英国发布全球健康保险卡

旅游健康保险

▲全球视野?本土思考。

英国已经宣布,全球健康保险卡（GHIC）将取代现有的欧洲健康保险卡（EHIC）,规则的绝对复杂性和仍在出现的细节造成了令人困惑的画面,专家报告了英国跨境医疗的现状以及对医疗旅行流量的可能影响。

英国居民和EHIC

当前的EHIC只要有效,就可以使用,英国公民前往欧盟旅行时可以继续使用。

欧盟居民和EHIC

当前的EHIC只要有效,就可以使用,并且欧盟居民在从欧盟到英国旅行时可以继续使用它们。

从欧盟国家到英国的患者在生病或在英国临时居留期间遇到紧急医疗事故时,仍可以使用其本国签发的有效EHIC而获得NHS医疗保健。

EHIC还涵盖了既往疾病的治疗以及常规的产妇保健,条件是探视的原因不是专门生孩子或接受治疗。

但是,没有EHIC的欧盟居民将被收取英国NHS费率150％的费用。

欧盟学生

于2020年12月31日或之前在英国认可的英国高等教育机构就读的欧盟居民,无论国籍如何,均可在课程结束前使用EHIC进行医疗必需的医疗保健。

但是,如果课程延长至2021年6月30日之后,则必须向欧盟解决方案提出申请。

则学生将需要支付移民健康附加费,作为学生签证申请的一部分,如果在英国的课程于2021年1月1日之后开始并且持续超过6个月。

GHIC覆盖的国家更少。

英国居民和GHIC

尽管他们仅需要在当前EHIC到期时申请新的GHIC,英国居民现在可以申请英国GHIC。

新的GHIC卡可以从GHIC的官方网站免费获得,人们应该在计划旅行之前至少申请两周,以确保其卡能够准时到达。

也可为紧急情况和医疗必需的医疗保健需求提供同等保护,国家提供的医疗保健将以降低的成本提供,或者在许多情况下是免费提供的,与EHIC一样,GHIC在欧盟临时居所（包括假期,学习和商务旅行）时,直到返回本国为止。

需要与所访问国家的相关医疗保健提供者预先安排一些治疗方法,这包括针对已存在或慢性病的必要治疗,必要医疗保健是指在逗留期间必需的医疗保健,他们无法合理地等到返回英国才能获得医疗保健,例如肾脏透析,氧气疗法或化学疗法。

EHIC和GHIC仅适用于国家医疗保健,国家与私人医疗保健之间的区别并不像英国那么明显,而不适用于私人医疗保健,尽管在某些国家。

GHIC覆盖的国家较少,EHIC和GHIC现在都不适用于瑞士,对于英国居民,列支敦士登,挪威或冰岛。

任何出国旅行的人,都应该购买全面的旅行保险,像有关EHIC的建议一样,英国政府继续强调,无论是去欧盟还是世界其他地方。

爱尔兰继续提供跨境医疗服务。

英国居民将能够通过出示居留证明文件来继续在爱尔兰获得必要的医疗保健,例如英国驾驶执照,根据与爱尔兰现有的“共同旅行区”安排,生物特征居留证,北爱尔兰医疗卡或EHIC或GHIC。

根据对公共旅行区的长期承诺,爱尔兰公民无需申请欧盟定居计划来英国接受治疗,尽管他们可能愿意这样做。

居住在英国的爱尔兰公民将继续以与英国居民相同的条件在英国享受医疗保健。

欧盟结算机制

但他们可以被视为英国公民,任何居住在英国的欧盟,尽管有很多警告,享受免费的NHS治疗,欧洲经济区或瑞士公民都可以根据欧盟定居计划申请在2021年6月30日之后继续在英国居住。

英国侨民

因此根据NHS规则,由于NHS是基于居民的系统,永久出国的英国国民将失去获得免费NHS医疗保健的权利。

在2020年12月31日或之前在欧盟国家,挪威,冰岛,列支敦士登或瑞士生活和工作的英国国民及其家庭成员可能有资格免费使用NHS服务,可能会要求他们提供居住证明。

在2021年1月1日或之后移居欧盟的任何英国国民,不应期望能够在访问英国时免费使用NHS服务,除非有EHIC,PRC或S2证明医疗费用由所居住欧盟国家资助,或者适用其他豁免。

