Why the EHIC card does not provide sufficient coverage for your students abroad

Are you a college or university staff member dealing with Erasmus or other exchange programs, and are you looking for an insurance that stands like a rock in times of crisis? In that case, you’ve probably heard of the European Health Insurance Card (EHIC). While this card comes in handy and provides coverage for a number of things, it’s important to know that in a lot of cases, it’s barely sufficient as health insurance coverage. In this article, Expat & Co provides some clarification on the matter.

What is the EHIC card?

If students are travelling in one of the countries of the European Union (or in Switzerland, Norway, Iceland or Liechtenstein) and require medical attention, their health-related expenses can be taken care of if they present their European Health Insurance Card (EHIC). The EHIC card replaces the old form E111. Depending on the health charges in effect in the country where they happen to be, the cost of medical care there will be fully or partly refunded on presentation of the card. This places them on the same footing as patients from that country. You can read more about the EHIC card here and here.

The good thing about the EHIC card is that it can be used in all countries of the EEA (EU + Norway, Iceland and Liechtenstein). 
Some nationalities (eg. the Belgians) can even use it in Australia because of the bilateral agreement between both countries. But that’s about as far as it goes. Outside Europe the EHIC is pretty much worthless.

Some background information about public health systems in Europe

Europe has two types of public health systems:

Care-in-kind-system

In this system students can go to the doctor for free, but only to public doctors/hospitals. Private doctors are not covered or reimbursed. They'll have to pay for it themselves. Furthermore, dental and optical care is often not, or only in a limited way, covered in this system. Mainly, except for the Scandinavian countries, the service is quite poor and there are long waiting lists before you can see a doctor. You find this care-in-kind system in countries like Italy, Spain, Netherlands and UK, countries that did not emerge unscathed from the corona crisis, because of important savings in their health care systems during the last years.

Reimbursement system

In this system students can go to any doctor they wish, pay the consult, and claim it back from their health fund. These health funds are named differently in the different countries. In France it is called ‘Caisse Primaire’, in German speaking countries you have ‘Krankenkasses’, in Belgium we use the name ‘Mutualité’ or ‘Ziekenfonds’, etc…These countries seem to resist the corona crisis in a better way than the care-in-kind countries.

All these health funds have different reimbursement rates, so in every country they are insured differently.

Examples

• Example 1: A student goes from one country with a care-in-kind system to another country with a care-in-kind system.

In this case, basically nothing changes, except that in some countries a certain treatment can be included, while that’s not the case in others. Non-included treatment should be paid by the student himself.

• Example 2: A student goes from a country with a reimbursement system to another country with a reimbursement system.

In this case, the reimbursement rate can differ. Your health fund will refund you following the reimbursement rate of the country where you had your care.
 But how do these health funds know the reimbursement rates from other countries, as many countries are under constant reform? They have a correspondence system which is quite the administrative merry-go-round, including a lot of paperwork, which can take up to 4 months or more. This means you’ll have to wait at least 4 months to receive your partial refund. We know cases where it took 2 years.
 So, the advantage here is that you have free choice of doctors/hospitals (not only state doctors), but on the other hand you have a lot more administration.

• Example 3: A student goes from a care-in-kind system to a reimbursement system.

In this case, you get reimbursed at the same rate as the country of care. 
If you go in the opposite direction, you lose your free choice and have to go to State doctors, but will be reimbursed in full or treated for free.

So, going abroad just with your EHIC card can be quite an adventure and sometimes your students will not be (fully) reimbursed! Also bear in mind that an EHIC card is only valid for 1 year. So maybe they will have to apply for a new card in the middle of their exchange program. Sometimes young people tend to forget about this, so there is a chance that their EHIC card is not valid during (a part of) their exchange.

How do I make sure they have proper coverage when they travel abroad? 

Expat & Co strongly advises to take out an extra private insurance that covers students up to 100% for all urgent and medically necessary treatments.
 People traveling between reimbursement system countries (see example 2 above) have free choice of doctors already and will enjoy comprehensive coverage with a top-up insurance, closing the gap of the EHIC card. 


In all other cases a full cover insurance is recommended as it guarantees free choice of health service provider. In a few countries, students really don’t want to be treated by the public health care system as service is terribly poor. In some public hospitals they don’t have MRI or CT-scanners available, so you almost are obligated to go private (so, non-refunded).
 Also, the insurance gives you a minimum of dental cover, which is often excluded or limited.

Get proper coverage for your students with Expat & Co’s Student Insurance

The Student Insurance of Expat & Co can offer both kinds of insurance (full cover or top-up) to individual students and universities all over Europe, at a very fair price for good covers. The insurance is also compliant to the EACEA minimum requirements (requirements of the EU-commission regarding Erasmus exchange). To be EACEA-compliant, the insurance has to include, besides 100% health insurance cover: Full Assistance cover, Accident insurance and Liability insurance. 

These extra covers are not included in the public health system (EHIC). 
For liability, the university and the student should be seen as third parties toward each other, which in normal liability insurances is not covered in these 4 covers. 
Also, EACEA-compliant insurances may not have any deductible or co-pay. Most public reimbursement systems always have a co-pay or deductible, as they don’t cover 100%.

On top of that, Austria and Switzerland have special demands for a student visa. In the Expat & Co Student policy you can add special clauses to comply with these demands, where EHIC does not comply either. Same story in the US where almost every university has their own demands and standards.

To conclude: make sure you get proper coverage for your students, because the EHIC card is absolutely not sufficient as a student cover abroad. 

Learn more about our Student Insurance plan on this page or apply by contacting us here.