Health. travellers. advice for. Vital information on. Important changes to E111

Transcription

1 Impotant changes to E111 Health advice fo tavelles Vital infomation on Avoiding health isks Planning fo healthy tavelling Obtaining emegency medical teatment Fom E111 the passpot to fee o educed-cost emegency medical teatment in most Euopean counties The Euopean Health Insuance Cad (EHIC)

2 Impotant note This vesion of Health advice fo tavelles is valid only until the end of August 2005, afte which the Euopean Health Insuance Cad (EHIC) will be intoduced and an updated vesion of this booklet made available. Fom E111s issued afte 19 August 2004 will continue to be valid until 31 Decembe Fom Septembe 2005, the EHIC will be issued by a cental agency and not by the Post Office; howeve, the new vesion of this booklet and the EHIC application fom will be available fom the Post Office and othe souces. The new booklet will explain how to apply fo an EHIC and will give advice on the changes to entitlement and the claims pocess. If you apply fo an E111 in 2005 and tick the appopiate box on the application fom, you will be sent you EHIC automatically, pio to the expiy of you E111 on 31 Decembe Euopean Health Insuance Cad The EHIC will be a moe convenient, plastic, cedit-cad-sized eplacement fo the E111. It will follow a standad fomat thoughout the Euopean Economic Aea (EEA) and will be in use thoughout Euope fom 1 Januay Each tavelling individual will need thei own EHIC.

3 Health advice fo tavelles anywhee in the wold Evey yea, esidents of the United Kingdom (UK) go on moe than 59 million oveseas jouneys. Tavel acoss the wold is now so common that it is easy to foget the health isks that can be involved and the fact that vey few counties offe such easy access to medical facilities as the UK. If you fall ill o have an accident when aboad, it could pove dangeous, even fatal. Obtaining teatment can seem complicated to UK esidents used to the National Health Sevice. And, unless you ae popely pepaed, it could tun out to be extemely expensive. Read this booklet now! Whethe you ae going off in seach of sea and sun, tavelling on business, o tekking though the wilds, this booklet is designed to help you enjoy a healthy jouney and to deal successfully with any medical emegencies that might aise. It contains essential infomation and advice on: how to avoid the need fo health cae when aboad; how to plan fo healthy tavelling; how to obtain emegency medical teatment in counties thoughout the wold; how to obtain and use Fom E111, which will povide you with fee o educed-cost necessay medical teatment in counties within the Euopean Economic Aea (EEA) and Switzeland. Medical cove aound the wold The level of emegency medical cove available to UK esidents in counties aound the wold vaies geatly. Counties fall into one of the following thee categoies: 1 Euopean Economic Aea counties The Euopean Economic Aea (EEA) consists of the membe states of the Euopean Union (EU) plus Iceland, Liechtenstein and Noway. The Euopean Community (EC) ecipocal health cae aangements apply to all of these counties and Switzeland.

4 Tavelles fom the UK, who ae eligible, ae entitled to fee o educed-cost emegency medical teatment in the othe 27 EEA counties and Switzeland in most cases on poduction of a completed Fom E111. This EC document confims the holde is entitled to all necessay teatment. A COUNTRY-BY-COUNTRY CHECKLIST OF WHAT IS INVOLVED IN OBTAINING TREATMENT IN EACH OF THE EEA STATES AND SWITZERLAND CAN BE FOUND ON PAGES OF THIS BOOKLET. An application fo the Fom E111 can be found at the back of this booklet. 2 Recipocal ageement counties Thee ae ove 25 moe counties aound the wold with which the UK has ecipocal health cae ageements that entitle you to emegency medical teatment in those counties. Recipocal ageements cove, among othes, the Channel Islands, the Isle of Man, Austalia, New Zealand, cetain Caibbean islands, and the epublics of the fome Soviet Union, including Russia itself. A COUNTRY-BY-COUNTRY CHECKLIST SHOWING THE SERVICES AVAILABLE AND HOW THEY MAY BE OBTAINED CAN BE FOUND ON PAGES OF THIS BOOKLET. Counties with no health cae ageements with the UK With the est of the wold and that means moe than 100 diffeent counties the UK has no health cae ageements whatsoeve. This includes some of the most popula tavel destinations, such as Canada and the United States, India and the Fa East, as well as the whole of Afica and Latin Ameica. If you ae tavelling to any county which is outside the EEA o Switzeland and which has no ecipocal medical ageement with the UK, you ae stongly advised to take out full medical insuance to cove the cost of teatment. Even in counties with which the UK has health cae ageements, you will need a cetain amount of insuance. Fo moe details, please see page 24 of this booklet. PREPARE NOW. AVOID EXPENSIVE EMERGENCIES LATER. PLEASE NOTE: This booklet gives guidance only. It should not be teated as a complete and authoitative statement of law.

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6 Contents Health isks aound the wold... and how to avoid them 4 6 Eat and dink... safely 7 Be safe out of doos 7 Take cae in the sun 7 Avoid insect and animal bites 8 Take cae in wate 8 Take cae on the oads 8 Hazadous spots and diving 8 No go aeas 8 Day tips 9 Majo diseases and the pecautions to take 9 Malaia 10 Rabies 11 HIV/AIDS 12 Bilhaziasis 12 Cholea 12 Dengue 13 Diphtheia 13 Hepatitis 14 Japanese encephalitis 14 Legionnaies disease 14 Meningitis 14 Poliomyelitis 14 SARS (sevee acute espiatoy syndome) 14 Tetanus 15 Tick-bone encephalitis 15 Tubeculosis 15 Typhoid 15 Yellow feve 16 Immunisation summay: what may be ecommended fo diffeent counties 18 Woldwide county-by-county disease and immunisation checklist Planning ahead 22 Consult you docto well in advance 23 Paying fo immunisations and anti-malaia tablets 23 Taking medicines out of the UK 23 Existing medical conditions and medication 23 Have a dental check-up 23 Cay a fist-aid kit 23 Emegency medical tavel kits 24 Reducing the isk of DVT duing the jouney 24 Health insuance 25 Receiving benefits while you ae away 26 Planning fo when you etun 27 Emegency health checklist

7 Getting teatment aound the wold 28 Getting teatment in counties with no health cae ageements with the UK 29 Getting teatment in counties outside the EEA with ecipocal health cae ageements with the UK 30 Recipocal health cae ageements: county-by-county checklist 34 Getting teatment in EEA counties and Switzeland 34 List of counties coveed 34 Who is coveed and in which counties 35 Documentation equied 35 How to apply fo the E Validity of the E What teatment is coveed 37 Chages fo teatment 37 Claiming efunds 37 Non-emegency teatment in an EEA county o Switzeland: Fom E Inteim guidance on obtaining medical teatment outside the UK 40 Studying in anothe EEA county o Switzeland 41 Woking tempoaily in anothe EEA county o Switzeland fo a UK employe o as a self-employed peson 41 Woking pemanently in anothe EEA county o Switzeland 42 Living in anothe EEA county o Switzeland 43 EEA and Switzeland: county-by-county checklist 43 Austia 53 Latvia 43 Belgium 54 Liechtenstein 44 Cypus 54 Lithuania 45 Czech Republic 55 Luxemboug 45 Denmak 56 Malta 46 Estonia 57 The Nethelands 47 Finland 57 Noway 48 Fance 58 Poland 49 Gemany 58 Potugal 49 Geece 59 Slovakia 50 Hungay 60 Slovenia 51 Iceland 61 Spain 52 Republic of Ieland 62 Sweden 52 Italy 62 Switzeland 5 Application fo Fom E111 (pull-out) 64 How to complete the Fom E111

