The EHIC, and what it does not cover

The European Health Insurance Card is one of the genuinely good things the EU has made, and it is misunderstood in one specific, expensive way: people treat it as insurance.

It isn’t. It is a proof of entitlement. Knowing precisely what it entitles you to is the difference between a €30 co-payment and a €4,000 invoice from a clinic you did not choose.

What the card actually entitles you to

The EHIC proves that you are covered by a state health system somewhere in the EU or EEA, and that you are therefore entitled to medically necessary state healthcare on the same terms as a resident of the country you are visiting.

Read that phrase carefully, because both halves matter.

State healthcare means the public system. Public hospitals, public clinics, doctors contracted to the national scheme. It has no application whatsoever in a private facility.

On the same terms as a resident means you get whatever a local gets, including whatever a local pays. In some systems that is free at the point of use. In others there is a standard patient contribution, and you pay it exactly as a local would. The card does not make you exempt; it makes you ordinary.

“Medically necessary” covers treatment that cannot reasonably wait until you go home, which includes emergencies, but also things like routine dialysis and oxygen therapy if you arrange them in advance. It does not cover travelling somewhere specifically to get treated.

It is free, and every site that charges you is a middleman

You apply through your own national health authority. In Ireland that is the HSE; in Denmark, Germany, France, Spain and everywhere else, the national or regional sickness-insurance body. The application is free, the processing is free and the card is free.

Search for it and the first results will frequently be commercial sites offering to “review”, “check” or “expedite” your application for a fee — reported charges of £20 or more, and up to around €40, for something that costs nothing. They are not scams in the legal sense; they are resellers, and some carry a disclaimer in small type.

Go directly to your own health authority’s site. There is nothing to expedite.

Each person needs their own card, including babies and children. A family of four needs four cards, and the child nobody applied for is a common and avoidable problem.

The GHIC, and where the UK version differs

After Brexit the UK replaced most EHICs with the Global Health Insurance Card. It works on the same principle — state healthcare, local terms — and is likewise free from the NHS.

The important difference is the country list, and it is not identical to the EHIC’s. Coverage in Switzerland and in the EEA countries outside the EU — Norway, Iceland, Liechtenstein — has been adjusted more than once since 2021, and certain groups such as students and some pensioners can still hold a UK EHIC with broader cover.

Do not take a general answer on this. If you hold a UK card and your trip touches Switzerland, Norway, Iceland or Liechtenstein, check the NHS page for the current list before you travel. It is the only source that is reliably up to date.

The four things it does not do

Private treatment. Nothing, anywhere, ever.

Repatriation. If you need to be flown home with a medical escort, the card contributes zero. This is the single largest bill in travel medicine and it is entirely uninsured by the card.

Cancellation. If you fall ill before you travel and lose a non-refundable booking, the card is irrelevant.

Baggage, theft, delay, liability. Not the card’s business.

Three of those four are the reason travel insurance exists. The card and the policy are complements, not alternatives.

The private clinic trap

This deserves its own section because it is the way most people actually get caught, and it is common in Spanish and Greek resort areas.

You are injured. An ambulance arrives, or a hotel receptionist or resort rep calls one, and you are taken to a clinic. It is clean, modern and English-speaking. It is also private, and your card is worth nothing in it.

Private clinics in tourist areas are often nearer than the public hospital, and the referral chain — reps, hotels, sometimes ambulance operators — does not always favour the public option. Nobody is necessarily acting badly. The incentive simply does not point where you would like it to.

Two things protect you.

Ask the question out loud, in the ambulance or at the desk: is this a public hospital? If the answer is no and your condition allows a choice, ask to be taken to the public one.

And phone your insurer’s emergency assistance line early — the number on the policy, not the claims line. That is the point of assistance cover: they will confirm which facility to use and, if a private admission is genuinely unavoidable, authorise it so that you are not arguing about it afterwards.

If you have already been admitted privately, present the card anyway and tell them you have one. Sometimes the facility has a public contract for emergency work. It costs nothing to ask.

If you were treated without presenting the card

Not fatal. You can usually still recover the money.

Ask for an itemised invoice showing the treatment given, and keep every receipt. Then claim reimbursement either from the national institution in the country where you were treated, while you are still there, or from your own health insurer once you are home.

Two things to expect. You will be reimbursed at the rates of the country where you were treated, not your own. And the local patient co-payment is generally not refundable, because a local would have paid it too.

Treatment at a private facility cannot be reimbursed this way at all.

Expiry is the commonest failure

Cards carry an expiry date, usually a few years out, and an expired card is not a slightly weaker card — it is no card.

This is the most frequent way the system fails people: the card is in the wallet, it has been in the wallet for years, and it stopped working in 2024. Check the date now rather than at a hospital reception desk, and renew through the same national body that issued it. Renewal is free too.

The exception: Switzerland, Norway, Iceland and Liechtenstein

All four accept the EHIC, and all four work differently enough to be worth a separate thought.

Switzerland is the one to watch. Its health system runs on compulsory private insurance with substantial patient cost-sharing built in, so “the same terms as a local” can mean a meaningful co-payment even with a valid card. Norway and Iceland also apply patient contributions for outpatient care, with inpatient treatment generally free.

None of this makes the card useless there — it still stops you being billed as an uninsured foreigner, which is the expensive category. But it is the clearest illustration that the card equalises your treatment, not your bill.

Carry both, and present the card first

The verdict is unglamorous: get the card, get a policy, take both.

The card first, always, because it is the cheaper instrument. Every euro the state system absorbs is a euro your insurer never has to pay — and since your claim is reduced by the excess before anything is paid out, a smaller bill often means the difference between claiming and not needing to.

Photograph both sides of the card and keep the image on your phone. Then put the card itself somewhere you will still have it if your bag doesn’t.