A new card has replaced many of the medical assistance forms used by European citizens when travelling or working outside their own countries. Here are the details.

Since 1 June 2004, European citizens who travel within the European Economic Area, (i.e., the European Union, Norway, Iceland and Liechtenstein) and Switzerland, for private or professional reasons, are eligible for a European Health Insurance Card, which simplifies the procedure when receiving medical assistance during their stay in a Member State.

All people who are insured under or covered by a social security system of a Member State and eligible for care in that Member State can benefit from the rules on coordination of social security and so are entitled to the European health insurance card.

However, several countries benefit from a transitional period and have until 31 December 2005 to implement it.

From 1 June, the card has replaced the following paper forms used to access healthcare during temporary stays in another Member State:

• E111 and E111B - used by tourists
• E128 - used by students and people working in a Member State other than their own
• E119 - used by people registered as unemployed and seeking work in another Member State.

Previously, a new form had to be applied for each time a trip was made. In some countries, it was required to present the form to national authorities before treatment was allowed.

The system of coordination of social security remains as before, with the Member State that has treated the individual being reimbursed by that individual's home social security institution. However, some changes have been made to simplify the existing entitlements, giving all persons certain rights to access medically necessary care.

The card only relates to necessary care (as breaking a leg, a tooth falling out, catching a virus) or on-going care for a serious medical condition (e.g., diabetes). It does not cover someone who decides to have treatment for a condition in another Member State. That treatment will only be provided with the agreement of the person's insuring institution or national social security administration. The card is intended to make access easier and to obtain reimbursements more quickly, and not to store and carry information about health status, condition or treatments.

Every Member State is responsible for the distribution of the European Health Insurance Card to its citizens. However, the production methods and distribution of this card are attributed to the exclusive competence of the authorities of the Member States. The period of validity of the card is a decision for each issuing Member State to make.

A common model with a distinctive European symbol is used by all Member States. This is to ensure immediate recognition of the card by all those involved in the health system, regardless of where the cardholder is staying. The obligatory information is the minimum necessary and its presentation is standardised to enable it to be read, irrespective of the user's language, by superimposing fields.

The European health insurance card will be introduced in all Member States. Those countries that request it – particularly those that do not have a national health insurance card – can make use of a transition period up to the end of 2005. By the end of 2005 all Member States will use the card. Some countries, such as Belgium, France, Luxembourg, Spain, Greece, Ireland, Sweden, Denmark, Finland, Norway, Estonia and Slovenia have introduced the card since 1 June 2004. In other countries it will be phased in gradually.

However, in France, the European health insurance card is not ready. Therefore, the French social security authorities are currently issuing a provisional certificate of replacement.

In the long term, the intention is that the card will be issued with an electronic chip to greatly facilitate exchange of information between Member States and reduce the risk of error, fraud and abuse. There is no fixed timing for either of these future phases, which depend on the evaluation of the first roll-out of the card, and the development of technological systems that allow exchange of information without changes to the architecture of national systems.

August 2004

Clarisse Brunet is a Manager in the International Assignment Services practice at TAJ Société d'Avocats in Paris, France. TAJ is the coordinator of Deloitte Tax services in France.