8 Health isks aound the wold and how to avoid them Tavelling ound the wold always bings some isk to health. Howeve, by taking cetain often simple steps, you can minimise you exposue to almost evey majo health hazad. Eat and dink... safely Wheeve you ae in the wold, be caeful what you eat and dink. Food and wate may be contaminated in a vaiety of ways and that includes the wate in swimming pools, lakes, ives and the sea, so ty not to swallow wate when you ae bathing. Tavelles diahoea is vey common, especially in hot counties. Tavelles diahoea, as well as diseases such as cholea, typhoid and hepatitis A, can be caught fom contaminated food and wate. Howeve, they can also lagely be avoided by taking simple pecautions: 6 Always wash you hands afte going to the lavatoy, befoe handling food and befoe eating. If you have any doubts about the wate available fo dinking, washing food o cleaning teeth, boil it, steilise it with disinfectant tablets o use bottled wate pefeably cabonated with gas in sealed containes. Avoid ice unless you ae sue it is made fom teated and chloinated wate. This includes ice used to keep food cool as well as ice in dinks. It is usually safe to dink hot tea o coffee, wine, bee, cabonated wate and soft dinks, and packaged o bottled fuit juices. Eat feshly cooked food which is thooughly cooked and still piping hot. Avoid food that has been kept wam. Avoid uncooked food, unless you can peel o shell it youself. Avoid food likely to have been exposed to flies. Avoid ice ceam fom uneliable souces, such as kiosks o itineant tades. Avoid o boil unpasteuised milk. Fish and shellfish can be suspect in some counties. Uncooked shellfish, such as oystes, ae a paticula hazad.

9 Be safe out of doos TAKE CARE IN THE SUN Many people tavel fom this county in seach of the sun. The sun should be enjoyed, but oveexposue can cause sunbun, leading to pematue skin ageing and an inceased isk of skin cance. It is the ultaviolet (UV) ays which cause this; even in the UK they can damage you skin, and UV is much moe poweful the neae to the equato you go. If you want to avoid touble, take cae not to bun. It is paticulaly impotant to cae fo you childen, and babies should neve be placed in diect sunlight. Stay out of the sun fo at least two hous aound midday, use what shade thee is at othe times, and cove up with a wide-bimmed hat and tightly woven but loose clothing. Potective ceams suitable fo you skin type can help potect unavoidably exposed pats of the body. Wea sunglasses that filte UV ays to potect you eyes. A sepaate isk of oveexposue to the sun is sunstoke o heatstoke, caused simply by oveheating. Avoid stenuous activity duing the hottest hous, and make sue you dink plenty of non-alcoholic liquids to balance the loss of body fluid though pespiation. What you dink must be safe eithe soft dinks fom sealed cans o bottles, o wate that has been boiled o is bottled. AVOID INSECT AND ANIMAL BITES To avoid insect and animal bites, use insect epellent pepaations and cove ams and legs when advised (page 9 gives moe details on potection against malaia). Tick-bone diseases such as tickbone encephalitis and boeliosis (Lyme disease) ae pevalent in tempeate climates. It is theefoe not only in topical aeas that one needs to take pecautions (see page 15). Animal bites can set up infections that can be seious and sometimes fatal. Be way of even appaently tame animals. Page 10 povides infomation on abies. Neve undeestimate how ill caeless exposue to the sun can make you thee is no excuse fo not potecting you childen popely. 7

10 TAKE CARE IN WATER Do not go swimming alone. Bathing will cool you but emembe that fatal accidents can happen vey easily and in the most unexpected conditions. Adults should watch each othe fo signs of touble when in the wate. Childen should always be supevised by an adult who can swim well. Young childen should neve be left unattended nea a stetch of wate, even a paddling pool. If you ae going to dive into wate, make sue that it is deep enough fo you to do so safely. Each yea, many people ae pemanently paalysed as a esult of injuies sustained fom diving into shallow wate. TAKE CARE ON THE ROADS Taffic accidents ae the majo cause of death among tavelles. Whethe you ae a dive o a pedestian, always check local taffic egulations. If you ae in a ca, always wea seat belts and put childen in a child estaint. If you ae on a moto- o pedal-bike, always wea a helmet and put childen in a child estaint. If you hie a ca o a bike, check its condition and the insuance cove. In addition, neve dink and dive. 8 HAZARDOUS SPORTS AND DIVING If you ae going to take pat in potentially hazadous spots, such as skiing, canoeing o mountaineeing, follow all the elevant safety guidance; make sue that thee ae adequate emegency medical facilities on hand; and check that you have medical insuance which coves you fully in the event of any accident. Dives should allow 24 hous between thei last dive and a flight. NO GO AREAS In many counties, thee ae aeas that ae unsafe fo tavelles to visit because of the isk of violence. Fo guidance and infomation, please use the Foeign and Commonwealth Office Advice to Tavelles telephone line: Altenatively, visit DAY TRIPS Even if you ae only going on a day tip to anothe county, accidents can happen. So please make sue you have adequate tavel insuance and a completed Fom E111 if you ae visiting a county in the Euopean Economic Aea.

11 Majo diseases and the pecautions to take MALARIA A paasitic disease, spead by the bites of infected mosquitoes, malaia poduces feve and, in some cases, complications affecting the kidneys, live, bain and blood. It can be fatal. Malaia is a majo health poblem thoughout the topics a county-by-county checklist is on pages and some foms ae paticulaly life-theatening. If you live in a malaial egion, you may build up some immunity to the disease, but this can be quickly lost. Childen bon in the UK will have no immunity at all. If you ae going to visit, tavel though, o even just stop ove, in a malaial county, even if you have lived thee befoe, take the following pecautions: Ask you docto about anti-malaial measues. Tell you docto which counties you will be visiting. Many aeas have malaia paasites that ae esistant to anti-malaia medicines. If you ae in any doubt about which anti-malaia medicines ae most suitable fo you, you docto can check with the National Tavel Health Netwok and Cente (NaTHNaC), the Scottish Cente fo Infection and Envionmental Health o othe pofessional souces of infomation. You and you childen should take the medication afte food, fo a week befoe tavelling, thoughout you stay, and fo a month afte etuning. 9 Avoid mosquito bites. Use insect epellent, pefeably one containing DEET (diethyltoluamide). Keep you ams and legs coveed afte sunset. Sleep in popely sceened ooms and employ a knockdown spay to kill any mosquitoes in the oom. Use a mosquito net aound the bed at night, pefeably one that is impegnated with an insecticide. You should ensue that thee ae no holes in it and that it is well tucked in. Nets can be bought in the UK fom tavel shops and tavel clinics, such as those un by Bitish Aiways and Tailfindes. None of these pecautions, howeve, will give absolute potection. If you develop a feve, o feel ill, while aboad o up to thee months afte etuning, it is essential to seek medical attention immediately. If you develop these symptoms afte you have left a malaial egion, tell the docto that you have been to a county whee malaia is a health isk.

