UK Reciprocal Health And Social Security Agreements Explained

Lisa Smith, BA (Hons), CeFA
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Britain has reciprocal healthcare and social security agreements with several countries – but the arrangements exclude many Commonwealth nations.

The agreements do not cover the cost of bringing a sick patient home from abroad nor do they pay for foreign doctors to keep up treatment of existing conditions.

This guide explains which countries Britain has healthcare and social security agreements with, how they work and what to do if you need medical help overseas.

Countries Covered Under Reciprocal Healthcare Agreements

Reciprocal healthcare agreements are in place with the countries in the European Economic Area (EEA) and a handful of other nations:

  • Anguilla
  • Australia
  • Bosnia and Herzegovina
  • British Virgin Islands
  • Falklands Islands
  • Gibraltar
  • Isle of Man
  • Jersey
  • Macedonia
  • Montserrat
  • New Zealand
  • St Helena
  • Serbia
  • Turks and Caicos Islands

The EEA agreements expire on December 31, 2020, when the transition period under the European Union Withdrawal Agreement ends. The UK government has yet to announce arrangements from January 2021 onwards.

This list does not cover countries where UK state pensions are uprated in line with the cost-of-living.

Healthcare: What is free and what is not

Do not expect free treatment from a doctor’s surgery, dentist, or hospital as you would from the National Health Service in the UK.

Reciprocal agreements mean British residents get the same level of treatment at the same cost as someone living in the other country receives.

Bluntly, that means if locals must pay, you pay, and to receive treatment you must show a UK passport and other official documents, like an NHS card or driving licence to prove residence in the UK.

The agreements do not cover repatriation costs, like flights accompanied by a nurse.

To pay for these costs, take out travel insurance.

For country specific healthcare details, go to the NHS web site or call 0191 203 7010 from the UK or +0044 191 203 7010 from outside the UK.

Expats And Reciprocal Healthcare Agreements

Reciprocal healthcare agreements exclude expats who must pay for treatment like any other patient or take out private medical cover.

In some countries, private health cover for expats is a condition of residence.

Reciprocal Agreements And The UK State Pension

Thousands of British expats complain that their UK state pensions do not keep pace with the cost of living because they do not live in a country with a reciprocal agreement with the UK.

The list of countries with healthcare and social security agreements are different.

Countries Covered Under Reciprocal Social Security Agreements

Reciprocal social security agreements are in place with the countries in the European Economic Area (EEA) and a handful of other nations:

  • Barbados
  • Bermuda
  • Bosnia-Herzegovina
  • Canada
  • Chile
  • Guernsey
  • Isle of Man
  • Israel
  • Jamaica
  • Japan
  • Jersey
  • Kosovo
  • Mauritius
  • Montenegro
  • New Zealand
  • North Macedonia
  • Philippines
  • Serbia
  • South Korea
  • Turkey
  • USA

The EEA agreements expire on December 31, 2020, when the transition period under the European Union Withdrawal Agreement ends. The UK government has yet to announce arrangements from January 2021 onwards.

This list does not cover countries where British expats can receive healthcare under a reciprocal agreement.

Reciprocal Agreements And NI Contributions

British expats need to talk with HM Revenue & Customs about how working in a foreign country will affect their entitlement to a state pension and other benefits.

Paying social security in another country can leave gaps in someone’s NI history in some cases, but not in others, depending on the country.

Normally, someone who is self-employed, or an employee pays social security in a country which has a reciprocal agreement with the UK.

To continue paying UK NI contributions while abroad, file a Form CA9107 with HMRC

Reciprocal Healthcare And Social Security Agreement FAQ

Figuring out healthcare and social security entitlements before leaving the UK to live in another country is necessary but is overlooked by so many people.

Take advice from HMRC and check out these answers to some commonly asked questions to help make those important financial decisions.

What does state pension uprating mean?

Uprating the state pension is applying any cost-of-living increase announced by the government.

Does an emergency health insurance card cover expats?

No. An EHIC card only covers emergency treatment in Europe and is not meant to offer health cover in the same way as travel insurance. Also, the card only covers British residents, not expats.

Do I get free health care in a reciprocal agreement country?

No. The offer of free healthcare is a common misconception. The agreement offers healthcare at the same level and cost a national of the country should expect and is really for emergencies only. Like EHICs, a reciprocal arrangement excludes repatriation costs.

Should I continue with UK NI contributions as an expat?

This depends on you, your age, and other personal circumstances. Paying social security in another can affect your state pension and healthcare benefits in the UK.

Which countries uprate the state pension for expats?

The list of countries where an annual increase in the state pension is paid is on the UK government web site

What happens to a state pension that is not uprated?

The amount paid stays at the same level as the first payment. For instance, a state pensioner in Australia reaching state pension age in May 2020 would receive £175.20 a week with the payment remaining at this level.
If the expat returns to the UK, the state pension rises to the current uprated amount.

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