The final Brexit Agreement between the UK and the EU makes provision for health cover for UK pensioners and visitors to France. Updated February 2022.

As we have previously reported on these pages, under the Withdrawal Agreement signed between the UK and the EU in January 2020, those who relocated to France before the end of the transition period (31st Dec 2020) have protected rights to healthcare as if the UK had remained in the EU.

That is noticeably the case for pensioners, who remain entitled to an S1 certificate of exemption for health, under which responsibility for the cost of their healthcare in France will continue to be met by the UK.

Those same rights apply to those living in France before the end of 2020 who later reach pensionable age, provided they are entitled to a UK pension. You can read more about these rights on the links below.

The exemption from social charges on pension income for holders of an S1 also remains in place. The same applies to capital gains and rental income, provided they hold an S1, although for such income a solidarity tax of 7.5% is payable.

According to the European Commission, UK nationals who relocate to France after 2020 will continue to have similar rights.

Protocol on Social Security Coordination

Although the final Agreement somewhat dramatically reached between the UK and the EU on Christmas Eve 2020 was primarily about trade, the negotiations ranged on a number of other issues. Hence, why it is called the 'Trade and Cooperation Agreement (TCA)'.

The agreement also includes a 'Protocol on Social Security Coordination', covering both cash benefits and health care.

In a press release last month on the protocol the European Commission stated that: "Pensioners will continue to benefit from healthcare in their State of residence on behalf of the State paying their pension if they move to the UK or the EU. The same goes for frontier workers, working in one Party and residing in another. While additional requirements may apply under domestic immigration legislation, the Agreement secures that the country of insurance reimburses the country of residence, so that ultimately the same arrangements apply as now.’"

We sought clarification from the European Commission on their statement. Daniel Derrie, their Brexit spokesman, confirmed to us that:

"A pensioner who resides outside a state where they never worked (e.g. a UK pensioner in Spain) shall be able to fully benefit from the healthcare in their country of residence at the expense of the state paying their pension. To receive this healthcare, they will have an S1 document or an equivalent document for UK."

The British government interpretation is slightly less clear cut, but they nevertheless state: "Where the UK or an EU Member State is responsible for the healthcare of an individual, that person will be entitled to reciprocal healthcare cover in accordance with the Protocol."

The protocol that sets out these arrangements is lengthy and complex, but there is specific provision for UK pensioners living in Europe to obtain health cover from the UK under specific circumstances. According to Tamara Hervey, Jean Monnet Professor of EU Law at the University of Sheffield, UK, "what is most important is that the wording of the Trade and Cooperation Agreement’s Social Security Protocol is in many relevant respects identical to the wording of the existing EU legislation."

Nevertheless, entitlement to health cover from the UK only arises where they are 'not entitled to benefits in kind under the State of residence', when they would then be able to claim health cover from their State of residence, with the costs met by the UK.

Although the protocol does not make any reference to S1 certificates, it states that the right 'shall be certified by a document issued by the competent institution upon request of the insured person or upon request of the institution of the place of residence'.

Subsequently, the UK confirmed that S1 certificates would remain in place for state retired pensioners and the visa authorities in the UK stated:

'Following new instructions on the issuance of Long Stay Visitor Visas, valid S1 Form is now accepted as evidence of medical coverage. Please provide a copy of your S1 Form.

If you don’t hold a S1 Form, you will need to provide a private Health insurance, which must cover full requested long stay visa, up to 1 year.'

Early retirees who relocate to France, in a twist of irony, will escape the 5-year residence rule that applies to EEA nationals, to benefit from a right to health cover after 3 months legal residence that is granted to non-EEA nationals. See our previous articles on this point, on the links below.

The provision does not, however, change the requirement for all UK nationals proposing to relocate to France to now obtain a visa, which will be conditional on proof of health cover being in place.

The protocol does require that that authorities in both countries provide clear information, stating: 'The competent authorities or institutions shall ensure that any necessary information is made available to insured persons regarding the procedures and conditions for the granting of benefits in kind where such benefits are received in the territory of a State other than that of the competent institution.'

Visitors

In addition to the provisions for pensioners, the final Brexit agreement provides for replacement of the EHIC (European Health Insurance Card) for those making a temporary visit, by a new document.

The protocol states: 'an insured person and the members of their family staying in a State other than the competent State shall be entitled to benefits in kind, provided on behalf of the competent institution by the institution of the place of stay in accordance with its legislation, as though the person were insured under that legislation.'

The card grants access to health cover in France (and Europe) on the same terms as the EHIC.

If you have an existing EHIC card you can continue to use it until it expires.