Under current 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, must prove they have had comprehensive sickness insurance (CSI) in place for at least five years to qualify for permanent residency.

However, there is a lack of clarity about what this insurance exactly is and the level of cover required. Furthermore, the majority of EU citizens living in the UK have never heard of it because of a lack of communication and information from the UK government. As a consequence, many of EU nationals in the UK are currently being refused permanent residency due to not having had comprehensive sickness insurance prior to their application.

“The CSI is 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)” notes 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.”

However, with Brexit, requirements are changing and proof of CSI will no longer be required in order to be granted settled status (which will replace the current permanent residence status for EU nationals after Brexit) but there are still some points of confusion. This article aims to answer most questions you may be asking yourself about comprehensive sickness insurance.

 

What is comprehensive sickness insurance?

The British government published a document intended for the Home Office staff in charge of accepting or refusing applications.

In this document, comprehensive sickness insurance is defined 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.”

There is clarity in what the CSI does not include:

“Cash back health schemes such as dental, optical, prescription charges, travel insurance policies and access to the UK’s NHS.”

Therefore, it is important to know that the UK’s National Health Service does not count as comprehensive sickness insurance.

However, this Home Office document doesn’t give any clarity or specific guidance about the comprehensiveness of that insurance. This consideration is left to the discretion of the Home Office staff member when they review an application: “You must take a proportionate approach when you consider if an insurance policy is comprehensive. For example a policy may contain certain exemptions but if the policy covers the applicant for medical treatment in the majority of circumstances you can accept it.”

Who is comprehensive sickness insurance for?

The Home Office document specifies that comprehensive sickness insurance is 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 is that self-sufficient persons and students should not become unreasonable burdens on the NHS.

“Yet this logic is unclear”, explains Aleksandra Herbeć : “the permanent residency application only requires one to have had a CSI – not to have made use of it. Indeed, people with CSIs can still access GPs and all treatments on the NHS. EU citizens are in many circumstances required or strongly encouraged to register with a GP, including when enrolling at a university. Moreover, private insurers do not cover all treatments even under the ‘comprehensive’ sickness insurance, often delegating the treatment of chronic conditions to the NHS.”

How to get comprehensive sickness insurance: documents required

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

First of all, there is a lack of information on CSI from official UK organisations (such as government, universities or immigration offices). Aleksandra Herbeć notes that “the UK government has been passing laws on CSI without communicating them widely, not even through the organisations directly in contact with EU citizens, such as universities, while upon arriving to the UK, EU nationals have not been provided with clear information on this requirement.”

The CSI is 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 is no standardised rate for private CSI for EU nationals. So what is the cost of comprehensive sickness insurance? Like any private medical insurance, premiums depend 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” says Aleksandra Herbeć.

It is also important to note that the European Commission considers the comprehensive sickness insurance requirement as a breach of EU law because the NHS doesn’t count as a proof of CSI. The website freemovement.org.uk explains: “The EU started infringement proceedings against the UK back in 2012 but nothing much seems to have happened with the case. The Commission confirmed in September 2017 that the case is ongoing, although would not say much about what, if anything, was going to happen and when. In light of Brexit, it now seems unlikely that the investigation will go anywhere.”

 

Comprehensive sickness insurance and Brexit

With the UK leaving the European Union, the rules of permanent residency are changing for EU nationals and in light of Brexit, the comprehensive sickness insurance requirement may not matter much to some people in the long run:

In order to formalise their situation in the UK post-Brexit, all EU nationals living in the UK will have to apply for settled status (find out more here: https://www.gov.uk/guidance/status-of-eu-nationals-in-the-uk-what-you-need-to-know).

And the good news is that within settled status, proof of comprehensive sickness insurance is no longer required.

So what can you do now? The website freemovement.org.uk summarizes the situation well:

“If you do not already have comprehensive sickness insurance, there seems little point in getting it now if what you want is permanent residence under EU law. By the time you build up five years of residence with comprehensive sickness insurance cover, the UK is set to have left the EU and it will no longer be possible to get permanent residence.

“Instead, most people who think comprehensive sickness insurance is an issue for them would be better off waiting and applying for “settled status”. The Home Office says that it will not enforce the requirement for comprehensive sickness insurance for those applications.”

However, there still can be some concern for people applying to stay while they build up the five years necessary to qualify for settled status as it is less clear whether the requirement is waived for this category of people. There can also be concerns that the Home Office will renege on its promise altogether, which could be allowed under the terms of the deal struck with the EU.

The worst case scenario can be guarded against by:

  • Having a right of residence that does not require comprehensive sickness insurance at the point when you apply for settled or temporary status. You can achieve that by becoming a worker or self-employed.
  • Having comprehensive sickness insurance at the point when you apply for settled or temporary status. You can achieve that by purchasing comprehensive private insurance.

“Neither are particularly easy options, obviously”, explains Freemovement.org. “It would be far preferable for EU law to be properly respected by the UK — for access to the NHS to be treated as comprehensive sickness insurance — and for full free movement rights of existing EU residents to be preserved along with continued access to the Court of Justice of the European Union when Brexit occurs.”

However, it is unlikely that this is going to change, as the focus now is on formalising the conditions of the Brexit. If you wish to purchase comprehensive private health insurance in order to guard you against the worst case scenario, Expat Assure can advise you on the best insurance in your situation and level of cover. When comparing the market, the most comprehensive health insurance is without a doubt an international private medical insurance as it provide a much wider cover than a classic UK medical insurance. Among other conditions, this kind of insurance covers chronic or recurrent illnesses, not covered by a UK medical insurance. (Find out more about expatriate health insurance and about expat health care and insurance in the United Kingdom) Don’t hesitate to contact us or to request your personalised insurance comparison.


Sources:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/588174/EEA-qualified-persons-v4_0EXT.pdf

https://www.gov.uk/guidance/status-of-eu-nationals-in-the-uk-what-you-need-to-know

http://blogs.lse.ac.uk/politicsandpolicy/the-little-known-loophole-used-to-deny-eu-citizens-permanent-residency/

https://www.freemovement.org.uk/comprehensive-sickness-insurance-what-is-it-and-who-needs-it/

2 Comments

  1. Michael Green

    More crazy UK rules. Reminds me of the Windrush Affair.
    My German wife has lived in the UK since 1983. She has 2 British sons (plus a dead one, buried in Edinburgh). On moving here she was given an NHS number and the German Consul in Liverpool told her she did not need to apply for anything. She worked for a number of years before becoming unable to work due to PTSD.
    Imagine our surprise to find that, under current rules, she is not eligible for a permanent residency because she does not have CSI. No-one in the NHS asks for it, so even is she had it she would never use it! As a GP myself I have never been aware of EEA nationals needing CSI.
    Do we continue to apply for permanent residency (she would like to apply for dual nationality under EU rules), or wait to apply settled status after Brexit, but then may not be eligible for dual nationality?

    Reply
    • Lisa Expat Assure

      Unfortunately we do not know if rules will change or not regarding dual citizenship, it will depend on any bilateral agreements with the EU after Brexit. It is a personal choice as to whether to go through permanent residency and then apply for dual citizenship, or wait for settled status. If you would like further clarification on dual citizenship following settled status we would advise you to contact the Home Office.

      Reply

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