12 10 RABIES Rabies is an acute vial infection of the nevous system. Its symptoms include deliium and painful muscle spasms in the thoat. Once a peson develops symptoms, the disease is usually fatal. Rabies occus in animals in Euope and Noth Ameica as well as in the less developed counties. You can contact the disease if you ae bitten by any infected animal. So be caeful not to touch any animals, whethe wild, stay o appaently tame. If you ae bitten, post-exposue teatment if given ealy enough usually pevents the disease developing. If you ae bitten by an animal while away fom the UK: Wash the wound immediately, using soap o detegent, o flush with clean wate. Apply alcohol if possible. Get medical attention fast. Go to the neaest docto o hospital. You may need a abies vaccination and the couse of injections must be stated immediately. Ask fo human diploid cell vaccine, if possible. In case of any difficulty, contact the neaest Bitish Consula official. Note the date and place of the incident, the animal s desciption and whethe it was wild o a stay. If the animal was not wild o a stay, ty to identify its owne as soon as possible to ascetain if it is aleady o if it becomes sick. If the animal can be kept unde obsevation fo two weeks following the incident, exchange names, addesses and telephone numbes with the peson esponsible fo it, and aange to keep in contact to find out whethe the animal becomes sick o dies. Find out whethe it has had the abies vaccine and ask to see the cetificate. But even if one is poduced, do not assume thee is no isk. Infom the local police. Whethe o not you eceive teatment outside the UK, consult you docto as soon as you etun. Rabies vaccine befoe tavel is only ecommended fo those who may be exposed to an unusual isk of infection o who ae undetaking long jouneys in emote aeas whee medical teatment may not be immediately available. This vaccine is not nomally povided fee fo tavelles unde the NHS. Even if you ae immunised, howeve, this does not emove the need fo ugent teatment if you ae bitten by an infected animal.

13 Remembe that the UK is still fee fom animal abies. Keep it that way. Do not bing any animals into the county without a licence. This is not only illegal and caies sevee penalties, it could also endange lives. HIV/AIDS AIDS (acquied immune deficiency syndome) has now spead acoss the wold. Thee is no vaccine o cue fo AIDS. AIDS is caused by a vius known as HIV (human immunodeficiency vius). Infection with HIV is moe common than AIDS itself. People infected with HIV emain infected and infectious all thei lives. Thee is no vaccine o cue fo HIV infection. HIV/AIDS can be passed on in fou main ways: Though unpotected sex with an infected peson. Though the use of infected syinges, medical and dental instuments, and anything else which punctues the skin, such as tattooing equipment. By tansfusions of HIV-infected blood. Fom an infected mothe to he baby, befoe o duing child-bith o though beast-feeding. HIV/AIDS cannot be passed on though eveyday social contact, o though insect bites, dity food o cockey, o activities such as kissing, coughing o sneezing. 11 To potect youself against HIV/AIDS: Do not have sex except with you usual patne. Casual sexual intecouse can be vey isky. People can be infectious even though they may not be awae of it, and even if they look and feel well. If you do have sex with a new patne, always use a condom. They ae the most effective potection against HIV/AIDS and othe sexually tansmitted diseases. Pack an adequate supply of condoms, if you think you may need them when tavelling, as they might not be easily available o of good quality in some counties. Those bought in the UK should cay the Bitish Standads Kite mak o the Euopean Standad mak. If you dink, emembe that alcohol can make it easie to foget about safe sex. Do not inject non-pescibed dugs. If you do, neve shae equipment.

14 12 Do not have a tattoo, acupunctue, o you eas pieced, unless you can be sue that the equipment is steile. Since some counties do not have the same standads of medical and dental hygiene as the UK, needles and othe equipment may not be adequately steilised, no blood sceened fo the pesence of HIV o hepatitis B o C, so: ty and ensue that any medical teatment, paticulaly a blood tansfusion, is absolutely necessay; make sue that any medical equipment used is feshly steilised o is taken fom a sealed pack; if you need a tansfusion, ask fo sceened blood. If you ae going to an aea whee the availability of steile needles and syinges fo medical teatment is in doubt, conside taking a special kit with you. (Please see page 23.) Some counties have intoduced HIV-antibody testing fo visitos, o equie an HIV-antibody test cetificate. If in doubt, check with the Embassy o High Commission of the county concened. BILHARZIASIS This is a paasitic disease caused by a wom that is most common in wateways in Afica. The wom penetates the skin and can cause damage to the intestines, the live and the uinay tact. The disease can be teated but no vaccine is available. Visitos to aeas whee bilhaziasis is pesent should avoid wading o bathing in steams, ives and lakes. CHOLERA Cholea is an intestinal infection that can cause sevee diahoea, which may lead to dehydation and ultimately death. It is caught fom the consumption of contaminated food and wate. An inceasing poblem in aeas of poo sanitation in South Ameica, the Middle East, Afica and Asia, it is elatively uncommon among tavelles. It can be avoided by scupulous attention to food and pesonal hygiene. No vaccine against cholea is cuently available (the old one was not effective) and no county now equies cholea immunisation as an official condition of enty. DENGUE Dengue and its moe sevee fom, dengue haemohagic feve occu thoughout the topics whee they ae inceasing in many counties. They ae tansmitted by the bite of an infected mosquito. Thee ae no vaccines against the diseases. Pevention is by avoiding mosquito bites by day as well as afte dusk (see page 9).

15 DIPHTHERIA Diphtheia emains a seious disease thoughout much of the wold, especially in topical counties whee thee is ovecowding and poo hygiene. It is caught though having close contact with an infected peson. Until the 1930s, it was one of the biggest causes of childhood death woldwide, but the mass immunisation of childen since the 1940s has effectively eadicated the disease in developed counties. Howeve, immunisation pogammes have to be continued if the disease is to be kept at bay. Fo unimmunised adults, a special low-dose vaccine is available. HEPATITIS Vial hepatitis is an infection of the live that can cause jaundice. Thee ae seveal foms of the disease, including hepatitis A, sometimes called infectious hepatitis, hepatitis B and hepatitis C. Hepatitis A Usually caught by consuming contaminated food o wate, this can also be spead fom peson to peson, since the vius is pesent in faeces. Tavelles to places whee sanitation is pimitive need to be especially awae of the isk of infection. The main pecautions ae cae ove what you eat and dink, and washing you hands afte going to the lavatoy and befoe handling food. Thee is a vaccine against hepatitis A. Hepatitis B This occus woldwide and is spead in the same ways as HIV/AIDS, that is though: intimate peson-to-peson contact; shaing contaminated needles o syinges; tansfusions of contaminated blood o the use of inadequately steilised equipment in medical teatment, tattooing and ea-piecing. Thee is a vaccine, which gives good potection against the disease. Howeve, it can take six months to become effective. The best way to pevent infection is to avoid the high-isk activities listed above and also to take a tavel kit fo use in medical emegencies (see page 23). Hepatitis C This is being inceasingly ecognised woldwide and is spead in the same way as HIV/AIDS and hepatitis B. Thee is no vaccine. The best way to avoid infection is to take the pecautions ecommended against HIV/AIDS and hepatitis B. 13

