Bishop & Sewell

The UK government has this week announced that future EU nationals will no longer need to demonstrate comprehensive sickness insurance when applying to stay in the UK long term.

While many will be relieved, it remains unclear when the government plans to introduce this comprehensive sickness insurance change and who it will affect.

In a statement summarising the government’s latest proposals for EU nationals, Prime Minister Theresa May said the requirement would be scrapped for those applying for “settled status” (which will replace “permanent residence” at some point).

The government has previously suggested it will start implementing new provisions for EU nationals next summer. However, this will be subject to the agreement of other EU member states.

Furthermore, even if agreement is reached on that point, it remains unclear how long it will take to implement the scheme, as well as whether this will affect those already living in the UK or only people moving to the country in the future.

Until that time, comprehensive sickness insurance unfortunately remains a part of UK and EU law, and so EU citizens will need to be aware of it and give it some thought if they are looking to secure their status in the UK.

  1. Who needs Comprehensive Sickness Insurance?

The following people need comprehensive sickness insurance:-

  • EU students
  • EU citizens who are “self-sufficient”, i.e. people whose income is not derived from employment or self-employment. Examples include those who have significant savings they live off, those supported by a partner, of those with another source of income, such as rent from a property for example.
  • Family members whose permission to be in the UK is linked to the above categories of EU citizen
  • Family members of a British person returning to the UK from elsewhere in the UK who does not intend to work on their return.
  1. Why is Comprehensive Sickness Insurance necessary?

Immigration law comprehensive sickness insurance

The majority of EU citizens living in the UK assume that their nationality alone gives them the automatic right to reside in this country. However, the legal position is slightly more complicated. Technically, EU citizens are only living in the UK in accordance with the law if they fall into one of the following categories:-

  • The employed
  • Those in self-employment
  • Students with comprehensive sickness insurance
  • The “self-sufficient” with comprehensive sickness insurance
  • Certain family members of the above

People who have lived here for five years in any of the above categories or a combination of those categories acquire “permanent residence”. They then have the right to apply to the Home Office for a document certifying permanent residence or a permanent residence card, if they so wish (and indeed must do so if they want to apply for citizenship).

People who do not fall into any of the above groups will get by for many years by simply showing a passport or national identity card. However, if they want to apply for a document certifying permanent residence – or indeed a document confirming their right to be in the UK at the start of that period – they will only be able to do so if they fall within the above categories.

  1. What is comprehensive sickness insurance?

Comprehensive sickness insurance is simply the EU legal terminology for medical health insurance that is as wide ranging as possible.

The Home Office defines it as “any form of insurance that will cover the costs of the majority of medical treatment” in the UK. It should not contain significant exemptions but “may contain certain exemptions”.

  1. How do I know if my insurance is “comprehensive”?

Unfortunately, the Home Office gives no more real guidance than the information above. It will look at each case individually and make a decision based on the terms of the policy.

There will always be some exemptions, such as GP visits and emergency treatments, which are not covered by UK providers. However, my general advice to individuals taking out a new policy is to call around as many insurers as they can and take out the policy that contains the fewest exemptions.

There is no “Home Office approved” policy.

  1. Are there any alternatives to private medical insurance?

Individuals who hold a European Health Insurance Card (or its predecessor E111) issued by a state other than the UK can rely on that in the following circumstances :-

  • If applying for a Document certifying Permanent Residence or a Permanent Residence Card after completing five years in the UK
  • If applying for a document confirming their right to be in the UK before completing five years in the country (Registration Certificate or Residence Card) provided their intention is to remain in the UK on a temporary basis only

A small number of individuals may also be able to rely on any of the following forms: Form S1, Form E109, Form E121, Form S2, Form E112 or Form S3.

  1. But doesn’t the NHS count?

I cannot tell you how many times I have been asked this question! The short answer is no, I’m afraid.

The theory is that people who are working or self-employed in this country are paying national insurance contributions and so are entitled to rely on the NHS.

Students or those who are self-sufficient cannot count the NHS as comprehensive sickness insurance. This does not mean they cannot use the NHS, simply that they cannot rely on it for the purpose of obtaining documentation from the Home Office.

  1. Do I need comprehensive sickness insurance if I’m married to a British citizen?

I am most commonly asked this question by women who have been homemakers supported by their British husband for many years.

Unfortunately, the fact you are married to a British citizen makes absolutely no difference if you fall into one of the categories requiring comprehensive sickness insurance, i.e. a student or self-sufficient.

If you want to apply for a document certifying permanent residence then you are applying based on your own nationality and your own status here, and not that of your British husband or wife, so they are irrelevant from the Home Office’s perspective.

There is another route open to those married to British citizens but it is a far more complex and expensive process, so is not one I would recommend unless absolutely essential.

  1. What can I do if I lived here without comprehensive sickness insurance and now I want to apply for permanent residence?

The first thing is to make absolutely sure you have none of the above documents listed at question 5. You’d be surprised how often people forget all about the fact that they applied for an EHIC many years ago.

However, if you don’t have any of those documents and you want to apply for a Document certifying Permanent Residence or a Permanent Residence Card, then I am afraid there is nothing you can do.

Time and again people tell me they had never heard of the insurance requirement until recently but it is nothing new. It is only coming to light now due to the fact so many people are trying to secure their status by applying for documents in the wake of the referendum.

  1. What can I do if I lived here without comprehensive sickness insurance?

You can do nothing about past periods without insurance but if you are still living here in one of the categories for which it is required, then my strong advice is to take it out now. Once you have this insurance, you can use it to apply for a Registration Certificate, confirming your current right to reside.

None of us can see into the future and it may be that such a document becomes useless in time. However, if the government decides to maintain the current requirements then what it will do is demonstrate that you had the correct type of insurance throughout the period in question, making it much easier to apply for some type of permanent residence document in the future.

That said, even in a worst-case scenario I cannot imagine the Home Office will start deporting EU nationals who have lived in the UK for years, regardless of whether they have the insurance or not. However, it may be that those who don’t hold such documents are required to make a different application under a more expensive and document-heavy regime in the future.

  1. I heard the Home Office is changing the law on comprehensive sickness insurance so it’s no longer needed. Is this true?

The prime minister has now announced it will eventually abolish the need for comprehensive sickness insurance for EU nationals. However, several points must be borne in mind. Firstly, this is a unilateral announcement on the part of UK authorities, which remains subject to agreement from our EU partners, which is far from guaranteed given the current hostility in negotiations.

Secondly, even if the government is able to follow through on this promise, there is no clarity on timelines as yet. This provision may not come into force until after we have left the EU in March 2019. Any EU nationals looking to secure their status in the UK, particularly if they wish to apply for citizenship, may not wish to wait that long.

Thirdly, even if the government does away with comprehensive sickness insurance, there is no guarantee it won’t replace it with something else. It is worth bearing in mind that people from outside the EU who move to this country are currently subject to the Immigration Health Surcharge, an extra fee of £200 per year that must be paid at the same time as applying for a visa. For families, this can add thousands of pounds onto their visa costs.

However, having said this, it is undoubtedly true that there will be people who currently do need comprehensive sickness insurance to apply for permanent residence, and who simply do not qualify under the present law. There is no way for them to go back and change the past, and so for them, Mrs May’s latest announcement will be very welcome news indeed.

Karma Hickman is an Associate Solicitor in our Immigration team.

For advice and assistance on making a visa, immigration or nationality application or for any other immigration enquiry, please contact our Immigration Team on 020 7631 4141 or email

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