S1 based health cover after Brexit - an update, and getting beyond the confusion and misunderstanding

The UK government's statement yesterday (read about it in yesterday's news update, here: https://www.francerights.info/2019/09/new-uk-government-contingency-plans-on.html) guaranteeing that as a fall back measure it would reimburse the health care costs for S1 holders for just 6 months after a no deal Brexit certainly caused a furore - as of course it should do.




I had at least 200 responses to my call for stories and testimonies from those who would be affected, and every single one was heartbreaking. A sample of these testimonies were taken to a meeting that British in Europe had yesterday afternoon with the Foreign Office minister Chris Pincher, who said that he found them 'genuinely helpful': you can read more about that meeting here: https://britishineurope.org/2019/09/24/bie-meets-chris-pincher/. My call for testimonies was also picked up by The Local, which ran an article on it today - you can read that here: https://www.thelocal.fr/20190924/pensioners-in-france-reveal-the-torture-of-brexit-healthcare-uncertainty


An update on ongoing agreements on reciprocal health care

One important thing did come out of the meeting with the minister. We asked whether the UK was still intending to negotiate ongoing EU-wide or bilateral agreements on reciprocal health care that would continue to cover S1 holders in countries either side of the Channel in the future. The government statement made no mention of this at all, only talking about negotiating an agreement up to 31 December 2020 or if this didn't succeed, covering health care costs on a unilateral basis for 6 months.




Chris Pincher said that it 'very definitely remained the government's policy' in the case of a no deal Brexit to seek to reproduce the existing EU reciprocal social security and healthcare scheme through either an EU-wide, or bilateral agreements.

Obviously we'll be keeping a very close eye on this to try and make sure that policy turns into action.


Why is this important?

The French no deal ordonnance states that France will maintain access to health care 'on the same terms as a someone covered by the French national régime' for S1 holders who are legally resident on Brexit day for 2 years, or up to the date of a bilateral agreement if this is a shorter period. Like the rest of the no deal provisions for us, it's subject to reciprocity.

The wording of the ordonnance implies that there is an expectation that the UK will seek an ongoing agreement on health care. If it happens that this is not actually the case and there were no intention of seeking ongoing agreements, then we must expect that 2 year period of cover to be vulnerable.

Spain is already making noises about reciprocity conditions not being met - so far France has not joined in, but we know from our meetings that France is very, very hot on the reciprocity condition - especially now when trust in the integrity of the UK government is at its lowest.

Where are we now - getting beyond the confusion and misunderstanding

We're aware that there's currently a lot of confusion and misunderstanding flying around on social media and elsewhere about what would happen on health care for S1 holders in France in a no deal scenario. This is perhaps not surprising, as it's neither especially easy to understand, nor a black and white scenario - there are a lot of unanswered questions and an awful lot of nuance to be dealt with.

Below we set out, as simply as possible, where things stand as of today.

1. The French no deal ordonnance states that S1 holders who are resident in France on the day of a no deal Brexit would retain access to health cover 'on the same terms as someone who is covered by the French régime' for 2 years or until the conclusion of an agreement on health cover if this is a shorter period. This, like all the no deal provisions, is subject to reciprocity.

2. The devil is in the detail: we don't yet know whether this would entail either being liable for contributions to PUMa, the universal health care scheme, and/or for the payment of social charges on pension income (as paid by French pensioners). If the UK doesn't agree to reimburse France for the health costs of S1 holders then we think that both could be likely as France would become the 'competent state' of S1 holders, and this would seem to be borne out by the wording (see paragraph 1). Your 'competent state' is the country responsible for paying for your health care - for S1 holders this is the UK.

3. The UK government has proposed to France that the current reciprocal health care scheme continues between the two countries until 31 December 2020. If this is agreed, the UK would remain the 'competent state' of S1 holders until this date, and no PUMa contributions or social charges would be payable during this period.

4. If France does NOT agree to continue the current reciprocal scheme until 31 December 2020, then the UK government's fallback 6 months comes into play, during which it unilaterally agrees to cover the health care costs of current S1 holders while they make arrangements to join the 'national health care scheme' - in our case this is PUMa.

5. During all of this argy-bargying we have been assured (see above) that the UK intends to seek ongoing agreements - either bilateral or EU wide - on reciprocal health care. It does in fact already have legislation in place that would permit this.

6. Remember that whatever happens - or doesn't happen - you will not be left without access to health cover. In an absolute worst case scenario - where France does not agree to continue the reciprocal scheme until 31 December 2010 and/or no ongoing agreements are put into place - you would have to switch your health cover to PUMa. If this happens you would in theory be liable for contributions, although this is means tested and only capital/investment income over 20k is taken into account - pension income is excluded from the calculation. PUMa doesn't come completely without cost: you may be liable for social charges on your pension income, depending on your income, although in the 2019 revisions there is a sliding scale of charges depending on income, and those with the lowest incomes are no exonerated altogether.


What do you need to do right now?


Apart from making sure that your S1 health cover is in place and that you meet the conditions to be legally resident on Brexit day, there's nothing else to do at this point apart from following any updates.

We understand that health care is absolutely primordial for everyone and anything that may put it at risk is incredibly scary. As I said yesterday, please rest assured that we're on this and will do everything we can to fight your corner and bring you all the up to date information.


Kalba

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