After Brexit: Effects on healthcare and EHIC

CA’s RATS (Regulations and Technical Services Group) is actively examining the myriad of issues that may affect CA members post-Brexit, one of which is healthcare and the EHIC. The article below, by RATS Ted Osborn, is an example of the regular articles by RATS in the CA’s Cruising magazine, and the valuable information it provides to CA members.

The UK decision to leave the EU could have a particularly significant impact on the reciprocal healthcare arrangements made between UK and EU. These arrangements are dependent on membership of EU – so no membership, no mutual healthcare arrangements.

The government has now responded to the House of Lords’ study on healthcare for UK citizens in the EU27 following Brexit, which we reported in the June 2018 issue of Cruising.

Their response still contains gaps although we do now know a little more of government intentions and the prospects for reciprocal health care in Europe, particularly the EHIC scheme which many yachtsmen find so vital.

Negotiations between UK and the EU Commission on behalf of the EU27 continue very actively and there will certainly be further changes but we can report some firming-up of intentions as follows.

Implementation of reciprocal healthcare arrangements will be in three stages. A “Withdrawal Agreement” was intended to be agreed by the EU27 in October to include those aspects to be implemented on Brexit Day (March 19, 2019), those aspects which will have to wait until the end of the Implementation Period (December 31, 2020) and those which will have to wait for the final tidying up activity (via a “Future Relationship Agreement”).

Although Brexit Day is fixed, there must be some scepticism that the democratic processes of all 27 of the EU27 countries can be completed to this timetable.

Undecided matters
At the time of writing the UK is still pushing hard for the inclusion in the Withdrawal Agreement of “onward movement” rights (entry to one of EU27 permits entry to all) but the EU has not agreed, and this important aspect must now wait.

Continuation of the S2 (planned health treatment in the EU) and EHIC reciprocal healthcare schemes are UK government priorities, but the EU27 does not yet agree.

The existing right of UK pensioners in EU27 to make periodic visits home after Brexit without losing EU residence rights again is not decided. The UK government is requesting that a two-year absence be permitted.

Continuation of the EHIC scheme is probably the most important aspect of Brexit for UK yachtsmen visiting Europe and it is firmly stated by the UK government that this is a priority matter. Little has yet been agreed with the EU27 or Commission, however.

A statement from the government describes the position: “On EHICs, we have also agreed to protect the rights of individuals who are temporarily staying in an EU27 member state at the end of the implementation period and entitled to a UK EHIC, to continue to benefit from that scheme for as long as that stay continues. This includes, for example, for holiday or study purposes.” (Bullet 6 of Section 4 of UK response to HoL paper).

This is a major concession by EU but note that it covers only those already in EU27 on December 31, 2020, says nothing about the situation beyond 2020, nothing about onward movements, multiple visits or, perhaps the elephant in the room, nothing about possible visa requirements.

At present, EU nationals in the UK are often not charged for certain NHS services even where this is allowed by law, and UK users of the EHIC in EU27 are also not always charged. It now appears that both UK and the EU27 will in future fully charge visitors up to the same level as locals. Therefore in many places the EHIC, even if continuation is finally agreed by EU27, may only cover genuine emergency situations without charge.

It remains important that all entitled UK visitors to the EU27 should carry a valid EHIC card. If you do not have one or your EHIC has little time before it expires, Do something about it !

S1 and S2 healthcare schemes
The S1 reciprocal healthcare scheme (for those with existing residential qualifications in EU) is included in the Withdrawal Bill and will shortly become UK law and later EU27 law. This is good news, but we do not know how many yachtsmen will be able to benefit.

Similarly, the UK government has the intention to continue the S2 scheme (for planned health treatment) but only for those with EU27 residential rights. This would prevent many UK residents from planning to use health services in Europe (including Switzerland) – but again, the EU has not yet agreed this.

The next steps
Many of the aspects already agreed by UK/EU only apply to UK citizens who are resident in EU27 countries before Brexit. The government summarises the position as: “[The agreement to date]... says nothing of whether and how the reciprocal healthcare entitlements of other UK and EU citizens will be protected post-Brexit. In the absence of an agreement on future relations that covers this topic, the rights currently enjoyed by 27 million UK citizens, thanks to the EHIC, will cease after Brexit. Other rights, provided for by the S2 scheme and Patients’ Rights Directive, will likewise come to an end.“

This bleak statement is not the end of the matter, however, for the government statement goes on to say: ”We will return to reciprocal healthcare arrangements for people not within scope by the end of the implementation period, in the next phase of negotiations. We welcome the progress that has been made so far but are clear that we want a wider agreement with the EU on reciprocal healthcare into the future, including:

  • the rights of UK state pensioners who retire to the EU (and vice versa) after the end of the implementation period to benefit from a reciprocal healthcare scheme;
  • the rights of UK residents to continue to receive needs arising treatment in the EU under the EHIC scheme (and vice versa); and
  • the rights of UK residents to be able to receive planned treatment in an EU Member State when this is preauthorised by the UK (and vice versa).” Government intentions are good, but in case of failure: “We are confident of securing a comprehensive deal but, to fully prepare for the unlikely event the UK and the EU do not agree the Withdrawal Agreement and implementation period, or secure a deal on future reciprocal healthcare rights, we are further developing contingency plans.”

The UK has made encouraging progress in withdrawal negotiations with the EU and, while “nothing is agreed until everything is agreed”, the UK Government and the Commission have stated that providing certainty for citizens is a priority For a full copy of the government position see

Under any circumstances it remains important that UK yachtsmen sailing in EU27 after March next year have comprehensive travel insurance

Who is RATS?
RATS is the CA’s Regulations and Technical Services Group that works on behalf of members by researching and advising on a wide range of issues of a technical or regulatory subject relating to cruising as well as campaigning on issues affecting the cruising community. This involves interacting with numerous international, national, parliamentary, trade, special interest and other local groups, many of whom actively seek advice from, and consultation with, the CA’s RATS.