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When living abroad

Updated : 31/10/2013

health

Your health insurance cover

In the EU, the country responsible for your social security, including your health insurance, depends on your economic status and your place of residence – not your nationality. Make sure you understand under which country's social security you should be covered. You may not choose which country you are covered by!

If you are unsure about your health care related rights and want to check before getting treatment, each EU country has at least one National Contact Point that can inform you whether or not you will be entitled to reimbursement, and any ceilings applied.

Special conditions apply to healthcare coverage if you are:

Working in one country, living in another

If you work in one EU country and live in another, you are entitled to medical treatment on both sides of the border.

You should first register in the country where you work and get an S1 form (former E 106 form) from your health insurance authority. This form entitles you and your dependants to register for health insurance in the country where you live. You will therefore have 2 health insurance cards: one for each country.

Your dependants can also enjoy the same rights as you if you live and work in:

Austria

Germany

Portugal

Belgium

Greece

Romania

Bulgaria

Latvia

Slovakia

Cyprus

Luxembourg

Slovenia

Czech Republic

Malta

France

Poland

If you live or work in Denmark, Estonia, Finland, Hungary, Ireland, Italy, Lithuania, Spain, Sweden, the Netherlands, or the United Kingdom, your dependants cannot have 2 health insurance cards. They can receive treatment in the country where you work only when one of the following conditions is met:

  • treatment becomes necessary on medical grounds during their stay in that country, taking into account the nature of the treatment and the expected length of the stay
  • there is an agreement between the countries/authorities concerned
  • prior authorisation has been granted using form S2 (former E 112 form) issued by the health insurance authority in the country where you live.

Caring for sick children — As a cross-border commuter, if you take time off work to care for a sick child, check with your health insurance whether you qualify for benefits. You may not if your child is insured together with your partner in the country where you live.

Posted abroad on a short assignment (<2 years)

As a worker posted abroad on a short assignment (<2 years) you can choose to stay insured in your home country (the one from which you have been posted – which is responsible for your social security coverage).

Ask your home-country healthcare authority for an S1 form (formerly the E 106). This will entitle you and your family to healthcare during your stay. Give the S1 form to the host-country healthcare authority on arrival.

A civil servant seconded abroad

If you are a civil servant seconded abroad, you are entitled to medical treatment in the country where you live. For this purpose, you will need to request an S1 form (formerly the E 106 - certificate of entitlement to healthcare for you and your dependants when you are living outside the country where you are insured) from your health-insurance provider in the country which employs you and submit it to a provider in the country where you work.

A student, researcher or trainee abroad

If you go to another EU country for your studies, research work, a work placement or vocational training, you must have comprehensive health insurance in your host country.

  • If you are employed in your host country, you will need to subscribe to a local healthcare scheme there.

    Some PhD students may be considered resident workers and can be required to subscribe to the local healthcare scheme or take out private insurance.

  • If you are not employed, the European Health Insurance Card could be an option, if you are eligible.
  • If you are being sent to a university or research institution in another EU country for a temporary period by your university or research institute of origin, then you will remain under your home healthcare scheme for the time you are posted. You should apply for the EHIC card, or for an S1 form, before leaving.

    Check with the health insurance provider or with National Contact Point in your home country whether they will cover the cost of your healthcare abroad for the full duration of your stay!

As long as your home health insurance covers you during your stay abroad, administrative procedures can be simpler if you have a valid European Health Insurance Card.

Some national health insurers will however only cover the costs of your healthcare in another country for a limited time; this is often the case for mature students (older than 28 or 30) and workers on training abroad. If this is the case for you, you will need to register for state healthcare in your host country or to take out private health insurance.

Sample story

Brief yourself on local social security rules

Wim is a Belgian national who went to the Netherlands for a university degree. He took a valid European Health Insurance Card with him. Wim planned to work part-time during his studies. However, in the Netherlands, it is obligatory to take out the national basic healthcare insurance, costing around € 1,100 a year, if one has a job there – even if one already has a valid European Health Insurance Card. The cost of basic healthcare insurance made working a more costly option than Wim had anticipated.