16 14 JAPANESE ENCEPHALITIS A vial inflammation of the bain that, in some cases, can be lifetheatening, this occus thoughout South-east Asia, mainly in ual aeas and duing the monsoon season. A vaccine is available and is ecommended fo tavelles who ae staying in isk aeas fo a month o moe. Howeve, the vaccine is not nomally supplied unde the NHS and you will have to pay a fee. LEGIONNAIRES DISEASE Legionnaies disease is an uncommon fom of pneumonia that occasionally occus in holiday-makes. It is spead though wate vapou containing the legionella gem, usually though pooly maintained cooling towes o ai-conditioning systems. It is teatable with antibiotics. Thee is no vaccine. MENINGITIS Meningitis is an inflammation of the membanes coveing the bain and spinal cod. It paticulaly affects childen and young adults and can esult in death. Meningococcal meningitis is moe pevalent in some aeas of Afica and Asia than in the UK, and a vaccine is available. This vaccine, howeve, does not cove the stain most common in the UK. Saudi Aabia equies the immunisation of all those going on hajj, the geat annual Muslim pilgimage. POLIOMYELITIS Polio is a vial infection that can cause paalysis of the muscles. Eveyone tavelling outside Noth and Westen Euope, Noth Ameica, Austalia and New Zealand should have up-to-date polio immunisations. Peviously unimmunised people should eceive a full couse of thee doses of vaccine. Those immunised moe than ten yeas ago equie a booste dose. SARS (sevee acute espiatoy syndome) SARS is a sevee espiatoy infection that stated in southen China in Novembe 2002 and subsequently spead in East and Fa East Asia and to many othe counties. In July 2003, SARS was declaed contained but it is not cetain whethe it may ecu. If you develop a high feve with one o moe espiatoy symptoms (fo example, cough, shotness of beath, difficulty in beathing) within ten days of tavelling in an affected o peviously affected aea, you should contact you docto fo advice. TETANUS Tetanus is a dangeous disease, which causes sevee and painful muscle spasms, and is caught by the intoduction of bacteial spoes into the body though even a slight wound. The spoes ae found woldwide, mainly in soil and manue. Tetanus is paticulaly dangeous whee medical facilities ae not available fo immediate teatment. Eveyone should be potected by immunisation, especially those who tavel to emote aeas. If you wee immunised as a child, ask you docto about a booste. If you wee not, you will need a couse of thee injections.

17 TICK-BORNE ENCEPHALITIS An inflammation of the bain contacted fom the bite of an infected tick, tick-bone encephalitis occus in foested pats of Austia, Nothen Euope and Scandinavia, especially whee thee is heavy undegowth. It is moe commonly caught in late sping and summe. When walking o camping in aeas whee the disease is pevalent, you should wea clothing that coves most of the skin and use insect epellents as well. A vaccine is available but not fee of chage unde the NHS. TUBERCULOSIS Tubeculosis (TB) is inceasing woldwide. If you o you family have not been immunised against the disease, and you ae going to stay fo moe than a month in Easten Euope, Asia, Afica, Cental o South Ameica, you should discuss the need fo BCG immunisation with you docto pefeably at least two months befoe depatue. You will need a skin test fist. Immunisation is paticulaly advisable fo those who will be tavelling, living o woking closely alongside the indigenous population, and fo membes of ethnic goups visiting thei county of oigin. It is not necessay fo shot visits if you ae staying in intenational-style hotels. Once immunised, eimmunisation is unnecessay. TYPHOID Typhoid feve is caught though the consumption of contaminated food o wate. Those tavelling to places whee sanitation is pimitive should conside immunisation against the disease. It is also essential to take scupulous cae ove food and wate. YELLOW FEVER Yellow feve is caught fom the bite of an infected mosquito and occus in pats of Afica and South Ameica. Some counties equie a vaccination cetificate fo enty (please see pages 18 21). The vaccine can only be given at a designated Yellow Feve Vaccination Cente you docto will be able to advise you. It is not available fee of chage on the NHS. The cetificate itself is valid fom ten days afte vaccination fo a peiod of ten yeas

18 Immunisation summay: what may be ecommended fo diffeent counties FOR ALL AREAS If you have not peviously been immunised against diphtheia, polio o tetanus, this is an ideal oppotunity to have the vaccinations. Booste doses of tetanus, diphtheia o polio may be ecommended fo some aeas. FOR ALL AREAS EXCEPT NORTH AND WESTERN EUROPE, NORTH AND SOUTH AMERICA, THE CARIBBEAN, AUSTRALIA AND NEW ZEALAND Poliomyelitis FOR AREAS WHERE STANDARDS OF HYGIENE AND SANITATION MAY BE LESS THAN IDEAL Hepatitis A Typhoid FOR KNOWN INFECTED AREAS (Please check with you docto o a tavel clinic) Anti-malaial tablets and pecautions against insect bites Yellow feve (compulsoy fo some counties) 16 IN CERTAIN CIRCUMSTANCES (Please check with you docto o a tavel clinic) Meningococcal meningitis Rabies Tick-bone encephalitis Hepatitis B Tubeculosis Diphtheia booste Japanese encephalitis Measles/MMR

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20 Woldwide county-by-county dis Please note, these ae geneal guidelines; advice See also page 16 fo additional immunisations that may be ecommended. 18 This alphabetical list shows fo each county: E = Immunisation is an essential equiement fo enty to the county concened and you will equie a cetificate. E1 = Immunisation essential except fo infants unde one yea (but note the advice above). E2 = Immunisation essential (except fo infants unde one yea) unless aiving fom non-infected aeas and staying fo less than two weeks. The UK is a noninfected aea, but if tavelling via equatoial Afica o South Ameica, seek medical advice. E3 = Immunisation essential if the tavelle aives fom an infected county o aea (this will not apply if you jouney is diect fom the UK). The lowe age limit vaies. E4 = Immunisation essential if aiving within six days of having visited an infected county. E5 = Immunisation essential fo enty to the county fom endemic aeas, tavelling to Easte Island. = Immunisation o tablets ecommended fo potection against disease, but note that fo yellow feve, pegnant women and infants unde nine months should not nomally be immunised and theefoe should avoid exposue to infection. D = Check immunised against diphtheia. M = Meningitis, depending on aea visited and time of yea. MI = Meningitis ACWY, equied fo those visiting Saudi fo the pupose of Hajj o Uma. a) = Depends on aea visited. b) = Recommended fo all tavelles going to Chiapas, Daién and San Blas. c) = Cetificate also equied if leaving Paaguay to go to endemic aeas. d) = Applies only to tavelles to the Azoes and Madeia. e) = Depends on season. f) = Cetificate may be equied fom tavelles leaving Sudan. No special immunisations ae equied fo those Euopean counties not listed. Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Afghanistan a) e) E3 Albania E3 Algeia E3 Ameican Samoa E3 Angola E3 M Anguilla E3 Antigua/Babuda E3 Agentina a) Amenia e) Austalia E4 Azebaijan a) e) Bahamas E3 Bahain Bali (see Indonesia) E3 Bangladesh E4 Babados E3 Belaus Belize E3 Benin E1 M Bemuda Bhutan a) E3 M Bolivia a) E3 a) Boneo (see Malaysia/Indonesia) a) E3 Bosnia/Hezegovina Botswana a) e) E3 Bazil a) E3 a) Bunei E4 Bulgaia Bukina Faso E1 M Buma (see Myanma) Buundi E3 M * Immunisation against typhoid may be less impotant fo shot stays in fist-class conditions.

