The S1 form: Healthcare for UK nationals moving to Europe

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14.12.23
S1 Form

The S1 form is an important document for Britons moving to Europe, providing access to essential healthcare services outside the UK – and in France, it can give you significant tax benefits too.

Moving to a new country can be an exciting adventure, but it also comes with its fair share of challenges, especially when it comes to understanding the local healthcare system. For UK nationals relocating to Europe, the S1 form is crucial for ensuring access to state healthcare services. In fact, UK nationals must be able to prove they have medical coverage for their destination to qualify for a visa/residency permit. This means that you will probably need to have private medical insurance in place in the absence of an S1 form before submitting your visa application.

In this article, we will explore the significance of the S1 and the local authority you must register within five popular European destinations: France, Spain, Portugal, Cyprus, and Malta.

What is the S1 form?

The S1 form, formerly known as the E121 form, is a document issued by the country of origin’s social security system. It allows individuals who have worked and paid social security contributions in one European Economic Area (EEA) country to access healthcare services in another EEA country. This is particularly relevant for retirees and individuals looking to relocate to Europe from the UK.

For the post-Brexit situation, see below.

What healthcare does the S1 form give you?

If covered by the S1 form, you will be entitled to state healthcare in your country of residence. However, this will not necessarily cover the entire cost of specific treatments, so having some insurance to top up the difference is advisable.

The amount of healthcare covered by the S1 form can differ between countries. Spain, for example, typically covers around 75%, whereas the other 25% must be paid by the individual or through a supplementary insurance scheme. Completely free treatment may be available in a limited number of hospitals, although the waiting lists tend to be very long, especially for non-emergency cases.

How can you get the S1 form?

You can apply for the S1 form through the Overseas Healthcare Services section of the NHS website and should do so before leaving the UK. You will also need to register with the local authority of the country you are moving to upon arrival.

France

France offers everything from mountains and valleys to cities and rural vineyards. Here, expatriates with the S1 form are entitled to the same healthcare rights as French nationals, a service that was ranked first for quality and efficiency in a global study held by the World Health Organisation in 2020. Once in France, you must register with the local Caisse Primaire d’Assurances Maladie (CPAM) office to activate your S1 rights.

Spain

Spain, known for its vibrant culture and sunny beaches, welcomes UK nationals carrying the S1 form. Upon moving to Spain, you should also register with the local social security office, the Instituto Nacional de la Seguridad Social (INSS), to access healthcare services. The S1 form ensures that you will benefit from the Spanish healthcare system, providing peace of mind as you settle into your new life.

Portugal

With its rich history and scenic landscapes, Portugal is an increasingly popular destination for expatriates. Those relocating with the S1 form can integrate seamlessly into the Portuguese healthcare system. Upon arrival, you should present your S1 form to the local Centre for Social Security (CDSS), after which you will be provided with your own Portuguese National Health Service (NHS) number and enjoy the same healthcare privileges as Portuguese residents.

Cyprus

Moving to the picturesque island of Cyprus is made smoother with the S1 form. You should register your S1 form with the General Health Service (GHS, known as Gesy) in Cyprus to activate your S1 rights.

Malta

Malta, known for its historic sites and Mediterranean charm, also caters to the S1 form. You should register with the Maltese Ministry of Health Entitlement Unit and present your certificate to access healthcare services.

Receiving pensions from multiple jurisdictions

If you already live in Europe and receive a local pension there as well as a UK state pension, you might not be eligible for an S1 – your country of residence may already be responsible for your healthcare.

If you receive both a UK state pension and a pension from a different EU country while living in another – for example, if you receive a state pension from the UK and France but are now living in Spain – the country to which you paid contributions the longest will be responsible for your healthcare.

Does the S1 form still provide healthcare in the EU after Brexit?

Under the Withdrawal Agreement, UK nationals who receive UK state pensions, or have exportable benefits, may be eligible to apply for the S1 form. However, since the UK left the European Union, the rules have changed surrounding the following exportable benefits:

  • Disability Living Allowance (DLA)
  • Personal Independence Payment (PIP)
  • Carer’s Allowance (CA)
  • Attendance Allowance (AA)

Claiming the S1 form under exportable benefits

If you moved to an EU country and applied for the S1 form before 1 January 2021, you will still be entitled to the healthcare services it provides whilst in receipt of one of these benefits. However, if you do not yet have an S1 form, you can no longer qualify solely under any of the benefits listed above.

If you do not yet have your S1 form

If you are still in the planning stages of leaving the UK, you must notify your GP to be removed from the NHS register, along with any other relevant family members, as you will no longer be eligible for this residence-based healthcare system.

Before leaving for your destination, check what health services will be available in that country. Available treatments and services will differ between countries, and you might not get the same services as you would free of charge with the NHS.

If you want further information on eligibility and application for a specific country, visit the UK government website.

Tax advantages for the S1 form in France

It is advantageous to have the S1 form when moving to any of the five countries covered in this article. However, there are additional financial benefits specifically for those of you who are planning to move, or already living in France.

French social charges are paid in addition to income tax and are levied against most forms of income. If you are covered by the S1 form, you are not only exempt from paying the 9.1% social charges on your pension and pension lump sum payments but receive a significant reduction (9.7%) for social charges on investment income such as bank interest and dividends, rental income and also on capital gains made on the sale of property or investments.

The S1 form – conclusion

The S1 form allows expatriates to enjoy healthcare benefits in their new European home. Whether you’re savouring the flavours of French cuisine, basking in the Spanish sun, exploring the beauty of Portugal, embracing island life in Cyprus, or immersing yourself in the history of Malta, the S1 form ensures that your health and well-being are well taken care of. Before embarking on your European adventure, familiarise yourself with the specific requirements and procedures in your country of interest to make the most of your S1 rights.

Planning your finances alongside your healthcare is advisable for a new life abroad. Ensuring your tax and estate planning, pensions, savings and investments are all set up in the most tax-efficient way possible will make the move easier and allow you to have more money on hand to deal with unexpected medical bills.

Blevins Franks has advisers living locally who are, as such, expatriates themselves. They have a deep understanding of the entire process and can help take the stress out of your move and ensure you make the most of the financial opportunities available.

Contact us now.

Tax rates, scope and reliefs may change. Any statements concerning taxation are based upon our understanding of current taxation laws and practices which are subject to change. Tax information has been summarised; individuals should seek personalised advice.

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