EUROPEAN COMMISSION EMPL/01590/2009 EN
SS.TM. 07/09European Health Insurance Card project
SECRETARIAT – 01.09.2009
Orig. EN
ADVISORY COMMITTEE
ON SOCIAL SECURITY FOR MIGRANT WORKERS
Subject: The European Health Insurance Card project
Note from the Secretariat of 1 September 2009
This year, the activities on the European Health Insurance Card (EHIC) were focused on 3 issues.
Firstly, the Secretariat prepared an overview of use of the European Card between 1 January 2008 and 31 December 2009 in the Member States.
Secondly, an awareness raising information campaign on the European Health Insurance Card has been conducted during the first semester of 2009.
And finally, as regards the work done in view of the introduction of an electronic European Health Insurance Card, the EHIC ad hoc group presented its final report to the Administrative Commission in June 2009. Furthermore, the CEN (European Standardisation Committee), which was mandated to examine the necessary standards for an electronic health insurance card in 2006, delivered its final report in March 2009.
1. Monitoring the use of the European Health Insurance Card
On the basis of Member State's replies to a questionnaire, the Secretariat prepared an overview of the use of the European Health Insurance Card from 1 January to 31 December 2008.
The following conclusion can be drawn from this survey:
· The number of EHIC in circulation is still increasing: more than 180 million EHICs or PRCs (Provisional Replacement Certificate) were in circulation at the end of 2008.Almost 36% of the European citizens had an EHIC at the end of 2007. It represents an overall increased of 5% over the end of year 2007.
· With regard to the use of the EHIC some problems remain, such as the refusal of the EHIC and the problem of interpretation of the notion of "necessary care".
· Some progress can still be made with regard the withdrawal procedure. Good practices exist in some Member States.
More detailed information is available in a document annexed to this note.
2. The EHIC information campaign
The decision of having a European-wide campaign to promote the use and the benefits of the European Health Insurance Card (EHIC) was decided following the yearly monitoring exercise regarding the use of the EHIC. It appeared that a raising awareness campaign would be useful, both for people who travel in Europe and are not aware of their rights and for health professionals who, in some cases, refused the EHIC.
This campaign was presented at the 312th meeting of the Administrative Commission.
The overall aim of the campaign is to raise awareness on the benefits of the EHIC, both among people who travel and among health professionals who welcome patients from other EU countries. Therefore the target public of the campaign are on one hand, the persons who travel, namely tourists, students abroad and business (wo)men and on the other hand, health professionals who are in contact with the previous persons.
Along with this information campaign, the EHIC website has been totally renewed by focussing on user-friendly information for both people who are travelling and health professionals.
The campaign started in 11 priority countries[1] though internet and in the media in January 2008 and will continue till the end of 2009.
Key messages of the campaign are:
- The EHIC guarantees one gets the same treatment as people living in the country visited. Valid in 31 European countries
- One website: http://ehic.europa.eu with the information available in all official languages
For the purpose of this information campaign, leaflets and posters have been done with the same visual identity and were disseminated at the occasion of selected events in the tourist and health care sector.
3. Preparations in view of the introduction of an eEHIC
The eEHIC ad hoc group presented its final report on legal, functional and technical basics for the introduction of a eEHIC at the 315th meeting of the Administrative Commission C in June 2009.
The ad hoc group which was composed by representatives of 18 Member States examined the following issues:
- The expected added value of an eEHIC
The Ad Hoc Group concluded that the purpose of the electronification of EHIC is first of all to provide an automated and more precise data entry system for the EHIC data set, ensuring a more reliable transmission of identification data related to insured persons and providing a modern and safe manner of data exchange between included entities. As regards the added value of the extension of the use of the eEHIC to other portable documents and other functions, the Ad Hoc Group concluded that complementary research is needed.
- Legal and administrative conditions for the use of the eEHIC
The Ad Hoc Group concluded that the electronification of EHIC with the same function as the EHIC would be in line with the provision of the new Regulation 883/04 and its Implementing Regulation.
- Technical specifications of an eEHIC
The Ad Hoc Group proposed that the Cen Workshop Agreement (CWA) should be accepted as the sole basis for further work and for introduction of eEHIC.
