Getting treatment in EEA countries and Switzerland: Form E111

The E111 Form

***The E111 has now been replaced by the EU medical card (EHIC).

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There are arrangements throughout the European Economic Area (EEA) and Switzerland for coordinating the health care systems of the member states.

Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen's Printer for Scotland

If you or any of your dependants are suddenly taken ill or have an accident during a visit to any of these countries, free or reduced-cost necessary treatment is available - in most cases on production of a valid Form E111.

Only state provided treatment is covered, and you will receive treatment on the same terms as 'insured' residents of the country you are visiting. Private treatment is generally not covered, and state provided treatment may not cover all of the things that you would expect to receive free of charge from the NHS.

Countries covered

The EEA is made up of the 25 European Union (EU) member states plus Iceland, Liechtenstein and Norway.

The member states of the EU are:

1. Austria
2. Belgium
3. Cyprus
4. Czech Republic
5. Denmark
6. Estonia
7. Finland
8. France
9. Germany
10. Greece
11. Hungary
12. Ireland
13. Italy
14. Latvia
15. Liechtenstein
16. Lithuania
17. Luxembourg
18. Malta
19. Netherlands
20. Poland
21. Portugal
22. Slovakia
23. Slovenia
24. Spain
25. Sweden
26. UK

Switzerland:

As a result of an agreement with the EU, which came into force on 1 June 2002, the E111 arrangements also cover Switzerland.

Form E111 is not valid outside the EEA and Switzerland.

Who is covered and in which countries

Persons ordinarily resident in the UK and registered with the NHS who are:

• EU and Swiss nationals going to EU countries or Switzerland.
  Note: nationals of Cyprus, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia or Slovenia, resident in the UK and travelling to Switzerland, are not covered at present;
• EEA nationals travelling to EEA countries;
• non-EEA nationals: the E111 arrangements apply, except in Denmark, Iceland, Liechtenstein, Norway or Switzerland, where private insurance should be obtained. However, non-EEA nationals visiting Iceland are covered for emergency treatment only under a reciprocal health care agreement between the UK and Iceland. You will need to produce your NHS medical card to get treatment;
• stateless persons and refugees travelling to EEA countries and Switzerland.

If you are working in the UK, but paying social security contributions to another EEA country or Switzerland, you should obtain your E111 from the institution to which you pay your contributions.

Documentation required

A revised Form E111, issued on or after 19 August 2004.

The revised Form E111 is valid until 31 December 2005 when it will be replaced by the European Health Insurance Card (EHIC). The UK will start issuing the EHIC in September 2005.

How to apply for the E111

To obtain a valid Form E111, fill in the application form as well as the Form E111 itself (available from the link below). The Form E111 will be provided separately by the Post Office. It will be stamped, signed, and returned to you. A separate Form E111 is now required by every traveller.

You can apply for an E111 for your spouse/partner and children under the age of 16 (or 19 if they are still in full-time education). Foster parents or guardians can include children in their care as dependent children when applying for Form E111.

Non-EEA nationals resident in the UK should NOT submit their E111 application form to the Post Office. They should instead send the completed application, together with photocopied evidence of their right to reside in the UK, to The Pension Service, International Pension Centre, at the address given in the section on refunds below.

If you change your address, you should obtain a new E111. You should also do this if any other changes occur that affect the details on the form. Do not amend your existing form.

To pre-apply and receive your EHIC automatically, later in 2005, you will need to tick the appropriate box on the E111 application form. Only do this if you do not plan to change address before the end of 2005.

If you lose your Form E111 while abroad, you will need to get a new one from The Pension Service, International Pension Centre, Medical Benefits Section, Newcastle, at the address given in the section on refunds below.

If you pay for private prescriptions, the cost will not be refunded.

Applying for an E111 form

Validity of the E111

E111s issued prior to 19 August 2004 are no longer valid and you must apply for a new one for yourself and each person travelling. Old Form E111s can be identified by their lack of expiry date. All new E111s will cease to be valid throughout the EEA and Switzerland after 31 December 2005, when the European Health Insurance Card (EHIC) will replace them.

UK issue of these cards will start in September 2005. Further information regarding the EHIC and the different methods available for applying will be available in summer 2005 on the Department of Health website or you can contact the Department of Health Customer Service Centre on 020 7210 4850.

You will need to apply for another E111 if you use it to claim for treatment and it is not given back to you, or if you mislay it.

Please note that your E111 will cease to be valid if you go to live outside the UK.

What treatment is covered

The Form E111 covers you for any treatment that becomes necessary during the course of your visit. This includes all maternity care, renal dialysis and oxygen therapy.

Treatment of chronic diseases and pre-existing illnesses that require ongoing medical care is included, but not if the purpose of your visit is to obtain medical treatment abroad. For example, blood tests, injections or medications are covered on the same terms as that available to 'insured' residents of the country you visit.

Pre-existing conditions that require advance arrangements:

Renal dialysis

Renal dialysis can be provided as emergency health care in all EEA countries and Switzerland under the E111 arrangements, subject to availability of places. However, you must make advance arrangements before leaving the UK. Contact your UK NHS renal unit for further details. Please note that due to the large number of visitors to Spain each year, it is essential that you obtain Spanish Form P10 before your departure from the UK. Your UK renal unit will arrange this for you.

Oxygen supplies

Oxygen supplies can be provided as emergency health care in all EEA countries and Switzerland under the E111 arrangements, subject to availability of places. A prior arrangement with the destination country is required to ensure availability of supplies, particularly in remote areas. Further limited information on services available can be obtained by ringing 020 7972 4125.

Obtaining treatment - general advice

Always keep a photocopy of your Form E111 with the original.

This is important if you apply for treatment in France, Germany, Hungary, Italy, the Netherlands, Slovakia and Spain, as a photocopy is required as well as your original E111. You will usually be given back your E111 but the photocopy will be kept. However, in some countries the authorities may keep the original E111.

Charges for treatment

Each of the EEA countries and Switzerland has their own rules for state medical provision. In some, treatment is free. In some, you have to pay part of the cost. In others, you have to pay the full cost and then claim a full or partial refund. For details for each of the countries, follow the link below. Follow the rules of each particular country or you may have to pay charges that cannot be refunded. At the time of publication, the information about each country was accurate but changes do occur.

Claiming refunds

You claim any refunds to which you are entitled by applying, either in person or by post, to the relevant authority in the country you are visiting while you are there. You must enclose the original document, therefore keep photocopies for your records. If you leave your claim until you return to the UK, you should write to or telephone the following section and ask for claim form POD 1679:

They will liaise with the authorities of the other country on your behalf. Send your E111, original bills, prescriptions and receipts. If possible, keep copies for yourself. However, you may face long delays until the foreign authority responds.