21 ease and immunisation checklist should be taken fo an individual itineay Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Cambodia E3 Cameoon E1 M Canada Cape Vede E3 Cayman Islands Cental Afican Republic E1 M Chad a) M Chile E5 China a) E3 Colombia a) Comoos Congo E1 Cook Islands Costa Rica a) Coatia Cuba Cypus Czech and Slovak Republics Democatic Rep. of Congo (fomely Zaïe) E1 M Djibouti E3 Dominica E3 Dominican Republic East Timo Ecuado a) E3 a) Egypt a) e) E3 El Salvado a) E3 Equatoial Guinea E3 Eitea E3 M Estonia Ethiopia a) E3 M Falkland Islands Fiji E3 Gabon E1 The Gambia E3 M Geogia Ghana E1 M Geece E3 Geenland Genada E3 Guadeloupe E3 Guam Guatemala a) E3 Guiana, Fench E1 Guinea E3 M Guinea-Bissau E3 M Guyana E3 Haiti E3 Honduas E3 Hong Kong (China) India E4 Indonesia a) E3 Ian Iaq a) e) E3 Isael Ivoy Coast E1 M Jamaica E3 19 This list is coect at the time and date of pinting.

22 20 Please see key on page 18 and also page 16 fo additional immunisations that may be ecommended Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Japan Jodan E3 Kazakhstan E3 Kenya E3 M Kiibati E3 Koea (Noth & South) Kuwait Kygyzstan Laos E3 Latvia Lebanon E3 Lesotho E3 Libeia E1 Libya E3 Lithuania Macau (China) Macedonia Madagasca Madeia E3 d) Malawi E3 Malaysia a) E4 Maldives E3 Mali E1 a) M Malta E3 Mashall Islands Matinique Mauitania E2 Mauitius a) E3 Mayotte Mexico a) Miconesia (Fedeated States of) Moldova Monaco Mongolia Montseat E3 Moocco Mozambique E3 M Myanma (Buma) E3 Namibia a) E3 M Nauu E3 Nepal a) E3 Nethelands, Antilles E3 New Caledonia E3 New Zealand Nicaagua E3 Nige E1 a) M Nigeia E3 M Niue E3 Nothen Maiana Islands Oman a) E3 Pakistan E3 Palau E3 Panama b) Papua New Guinea a) E3 Paaguay a) E3 c) Peu a) E3 a) Philippines a) E3 Pitcain Island E3 Poland Polynesia, Fench (Tahiti) E3 * Immunisation against typhoid may be less impotant fo shot stays in fist-class conditions.

23 Hep. A Yellow Meningitis County Typhoid* Malaia feve ACWY Potugal E3 d) Pueto Rico Qata La Réunion E3 Romania Russia a) Rwanda E1 M St Helena E3 St Kitts and Nevis E3 St Lucia E3 St Vincent and Genadines E3 Samoa E3 São Tome and Pincipe E1 Saudi Aabia a) E3 MI Senegal E3 M Sebia and Montenego a) Seychelles E4 Siea Leone E3 M Singapoe E4 Slovenia Solomon Islands E3 Somalia E3 M South Afica a) E3 Si Lanka E3 Sudan f) E3 a) M Suinam E3 Swaziland E3 Syia a) e) E3 Taiwan Tajikistan a) e) Tanzania E3 M Thailand a) E3 Togo E1 M Tokelau Tonga E3 Tinidad and Tobago E3 a) Tunisia E3 Tukey a) e) Tukmenistan a) e) Tuks & Caicos Islands Tuvalu Uganda E3 M Ukaine United Aab Emiates Uuguay USA Uzbekistan Vanuatu Venezuela Vietnam a) E3 Vigin Islands Wallis and Futuna Islands Yemen E3 Yugoslavia Zambia a) M Zimbabwe a) e) E3 21 This list is coect at the time and date of pinting.

24 Planning ahead Befoe you set out to tavel anywhee in the wold, check the health equiements fo you destination. Look at the potential isks and plan the pecautions you need to take both befoe you go and once you ae away. These will depend not only on the counties you may be visiting, but which pats, fo how long, at what time of the yea, and whee you will be staying. Camping, fo example, pesents diffeent potential health poblems to staying in a hotel. And thee may be special immunisation equiements if you plan to ente a Euopean Economic Aea (EEA) county fom a non-eea state. You can get moe infomation on all these points fom you tavel agent, the Embassy o High Commission of the counties concened, o fom a specialist tavel clinic. Consult you docto well in advance 22 You should consult you docto well in advance (pefeably at least two months) of you depatue, fo advice and to aange immunisations. Some of these cannot be given at the same time. Some take time to be effective. Immunisation against hepatitis B, fo example, can take six months to give full potection. Howeve, see you docto even if you ae going at shot notice some potection may be bette than none. Tell you docto whee you ae going, if you ae o may become pegnant, and if you ae taking childen with you. This is paticulaly impotant if they have not had thei full couse of childhood immunisations. If you need anti-malaia medication, you docto will advise on which is most appopiate. You should stat taking the medication a week befoe depatue. If you equie pescibed medicines while aboad, check on thei availability at you destination since you docto can nomally only pescibe a limited quantity unde the NHS. If the medication cannot be obtained whee you ae going, you will have to puchase supplies in the UK.

25 PAYING FOR IMMUNISATIONS AND ANTI-MALARIA TABLETS Some immunisations ae fee unde the NHS. Fo othes thee may be a chage. Doctos can chage fo signing o filling in a cetificate. Some anti-malaia tablets ae available fom phamacists without a pesciption. TAKING MEDICINES OUT OF THE UK If you want to take any sot of medicine with you eithe pescibed o bought fom a phamacist find out if thee ae any estictions on taking it in and out of the UK o the county you ae visiting. Ask the elevant Embassy o High Commission o the Home Office Dugs Banch (Tel: /8446). Always cay medicines in a coectly labelled containe, as issued by the phamacist. Othewise, take a lette fom you docto o a pesonal health ecod cad giving details of the dug pescibed in case you need it to get you though Customs. Remembe, some medicines available ove the counte in the UK may be contolled in othe counties, and vice vesa. EXISTING MEDICAL CONDITIONS AND MEDICATION Keep a witten ecod on you peson of any medical condition affecting you, such as angina pectois, diabetes and haemophilia, and the pope names not just the tade names of any medication you ae taking. HAVE A DENTAL CHECK-UP If you have any doubts about you teeth, o you plan to be away fo a long time, see you dentist. It may be difficult and expensive to obtain dental teatment at you destination. CARRY A FIRST-AID KIT A packet of adhesive dessings, some insect epellent, antiseptic ceam and wate-steilisation tablets will take up little space and could be useful. EMERGENCY MEDICAL TRAVEL KITS These contain a vaiety of steilised and sealed items of equipment, such as syinges, needles and sutue mateials, and may be puchased though a phamacist, pivate medical cente, o fom a numbe of othe supplies. They should nomally be handed to a docto o nuse fo use in a medical emegency in a county whee the safety of such items cannot be assued. A typical kit should contain: 2 x 5ml syinges 5 x needles (pefeably two sizes) 1 dental needle 1 intavenous cannula 1 skin sutue with needle 1 packet skin closue stips 5 alcohol swabs fo skin cleansing 5cm x 5cm and 10cm x 10cm non-stick dessings 1 oll sugical tape 23

