Post-Brexit: How does treatment work on visits to the UK?

People with a French Ceam card

French Ceam cards (the French equivalent of Ehics / Ghics) continue to be recognised in the UK as agreed in the EU/UK Trade and Cooperation Agreement.

It means people insured in the French system through work or due to residency under Protection universelle maladie (such as early retirees) and who have a French Ceam can continue to use these in the UK as before to access medically necessary healthcare required during a trip.

As the UK’s NHS has no system of ‘co-payments’ (a part of healthcare costs that is not fully-reimbursed, such as 30% of the cost of a GP visit in France), necessary healthcare obtained during visits is ‘free’ to visitors with a French Ceam or other EU-issued card.

Holders of British Ehics/Ghics

British S1 holders covered by the Withdrawal Agreement can still have British-issued Ehics. This includes those who were living in France with S1s before Brexit, as well as those living in France before Brexit who have since claimed a UK state pension. New UK Ehics are marked CRA (for Citizens Rights Agreement).

EU citizens living in the UK and covered by the Brexit WA can also still have British ‘CRA Ehics’. British S1 holders moving to France since 2021 are issued with Ghics instead. UK-issued Ehics/Ghics are not intended for use within the UK itself or by French residents while in France but rather while on visits to other parts of the EU.

Before Brexit, the UK allowed its state pensioners living in the EU to use NHS services free of charge on presentation of a copy of their S1 but the rules on this changed. The UK now treats its S1 holders differently depending on whether they were living in the EU before the year 2021. 

The Department for Health and Social Care told The Connexion that anyone who was living in France before 2021 and the end of the Brexit transition period and who had registered their S1 with a French Cpam before then, can continue to use the NHS free of charge on visits. However, this is not the case for people who move over as of 2021. Those with this pre-2021 entitlement should take a copy of their S1 to show as evidence in the UK, if necessary.

The principles of the Brexit Withdrawal Agreement, aimed at maintaining the rights of Britons who moved to the EU before Brexit, suggest the same rights should also apply to Britons who were living in France before 2021 and who later reach state pension age and obtain an S1 when they start to draw their pensions.

Though this point was not confirmed by the DHSC, an official UK website states: “Some former UK residents do not have to pay for NHS treatment when visiting England. This includes:

1) UK war pensioners

2) UK government employees

3) UK nationals living in the EU on or before 31 December 2020, once they have a registered, UK-issued S1.”

As newcomer pensioners with S1s issued since January 1, 2021 are excluded from this, and they are not entitled to a French Ceam they may be asked to pay for healthcare costs incurred during trips to the UK, and should therefore look to take out a travel insurance policy including healthcare cover, official UK sites state. Newcomer pensioners are now therefore disadvantaged compared to other EU residents under the post-Brexit rules. A spokeswoman for Cnam, responsible for the network of French Cpam state health insurance offices, said France has no responsibility for reimbursing this group for healthcare in the UK.

Some UK care is ‘free’ for all 

It should be noted, however, that some care in the UK is ‘free’ at the point of delivery for everyone. This includes:

1) GP visits (though the practice has to accept to treat you as a temporary patient, which is not obligatory)

2) Treatment as an outpatient in an A&E department – but not subsequent care if you are admitted to hospital as an in-patient following this

3) Treatment for most infectious diseases, including STIs

Note that all hospital treatment other than in emergencies requires a GP referral in the UK. 

This website has further information for non-UK residents on accessing the NHS. It states, among other points, that visitors will always receive urgent treatment and treatment that cannot safely wait until you return home, and payment if required, will be dealt with afterwards.