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Unfair holiday medical costs

BEFORE a trip to Australia, I confirmed with my mutuelle [top-up health insurance] that I would be covered while away. On the trip I needed health treatment costing $475 and when I came back the mutuelle said to present the bill first to my French Cpam [state health insurance body]. They said to apply to the UK because I have the S1 [former E121] form. The UK said I cannot have a refund. They have an agreement with Australia but only for Britons living in the UK. It seems the mutuelle gave the wrong advice. D.S.

Mutuelles usually pick up all (or some) of the cost remaining after the Cpam reimbursement, so the initial problem seems to be that there was no Cpam reimbursement. This complication follows EU rules changes with regard to European Health Insurance Cards (EHICs) in 2010. As you receive your healthcare via the S1 we assume you are a British state pensioner in France. Under the old arrangements you would have had a French card to entitle you to urgent healthcare while visiting another EU country, while under the new ones you need a British one.

A legal expert at Cleiss, experts in cross-border social security, said there was a change in funding methods too. The UK used to pay France a set regular sum per E121-holder in France, France then treated the person in the same way as a resident. Under the new rules, the UK pays France for care you receive in France. Outside France any reimbursements – including for trips outside the EU – are the responsibility of the UK alone.

Under reciprocal EU rules, healthcare that is vital during a stay in another member state is free, or reimbursed, depending on the normal practices of the country you are visiting.

France and the UK have different rules on refunding non-EU healthcare. In France this is at the discretion of the Cpam, though it is common. Where agreed, the reimbursement is within normal limits for the treatment kind within France.

The UK allows people only to be covered if visiting states it has an agreement with, which include Australia. However, these agreements were only made with UK residents in mind.

The Cleiss expert said: “It’s true that these people are disadvantaged. It’s perhaps not surprising if they are not treated like British residents, as, for example, when the changes came in, the UK decided it would not treat expat Britons visiting the UK the same as residents, but only give the minimum EU entitlement [eg. they only get free care if it is medically urgent]. French expats visiting France are treated the same as residents.

It is therefore important to make other arrangements, such as a travel insurance policy including emergency medical care.

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