- Roadmap and calendar
The report of the eEHIC Ad Hoc Group contains a detailed roadmap and calendar for the introduction of the eEHIC. It foresees a timeline of 3 years starting from a pilot phase to a fully operational phase.
Annex
Monitoring the use of the EHIC from 1 January to 31 December 2008
Part I. Overview of the statistics relating to the use of the EHIC
1. Number of EHIC's in circulation
The following table has been developed on the basis of data provided by the Member States
State / (1) EHIC issued in 2008 / (2) PRC issued in 2008 / (3) EHIC in circulation 31/12/08 / (4) population 1/1/08 / (5) % cards / (6) % new cardsBelgium / 1657700 / 70.736 / 2370593 / 10.666.866 / 22,2% / 69,9%
Bulgaria / 91450 / 27327 / 116.902 / 7.640.238 / 1,5% / 78,2%
Czech Rep / 1087637 / Not available / 9487146 / 10.381.130 / 91,4% / 11,5%
Denmark / 894130 / Not available / 891814 / 5.475.791 / 16,3% / 100,3%
Germany / 0 / Not available / 45000000 / 82.217.837 / 54,7% / 0,0%
Estonia / 100005 / 21448 / 100005 / 1.340.935 / 7,5% / 100,0%
Greece / 103669 / 16983 / 92930 / 11.213.785 / 0,8% / 111,6%
Spain / 1657826 / 157903 / 1748578 / 45.283.259 / 3,9% / 94,8%
France / 4787222 / 1541527 / 4787222 / 63.753.140 / 7,5% / 100,0%
Ireland / 341520 / 68349 / 1317512 / 4.401.335 / 29,9% / 25,9%
Italy / 7440691 / 190365 / 58160655 / 59.619.290 / 97,6% / 12,8%
Cyprus / 44789 / 16 / 44789 / 789.258 / 5,7% / 100,0%
Latvia / 50458 / 215 / 40135 / 2.270.894 / 1,8% / 125,7%
Lithuania / 78229 / 5860 / 179472 / 3.366.357 / 5,3% / 43,6%
Luxembourg / 89049 / 9102 / 401177 / 483.799 / 82,9% / 22,2%
Hungary / 401601 / 31755 / 555196 / 10.045.401 / 5,5% / 72,3%
Malta / 37435 / 13 / 151901 / 410.290 / 37,0% / 24,6%
Netherlands / 3011101 / 5218 / 1944786 / 16.405.399 / 11,9% / 154,8%
Austria / 732397 / 1135 / 8002825 / 8.331.930 / 96,1% / 9,2%
Poland / 1231071 / 20970 / 627919 / 38.115.641 / 1,6% / 196,1%
Portugal / 349164 / 240926 / 883133 / 10.617.575 / 8,3% / 39,5%
Romania / 36210 / 188058 / 12298 / 21.528.627 / 0,1% / 294,4%
Slovakia / 298102 / 143668 / 1502404 / 5.400.998 / 27,8% / 19,8%
Slovenia / 663189 / 178922 / 560642 / 2.025.866 / 27,7% / 118,3%
Finland / 295339 / 7346 / 446577 / 5.300.484 / 8,4% / 66,1%
Sweden / 1100000 / 21000 / 3000000 / 9.182.927 / 32,7% / 36,7%
United Kingdom / 3776746 / 11711 / 30502473 / 61.185.981 / 49,9% / 12,4%
Switzerland / 2400000 / 0 / 7500000 / 7.593.494 / 98,8% / 32,0%
Liechtenstein / 1115 / 106 / 35000 / 35.356 / 99,0% / 3,2%
Norway / 464824 / 16851 / 1303154 / 4.737.171 / 27,5% / 35,7%
Iceland / 45277 / 780 / 124019 / 313.376 / 39,6% / 36,5%
Total / 33267946 / 181891257 / 510.134.430 / 35,7% / 18,3%
The total number of valid cards is over 180 million, covering over a third of the population. The percentage of card-holder in the population varies widely from country to country, as does the number and percentage of PRCs.