26 Additional items such as an intavenous-giving set and a blood substitute solution may be advised fo jouneys to emote aeas. You docto will be able to povide moe infomation. Emegency medical tavel kits should cay sufficient identification to ensue thei acceptance by Customs officials, but the contents should not be opened until needed. It is also unwise to cay loose syinges o needles unless you have a docto s lette explaining thei pupose if, fo example, you ae diabetic. REDUCING THE RISK OF DVT DURING THE JOURNEY Polonged immobility on long jouneys, whethe by plane, tain o ca, can lead to deep vein thombosis (DVT a blood clot in the leg). Move you feet aound, o get up and walk aound egulaly if you can. And avoid dehydation take egula non-alcoholic dinks. If you have eve had a DVT o clots in you lungs, have a family histoy of clotting conditions, have had majo sugey, especially a hip o knee eplacement in the last thee months, o suffe fom heat disease, cance o have eve had a stoke, you may be at inceased isk. Ask you docto fo advice. Health insuance 24 Health insuance is vey often one of the last items on a tavelle s checklist, yet it is pehaps the most impotant of all. People fom Bitain tend to foget that they may have to pay thousands of pounds in medical costs if they fall ill o have an accident outside the UK. This is tue even in counties, such as EEA states, with which the UK has mutual health cae ageements because, even in such cases, the aangements may not cove all the expenses you can incu. And the cost of binging a peson back to the UK, in the event of illness o death, is neve coveed, even unde the ecipocal aangements. Befoe you tavel, always aange health insuance adequate fo you destination. Talk to you tavel agent, insuance company o bank. Use the county-by-county checklists on pages and to see what level of fee o educed-cost necessay medical teatment you can expect in any paticula county. Then make any appopiate exta insuance aangements. If you have a pe-existing condition, always tell you tavel insue. Othewise, you may not be coveed by the policy you buy.

27 Even if you ae visiting a county with a ecipocal health cae ageement with the UK, bea in mind that in an emegency you might be sent acoss the bode fo teatment in a county whee no such aangement exists. Make sue you tavel insuance allows fo that. Some cedit and chage cads povide health insuance fo tavelles. Check that it is adequate fo you needs. If not, take out exta cove. If you ae tavelling on business, you company will pobably aleady have insuance that coves you. But check whethe the cove is adequate. If it is not, take out additional insuance. If you ae diving in any county outside the UK and you have an accident, you may not be coveed fo medical o hospital expenses. Consult you insuance company o a motoing oganisation befoe leaving the UK to make sue that you ae fully insued. No matte whee you ae going to tavel, ALWAYS check that you insuance cove is adequate to meet whateve expenses you ae likely to incu. Always examine the small pint of the policy. And talk to you insue if in any doubt. Receiving benefits while you ae away If you ae eceiving a cash benefit except a etiement pension tell the Depatment fo Wok and Pensions (DWP) office that pays you that you ae going aboad. Some benefits can be paid while you ae away. Howeve, you should find out about the ules fo obtaining benefits aboad well befoe you leave. State Retiement Pensions If you ae eceiving a State Retiement Pension, you must tell you local Jobcente Plus/Social Secuity office, if you ae going aboad fo moe than six months at a time. Claiming Incapacity Benefit o Statutoy Sick Pay while away If you ae taken ill while tempoaily in anothe EEA county, you employe in the UK geneally pays you fo the fist 28 weeks of illness, but not fo the cost of medical teatment. Let you employe know about you illness as soon as possible. If you ae self-employed, claim Incapacity Benefit as soon as possible o you may lose money. Contact the Jobcente Plus/Social Secuity office neaest you home in the UK o wite to:

28 The Depatment fo Wok and Pensions The Pension Sevice Intenational Pension Cente Tyneview Pak Whitley Road Newcastle-upon-Tyne NE98 1BA O, fo Nothen Ieland: Social Secuity Agency Incapacity Benefits Banch Castle Cout Royal Avenue Belfast BT1 1UB When you tavel, take these addesses, and the addess and telephone numbe of you local Jobcente Plus/Social Secuity office with you. Planning fo when you etun As fa as health is concened, you must plan not just fo you jouney but also fo what to do when you etun home. If you wee given any medicines in anothe county, it may not be legal to bing them back into the UK. If in doubt, declae them at Customs when you etun. 26 If you wee taking anti-malaia tablets on you jouney, emembe to continue taking them fo a month afte you etun. If you developed diahoea when away o shotly aftewads, and you wok involves handling food, tell you employe as soon as possible. If you become ill on you etun, do not foget to tell you docto that you have been out of the UK, and what counties you have visited o tavelled though. Even if you have eceived medical teatment in anothe county and feel well on you etun: if you have been bitten by an animal o isked catching a sexually tansmitted disease, always consult you UK docto; if you ae a blood dono, always tell the blood tansfusion staff if you have tavelled outside Euope o if you have had medical teatment in any county outside the UK. If you had medical teatment aboad, claim on you insuance as soon as possible when you etun. Holdes of Fom E111 should put in a claim fo a efund befoe etuning. If you did not have time, please see the instuctions on page 37.

29 Emegency health checklist This checklist is designed to help emind you of some of the impotant things to do to help you deal with any health poblems when tavelling. Make sue that you have all the documents you need befoe seeking teatment: you passpot; a valid Fom E111, whee appopiate even if you ae only going on a day tip; poof of UK esidence, such as a dive s licence o NHS cad; vaccination cetificates. Whee you ae eligible fo fee o educed-cost teatment, these will help pove you entitlement. Read you insuance document befoe teatment so that you know what you insues will pay fo. Read pages and of this booklet to see if you ae entitled to fee o educed-cost emegency medical teatment. Contact the epesentative of you tavel company, if that is applicable Tell any pactitione you consult if you ae taking any medication and povide its geneic name as on the pesciption label not just the band name. Tell any pactitione you consult if you have visited anothe county befoe becoming ill. Keep all eceipts, special poofs of puchase, pice tags and labels fo all payments made fo teatment o dugs if you intend to claim a efund o claim against you insuance. Keep the names and addesses of fiends and elatives with you passpot so that Bitish Consula officials can contact them if thei help is equied. Contact Bitish Consula officials if you need to etun to the UK quickly. They may be able to aange this fo you. But emembe, you will have to bea the costs.