A pensioner

Healthcare coverage in the country where you live

If you receive a pension from the country where you live, you and your family are covered by that country's healthcare insurance system — whether or not you are also receiving pensions from other countries.

If you do not receive a pension or any other income from the country where you live, 2 situations are possible:

  • if you receive a pension from another EU country, you belong to that country’s health insurance system
  • if you receive a pension from several other EU countries, you belong to the healthcare insurance system of the country where you were insured for the longest period of time.

In either case you need to request a certificate of entitlement to healthcare – the S1 form (formerly known as an E 121) — from the health insurance authority in the country whose healthcare insurance system you belong to.

This document establishes your right to full healthcare coverage in your country of residence. You must submit it to the health insurance authority there.

In principle, you and your family are only fully entitled to medical treatment in the country where you live. However, some countries (see list below) offer pensioners who live abroad — but belong to their social security system — complete healthcare coverage on their territory too.

Sample story

Get to know the healthcare system in your new country

Nicolas has always lived in France and worked there almost all his life — except for a few years in Italy working as a waiter when he was young.

When Nicolas retires, he moves to Italy. His pension will be made up of 2 parts: an Italian pension reflecting the years worked in Italy and a French pension for the years worked in France.

Because Nicolas lives in Italy AND receives an old age pension from the Italian authorities, he belongs to the Italian health insurance system. He is no longer part of the French system.

Healthcare coverage in the country where you used to work

If the country which pays your pension is one of the following, you and your family members are entitled to complete healthcare coverage in both the country which pays your pension and the country where you now live (if these are different):

Austria

France

Netherlands

Belgium

Germany

Poland

Bulgaria

Greece

Slovenia

Cyprus

Hungary

Spain

Czech Republic

Luxembourg

Sweden

If you paid contributions in a country which is not in the list above, you will only be entitled to complete healthcare coverage in the country where you live.

Former cross-border commuters

If your most recent job was as a cross-border commuter, meaning you lived in one country but commuted to work in another, the following applies to you:

Continuation of a treatment

You can continue to receive a treatment that began in the country where you used to work even after having retired. This is also applicable to your dependants if their treatment began in:

Austria

Germany

Portugal

Belgium

Greece

Romania

Bulgaria

Latvia

Slovakia

Cyprus

Luxembourg

Slovenia

Czech Republic

Malta

France

Poland

As of 1 May 2014, this will also be possible for treatment begun in:

Estonia

Italy

Netherlands

Hungary

Lithuania

Spain

To continue receiving a treatment that began in the country where you used to work, you must submit an S3 form to the health authorities in that country.

Coverage in the country where you used to work and in the country where you live

If you worked for at least 2 years as a cross-border worker during the 5 years preceding retirement, you are entitled to healthcare both in your country of residence and in the country where you used to work.

This is also applicable to your dependants if the country where you now live and the country where you used to work are both in this group:

Austria

Germany

Spain

Belgium

Luxembourg

France

Portugal

If you want to access medical treatment in both your country of residence and the country where you used to work, you must submit a S3 form to health authorities in that country.

National healthcare systems differ greatly within Europe

EU countries are free to establish their own rules on entitlement to benefits and services. For example, if you apply for medical care in the country where you now live, you probably won’t be entitled to exactly the same services for the same price as in your country of origin.

To avoid potentially serious problems and misunderstandings, find out about the social security system in your host country or contact National Contact Point.

Sample story

Get to know the social security system of your new country

Susanne always worked in Germany and moved to Spain when she retired. When she became ill, she contracted a home-care service with a private company because there is no public home-care insurance in Spain.

Her German home-care insurance paid part of the costs, but Susanne’s share was much higher than what she would have had to pay if she had stayed in Germany. This was a consequence of the differences between the German and the Spanish benefits systems.

Differences in assessing incapacity level

If you claim an invalidity pension or incapacity benefit, each country you have worked in could insist on examining you separately. One country might assess you as seriously incapacitated, while another country may not consider you incapacitated at all.

Find out more about invalidity pensions in Europe.

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