EUROPEAN COMMISSION EMPL/000805/10 - EN
CA.SS.TM. 164/10Introduction of the European Health Insurance Card
SECRETARIAT – 19.04.2010
ORIG.: EN
Annexes: 2 (below)
ADMINISTRATIVE COMMISSION
ON SOCIAL SECURITY FOR MIGRANT WORKERS
Subject: Monitoring the introduction of the European Health Insurance Card (EHIC)
Note from the Secretariat of 19 April 2010
In its note ref. 004/10, the Secretariat issued a questionnaire on the introduction and the use of the EHIC from 1 January to 31 December 2009.
The present note summarizes the Secretariat's understanding of the current situation on the basis of delegations' replies to the above mentioned questionnaire, for which the Secretariat would like to thank the Delegations[1].
· Annex 1 gives an overview of the statistics;
· Annex 2 reports the legal and practical difficulties relating to the use of the EHIC.
The overall number of EHICs in circulation cannot be determined as figures from four countries were not available. However, assuming that the number of EHICs in circulation in these four States is at least equivalent to the number of 2008, more than 187 million EHICs or PRCs (Provisional Replacement Certificate) were in circulation at the end of 2009, which is an overall increase of 3.2% compared to 2008.
As far as the legal and practical difficulties related to the use of the EHIC are concerned, the replies to the questionnaire show that some problems remain, such as the refusal of the EHIC and the problem of interpretation of the notion of "necessary care".
Annex I
Overview of the statistics relating to the use of the EHIC from 1 January to 31 December 2009
1. Results Eurobarometer 337 – Mobility in the European Union
A part of the Eurobarometer survey on Mobility in the EU is dedicated to a discussion on how widespread awareness of the EHIC is, and whether Europeans carry it when travelling. The survey was carried out in September-October 2009.
Just over a quarter of respondents (26%) say that they have an EHIC, 67% say they do not, and 7% are unsure. Respondents living in EU-15 countries are more likely than their EU-12 counterparts to say they have the card (29% vs. 16%). Huge differences exist between the Member States, ranging from 78% of respondents in Austria saying they have an EHIC to 5% in Bulgaria. The numbers for the Member States do not always correspond to those stated infra under 2. The fact of having lived, worked or studied abroad has some influence on the likelihood that people have the card.
Asked why they do not hold an EHIC, 68% of respondents without the card say they have never heard of it, and know nothing about it. The next most frequent given reason is that people have separate travel insurance and therefore do not need an EHIC (11%). Five percent of respondents said they could not be bothered with it, and the same proportion feel they do not need an EHIC because they can be reimbursed for health costs without it.
Respondents with the card were asked if they had taken it with them on trips within the EU in the past two years. The survey shows that two out of three of these respondents always have the EHIC with them while travelling in the EU. Recalculating this result on the entire sample indicates that 17% of Europeans carry the card with them. However, as the survey showed, 22% of respondents with the card have not travelled within the EU in the past 2 years, which implies that those who traveled almost always have had the EHIC with them. Four percent of the respondents who are EHIC-holders only took their card on some trips.
Therefore the survey clearly shows that card holders value the EHIC as only six percent did not take the card with them on some or all trips abroad. Respondents living in EU-15 Member States more often say they always have the card with them than those living in EU-12 countries (66% vs. 56%), whilst those living in the latter States more often say they have not travelled within the EU in the past two years.
Those respondents who did not take the card with them on their EU trips in the past two years most commonly say they forgot to take it with them (28%), closely followed by the fact that they took out separate travel insurance and therefore did not need the card (25%). 12% of respondents who did not bring along the EHIC during their travel indicated that they did not have the card at that time, whilst ten percent said they could not be bothered, and eight percent said it was unnecessary as they could be reimbursed without it. Respondents living in EU-15 States are more likely to say they forgot the card (29% vs. 22%), whilst those in EU-12 countries are more likely to say they took out separate travel insurance (32 vs. 23%), and that they did not need an EHIC as they could be reimbursed without one (15% vs. 7%).