30 Getting teatment aound the wold Use this booklet; take advice fom you docto and tavel agent; and obtain infomation fom the Touist Office, Embassy o High Commission of you destination county to ensue that befoe you set out fom the UK, you fully undestand what obtaining emegency medical teatment in that county might involve. You can aely expect to be teated in such a staightfowad manne as unde the National Health Sevice. You may find youself dealing with vey unfamilia official systems that can involve a geat deal of time and effot on you pat. Above all, in most counties aound the wold you will have to pay often lage amounts fo what may seem to be elatively mino teatment. 28 The following sections tell you about obtaining health teatment aboad. Thee diffeent sets of ules apply: Getting teatment in counties with no health cae ageements with the UK; Getting teatment in counties outside the EEA with ecipocal health cae ageements with the UK; and Getting teatment in EEA counties and Switzeland. Getting teatment in counties with no health cae ageements with the UK Fewe than 60 counties woldwide have any sot of health cae ageements with the UK. The vast majoity do not including Tukey; Canada, the United States and Mexico; most of the islands in the Caibbean; all the South Ameican nations; evey county in the Middle East and Afica; and most of Asia, including India, Thailand, Japan, Hong Kong and the whole Pacific egion, except fo Austalia and New Zealand. To secue even basic medical cae in these counties, you ae stongly advised to take out compehensive medical insuance. And in the case of the United States, fo example, you should cay a vey high level of cove. You tavel agent o insuance boke will be able to advise you on the amount of insuance to take out, depending on you destination.

31 Getting teatment in counties outside the EEA with ecipocal health cae ageements with the UK The UK has ecipocal ageements with cetain counties fo the povision of ugently needed medical teatment eithe at educed cost o, in some cases, fee. The counties and the sevices available ae listed on the following fou pages. Only ugently needed teatment will be povided and you will be teated on the same tems as esidents of the county in question. The ange of medical sevices may be moe esticted than unde the NHS, and if chages ae involved, these cannot be efunded by the Bitish Govenment. You should cay sufficient insuance to cove them. In ode to obtain teatment, you will nomally have to poduce you passpot o some poof of UK esidence, such as a diving licence o medical cad. Requiements vay fom county to county and ae shown in the list on the following pages. WHO IS COVERED In geneal, you and you dependants ae entitled to emegency medical teatment on the tems shown if you ae a UK national and live in the UK. Even if you ae not a UK national, you may still be entitled to teatment in some of the listed counties if you nomally live in the UK. 29 If you ae going to live o wok in one of the ecipocal ageement counties, the aangements in this booklet may not apply. Please wite fo details to: Inland Revenue Cente fo Non-Residents Room BP1301 Benton Pak View Newcastle-upon-Tyne NE98 1ZZ Tel: Fom outside the UK: If you ae a membe of the Amed Foces seving in any of the ecipocal ageement counties, you and you dependants should geneally not use the local health sevices but the medical facilities of HM Foces. You standing odes will tell you what facilities ae available.

32 Recipocal health cae ageements: Counties outside the Euopean Documents needed County to get medical teatment What is nomally fee Anguilla Poof of UK esidence Mino emegency teatment. (e.g. NHS medical cad o UK diving licence). Austalia Poof of UK esidence Public hospital teatment (this includes (e.g. UK passpot o enal dialysis, but you must make NHS medical cad) advance aangements befoe leaving and tempoay enty the UK. Please ask you NHS enal pemit. unit fo futhe details). 30 Babados UK passpot (o NHS Hospital teatment. medical cad if not a Teatment at polyclinics. UK national). Ambulance tavel. Pescibed medicines fo childen and the eldely. Bitish Vigin Poof of UK esidence Hospital and othe medical teatment Islands (e.g. NHS medical cad o fo pesons aged 70 o ove and UK diving licence). school-age childen. Bulgaia UK passpot and NHS Hospital teatment. medical cad. Othe medical and dental teatment. Channel Islands Poof of UK esidence On Guensey/Aldeney: if staying less (e.g. diving licence o Hospital in-patient teatment. than thee NHS medical cad). months On Jesey: Hospital in-patient and out-patient teatment. Ambulance tavel. Falkland Islands Poof of UK esidence (e.g. medical cad o UK diving licence). Hospital teatment. Dental teatment. Othe medical teatment. Pescibed medicines. Ambulance tavel. Gibalta UK passpot. If you ae GP and medical cae and dental up to 30 not a UK national, teatment unde the local Medical days stay show you Fom E111. Scheme is available at the Health Cente. Hospital teatment in public wads. Isle of Man No documents needed. Teatment simila to UK National Health Sevice.

33 County-by-county checklist Economic Aea What you pay chages fo Hospital in-patient and out-patient teatment. Hospital accommodation. Dental teatment. Pescibed medicines. Ambulance tavel. Teatment at most doctos sugeies. Pescibed medicines. Ambulance tavel. Dental teatment. Dental teatment. Pescibed medicines. Othe infomation Family-docto-type teatment is available at out-patient clinics. A chage is made. You will need to enol at a local Medicae office, but this can be done afte you get teatment. Some doctos chages may be patially efunded by the Medicae scheme. Claim at the local office befoe you leave. UK visitos ae chaged fo all sevices at ates applicable to esidents. Medicines supplied by public phamacy. Some pescibed medicines. Accident and emegency hospital teatment. Emegency dental teatment. GP and othe medical cae. Ambulance tavel. Teatment at a docto s sugey. Dental cae. Pescibed medicines. On Sak: All medical teatment. Recent changes suggest that only a vey limited state health cae secto (some hospitals only) now exists. Pending futhe claification, pivate medical insuance cove is stongly ecommended. No out-patient depatment at Guensey Geneal Hospital. Fee teatment at a family-docto-type clinic is available most weekday monings at the Jesey Geneal Hospital. Hospital teatment povided in Guensey. 31 Nominal fee payable fo house calls. Small chage fo each item of medicine pescibed unde the scheme. Pivate dental teatment. Nominal fee fo a limited emegency sevice at the Pimay Cae Cente. Dental teatment. Pescibed medicines. You ae not coveed if you go to Gibalta expessly fo teatment of a condition that aose elsewhee, e.g. in Spain. If you ae a UK State Pensione and go to live in Gibalta, you will be povided with any medical teatment you need by the Gibalta authoities, without having to pay insuance contibutions. You will have to pay pesciption chages.

