What has Brexit changed regarding the CSI?
Under pre-Brexit UK law, EU citizens coming to the UK as either a student, a self-sufficient person or a family member of one of the former categories, had to prove they had a comprehensive sickness insurance (CSI) in place for at least five years to qualify for permanent residency.
With Brexit, requirements have now changed and proof of CSI is no longer required in order to be granted permanent residence in the UK. EU nationals who arrived in the UK before 31st December 2020 applying for Settled Status are not required to show proof of CSI either.
Europeans staying temporarily in the UK for more than 6 months must now pay an Immigration Health Surcharge, that gives them the right to use the National Health Service.
However, the CSI problem might resurface for some EU nationals residing in the UK and who want to naturalise as British citizens within the next 5 years and who didn’t have a CSI in place when this was an obligation for them.
CSI: a problem for people who want to acquire the British citizenship
Any applicant for naturalisation must satisfy the Home Office that they have not been in breach of the immigration laws in the 5 years prior to their date of application (or just 3 years for those married to a British citizen). A component of being lawfully in the UK, is showing proof of past possession of a comprehensive sickness insurance if this was an obligation for them (for example if they were a student or if they didn’t work during a period of time).
The grant of EU settled status does not mean that the European person was in the UK lawfully prior to that grant.
Therefore, for people who can’t prove they had one in the past, their naturalisation might take longer and they might have to wait until they have built up 5 years of residence in the UK with Settled Status (or 3 years for people married with a British person).
Buying a CSI now wouldn’t make up for the CSI not purchased in the past and wouldn’t speed up the naturalisation process.
What is a comprehensive sickness insurance?
In this document, the Home Office defined comprehensive sickness insurance as “any form of insurance that will cover the costs of the majority of medical treatment [an EEA national or their family member] may receive in the UK.”
Cash back health schemes such as dental, optical, prescription charges, travel insurance policies and access to the UK’s NHS don’t count as CSIs.
In short, a “comprehensive sickness insurance” is another word for “private health insurance”.
Who was comprehensive sickness insurance for?
The comprehensive sickness insurance obligation was for people not working applying for EU law right of residence:
- a self-sufficient person or any of their family members
- student or any of their family members
- family members dependent on a child who is a EEA national living in the UK self-sufficiently
- family members of British citizens where the British citizen is economically inactive
The intention behind the rule of holding CSI was that self-sufficient persons and students should not become unreasonable burdens on the NHS.
Documents required to show proof of comprehensive sickness insurance
In the document intended for the Home Office staff in charge of accepting or refusing applications, here are the documents required to show proof of CSI:
- a comprehensive private medical insurance policy document
- a valid European Health Insurance Card (EHIC) issued by an EEA member state other than the UK (for people living in the in the UK on a temporary basis only)
- S1 form: The S1 form is a certificate of entitlement to health care in another EEA country for a limited duration and can only be used by certain people. For example: state pensioners or dependants of an insured person working in another member state
- S2 form: The S2 covers the actual cost of treatment. For example, insured people who are referred for specific treatment in another EEA country or Switzerland will have the cost of their treatment covered.
- S3 form: The S3 form will cover the cost of treatment. For example, retired frontier workers continuing treatment in the member state they previously worked in will have the cost of their treatment covered.
The problems surrounding the comprehensive sickness insurance in the past
There was a lack of information on CSI from official UK organisations (such as government, universities or immigration offices): the majority of EU citizens living in the UK had never heard of it. Before Brexit, many EU nationals in the UK were being refused permanent residence or naturalisation due to not having had comprehensive sickness insurance prior to their application.
The CSI was mainly “a concern for thousands of EU nationals who, for a proportion of their period of residence in the UK, were either a student, or a self-sufficient person (e.g. carers, stay-at-home spouses, or part-time workers)” explained PHD student Aleksandra Herbeć. “This would include cases in which an EU national worked full-time for 4 years and then enrolled at a UK university without having a CSI, thus unwittingly interrupting the 5-year residency rule.”
There was also been a lack of clarity about what this insurance exactly was and the level of cover required.
The CSI was also criticised for being “an unnecessary financial burden and a discriminatory barrier to residency”: contrary to the immigration health surcharge paid by international students in the UK, there was no standardised rate for private CSI for EU nationals. Like any private medical insurance, premiums depended on age, sex, health, and prior conditions, among others. “Even the cheaper options for healthy young adults (c. £30-40/month) could be unaffordable to many” pointed at that time Aleksandra Herbeć.
The European Commission also used to consider the comprehensive sickness insurance requirement as a breach of EU law because of the fact that the NHS didn’t count as a proof of CSI. The EU had even started infringement proceedings against the UK back in 2012. “In light of Brexit, it now seems unlikely that the investigation will go anywhere”, explains the website freemovement.org.uk.
In conclusion, now that the UK has left the EU and its system of laws, the EU law rights of residence or permanent residence will no longer exist in the UK. Showing proof of comprehensive sickness insurance is therefore no longer required, except for people applying for naturalisation and who need to show past possession of a CSI if this was an obligation for them.
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- An immigration health surcharge for long stays in the UK - Visitors staying for more than 6 months in the UK must pay an 'Immigration Health Surcharge'. Since Brexit, European citizens are also included.