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Comprehensive Sickness Insurance and EU Nationals - 10 FAQs

In this post we look at the Comprehensive Sickness Insurance (CSI) requirements for EU Nationals.  We answer 10 frequently asked questions, including: What is Comprehensive sickness insurance and who needs to have Comprehensive sickness insurance cover?

1. Who needs to have Comprehensive Sickness Insurance?

European nationals who are or were present in the UK as students or self-sufficient persons under the Immigration (EEA Regulations) 2006 (as amended in 2016), referred to below as ‘the Regulations’.  These are the Regulations which have governed the presence of EU nationals and their family members in the UK; the Regulations expire on 31 December 2020 and will be completely  replaced thereafter by the EU Settlement Scheme.    

Comprehensive Sickness Insurance for self-sufficient European nationals present in the UK under the Regulations is also a requirement for their family and extended family members issued with a family permit or residence card.  CSI became a requirement for family members of students from 6 April 2015.

2. Who does not need to have Comprehensive Sickness Insurance?

European nationals who are or have been present in the UK as ‘qualified persons’ and who are or were workers, self-employed persons or jobseekers under the Immigration (EEA Regulations) 2006 (as amended in 2016), and their family and extended family members.  However, attention should also be paid to minimum income/number of hours worked requirements (for workers or the self-employed) which might affect whether an EU national would be regarded as a ‘qualified person’ under the Regulations.

European nationals who are or have been present in the UK and have acquired Permanent Residence status, and their family and extended family members.

3. Do I need CSI if I have been granted pre-settled or settled status?

No. This is not a requirement for European nationals and their family and extended family members who have been granted pre-settled or settled status.  However, this does not extinguish the requirement for Comprehensive Sickness Insurance for periods before the grant of pre-settled or settled status for students or self-sufficient persons (see above).  

4. When did this become a requirement?

The UK Government implemented Comprehensive Sickness Insurance as a requirement for EEA nationals present in the UK as students or self-sufficient persons from 20 June 2011. Note again that minimum income/minimum hours requirements may render an EEA national who is or was a worker or self-employed person to actually be a self-sufficient person.  

5. What is Comprehensive Sickness Insurance?

This is not particularly well-defined; the relevant guidance states that it must ‘cover the costs of the majority of the medical treatment’ which might be received in the UK.  The following is from the EEA Nationals: qualified Persons guidance:-

Comprehensive sickness insurance 

This page defines comprehensive sickness insurance (CSI) and explains which European Economic Area (EEA) nationals and their family members must hold it. You can accept an EEA national or their family member as having CSI if they hold any form of insurance that will cover the costs of the majority of medical treatment they may receive in the UK. 

You must take a proportionate approach when you consider if an insurance policy is comprehensive. For example, a policy may contain certain exemptions but if the policy covers the applicant for medical treatment in the majority of circumstances you can accept it. 

The definition of CSI does not include: 

  • cash back health schemes, such as: 

o dental 

o optical 

o prescription charges 

  • travel insurance policies 
  • access to the UK’s NHS 

6. Why didn’t I know about this requirement when I first came to the UK?

There has been wide-spread criticism that the Comprehensive Sickness Insurance requirement has not been well publicised, and that there has been a lack of clear information on the Home Office websites relating to exactly when an EU national required to obtain CSI.  Often the requirement was not recognised or appreciated by EU nationals when switching from worker/self-employment status to student status, or from worker/self-employment status to self-sufficient status.  Some of these ‘switches’ were not clearly defined, for instance when a student had continued working whilst studying, stopped their employment when exams were due, and did not recommence work for a considerable period thereafter.  Under the Regulations, Comprehensive Sickness Insurance may have been needed even when the student’s income/work hours were reduced to below a level which would qualify them as qualified persons in the ‘worker’ categories.

7. Would having had a European Health Insurance Card (EHIC) meet the CSI requirement?

There is no simple answer to this question.  In order to comply with the requirement under the previous regulations, if you wished to rely on an EHIC card you needed to declare that you were temporarily resident in the UK.  However, if applying for Permanent Residence under the Regulations, the guidance states that a statement of intent is unnecessary and it may be possible to rely on having had an EHIC card during the qualifying period to meet the residence requirements.

It is also important to check whether the EU country of origin has other reciprocal arrangements with the UK with regard to healthcare, or, as is the case with some students from some EU countries, whether they are covered by their country’s health service whilst studying abroad.

8. What effect will failure to have Comprehensive Sickness Insurance have on my future ability to remain in the UK?

Once settled status has been granted under the EU Settlement Scheme, the lack of Comprehensive Sickness Insurance will not affect an EEA national’s right to reside in the UK.  However, it is with naturalisation applications that the lack of Comprehensive Sickness Insurance becomes an issue.  Firstly, if an EEA national did not have CSI when required under the Regulations for their lawful presence in the UK, then that period would not be considered ‘lawful residence’ and that period would not be able to be used for the residence requirements when seeking to naturalise as a British Citizen.  This has a further effect, in that failure to comply with the required conditions for residence in the UK under the  Regulations, as with the conditions of leave under the Immigration Rules, will impact negatively on an assessment of an applicant’s good character.

9. Can I acquire CSI retrospectively for periods when I didn’t have it?

No, but checks should be made as to whether an applicant has – for instance in the case of an EU student – had coverage provided by the healthcare provisions in their home country and/or whether the applicant had an EHIC and/or whether the applicant’s family held private insurance which covered medical treatment abroad and/or whether there are individual reciprocal arrangements for medical coverage between the UK and the applicant’s home country (see above).

10. What will be taken into consideration by the Home Office in a naturalisation application if I didn’t have it?

The Home Office naturalisation guidance in respect of the ‘good character’ requirement has been altered a number of times, and has (controversially) narrowed the discretion which will be applied to the failure to have had CSI in the periods relied upon in the naturalisation application.  The relevant part of the guidance issued on 2 October 2020 reads as follows:-

“Comprehensive sickness insurance 

Comprehensive Sickness Insurance (CSI) is a legal requirement for EEA and Swiss students, self-sufficient persons and their family members who are residing in the UK with them.

If a person did not have CSI, you must consider why they did not have it. Where a person has been granted ILR under the EUSS but has been in breach of the EEA Regulations 2016 due to a lack of CSI you must consider whether it is appropriate to exercise discretion in their favour. 

Some applicants will have previously been refused permanent residence on the basis of not having CSI. When considering whether it is appropriate to exercise discretion, you must assess the reasons given for this, and why they did not then obtain CSI. 

For further information on how to exercise discretion in relation to immigration breaches see guidance on naturalisation as a British citizen by discretion.”

See also our recent post here.

The further guidance referred to above does not take the applicant much further, and therefore if an applicant did not have Comprehensive Sickness Insurance when required careful representations must be made to explain why this occurred.  Previous guidance to caseworkers suggested that, for instance, discretion might be exercised if a former student explained that they were previously working in the UK and did not realise when they commenced their studies that Comprehensive Sickness Insurance was a requirement.  

It is important also to note that even though Comprehensive Sickness Insurance is not a requirement for the grant of ‘Settled Status’ under the EU Settlement Scheme, an applicant’s failure to have had CSI in periods before the grant of ‘Settled Status’ will be considered a breach of the Regulations, which will require discretion in a naturalisation application. 

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