UPDATE: Proof of CSI is no longer required in order to be granted settled status to remain in the UK as an EU national. However, people who want to apply for naturalisation as a British citizen must prove that they had a CSI in place in the past if this was an obligation for them. We’ve left this article on the website as the information in it can still be relevant to people in this category.

 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 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 settled status.

Settled status replaces the permanent residence status for EU nationals and after 31 December 2020, people who want to apply for permanent residence in the UK must instead apply for Settled Status.

However, people who want to apply for naturalisation as a British citizen must prove that they had a CSI in place in the past if this was an obligation for them. We’ve left this article on the website as the information in it can still be relevant to people in this category.

Comprehensive sickness insurance and Settled Status

With the UK leaving the European Union, the rules of permanent residency have changed for EU nationals and in light of Brexit, the comprehensive sickness insurance isn’t a requirement anymore to most people.

In order to formalise their situation in the UK post-Brexit, all EU nationals living in the UK have to apply for settled statusAnd 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.

A problem for people who want to acquire the British citizenship

The CSI problem might however resurface for some EU nationals 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.

The solicitor’s firm McGill and Co puts it very well on their blog: “The Home Office subtly updated its policy guidance for applications for naturalisation (British citizenship applications) to now require evidence of “exercising Treaty rights” from holders of settled status, up to the date they were granted their settled or pre-settled status. This change will affect all pending and future naturalisation applications.

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). The Home Office position is that the grant of EU settled status does not mean that the European person was in the UK lawfully prior to that grant. The person will now need to prove that they resided lawfully in the UK in accordance with the EEA Regulations in the lead-up to their grant of settled (or pre-settled) status.”

A component of being lawfully in the UK, is having had a comprehensive sickness insurance in place if this was an obligation for them.

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 comprehensive sickness insurance?

In this document, the Home Office defines 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.”

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, the UK’s National Health Service does not count as comprehensive sickness insurance.

In short, a “comprehensive sickness insurance” is another word for “private health insurance”. This insurance can be local or international.

However, there is no clarity or specific guidance about the comprehensiveness of that 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.

What constitutes a proof of 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 in the past

There was a lack of information on CSI from official UK organisations (such as government, universities or immigration offices). The problem was that the majority of EU citizens living in the UK had never heard of it because of a lack of communication and information from the UK government. As a consequence, many EU nationals in the UK are currently being refused permanent residence or naturalisation due to not having had comprehensive sickness insurance prior to their application.

PHD student 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.”

Consequently, the majority of EU citizens living in the UK have never heard of CSI and many of them 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)” explains 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.”

As explained above, there is also a lack of clarity about what this insurance exactly is and the level of cover required.

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.”


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/

https://www.gov.uk/apply-for-a-uk-residence-card/permanent-residence-card

https://www.freemovement.org.uk/it-just-got-more-difficult-for-europeans-to-become-british-citizens/

https://www.gov.uk/government/publications/naturalisation-as-a-british-citizen-by-discretion-nationality-policy-guidance

 

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