Getting health treatment abroad - know the rules or pay the price

By Alan Taylor - 14/07/2008

So, you have booked your holiday, sorted out all you need to take with you and planned what you want to do on your holiday. You also have all the paperwork, passport, travel insurance documents, itinerary, tickets and, hopefully, you have packed your European Health Insurance Card (EHIC). Each member of your family should have their own EHIC.

The one item you hope you will not need to use is your EHIC. But if you become ill or have an accident during your holiday would you know how to get medical treatment which would be covered by the EHIC? If medical treatment becomes necessary during your holiday you should present your EHIC to access healthcare provided by the state health authorities under the same rules that apply to residents of that country.

 

This means you may receive free treatment or you may have to pay all or part of the cost then claim a refund of the cost or part of it later. But you must follow the rules for the other country details of which are available on the Department of Health’s website.

What if I don’t follow the rules for whatever reason?

How many of you will push your EHIC in your bag where it will remain until you need medical treatment? Travelling or holidaying abroad comes with risks and one of them is being ill when you are away. This is especially so if you visit a country where you do not speak the language or whose healthcare system is different from the NHS as is the case in most European member states. The reality is that healthcare is a business and if you don’t get it right you pay the price.

If you become ill in your hotel you have some support, at least in theory, because the hotel reception staff, or your holiday rep, will call a doctor for you. Show your EHIC to the reception staff and make it clear that you want a state healthcare doctor. Whatever you tell them they may call a private doctor who is not interested in your EHIC. This is one of the reasons why the Department of Health recommend that you have private insurance covering your trip.

If you become ill or have an accident away from your hotel, or you are in self catering accommodation, you may need know quickly how to obtain medical treatment. Your first thought will be to see a doctor or go to hospital for treatment and then sort out the detail of payment. A quick decision may be needed but if you don’t get this right and you are treated privately by a doctor or by a private hospital instead of by a doctor or hospital which are part of the state health service you will have to pay the costs which will not be covered by your EHIC.

Since 1973 thousands of people have paid for medical treatment when on holiday in an EEA country which cannot be recovered under the EU rules. Many have received private treatment for which they had to pay because they didn’t have an EHIC or if they had an EHIC they didn’t follow the rules and received private treatment.  Others who had an EHIC will have done their best to receive state healthcare but were misdirected one way or another into private treatment - there is not much they can do about this.

What else should I do?

So, what can you do to help yourself? The starting point is to get your EHIC and make sure everyone in your party knows the rules. Take a copy of the information about medical treatment in the country you are visiting which you can download from the Department of Health’s website. Keep this information and your EHIC with you all the time you are on holiday.

 

If you need medical treatment try to follow the rules to obtain state healthcare and show your EHIC and the information about medical treatment to whoever you contact about treatment. The Department of Health have recently published a new leaflet with guidance to other sources of information. This is called “Access to Healthcare Abroad” and is widely available from GP surgeries, pharmacies, dental practices and some supermarkets.   

If you can find the healthcare office in the area where you are staying when you get there that could be helpful if you need medical treatment later. Language is often a problem and you may end up with private treatment but at least if you persist in saying that you want state healthcare you will have done all you could do to avoid paying for treatment. It is possible that you may end up with private treatment instead of state healthcare so it is important to take out a travel insurance policy to cover medical costs.    

Can the cost of private treatment be refunded in any country?

There are two exceptions to the rule that the cost of private medical treatment will not be refunded. In Greece healthcare is run by the Social Insurance Institute – known as the IKA. If you receive treatment privately you must pay the full cost then claim a refund from the IKA office within one month. The amount of the refund will be the limited to the cost of the treatment if it had been provided by IKA.

 

If there is no IKA office within easy reach, because you are in a remote area or on a small island, you can claim a refund from the Department for Work and Pensions on 0191 218 1999 when you return to the UK. The general advice from the Department of Health is that it is often possible to contact the authorities in whichever member state is being visited, to enquire about any reimbursement to which you may be entitled, before you return to the UK.    

In Madeira, an autonomous region of Portugal, you can receive private treatment but you will receive a refund of only a small part of the cost.

Free prescription medicines for state pensioners visiting Spain  

The rule for pensioners receiving prescription medicines in Spain is worth mentioning. In Spain medicines prescribed by a health service practitioner under the state healthcare system are obtained from a pharmacy - you will pay 40% of the cost. If you are treated in an emergency department at a hospital and you need medicines when you are discharged you will be given a “medical report” form. Take this to a state health service doctor who will give you a prescription form, either red or green, which you take to the pharmacy to obtain the medicines.

 If you are receiving a state pension from the UK or any other EEA country prescription medicines are free of charge if you have proof that you are a state pensioner. The Department of Health have contacted the authorities in Spain to find out what their pharmacists will accept as proof that someone is a state pensioner. They are still seeking a resolution to this issue and further information will be published on the Department of Health’s website when it is available.

If you cannot prove your pensioner status to the pharmacist when you in Spain it is important that you keep your receipts. The Department of Health has suggested that you try to claim a refund from the authorities in Spain when you are there. However, if you cannot get a refund when you are in Spain contact the Department for Work and Pensions when you get back home.       

How to apply for a EHIC

Information about the EHIC is on the Department of Health’s website at www.dh.gov.uk/travellers where you can apply for an EHIC online and download the information you need under “Country-by-country guide to entitlement.” You can also apply for an EHIC by phone on 0845 606 2030. An application pack is available from Post Offices which process passport applications. Applying on line is the quickest way to obtain an EHIC.

Remember that the EHIC is not a substitute for a travel insurance policy which will cover costs which are not for medical treatment.

See the links below for further information.