Virginia, US
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| Charlotte Nicolas

The Impact of Comprehensive Sickness Insurance on EEA Permanent Residency

According to a recent Liberal Democrats analysis reported in The Guardian, in the last two quarters of 2016, more than 12,800 EU citizens had their permanent residency requests refused with a further 5,500 declared invalid, a rejection rate of around 28%.

To qualify for permanent residency in the UK, EEA nationals need five years of continued residence in the UK and must meet certain criteria. We are aware of a recent trend in residency applications submitted by EEA citizens relying on the period of time spent as students or as self-sufficient persons being refused on the grounds that they did not hold Comprehensive Sickness Insurance (CSI) coverage. These cases highlight a little-known requirement, which has the capacity to seriously prejudice an application for permanent residency.

When do EEA Nationals Require Comprehensive Sickness Insurance?

Under EU law, EEA citizens who are students, or self-sufficient persons resident in another member state for more than 3 months must have their own medical insurance. The CSI rule was designed as a barrier against benefit tourism.

This covers applications for Residence Cards and Permanent Residence cards, and also applies to non-EEA family members applying on the basis that their EEA national family member is exercising Treaty rights and sponsoring them in the UK.

Applicants must submit evidence that they:

  1. Have sufficient resources for themselves and family members so as not to become a burden on the social assistance system of the host Member State and have comprehensive sickness insurance cover in the host Member State; or
  2. Are enrolled as students within the host Member State and have Comprehensive Sickness Insurance cover and assure the national authorities that they have sufficient resources for themselves and family members not to become a burden on the social assistance system of the host Member State during their period of residence; or
  3. Are family members of Union citizens falling within one of the above categories.

Applications will normally be refused if none of these conditions are met.

What Documents can an EEA National or their Family Members Provide to Show they have CSI?

EEA nationals applying for documentation confirming their right to reside in the UK as a student or self-sufficient person must present one of the following forms of evidence covering the duration of period of residence in the UK.

For applications for a registration certificate or a residence card, they must provide one of the following documents to show they have CSI: 

  1. A comprehensive insurance policy document confirming that the applicant has private medical insurance. When considering what is ‘comprehensive, the caseworker may accept for example, a policy containing certain exemptions if the applicant is  covered by  the  policy  for medical treatment in the majority of circumstances; or
  2. For persons temporarily in the UK, a valid European Health Insurance Card (EHIC). The EHIC is the replacement for form E111. It must have been issued by a member state other than the UK because the member state that issued the card will cover the cost of treatment. The applicant must also provide a statement of intent that they intend to return to their home country; or  
  3. In certain circumstances, Form S1, S2 or S3. The S1 form is a certificate of entitlement to health care in another EEA country for a limited duration and may only be used in limited circumstances; for example, by state pensioners or dependents of an insured person working in another Member State. The S2 form covers the actual cost of treatment; for example, for insured persons who are referred for specific treatment in another EEA country or Switzerland. The S3 form will cover the cost of treatment; for example, for retired frontier workers continuing treatment in the Member State they previously worked.

For applications for a document certifying permanent residence or a permanent residence card, they must provide one of the following documents or a combination of these documents covering the whole of their 5 years continuous residence in the UK:  

  1. A comprehensive private medical insurance policy document; or 
  2. A valid European Health Insurance Card (EHIC) issued by an EEA member state other than the UK (or its predecessor form E111); or 
  3. Form S1 (or its predecessor forms E109 or E121), Form S2 (or its predecessor form E112) or Form S3. 

If the applicant submits an EHIC which does not cover the whole of the period relied upon, or does not feature a valid from date, they must also submit evidence from the issuing authority confirming that they held a valid EHIC card for the period relied upon. 

If the applicant submits Forms S1, S2 or S3 they must provide one or a combination of these forms for their 5 years continuous residence. It is possible to apply to the country of origin retrospectively for these certificates.

What Happens If You have not had CSI and Your Application is Refused?

A refusal means that Permanent Residence will not be granted, but this does not mean removal from the UK.

There were growing fears among EEA citizens that they would be deported for not complying with the requirement to have CSI after a German student was warned by a UKVI official that she could be removed if she could not show insurance documents.  

On 1st March 2017, the Home Office confirmed that this will not be acted upon, and issued the following statement:

“EU citizens will not be removed from the UK or refused entry solely because they do not have comprehensive sickness insurance.”