2. Basic characteristics of the EHIC
2.1. Physical details
An image of the EHIC issued by each participating State is available on the Europa portal at the following address:
http://ec.europa.eu/social/main.jsp?catId=653&langId=en
The design and technical specifications of the European Health insurance card are available on the Europa portal at the following address:
http://europa.eu/eur-lex/pri/en/oj/dat/2003/l_276/l_27620031027en00040018.pdf
2.2. Validity period of the EHIC
It follows from the replies of the participating States that there are huge differences between the States as regards the validity period of the EHIC. The validity period ranges from 3 months (Latvia) to 10 years (Austria, Bulgaria). Romania issues EHICs, the validity period of which is limited to the duration of the stay abroad.
In several States the validity period differs depending on the status of the cardholder (pensioner, worker with temporary labour contract, students, etc.).
Some Member States (Estonia, Latvia and Liechtenstein) extended in 2008, or are considering extending, the validity period of their EHIC, mainly to cut red tape and to reduce the issuing costs. Other Member States (Finland and Ireland) are considering reducing the validity period in 2009. In particular, Finland will limit the validity period of the EHIC issued to persons registered with a E-121 or E-109 to 1.3.2010 taking into account the changes introduced by Regulation 883/2004 and its Implementing Regulation.
3. Distribution of the EHIC
3.1. Procedure for getting the EHIC
In most of the States, there are several ways to apply for an EHIC: in person, by e-mail, by letter, by fax, by phone or on-line. In Sweden and in Norway, applications for an EHIC can be submitted through a text messaging system.
In Slovenia, the EHIC can be requested through self-service terminals. However in 2009, due to the introduction of on-line verification of health insurance, the self-service terminals will be removed.
As regards the time it takes to issue an EHIC, there are huge differences between States, varying from immediately in the case of an in-person application (e.g. Belgium, Spain, Hungary) to 30 days (Slovakia).
3.2. Withdrawal procedures for the EHIC
Despite the fact that Member States perceive the use of the EHIC when the cardholder is no longer eligible to receive health care at the expense of the issuing State as one of the major problems in respect of the use of the EHIC, only a few of them have introduced a special withdrawal procedure.
In Poland, Bulgaria, Czech Republic, Estonia, Latvia, Hungary and Slovakia, the cardholder is obliged to return his/her card when he/she is no longer insured. In Slovakia, there is a legal obligation to return the EHIC after termination of the insurance subject to a fine for non-compliance.
Luxembourg applies the cooperation procedure established in Decision 203 when a person applies for registration on the basis of a form E-121 or E-109.
In Bulgaria, it is mentioned on the reverse side of the EHIC that the card must be returned when the insurance ends.
The Estonian Sickness Fund sends a letter to persons whose insurance has ended, informing them that they can no longer use their EHIC. In Sweden and the UK, insured persons, when applying for a EHIC, are informed that the EHIC must be returned when the insurance ends.
In some States (Bulgaria, Czech Republic, Italy and Austria in the future) invalid EHICs are registered and/or a list of blocked or invalid EHICs is available on the internet.
4. Raising awareness
4.1. Information for the insured person
In most of the Member States, no major information campaigns have been launched, although most of them keep the information available on their websites regularly updated, or continue disseminating information through leaflets, press releases, posters.
In Denmark a massive information campaign (post cards, TV spots, advertisements, leaflets, etc.) was carried out due to some legislative amendments in the field of the Danish tourist insurance.
In the UK a special information campaign (TV and radio fillers, adverts in newspapers) was launched in order to remind card holders that they should check whether their EHIC needed to be renewed.
4.2. Information for health care providers
In most of the States information on the EHIC for health care providers is available on the websites of the competent institutions or Ministries. This information is systematically updated. In several Member States, information is provided through leaflets, articles in specialised press, circulars and instructions.
In Germany and Ireland information on the EHIC was disseminated through respective umbrella organisations and representative bodies in order to improve the awareness and the knowledge of health care providers on an ongoing basis. In Liechtenstein, brochures and leaflets were updated and in Switzerland circulars were sent to organisations of health care providers.
In Poland, all health care providers were given a telephone number of employees of the competent institution who can be called on the spot to give specific information on the EHIC and its procedures. In Iceland, the competent institution regularly contacts the health care providers by phone or e-mail.