2. Number of EHICs in circulation
The following table has been developed on the basis of the data provided in the replies to the questionnaire:
State / (1) EHIC issued in 2009 / (2) PRC issued in 2009 / (3) EHIC in circulation 31/12/09Belgium / 1.960.162 / 50.374 / 2.466.449
Bulgaria / 103.728 / 26.021 / 123.282
Czech Rep / 5.197.989 / Not available / 9.664.648
Denmark / 604.571 / Not available / 1.142.115
Germany / Not available / Not available / Not available[2]
Estonia / 52.118 / 11.049 / Not available
Greece / 129.783 / 17.263 / 115.796
Spain / 1.778.915 / 182.718 / 1.779.336
France / 4.616.843 / 1.542.000 / 4.616.843
Ireland / 228.909 / 52.441 / 1.493.333
Italy / 7.820.789 / 176.414 / 58.196.144
Cyprus / 58.345 / 37 / Not available
Latvia / 53.460 / 372 / 52.288
Lithuania / 78.436 / 4.966 / 191.712
Luxembourg / 233.473 / 11.508 / 457.375
Hungary / 427.337 / 28.388 / 572.222
Malta / 61.204 / 15 / 138.438
Netherlands / 22.167.531 / 88.367 / 3.648.290
Austria / 715.295 / Not available / 8.033.287
Poland / 1.230.838 / 17.555 / 779.176
Portugal / 380.394 / 25.133 / 1.166.540
Romania / 161.102 / 50.400 / 111.008
Slovakia / 299.358 / 162.961 / 1.756.361
Slovenia / 574.592 / 147.526 / 523.205
Finland / 297.124 / 10.182 / 556.489
Sweden / 900.000 / 17.000 / 3.200.000
United Kingdom / 4.519.790 / 9.685 / 33.827.200
Switzerland / 2.500.000 / Not available / 6.500.000
Liechtenstein / 9.050 / 38 / 34.980
Norway / Not available / Not available / Not available
Iceland / 26.012 / 380 / 62.829
Total / 37.187.148 / 2.556.830 / 141.209.346
4
3. Basic characteristics of the EHIC
3.1. Physical details
An image of the EHIC issued by each participating State is available on the Europa portal at the following address:
http://ec.europa.eu/social/main.jsp?catId=653&langId=en
3.2. Validity period of the EHIC
According to the replies of the participating States there are huge differences between them as regards the validity period of the EHIC. This period ranges from several days (DE - planned duration of the stay abroad) to 10 years (BG, CZ, AT).
In some Member States the validity period differs depending on the status of the cardholder (pensioner, worker, students, etc.).
In 2009, some States extended the validity period of their EHIC (HU, IS), whilst others intend to change the period of validity as of 1 May 2010 (DK). Several delegations (BE, PT, FI) indicate that the validity of EHICs issued to resident pensioners and their family members receiving healthcare on the basis of forms E121 and E 109 respectively has been extended to 30 April 2010.
4. Distribution of the EHIC
(In the case of those countries that did not provide the data on the EHIC in circulation in 2009, the data from last report were used.)
4.1. Procedure for getting the EHIC
In the majority of Member States, no changes are reported when it comes to the procedure for obtaining the EHIC.
As already reported in 2008, in most of the States, there are several ways to apply for an EHIC: in person, by e-mail, by letter, by fax, by phone or online. In 2009, several Member States introduced the possibility of online application (ES, HU, FI). In Denmark the possibility to apply for an EHIC online was introduced by some more issuing institutions. In Slovenia, the EHIC can be requested through self-service terminals. In several States (SE, NO, SL), applications for an EHIC can be submitted through a text messaging system (SMS). The UK has introduced an automated voice recognition system on the application telephone lines.
In several States (AT, CH, CZ, IT), the EHIC is automatically issued. In the Netherlands, additional health insurers started the automatic issuing of the EHIC.