英国政府雇员和居住在欧盟的英国国民,一些前英国居民在访问英国时不必支付NHS待遇,其中包括2020年12月31日或之前居住在欧盟的英国战争退休人员。

这会影响英国的医疗旅游吗。

因此EHIC或GHIC卡均无法涵盖计划的医疗旅游或出国生育,“必要的医疗保健”的定义不包括人们专门旅行接受医疗保健的医疗保健。

希望在成员国寻求有计划治疗的个人可以在与欧盟的更广泛的医疗安排中得到覆盖,但从2021年起,这一数字不再包括居住在英国的英国公民。

在挪威、冰岛、列支敦士登或瑞士(以及欧盟国家),如果有以下情况,一些人可以申请英国资助计划中的S2路线治疗：。

·?欧盟,瑞士,挪威,冰岛或列支敦士登国民,自2021年1月1日起一直在英国居住。

·?自2021年1月1日起在欧洲经济区或瑞士居住的英国国家养老金领取者。

只要他们在东道国继续担任边防工作者即可,自2021年1月1日之前一直担任该边防工作者,·?在一个国家工作并居住在另一个国家的边防工作者。

·?上述之一的家庭成员或家属。

英格兰,在英格兰,NHS英格兰将需要满足以下资格标准：,对于入境医疗,苏格兰,威尔士和北爱尔兰适用不同的规则,例如。

·?该人通常居住在英格兰,并有权享受NHS的治疗。

· NHS通常会将所要求的治疗提供给该个人。

临床医生的陈述必须清楚地说明为什么需要寻求治疗,证明他们已经由英国、欧洲经济区国家或瑞士的临床医生进行了完整的临床评估,以及临床医生认为在什么时间内他们应该再次接受治疗,·?患者提供了书面证据。

·?所要求的治疗可在治疗国的国家保健计划下获得。

· NHS已经确定,国民健康保险制度不能在合理的医疗期限内提供相同或同等的治疗。

·?要求的治疗方法不是实验性的,也不是药物试验的一部分。

·?要求的治疗不是紧急治疗。

则将在与所治疗国家的居民相同的照护和付款条件下提供治疗,如果批准了S2路线下的申请,这可能意味着他们必须自付一定比例的费用（自付费用）以及旅行和住宿费用。

在某些国家/地区,则他们将被要求支付与该国患者相同的自付费用,患者负担了国家政府提供的治疗费用的25％,而国家政府则承担了其他75％,如果患者在这样的医疗体系下接受治疗。

未来发展

英国正在寻求与成员国和瑞士缔结互惠医疗的新协议英国正寻求与欧共体(EEA)、欧洲自由贸易协定(EFTA)成员国和瑞士达成新的互惠医疗协议。

临时交易

联合王国和挪威政府将临时适用1991年《社会保障公约》和联合王国和挪威政府之间的《医疗议定书》的修订本,这包括必要的医疗保健,在达成一项新协定之前。

互惠医疗

科索沃）签订了互惠医疗协议的世界其他国家/地区,直布罗陀）和一些巴尔干国家（波斯尼亚,这些协议要求提供不同的资格证明,英国目前与澳大利亚,新西兰,一些王室附属国和海外领土（例如马恩岛,泽西岛,塞尔维亚,黑山。

以下欧洲国家不接受EHIC或GHIC：。

·?海峡群岛,包括根西岛,奥尔德尼岛和萨克岛。

·?马恩岛

·?摩纳哥

·?圣马力诺

·?梵蒂冈

旅行禁令

英国不再是欧盟的一部分,也不是与所有欧盟国家达成的旅行协议的一部分,这意味着西班牙和葡萄牙等单个国家可以在不参考欧盟合作伙伴的情况下对英国实施旅行禁令,而且已经这样做。

如此众多的英国和欧盟医院忙于大流行和疫苗接种,如果医院管理人员或医生有足够的带宽来处理上述疾病的一小部分,这些更改可能需要一些时间才能筛选出整个医疗保健系统,那将是令人惊讶的,＊。

