Why the EHIC card does not provide sufficient coverage when studying abroad

Leaving for an Erasmus adventure, or going abroad for study purposes? 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 you are travelling in one of the countries of the European Union (or in Switzerland, Norway, Iceland or Liechtenstein) and require medical attention, your health-related expenses can be taken care of if you present your European Health Insurance Card (EHIC). The EHIC card replaces the old form E111. Depending on the health charges in effect in the country where you happen to be, the cost of your medical care there will be fully or partly refunded on presentation of your card. This places you on the same footing as a patient from that country. You can read more about the EHIC card here. 

The good thing about the EHIC card is that you can use it 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 you can go to the doctor for free, but only to public doctors/hospitals. Private doctors are not covered or reimbursed. You’ll have to pay them yourself. Furthermore , dental and optical care is often not, or only in a limited way, covered in this system.

Reimbursement system

In this system you can go to any doctor you wish, you pay the consult, and claim it back from your 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…

All these health funds have different reimbursement rates, so in every country you 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. 

  • 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 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.

So, going abroad just with your EHIC card can be quite an adventure and sometimes you will not be (fully) reimbursed!

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

Expat & Co strongly advises to take out an extra private insurance that covers you up to 100% for all urgent and medically necessary treatments.
 People traveling between reimbursement system countries 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, you 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 obliged to go private.
 Also, the insurance gives you a minimum of dental cover, which is often excluded or limited.

Get proper coverage with Expat & Co’s Student Insurance Plan

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 health insurance: Full Assistance cover, Accident insurance and Liability insurance. 

These extra covers are not included in the public health system (EHIC). 
For liability, the University should be covered as a third party, which in normal liability insurances is not covered as this a contractual matter. 
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.

To conclude: make sure you get proper coverage, 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

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