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Rise of the e111 Card

free e111 card renewalHow did the e111 Card come about? There was a time when the world lived by the saying, “to each their own”. Countries were divided, businesses had to depend on the resources found in their countries and focused only on selling inside these countries. However, with the advent of globalization, many countries have started to negotiate with each other, bringing about better businesses, more job opportunities, and, of course, promotion of tourism. Today, traveling to other countries has become a lot easier, especially with lower plane fares and less restrictions. As long as budget permits, people can easily book flights and spend their vacation in any country they wish to visit.

One of the major concerns that many travellers overlook, though, is that of healthcare. With all the fuss of packing and getting visas, many travellers forget that they will need to take necessary precautions in case of health emergencies. Either that or they just don’t understand how much healthcare services abroad can cost them. This is where the European Health Insurance Card comes in.

The European Health Insurance Card, or EHIC card for short, was conceptualized by members of the European Economic Area, or EEA. It seeks to provide European residents with quality healthcare treatments and services whenever they travel to EHIC-participating nations. Not only will these treatments and services be of the same quality as those offered to their residents, it may also be available at lower or no costs at all. The card is accepted in many European countries, though the benefits received may vary depending on the healthcare laws and policies of the country that the cardholder is in.

ehic card applicationIt is very advantageous to become an EHIC cardholder especially if you travel frequently. However, it is important to understand what it does and does not cover, which countries it can be used in, its application and renewal process, and, of course, a little background on how it came to be. These will help you decide on whether or not you should apply for a e111 card.

History and Origin of the European Health Insurance Card

Before the EHIC card, there was the E111. The E111 card equivalent was a piece of A4-sized paper that was carried by European travellers whenever they were in another European country. This form contained important information about the owner, including the owner’s full name, nationality, address, date of birth, and dependents, if there are any. The purpose of the form was to give travellers access to necessary medical treatments in cases of injuries incurred or illnesses developed during the trip, or any other emergencies.

european health insurance card vs travel insuranceTravellers may, for example, break a leg during a ski trip, get stung by a jellyfish while swimming, or suffer heat strokes or food poisoning during the trip. Typically, a trip to the emergency room may cost these travellers hundreds of dollars, especially since they aren’t residents of the country. The E111 form helped radically decrease the cost of any treatments done and/or services rendered, and ensured that the travellers are treated as how a resident of that country is treated.

Unfortunately, since the form was simply typewritten on a piece of paper, it can easily get crumpled, mutilated, or lost, especially if you needed to bring it everywhere during your trip. The print could easily become illegible so healthcare providers were left with no choice but to accept it even without proof that the patient really was the owner or to deny the patient the privileges that he/she would’ve otherwise received. It’s usually the latter, so patients had to pay for all the expenses just because the form was ruined. Again, this does not come cheap.

Another issue with the E111 card was that a whole family was covered by a single piece of paper. The form was not given individually, which was a problem if the family decided to go on separate ways during the trip. A family member who isn’t holding the form may get into an accident and the one holding it may not be able to provide the form right away, so the patient will still have to pay for the whole amount even though he/she is technically covered by the E111 form.

Of course, it is selfish for countries to deny patients with necessary treatments, especially if it is an emergency. This means that in severe cases, the healthcare institution should still be able to provide travellers with the proper basic care even without the E111 form. Patients would have to pay the bill upfront but those with E111 forms could reimburse the amount afterwards. However, additional treatments needed and other services rendered will not be covered.

Because of all these concerns, the European governments decided to do away with the E111 and develop a more comprehensive and functional document (or in this case, card)—the EHIC card. Instead of simply being a piece of paper, the European Health Insurance card was made to look like many of the wallet-sized cards that we have today. This makes it a lot easier to safekeep the “form” without damaging it in any way. Members of families, no matter how old they are can also get their own cards so that they can avail of necessary yet affordable medical treatment even though they’re away from the principal.

The EHIC card was introduced in 2004 but was not fully implemented until the year 2006. Today, it is known as a very beneficial tool that has changed the way Europeans travel.

A Closer Look at the EHIC Card

european health card benefitsThe European Health Card is a product of an agreement between members of the European Economic Area (EEA). The EEA is composed of two major units that are further made up of different European countries: the European Union (EU) and the European Free Trade Association (EFTA). It is rooted in the “Single Market” scheme created by the

EEA, where the whole of Europe is treated as one. There are many agreements under the Single Market scheme, one of them concerning healthcare. Countries associated with the EEA have realized the importance of healthcare and want their residents to receive quality healthcare treatments within the whole of Europe, whether or not they are residents or simply travelling to that country. Thus, the EHIC card was born.