UK launches Global Health Insurance Card。

The UK has announced that a Global Health Insurance Card (GHIC) will replace the existing European Health Insurance Cards (EHIC). The sheer complexity of the rules and the still emerging details creates a confusing picture. Ian Youngman reports on the current state of play for UK cross-border healthcare and possible impact on medical travel flows.。

The UK’s new Global Health Insurance Card (GHIC) has recently been launched, but like much of the UK-EU deal, once beyond the headlines, the reality is more complex than what it replaced. Detailed guidance notes have been published, with new notes coming out daily.。

Broadly, the new agreement ensures that the rights of UK residents to access emergency and medically necessary care when travelling in the EU will continue. This includes medically necessary treatment for a pre-existing or chronic condition. The specifics include the following:。

EHICs still apply。

UK residents and EHICs。

Current EHICs are valid as long as they are in date and UK citizens can continue to use these when travelling to the EU.。

EU residents and EHICs。

Current EHICs are valid as long as they are in date and EU residents can continue to use these when travelling from the EU to the UK.。

People visiting the UK from an EU country who fall ill or have a medical emergency during a temporary stay in England, can also still use a valid EHIC issued by their home country to access healthcare from the NHS.。

The EHIC also still covers the treatment of pre-existing medical conditions and for routine maternity care, providing the reason for the visit is not specifically to give birth or receive treatment.。

However, EU residents without an EHIC will be charged at 150% of the national NHS rate.。

EU students。

EU residents who are students at an accredited UK higher education institute in the UK on or before 31 December 2020, may use an EHIC for medically necessary healthcare until the end of the course, irrespective of nationality.。

They must however apply to the EU Settlement Scheme if the course extends beyond 30 June 2021.。

If a course of study in the UK begins after 1 January 2021 and lasts for more than 6 months, students will need to pay the immigration health surcharge as a part of the student visa application.。

GHICs cover fewer countries。

UK residents and GHICs。

UK residents will now be able to apply for a UK GHIC, although they only need to apply for their new GHIC when their current EHIC expires.。

The new GHIC card is free to obtain from the?official GHIC website.?People should apply at least two weeks before they plan to travel to ensure their card arrives on time.。

Like the EHIC, the GHIC will offer equivalent protection for emergency and medically necessary healthcare needs when in the EU on a temporary stay, which includes holiday, study and business travel. The state-provided healthcare will be provided at a reduced cost or, in many cases, free of charge, until planned return home.。

Necessary healthcare means healthcare that becomes medically necessary during the stay and for which they cannot reasonably wait until back in the UK to get. This includes medically necessary treatment for a pre-existing or chronic condition. Some treatments need to be pre-arranged with the relevant healthcare provider in the country being visited, for example kidney dialysis, oxygen therapy or chemotherapy.。

EHIC and GHIC only apply to state healthcare, not private healthcare, although in some countries the difference between state and private healthcare is not as clear cut as in the UK.。

GHIC covers fewer countries and for UK residents, neither the EHIC nor GHIC now apply in Switzerland, Liechtenstein, Norway or Iceland.。

Like the advice on EHICs, the UK government continues to stress that anyone travelling overseas, whether to the EU or elsewhere in the world, should take out comprehensive travel insurance.。

Cross border healthcare continues with Ireland。

Under existing Common Travel Area arrangements with Ireland, UK residents will continue to be able to access necessary healthcare in Ireland by showing proof of residency documentation, such as a UK driving licence, a biometric residence permit, a Northern Irish medical card, or an EHIC or GHIC.。

In line with longstanding commitments under the Common Travel Area, Irish citizens do not need to apply to the EU Settlement Scheme for treatment in the UK, although they may do so if they wish.。

Irish citizens living in the UK will continue to access healthcare in the UK on the same terms as a UK resident.。

EU settlement scheme。

Any EU, EEA or Swiss citizen living in the UK can apply under the EU Settlement Scheme to continue living in the UK after 30 June 2021. With many caveats, they can then be regarded as a UK citizen for free NHS treatment.。

UK expatriates。

Because the NHS is a residency-based system, under NHS rules UK nationals who move abroad on a permanent basis lose their entitlement to free NHS healthcare.。

