First published in ITIJ 102, July 2009
A lack of clarity and consumer education is leaving many British holidaymakers unsure of what medical care they are expected to pay for while on holiday within Europe. David Craik asks if this is a UK problem, or if other European consumers are also unsure about what exactly the EHIC provides
The summer is here and UK holidaymakers are heading abroad for happy and relaxing days in the sun. They have spent weeks preparing for their trips, ensuring that they get to the airport on time and that every last thing is crammed into their suitcases. But according to a recent survey by Sainsbury’s Travel Insurance, the failure of UK holidaymakers to adequately check the status of one of their smallest pieces of luggage could turn their dream holidays into a nightmare.
According to Sainsbury’s, Britons are taking an insurance gamble by failing to check their European Health Insurance Card (EHIC) and suffering costly repercussions as a result. The survey found that the EHIC did not cover the expenses of over half of Britons needing medical assistance abroad. Cardholders paid an average of £386 to settle their medical bills, with 51 per cent not being able to claim any of this amount back when they returned to the UK. It was even found that eight per cent of those surveyed and who held an EHIC failed to take out any other form of insurance because they thought they were fully covered. As a reminder – the EHIC does not cover holders for private medical or repatriation back to their home country.
the main problems UK holidaymakers face with EHICs when they are admitted to hospital are because of an expired or a forgotten card
The issue gained more coverage in the UK press after figures from the Department of Health revealed that only one in ten Britons has remembered to renew their EHIC. Each card carries an expiry date of five years after the date of issue. The UK government received the blame for this low renewal rate because of its failure to notify EHIC holders that their renewal dates were approaching.
There is a clear lack of consumer education in the UK regarding how EHICs work and what exactly they offer the holder. The UK Government’s failure to properly inform UK holidaymakers is continuing to leave some surprised when they discover that they still have to pay for the treatment they receive in a foreign hospital.
But what of the rest of Europe? Are other countries experiencing similar problems? Do their citizens have a broader knowledge of EHICs than in the UK? Assistance companies are a good place to start to get a feel for how EHICs are treated on the continent.
Franck Molinier, director of business development at Save Assistance France, which deals with medical assistance issues involving European travellers, says the major cases involving EHIC are UK-born. “The main problem we face comes from UK travellers,” he says. “On all medical cases we open for UK citizens in France, around 10 per cent of them are to do with troubles with regards to the EHIC. We need to re-open the assistance case to solve an EHIC trouble; we do not have so much trouble with citizens from other European countries.” Molinier explains that the main problems UK holidaymakers face with EHICs when they are admitted to hospital are because of an expired or a forgotten card. “We never hear of patients being invoiced directly. The administration of the hospital concerned calls us to confirm whether we can obtain a valid EHIC or not before they issue their invoice,” Molinier says. “Ninety per cent of the troubles with EHICs appear during the winter sport season. You have more tourists in the same area enjoying the activities and suffering more accidents and injuries than you would do in the summer.”
People in France are well informed about what isn’t covered, such as repatriation
But the extra workload of EHIC cases during this time is not just down to ill-educated or forgetful holidaymakers. Molinier says ‘overcrowded’ hospitals over the winter are guilty of making administrative and paperwork errors as well. “Some mistakes are made on their side because of the rush of people,” he states. “The hospitals are very busy and they make errors such as sending the invoice to a patient’s home address rather than to us.”
The European approach
Molinier believes that French citizens have a good level of consumer education on EHICs. “In France, the EHIC is called the Carte Europeene d’Assurance Maladie. It is very easy to access it via the Internet or directly through social security,” he says. “The explanations about the use of the card are very simple and easy for travellers to understand. People in France are well informed about what isn’t covered, such as repatriation. The most frequent queries regard the countries which accept the card and sometimes the amounts covered in each country.”
Despite this, there are still occasional problems regarding expiry dates. Molinier highlights troubles faced by French travellers whose EHICs expire during their travels abroad. “I know in these cases that there are some technical complications related to getting a new, valid card,” he says. “People must go to their Social Security office before they leave and show that their card is due to expire to get a new one.”
Laurent Secheret, media relations officer at Axa Assistance, also believes that French education on EHICs is better than that seen in the UK. He says there are no problems in France related to travellers believing that an EHIC makes the need for taking out travel insurance redundant. “We have had no feedback of any existing confusions between the EHIC and travel insurance in France,” he says.
