply, for your information.

I am sure the debate will rumble on and even the French will understand it all one day too. In the meantime, I must retire for Croissants and coffee.

"Sir,

I am a French national and having taken early retirement,intend moving permanently to the UK.

I do not intend to work but would like to know whether I qualify for comprehensive healthcare cover within the NHS?

The question I ask is hypothetical but ask it because I am planning to move permanently to France but under healthcare changes being implemented by Prsident Nicolas Sarkosy, healthcare cover for non-French, non-working EU citizens is being withdrawn for those under retirement age.

If the answer to my hypothetical question is 'yes', then can Sarkosy's changes be correct under EU law and member state agreements? I understood there was supposed to be equality between EU member countries on such matters.

Your comments would be very much appreciated, as I am writing on behalf of several, very concerned people in the same position.

Yours sincerely,

John Kelly"

The reply

"

Our ref: DE00000240962 

Dear Mr Kelly,

Thank you for your email of 26 September to the Department of Health about reciprocal healthcare agreements between the UK and France.

The UK has healthcare arrangements with all of the other Member States of the European Economic Area (referred to as the EEA, consisting of the other European Union Member States, plus Iceland, Liechtenstein and Norway) and Switzerland, derived from the European Community Social Security Regulations.  Under these regulations, UK residents are covered for any necessary medical treatment required during a temporary stay in another Member State on production of a European Health Insurance Card (EHIC), so long as they have not travelled specifically for that treatment.  These regulations also cover people who move to another EEA country to live and are in receipt of a UK state pension or if they are posted abroad by a UK employer and still pay tax and National Insurance in the UK.  In addition, the UK does under certain circumstances pay the healthcare costs for a limited period of those people who move abroad before they are in receipt of their pension.

A key feature of these arrangements is that the treatment must be provided on the same terms as it is provided to locally insured residents.  This means that treatment is not always free.  For example, in France, people have to pay a proportion of their hospital costs themselves.  This proportion is not refundable from state funds.  The majority of French residents take out private ‘top up’ insurance to help them meet these costs. 

As you are aware, the French have changed their domestic rules on eligibility for healthcare services for people who are not working.  Some people, including those retiring to France from other European countries (including the UK) and who are not yet in receipt of a state pension, will no longer be covered by the French system and will need to take out private health insurance until they reach UK retirement age or until they qualify as a French resident (which is after five years of regular uninterrupted residence).

The change in the French regulations will affect only those people who are under UK state pension age.  Under EU regulations, once a person is in receipt of a UK state pension they are entitled to apply to the UK for a form E121 which gives them access to healthcare on the same basis as a member of the country in which they are living.

With regard to the provision of healthcare services for foreign visitors to the UK, I would reassure you that the NHS remains first and foremost for the benefit of people living in this country.  Entitlement to free NHS treatment is based on residence in the UK, not on nationality, the past or present payment of UK taxes or National Insurance contributions.  An overseas visitor is a person who is not ordinarily resident in the UK.  Theirs is essentially a short-term position until they return abroad or become resident here on a legal and settled basis.  ‘Ordinarily resident’ is a common law concept interpreted by the House of Lords in 1982 as referring to someone who is living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, with an identifiable purpose for their residence here which has a sufficient degree of continuity to be properly described as settled.

This general principle does not apply to emergencies and treatment that in the clinical opinion of the healthcare professional is immediately necessary, that is, treatment that cannot be reasonably delayed.  This must be provided free of charge by a GP practice, regardless of whether or not the person is a registered NHS patient or their status in this country.  The UK also has bilateral health agreements with a number of non-EEA states, which generally entitle their nationals or residents to immediately necessary treatment.

In order to access routine treatment (NHS primary medical services), it is necessary to register with a local GP practice to join its list of NHS patients.  GP practices have the discretion whether to accept any application to join their list of NHS patients either as a registered patient or as a temporary resident, defined as a person in an area for not less than one day but no more than three months.  Acceptance guarantees that a person will receive free NHS primary medical services from their GP practice, but they are not necessarily entitled to receive free hospital care because different rules apply. 

A GP practice can refuse an application only if it has reasonable grounds for doing so, such as if the applicant lives outside the practice’s area.  It cannot discriminate on grounds of disability or medical condition, age, appearance, race, gender, social class, religion or sexual orientation.  If a practice refuses an application, it can offer to treat the person as a private patient.  The amount charged is a matter for the practice.

European Union law changed on 1 June 2004 so that insured EEA residents visiting EEA Member States are now entitled to all necessary medical treatment during a temporary stay in another Member State.  In each individual case, it is for the attending clinician to decide if treatment is necessary or can wait until the patient returns home.  This does not cover planned treatments, where the patient travels specifically to receive medical treatment, but it does include ongoing care for pre-existing medical conditions, such as prescriptions and blood monitoring tests for diabetic patients.  An EEA visitor might therefore usually apply to join a GP practice’s list as a temporary resident.

In cooperation with the Home Office, the Department of Health has been reviewing access to NHS healthcare by foreign nationals.  The review includes access to both primary and secondary care and considers a range of issues relating to immigration and asylum arrangements, including the position of failed asylum seekers, as well as public health and humanitarian issues.  It is due to be completed shortly.

I hope this reply is helpful.

Yours sincerely,

Edward Corbett
Customer Service Centre"