DE00000301448

Dear Mr and Mrs Peters,

Thank you for your email of 17 April to the Department of Health regarding your application to the health insurance office in Alicante for European Health Insurance Cards (EHICs).

In terms of the difficulties you have been experiencing in obtaining EHICs, we think there may be a question over whether you are fully insured with the healthcare system there.  I do not know what the criteria are for being fully insured in that area of Spain, and I understand that the criteria vary between the different Spanish regions.  However the questions they are asking you seem to imply that you are not fully insured in the same way as Spanish residents.

It is often the case that UK residents who take early retirement to another European Economic Area (EEA) country are only able to register with the health system in that country if they are able to produce a form which proves they are entitled to medical treatment which will be funded from the UK.  I hope the following paragraphs will clarify the situation relating to UK residents who retire to another EEA member state.
     
People who retire early to another member state before a UK state retirement pension becomes payable, may in certain circumstances be entitled to healthcare cover provided by the UK.  This is provided under a Form E106. 

Entitlement to a Form E106 is normally dependent on what an individual’s payment of UK National Insurance contributions was when in work.  It does not depend on contributions paid during the whole of their working life, but on the period before they leave the UK.  Only compulsory National Insurance contributions count.

The maximum period of entitlement provided by a Form E106 is about two and a half years following payment of the last contribution.  Once an E106 expires, so does eligibility to healthcare cover in the EEA with a Form E106. 

If an individual was never issued with an E106, or if it has expired, then until they reach UK state retirement age (currently 65 for a man and 60 for a woman), and become entitled to a UK state retirement pension, their healthcare costs will not be a UK responsibility under either UK or European Community (EC) law. 

In some EEA countries it is possible to pay voluntary contributions to the state sickness insurance scheme, but if this is not possible in that country, then unfortunately there may be no alternative to an individual making their own arrangements for private medical insurance.

When the individual reaches UK state retirement age, they will once again be eligible under EC law to healthcare cover at UK expense.  The appropriate form to cover them then would be Form E121.  If a person’s spouse receives a UK state retirement pension (and therefore becomes eligible for an E121) before they do, it is possible that the health authority in that country may then agree to cover the individual’s health care needs as the dependant of the spouse until that individual also receives a UK state pension.

There is no form called an E122, and it is likely that the form they were referring to in the office in Alicante is an E121.  If you would like more information regarding the E121, please contact the DWP International Pension Centre.  Their details are as follows:

DWP International Pension Centre
Tyneview Park
Whitley Road
Newcastle-upon-Tyne
NE98 1BA
     
Telephone:  00 44 191 218 7777 or 00 44 191 218 6503

If you never applied for a form E106 then it is unlikely that you would be able to now, as the National Insurance contributions have to be in the recent past.  However, if you would like further information regarding the E106 then please contact the Medical Benefits section of the Department of Work and Pensions (DWP).  Their details are as follows:

DWP Medical Benefits
Room TC001
Tyneview Park
Whitley Road
Newcastle-upon-Tyne
NE98 1BA

Telephone: 00 44 191 218 1999

The email address for both offices is tvp.internationalqueries@thepensionservice.gsi.gov.uk
In terms of what level of healthcare you will be entitled to during a visit to the UK, if you do not have Spanish-issued EHICs, then your entitlement will be the same as that for visitors to the UK from a country with which the UK does not have a reciprocal healthcare agreement.  That is, if you require treatment that a GP or healthcare professional regards as emergency or immediately necessary treatment, you will receive that treatment free of charge.  At a hospital you will be charged the full cost of any treatment you receive, including emergency treatment, except to the extent that treatment in an Accident and Emergency (A&E) department is free to everyone.
If you have Spanish-issued EHICs, then during a visit to the UK you will be entitled to treatment which a GP decides is medically necessary.  Elective treatment is not included, however, nor the treatment of a pre-existing condition which in the medical opinion of a GP can wait until you return to Spain.
If you would like to see confirmation of this on the Department of Health website, please click on the following link to a document called ‘EU enlargement and overseas visitors' rights to primary care treatment in the UK’:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_064150
Page 3 of the document confirms what I have set out above regarding the level of primary care to which visitors from other EEA countries are entitled to in the UK under the EHIC scheme.
In terms of what your entitlement to NHS hospital treatment will be, this will include treatment required for a condition that occurs after your arrival in the UK, as well as treatment for chronic conditions which acutely exacerbate whilst here, and routine monitoring of pre-existing conditions. 
To see confirmation of this on the Department of Health website, please click on the following link to a page entitled ‘Are you visiting the United Kingdom?’ to a section called ‘People Entitled to Some NHS Hospital Treatment’:
http://www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/OverseasVisitors/Browsable/DH_074379
As referred to above, in order to access this treatment, it will be necessary for you to have Spanish-issued EHICs.  Please be aware that the fact you are paying UK tax on your police pension is not relevant to your entitlement to NHS treatment.
I hope that this information has been of help.

Yours sincerely,

Dot Crowe
Department of Health