UK nationals living and working in EU countries, Norway, Iceland, Liechtenstein or Switzerland on or before 31 December 2020 and their family members may be eligible to use NHS services without charge. They may be asked to provide evidence of residency.。

Any UK national who moves to the EU on or after 1 January 2021, should not expect to be able to use NHS services for free when visiting the UK unless they have an EHIC, PRC or S2 to show healthcare costs are funded by the EU country in which they now live, or another exemption applies.。

Some former UK residents do not have to pay for NHS treatment when visiting England. This includes UK war pensioners, UK government employees, and UK nationals living in the EU on or before 31 December 2020.。

Will this impact UK medical tourism?。

The definition of ‘necessary healthcare’ does not include healthcare where people travel specifically to receive medical treatment, so neither EHIC or GHIC cards cover planned medical tourism or going abroad to give birth.。

Individuals who want to seek planned treatment in a member state may be covered under the broader healthcare arrangements with the EU. But from 2021 this now excludes UK citizens resident in the UK.。

Some people may be able to request UK funding for planned treatment under the S2 route in Norway, Iceland, Liechtenstein or Switzerland (as well as EU countries) if they are:。

·?An EU, Swiss, Norwegian, Icelandic or Liechtenstein national, and have been living in the UK since before 1 January 2021.。

·?A UK State Pensioner living in the EEA or Switzerland since before 1 January 2021.。

·?A frontier worker who works in one state and lives in another, and have been one since before 1 January 2021, for as long only as they continue to be a frontier worker in the host state.。

·?A family member or dependant of one of the above.。

For inbound medical treatment, different rules apply in England, Scotland, Wales and Northern Ireland. In England, for example, NHS England will need to be satisfied that the following eligibility criteria are met:。

·?The person is ordinarily resident in England and entitled to treatment on the NHS.。

·?The requested treatment would normally be provided on the NHS to that individual.。

·?The patient has provided written evidence that they have had a full clinical assessment by a clinician in either the UK, any EEA country, or Switzerland. The clinician's statement must clearly state why the treatment sought is needed, and what the clinician considers to be a medically justifiable time period within which they should be treated again.。

·?The requested treatment is available under the treating country's state healthcare scheme.。

·?NHS England has determined that the same or equivalent treatment cannot be provided on the NHS within a time period that's medically justifiable.。

·?The requested treatment is not experimental or part of a drug trial.。

·?The requested treatment is not emergency treatment.。

If the application under the S2 route is approved, the treatment will be provided under the same conditions of care and payment that would apply to residents of the country being treated in. This could mean they have to pay a percentage of the costs personally (a co-payment charge), as well as travel and accommodation costs.。

In some countries, patients cover 25% of the costs of their state-provided treatment while the state covers the other 75%. If the patient received treatment under such a healthcare system, they would be expected to pay the same co-payment charge as a patient from that country.。

Future developments。

The UK is seeking to conclude new agreements on reciprocal healthcare, with the EEA EFTA States and with Switzerland.。

Temporary deals。

Until a new agreement is in place, the UK and Norway will apply, on a temporary basis, an amended version of the 1991 Convention on Social Security and Protocol on Medical Treatment between the governments of the UK and Norway. This includes medically necessary healthcare.。

Reciprocal healthcare。

The rest-of-the-world countries that the UK currently has reciprocal healthcare agreements with are Australia, New Zealand, some Crown Dependencies and overseas territories (such as Isle of Man, Jersey, Gibraltar), and some Balkan states (Bosnia, Serbia, Montenegro, Kosovo). Different proofs of eligibility are required under these agreements.。

The following European countries do not accept the EHIC or GHIC:。

·?The Channel Islands, including Guernsey, Alderney and Sark。

·?The Isle of Man。

·?Monaco

·?San Marino。

·?The Vatican。

Travel bans。

As no longer part of the EU, the UK is not part of travel deals agreed with all EU countries. This means that individual countries such as Spain and Portugal can apply travel bans to the UK without reference to EU partners, and have done so.。

These changes may take some time to filter through the healthcare systems. With so many UK and EU hospitals franticly busy with the pandemic and vaccinations, it would be surprising if hospital managers or doctors have the bandwidth to process a fraction of the above.。