As regards the time it takes to issue an EHIC, there are huge differences between States, varying from immediately, in the case of an in-person application (BE, CY, ES, LT, HU, IS), to 4 weeks. Some delegations report an improvement in the issuing time in relation to 2008 (IT, LT, NL), whereas in one country two additional days compared to 2008 were needed.
4.2. Withdrawal procedures of the EHIC
As already indicated in the 2008 report, despite the fact that Member States perceive the use of the EHIC when the cardholder is no longer eligible to receive healthcare at the expense of the issuing State as one of the major problems in respect of the use of the EHIC, only a few of them have introduced a special withdrawal procedure. No major changes compared with 2008, are reported.
The UK envisages the introduction of such a procedure.
In some countries, EHICs are automatically cancelled upon their expiry (BE for some institutions, EL, LT).
In several Member States (PL, SK), the cardholder is obliged to return his/her card when he/she is no longer insured. Slovakia maintained a legal obligation to return the EHIC after termination of the insurance, subject to a fine for non-compliance, as reported already in 2008. Some Slovak institutions inform the insured person in writing before having recourse to sanctions.
In Spain, Poland, Sweden and the UK, when applying for an EHIC insured persons are informed that the EHIC must be returned when the insurance ends and/or that misuse may result in a recovery procedure. In Bulgaria, it is indicated on the reverse side of the EHIC that the card must be returned when the insurance ends. Likewise, several institutions in the Netherlands point out in a letter accompanying delivery of the EHIC that its validity is subject to the holder being insured. One Dutch institution includes this on the EHIC itself.
In 2010, Finland will introduce the possibility to recover the cost of unduly received benefits from persons who misused the EHIC.
In Iceland, people are asked to hand in their EHIC when applying for a form E 104.
Some delegations report that their institutions (DE, EE, SL, FI, UK), or some of them (BE, ES, EL, NL) formally invite insured persons whose EHIC is no longer valid to return their card and/or to renew it.
The Luxembourg institutions apply the cooperation procedure established in Decision No 203 when a person applies for registration on the basis of a form E 121 or E 109, requiring the former EHIC before issuing a new one..
In Lithuania, healthcare providers and insured persons have the possibility to check the validity of EHICs online. In some States (BG, CZ) invalid EHICs are registered and/or a list of blocked or invalid EHICs is available on the internet. The Austrian delegation announced plans to introduce such a system in the future.
5. Raising awareness
5.1. Information for the insured person
In most of the Member States, no major specific information campaigns on the EHIC have been launched, although most of the Member States keep the information available on their websites regularly updated, or continue disseminating information through leaflets, press releases, posters, radio/television programmes or brochures/magazines (e.g. AT, BE, BG, CY, DE, FR, LT, LV, MT, SK, UK).
A special information clip on the EHIC was shown during the Cyprus international Fair.
Some Member States (e.g. PL, SL) step up their information campaigns before or during the holiday season.
One Slovak competent institution includes information on the EHIC and the rights attached to it in a “welcome pack” supplied to every new affiliate.
In Malta, the institution responsible for issuing the EHIC participated in a travel fair with the aim of promoting the card and its correct use.
The Hungarian delegation emphasises the considerable role of travel insurance companies when it comes to raising awareness about the EHIC.
One delegation reports that, given the widespread distribution of the EHIC, there is no need for new mass campaigns.
Bearing in mind the change of the EHIC issuing State after the entry into force of Regulations 883/2004 and 987/2009, some special information campaigns have been launched.
In Spain, cardholders whose EHIC will expire in 2010 will receive a letter from the Spanish institutions informing them of the new procedure for obtaining or renewing the EHIC.
Given the large number of UK citizens residing in Spain, the UK carries out extensive research there, focusing among other things on the rights and obligations related to the use of the EHIC. This can take the form of face-to-face meetings, media communications or cooperation with Spanish authorities.