Mondial Assistance in Spain is a travel insurance services provider. A spokesperson says that when the firm receives a call from a prospective travel insurance customer, it always explains what the EHIC will cover them for abroad. “We also show how it can complement our travel insurance in those severe cases where the policy limit is lower than medical expenses,” the spokesperson says. “We are in continuous contact with other Mondial Assistance business units regarding European travellers requesting assistance. They then contact us to send a medical expenses guarantee or to organise a consultant or repatriation.” The spokesperson adds that Mondial has yet to experience European travellers being caught out by not knowing the small print behind the EHIC or by not knowing what the EHIC covers.
This level of compliance is not down to education through the Spanish government. “They do not actively promote the EHIC and educate citizens on the benefits of the EHIC,” Mondial says. “It is widely accepted that Spanish people will ask for the information on EHICs when they arrange their travel and insurance.”
Jonathan Olsson is the organisational developer in the International Health Care department at Forsakringskassan, the Swedish Social Insurance Agency. He says: “The differences between different countries can create difficulties for a person who is temporarily visiting a country and who is not familiar with the healthcare system of that country. As a result there will probably always be people who for different reasons will need to claim reimbursement when they get back home.” Olsson explains that Forsakringskassan is tasked with the role of informing the Swedish public about the EHIC. “All EHICs that are issued in Sweden are sent out with [information], which explains what type of care the card covers,” he says. “It also briefly explains that the European countries have different systems concerning patient contributions and reimbursements. We also have printable information on our website about the EHIC and what it covers. In this we mention that the EHIC can never completely replace private travel insurance since there are costs, such as repatriation, which are not covered.”
Olsson states that the Swedish EHIC is valid for three years. “When the earliest issued cards started to expire two years ago, an information campaign was launched in order to remind people to renew their cards. There was also an information campaign when the card was first introduced in 2004.”
So is this as simple as Britain bad, Europe good? According to the European Citizens Action Service (ECAS) it isn’t. It recently reported that national authorities in Europe do not give sufficient information to visitors to clarify the period of validity of EHICs in their country. European citizens who hold the card are also not warned that the EHIC is not a ‘passport for programmed care’ in other Member States, ‘which is the impression given with such a card’.
The ECAS says: “Users also largely ignore that the EHIC cannot be used for private sector healthcare providers. They then question the utility of the EHIC and maybe even complain that this had led to unforeseen costs. A lot of people still travel to other Member States without taking the precaution of using the EHIC.”
What does the European Commission (EC) say about the EHIC? A spokesperson begins by informing ITIJ that the five years of EHIC’s existence have proved a success. “The number of cards in circulation continues to rise and more and more citizens and healthcare providers are becoming familiar with the importance of the EHIC,” she states.
the countries with the highest rates are those who have the EHIC on the reverse side of their National Health Insurance Card or who issue the EHIC automatically
According to the EC, at the end of 2008, over 180 million Europeans held an EHIC, equivalent to 35.7 per cent of the total population of the 31 subscribing countries. “The usage of the card has also increased every year,” the spokesperson adds. “This indicates that people are becoming more and more familiar with the advantages of the card.”
Despite this ‘success’, it is clear from examining the EC’s figures that there is a wide discrepancy in the number of EHIC subscribers per country, and they don’t single out the UK as a worst case. For example, a remarkable 98.8 per cent of the Swiss population has an EHIC, 97.6 per cent of all Italians and 96.1 per cent of all Austrians. In the UK, though, 49.9 per cent of people have an EHIC compared with 7.5 per cent of the French population and 3.9 per cent of the Spanish. In Greece only 0.8 per cent of the population have an EHIC. Of course, this may mean that in these countries people have comprehensive travel insurance instead, and they give no indication of misuse, but the figures are worrying enough for the EC to try and promote increased awareness throughout the continent.
“The countries with the highest rates are those who have the EHIC on the reverse side of their National Health Insurance Card or who issue the EHIC automatically,” the spokesperson explains. “Lower circulation is blamed partially on citizens from countries such as Greece who take fewer holiday trips outside of their home country. In general, the EHIC is more widely known in countries who have been members of the EU longer. In addition, some national authorities have run specific information campaigns to raise awareness. The UK has increased the number of cards issued there thanks to such a large-scale campaign.”
The EC says it is working with Member States to support these activities and earlier this summer launched a new promotional campaign to urge holidaymakers to carry the card. “It’s free to get and makes your life a lot easier”, it states. The question is, will Europeans listen as they head off to the sun?