In line with the government’s vision of providing quality state-provided healthcare treatments and services to all EEA residents, EHIC cardholders are assured that they will get treated exactly how the residents of the country that they are visiting are treated. This means that if a resident of one country, for example, receives free healthcare treatments, the European Health Insurance cardholder should also get the same level of treatment for free even though he/she is not a resident of that country. Keep in mind, though, that each country will have its own healthcare laws and policies. Some can offer free healthcare services while others can only subsidize a certain percentage. Therefore, a cardholder who is used to getting free healthcare from his/her home country may not be able to avail of the same privileges if the country he/she visits does not offer it to its residents.

Listed below are some of the countries that accept and adhere to EHIC rules and regulations:

  • Austria
  • Belgium
  • Bulgaria
  • Croatia
  • Czech Republic
  • Denmark
  • Estonia
  • Finland
  • France
  • Germany
  • Greece
  • Hungary
  • Iceland
  • Italy
  • Latvia
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Malta
  • Norway
  • Poland
  • Portugal
  • Republic of Cyprus
  • Romania
  • Slovakia
  • Slovenia
  • Spain
  • Sweden
  • The Netherlands
  • United Kingdom

It can be observed that most of these countries are members of the European Union, except for Iceland, Norway, Liechtenstein, and Switzerland, which are part of the European Free Trade Association (EFTA). The EFTA was founded by Austria, Denmark, Norway, Portugal, Sweden, Switzerland, and the United Kingdom in 1960. Iceland and Liechtenstein joined the EFTA shortly after. However, only 2 of the 7 original members, Norway and Switzerland, have remained in the association. The other 5 EFTA founders went on to become part of the European Economic Community, which was the proprietor of the European Union.

e111 renewal stepsTake note that despite the Brexit referendum that happened last 2016, the United Kingdom is still listed as part of the European Union as far as the EEA is concerned. There may also be some confusion with Switzerland being part of the EEA. Though the country was one of the first members of the group, a constitutionally mandated referendum has officially excluded them from the EEA. Despite not being a member of the EEA, however, Switzerland has made multiple bilateral agreements with many EU countries. This, along with the fact that they are a member of the EFTA, allows them to participate in the European Health Insurance System (EHIS), which therefore means that they offer and accept the EHIC.

Keep in mind that some EEA member countries have territories that are technically not part of the EU. It should be noted that the EHIC is also applicable for use in these countries, which include the following:

  • French Guiana
  • Guadeloupe
  • Martinique
  • Reunion Islands

Furthermore, some countries that are not part of the EEA, such as the Faroe Islands and Greenland, also have existing healthcare agreements with the EEA. This means that EHIC cardholders travelling to these countries can still use the EHIC card in cases of emergencies. It should be noted, however, that the benefits from these countries may not be the same as those from EEA member countries.

How the European Health Card Works

The European Health Insurance card's purpose is practically the same as that of the E111 card – to provide EEA residents with free or low-cost healthcare treatment and services when they travel

EEA countries other than their own. The procedure for claiming the EHIC benefits is simple: simply present your card along with a valid proof of identification (travellers are usually asked for passports) to the institution providing the treatments. Keep in mind that the EHIC card does not bear any photos, so the healthcare providers will have to compare the EHIC details with those on the valid IDs just to make sure that the patient is the valid owner of the card.

It is also good to note that different countries have different healthcare policies and restrictions. Since European Health Insurance cardholders will be treated as a resident of the country that they are traveling to, it is important to understand that they will also be bound by the policies and restrictions of the said country. Some countries, for example, offer ambulance services for free while others charge for it. You may want to research about the healthcare policies of the country that you are traveling to before booking your flight just so that you have an idea of what you can or cannot avail of in that country. Knowing what you are entitled to and what you aren’t can definitely save you a lot of time and money in cases of emergencies.

If you unfortunately end up needing medical attention during your trip, here are a few things you should do:

  • Make sure that the institution you are going to is a public institution and that it accepts and honors EHICs;
  • Show your EHIC card and passport (or any proof of identification) upon arrival; and
  • Ask about the healthcare policies of the institution, including what treatments/services the EHIC covers and whether or not you will need to pay for it.

Some countries will ask European Health cardholders to pay for the treatments beforehand and then just reimburse the amount after. For this reason, you will need to obtain and keep the following documents right after being treated:

  • Official receipts
  • Official prescriptions
  • Official medical report/s
  • Any other official documents that were given by the physician/s

In the past, EHIC reimbursements were claimed once the cardholder returns to his/her home country. However, it is now possible to claim refunds right after the treatment. Just present the aforementioned documents to the office in charge of European Health Card reimbursements and you will immediately get your refund. Take note, however, that countries with patient sharing or co-payments will only refund the amount left from the total bill after deducting the amount of the patient’s share.

In cases where cardholders have left their cards at home or haven’t received their cards yet, the European Health Insurance System allows the cardholder or any authorized representative to apply for a Provisional Certificate. This certificate can be requested from the EHIC office and guarantees that the person requesting it is indeed a valid EHIC cardholder. The Provisional Certificate is valid for the duration of the trip and is honoured as a temporary replacement for the e111 card.

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