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Health in France

Early Retirees Lose S1 Health Cover

Tuesday 07 January 2014

The UK government has confirmed that early retirees relocating abroad will lose access to S1 health cover - probably!

In an announcement made over the Xmas break the UK Department of Health stated that “we intend to investigate ending S1s as soon as is practicable; probably from April 2014.”

The S1 certificates, which grants access to the French health system for up to two and half years, are being abolished for early retirees as “these payments exceed our obligations under the EU agreement, and most other states do not make them.”

The European Commission have confirmed to us that under European regulations there is no legal requirement to issue these certificates to early retirees.

However, there do remain practical difficulties in the implementation of this change, for the government will need to consider whether S1s will continue to be available for those relocating in search of work, in fulfillment of their employment mobility obligations under European regulations.They will also need to consider whether there will be any exemptions, such as for those with a medical illness that prevents them obtaining private medical cover.

These and other issues are probably why, in a statement to us, the Department of health nuanced their intentions by stating that, “We are continuing to work through the operational implications of the change and will make a further announcement once this work has been completed.”

Eligibility to S1 certificates for those of retirement age, which grants access to the French health system for an unlimited duration, are unaffected by this change, as are early retirees in France who currently hold an S1 certificate, which the government has confirmed will be allowed to run until their expiry date.

However, for early retirees moving permanently to France in the future it will mean that they will need to take out a private health insurance policy to cover all their health needs.

Alternatively, access to the health system can be obtained automatically as of right, either by entering employment or setting up a business in France.

Since 2007, when France made access to their health system for early retirees conditional on 5 years legal residence, many thousands of expatriates in France have already done precisely that, by setting up as an auto-entrepreneur, under which social security contributions are payable as a percentage of sales.

Access to UK Health System

In the same announcement the government also stated that new restrictions will be introduced on expatriates using the UK health system, although the proposals have yet to be specified.

They are likely to be far less draconian than might be inferred from one headline that appeared on an English language newspaper website in France that expats would face charges for UK healthcare.

In reality, for most UK expats from France visiting the UK, the position will remain unchanged, for under EU laws citizens benefit from their own countries national social security scheme if they fall sick while travelling in another Member State by use of European Health Insurance Certificate (EHIC) arrangements.

Indeed, even where EHIC arrangement do not apply, the government stated that access to a GP would remain free and that it "supports the principle of those who have previously made a fair contribution continuing to be entitled to free NHS treatment and this should be consistent with the principles of ex-pat eligibility for UK pensions and other state benefits."

Right to Cross-Border Healthcare

Part of the explanation for why the rhetoric of change is likely to outstrip the reality is because European citizens now have the right to choose and be reimbursed for treatment anywhere in the EU.

This right arises as a result of a new EU Directive on cross-border healthcare that came into effect on 25th October 2013,

In general, there is no need for any prior authorisation for cross-border healthcare, which will now become the exception rather than the rule.

The regulation states that one of the reasons why a person may seek health treatment in another Member State is to be closer to family members during the treatment.

Needless to say, there are various caveats surrounding such a right, and the full implications of the new regulation have yet to be played out. However, the proposed new rules in the UK will have to be consistent with this regulation.

Accordingly, we shall be monitoring with interest developments on this issue, on which we shall post further information.

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