Post-Brexit travel healthcare: What is a UK ‘CRA’ Ehic card?

British Ehics (European Health Insurance Cards) issued since the end of the Brexit transition period at the end of 2021 now feature the letters ‘CRA’ - leading some people to wonder about the significance of this.

Ehics are used for necessary healthcare (that cannot wait for you to return home) during visits to countries in the EU.

‘CRA’ stands for ‘Citizens Rights Agreement’ and relates to the Brexit Withdrawal Agreement (WA), which was signed between the UK and EU on January 24, 2020.

Despite the word ‘European’ which remains in the cards’ name, it was agreed in the WA that the UK would be able to continue to issue Ehic cards to people with rights under the WA.

This was in the general spirit of the agreement, that people who had been exercising their free movement rights before Brexit, including Britons in the EU and EU citizens in the UK, should be able to go on largely living their lives as before.

Until the second Brexit treaty, the Trade and Cooperation Agreement (TCA) was signed on December 30, 2020, it was unclear if the UK would be able to continue to issue any other Ehics, or an equivalent, to people not covered by the WA, as the Ehic scheme is in principle an EU scheme, allowing mutual cooperation across the union for essential travel healthcare needs.

As the Brexit transition period neared its end in late 2020, the UK invited those concerned to apply for new ‘CRA’ Ehics, saying that old ‘EU’ British Ehics may cease to be valid after the transition period.

These have the ‘CRA’ lettering on them and no EU stars.

Who are CRA Ehics aimed at?

CRA Ehics are aimed at groups covered by the WA including:

• British S1 holders (state pensioners and certain disability benefit recipients) living in the EU, who have always been issued with UK Ehics and not the French equivalent (Carte européene d’assurance maladie), as the UK pays for their healthcare. This was agreed to continue under the Brexit WA. Their Ehics would be valid for five years as is usual for British Ehics. These can be used to access healthcare in other parts of the EU when on trips.
• British students studying in EU institutions before the end of the transition period, who could receive a card valid for the duration of their studies.
• EU citizens living in the UK before 2021 and benefiting from ‘settled status’ in the country under the WA deal.

However, once the TCA treaty was signed and ratified it was clarified that the UK could continue to issue its own version of the Ehic, called the Ghic (Global Health Insurance Card), as similar cooperation on healthcare was agreed in the TCA as had existed when the UK was part of the EU.

What are the current rules on Ehics and Ghics?

The current situation is that:

• People who still have old ‘EU’ British Ehics can still use them until they expire
• Residents of the UK using the NHS for their healthcare and wishing to travel in the EU and applying for a new card are issued with Ghics
• British state pensioners moving to the EU since January 1, 2021 are also issued with a Ghic
• British state pensioners or disabled people living in the EU and benefiting from the WA, with ‘S1’ entitlements dating from before the end of the transition period are issued with a ‘CRA’ Ehic when they apply for a new card.
• Some people are also eligible for a CRA Ehic if a close family member such as their spouse is eligible for one

The aim of the ‘CRA’ lettering is to clarify that these are UK Ehics with ongoing validity, for people covered by the Withdrawal Agreement rights, as opposed to people who would otherwise be issued with a Ghic under the TCA.

Is there a difference between the benefits attached to the cards?

Practically-speaking, there is no difference in the health entitlements conferred by one or the other card, however while both cards can be used in EU states and Switzerland, CRA Ehics can also be used in Norway, Iceland and Liechtenstein, whereas Ghics cannot.

It is possible this could change in future due to bilateral negotiations, and it is already possible for UK nationals to access necessary healthcare during visits to Norway using their UK passport, until such a time as a new agreement is in place.

For UK S1 holders living in the EU, the CRA Ehic or Ghic is not intended for healthcare on visits to the UK, however whereas UK state pensioners living in France with a registered UK-issued S1 before 2021 can access free healthcare in the UK, UK state pensioners moving to France after January 1, 2021 may be charged for certain services.

However, in the UK no one is charged for primary care such as GP visits, or treatment as an outpatient in A&E.

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