Brexit - Health Insurance for Visas
Tuesday 23 March 2021
The French Embassy in the UK have provided guidance on the health insurance requirement for visas. UPDATED 12th May 2021
UPDATE: The French Embassy in the UK have confirmed that a GHIC card is now an acceptable alternative to private medical insurance for a long-stay visa up to 180 days. You can read more at French Visa Health Requirements Eased. 12th May 2021
UK nationals wishing to visit France for longer than three months, or to relocate permanently post-Brexit, are required to obtain a visa prior to their departure.
The visa application is made online at France Visas.
Article L313-6 of the Code de l'entrée et du séjour des étrangers requires that a visa is issued on condition of sufficient resources and health insurance cover for the duration of the stay, stating:
'L'étranger doit en outre justifier de la possession d'une assurance maladie couvrant la durée de son séjour et prendre l'engagement de n'exercer en France aucune activité professionnelle.'
This requirement applies for both a Visa Long Séjour Temporaire (VLS-T), for stays from three months to less than a year, and a Visa de Long Séjour valant Titre de Séjour (VLS-TS), which covers stays up to a year. The former would normally be used by those visiting France for up to a year, whilst the latter by those intending to relocate to France permanently. No visa is required for a visit under 3 months.
However, just what type of health insurance is required and would possession of travel health insurance and/or a Global Health Insurance Card (formerly EHIC) satisfy the health insurance condition?
Up to Three Months
For stays up to 3 months, for which no visa is required, the rules are reasonably clear.
Under Schengen rules visitors must have 'travel medical insurance covering emergency medical, hospitalisation and repatriation (including in case of death). The minimum cover should be of €30.000. This insurance must be valid for the entire Schengen area and throughout the duration of the stay.'
As Schengen requires that visitors must be in possession of insurance that provides for repatriation, that means a GHIC on its own is not entirely adequate, even for a visit up to 3 months.
Indeed, the UK government, on its own website states that: 'The GHIC is not an alternative to travel insurance. It will not cover any private medical healthcare or costs, such as mountain rescue in ski resorts or being flown back to the UK. Make sure you have both a GHIC and a travel insurance policy that includes healthcare in place before you travel.'
Over Three Months
The requirement for health cover for a long stay has always been in place; what has now changed is that UK nationals now need to prove they have it before they can obtain entry into France.
We therefore asked the French Embassy in London what their requirements would be for a visitor visa for a stay over three months. They stated that:
'For a Visitor Long Stay visa (VLS-T or VLS-TS), an applicant must provide a health insurance for the full duration of the stay. The insurance must cover the visa’s entire validity period (1 year at the most). The applicant needs a private health insurance policy covering all medical expenses.'
The Embassy also state that proof of payment of the policy must be shown.
The requirement for a PHI policy does seem at odds with the visa application website, which asks for 'Travel Health Insurance'. However, when we put this point to the Embassy, they reiterated that such a policy was inadequate, as was a GHIC.
Travel Insurance or PHI?
In the context of a visit abroad, the difference between 'travel medical insurance' and a 'private health insurance' (PHI) policy is not always clear, as both are 'private' and the latter will need to be an 'international' policy.
Essentially, however, travel insurance covers treatment in the event of an emergency, whilst a private policy also provides cover for routine treatment and treatment for pre-existing conditions.
Travel insurance will also provide cover for you to be returned home for treatment, whereas a PHI policy will provide for your treatment to take place in the country you are visiting.
The former are also for more limited duration, normally six months maximum, whilst private policies cover a prolonged stay abroad.
Travel medical insurance policies also tend to have a cap on the maximum amount of cover and the scope of cover is more limited. A PHI policy should provide comprehensive cover, although all policies vary in their scope.
Finally, although those with a medical condition or aged 70+ are able to obtain travel medical insurance, it is far less easy for them to do so for a PHI.
As a result of those differences, the cost of a PHI policy is substantially higher than an average travel medical insurance policy.
In the end, the terms that are used are probably less important than the scope of the policy; French law requires that those who are resident in France have comprehensive cover.
That would clearly apply to those who are seeking to become resident in France, but even for stays over 3 months the requirement remains substantial.
Based on Article R.121-4 of the code l’entrée et du séjour des étrangers, the administrative doctrine on residence in France for more than 3 months requires 'un régime d'assurance privée offrant des prestations en nature d'un niveau comparable à celles offertes par le régime général français d'assurance maladie et maternité.'
However, there are very few policies on the planet that would cover 'all medical expenses' and even the French health system itself does not provide for complete cover in all circumstances. Thus, for routine medical expenses the State system only covers around 70% of the costs.
In addition, Art. R211-29, Code de l'entrée et du séjour des étrangers states: 'Le contrat d'assurance souscrit par l'étranger ou par l'hébergeant pour le compte de celui-ci doit couvrir, à hauteur d'un montant minimum fixé à 30 000 euros, l'ensemble des dépenses médicales et hospitalières, y compris d'aide sociale, susceptibles d'être engagées pendant toute la durée du séjour en France. '
The stated rule for UK nationals certainly appears to be tougher than is applied for other 'third-country' nationals, many of whom we know obtain a visa with a travel insurance policy.
Whether the stance taken by the Embassy could be challenged is doubtful. It is more likely that, in practice, some softening of the approach will emerge.
That is certainly what appears to take place within the prefectures in France, in the issue of residence permits. Fabien Pellisier, an insurance broker who runs an English-language health insurance service in France, states that: "We provide health insurance to many foreign nationals for visa applications and, except when the application is otherwise marginal, the theoretical rules are not the ones applied on the field. In the overwhelming majority of cases, officials accept a wide definition of 'full' medical cover, on premiums that are bearable, as long as it runs for a year."
We can also report that one of the policies issued by the company has been accepted by the French Embassy for a visa application. This occurred after the applicant presented a policy from a UK insurer that was refused. The cost of the policy is around €1,000 for someone in their 50s. More information from our insurer in the link below. That said, there appears to be a lack of consistency in the treatment of visa applications, and it is something of a lottery whether a health policy will be accepted. For that reason, the broker offers a refund of the premium if the policy is refused.
Although of no solace to second-home owners, those who relocate permanently to France have a right of access to the State health system after three months legal residence. The application process may well take several additional months, but, provided you hold a PHI policy that includes a break clause, there is no need to retain the policy for the duration of your visa.
You can obtain a quotation for PHI, travel or 'top-up' health insurance from Fabien at Fab French Insurance.