34 Recipocal health cae ageements: Counties outside the Euopean Documents needed County to get medical teatment What is nomally fee Montseat Poof of UK esidence Teatment at govenment (e.g. NHS medical institutions fo pesons aged cad o UK diving ove 65 and unde 16. licence). Dental teatment fo school-age childen. New Zealand UK passpot. Dental teatment (pesons unde 16). Public hospital in-patient teatment. Romania UK passpot. Hospital teatment. Some dental teatment. Othe medical teatment. Russia UK passpot. Teatment in state hospitals. St Helena Poof of UK esidence Hospital teatment in (e.g. NHS medical out-patient clinics duing cad o UK passpot). nomal clinic times. 32 Tuks and Poof of UK esidence All teatment to those unde 16 and Caicos Islands (e.g. NHS medical ove 65. cad o UK diving licence). On Gand Tuk Island: Dental teatment (at dental clinic). Pescibed medicines. Ambulance tavel. On oute islands: Medical teatment at govenment clinics. Pescibed medicines. Fome USSR UK passpot. Hospital teatment. (Soviet Union) Some dental teatment. Othe medical teatment. Yugoslavia UK passpot if you ae a Hospital teatment. (Sebia and UK national. If you ae a Some dental teatment. Montenego) UK esident but not a UK Othe medical teatment. and successo national you will need a states Coatia, cetificate of insuance, Bosnia and obtainable fom the Hezegovina, Inland Revenue Cente Fome fo Non-Residents, Yugoslav Benton Pak View, Republic of Newcastle-upon-Tyne, Macedonia NE98 1ZZ.

35 County-by-county checklist Economic Aea What you pay chages fo Hospital in-patient and out-patient teatment. Hospital accommodation. Most pescibed medicines. Dental teatment. Ambulance tavel. Teatment at hospitals (out-patient). Teatment at a docto s sugey. Pescibed medicines. Dental teatment. Medicines supplied by public phamacy. Othe infomation Family-docto-type teatment is available at govenment clinics and the hospital casualty depatment. A chage is made. Ask hospital o docto if a efund is due. If not, claim at the local health office. Cash benefits fom New Zealand Depatment of Health educe chages. Pescibed medicines. Hospital in-patient teatment. Dental teatment. Pescibed medicines. Ambulance tavel. Family-docto-type teatment is available at the hospital out-patient clinic. On Gand Tuk Island: Hospital in-patient teatment. Othe medical teatment and teatment at the town clinic. On oute islands: No hospital sevices available on the oute islands. 33 Pescibed medicines. Pescibed medicines. This ageement applies to the following epublics of the fome USSR: Amenia, Azebaijan, Belaus, Geogia, Kazakhstan, Kygyzstan, Moldova, Tajikistan, Tukmenistan, Uzbekistan, Ukaine. If you ae a Yugoslav national, esident in the UK, you will need to show you Yugoslav passpot and a cetificate of UK social secuity insuance, obtainable fom the Inland Revenue Cente fo Non-Residents, Benton Pak View, Newcastle-upon-Tyne, NE98 1ZZ. If you ae not a UK/Yugoslav national but ae the dependant of someone who is, you should also apply fo a cetificate. The ageement applies to all the successo epublics.

36 34 Getting teatment in EEA counties and Switzeland Waning: please ensue you have a evised E111, issued afte 19 August 2004, fo each membe of you family. A evised E111 can be identified by it having an expiy date of 31 Decembe Afte 31 Decembe 2005, a Euopean Health Insuance Cad (EHIC) will be equied. Thee ae aangements thoughout the Euopean Economic Aea (EEA) and Switzeland fo coodinating the health cae systems of the membe states. If you o any of you dependants ae suddenly taken ill o have an accident duing a visit to any of these counties, fee o educed-cost necessay teatment is available in most cases on poduction of a valid Fom E111. Only statepovided teatment is coveed, and you will eceive teatment on the same tems as insued esidents of the county you ae visiting. Pivate teatment is geneally not coveed, and statepovided teatment may not cove all of the things that you would expect to eceive fee of chage fom the NHS. Counties coveed The EEA is made up of the 25 Euopean Union (EU) membe states plus Iceland, Liechtenstein and Noway. The membe states of the EU ae: 1. Austia 2. Belgium 3. Cypus 4. Czech Republic 5. Denmak 6. Estonia 7. Finland 8. Fance 9. Gemany 10. Geece 11. Hungay 12. Ieland 13. Italy 14. Latvia 15. Lithuania 16. Luxemboug 17. Malta 18. Nethelands 19. Poland 20. Potugal 21. Slovakia 22. Slovenia 23. Spain 24. Sweden 25. UK Switzeland: As a esult of an ageement with the EU, which came into foce on 1 June 2002, the E111 aangements also cove Switzeland. Fom E111 is not valid outside the EEA and Switzeland. Who is coveed and in which counties Pesons odinaily esident in the UK and egisteed with the NHS who ae:

37 EU and Swiss nationals going to EU counties o Switzeland. Note: nationals of Cypus, the Czech Republic, Estonia, Hungay, Latvia, Lithuania, Malta, Poland, Slovakia o Slovenia, esident in the UK and tavelling to Switzeland, ae not coveed at pesent; EEA nationals tavelling to EEA counties; non-eea nationals: the E111 aangements apply, except in Denmak, Iceland, Liechtenstein, Noway o Switzeland, whee pivate insuance should be obtained. Howeve, non-eea nationals visiting Iceland ae coveed fo emegency teatment only unde a ecipocal health cae ageement between the UK and Iceland. You will need to poduce you NHS medical cad to get teatment; stateless pesons and efugees tavelling to EEA counties and Switzeland. If you ae woking in the UK, but paying social secuity contibutions to anothe EEA county o Switzeland, you should obtain you E111 fom the institution to which you pay you contibutions. Documentation equied A evised Fom E111, issued on o afte 19 August The evised Fom E111 is valid until 31 Decembe 2005 when it will be eplaced by the Euopean Health Insuance Cad (EHIC). The UK will stat issuing the EHIC in Septembe How to apply fo the E111 To obtain a valid Fom E111, fill in the application fom at the back of this booklet as well as the Fom E111 itself. The Fom E111 will be povided sepaately by the Post Office. It will be stamped, signed, and etuned to you. A sepaate Fom E111 is now equied by evey tavelle. You can apply fo an E111 fo you spouse/patne and childen unde the age of 16 (o 19 if they ae still in full-time education). Foste paents o guadians can include childen in thei cae as dependent childen when applying fo Fom E111. Non-EEA nationals esident in the UK should NOT submit thei E111 application fom to the Post Office. They should instead send the completed application, togethe with photocopied evidence of thei ight to eside in the UK, to The Pension Sevice, Intenational Pension Cente, at the addess given on page 37. If you change you addess, you should obtain a new E111. You should also do this if any othe changes occu that affect the details on the fom. Do not amend you existing fom. To pe-apply and eceive you EHIC automatically, late in 2005, you will need to tick the appopiate box on the E111 application fom. Only do this if you do not plan to change addess befoe the end of 2005.

38 36 If you lose you Fom E111 while aboad, you will need to get a new one fom The Pension Sevice, Intenational Pension Cente, Medical Benefits Section, Newcastle, at the addess on page 37. If you pay fo pivate pesciptions, the cost will not be efunded. Validity of the E111 E111s issued pio to 19 August 2004 ae no longe valid and you must apply fo a new one fo youself and each peson tavelling. Old Fom E111s can be identified by thei lack of expiy date. All new E111s will cease to be valid thoughout the EEA and Switzeland afte 31 Decembe 2005, when the Euopean Health Insuance Cad (EHIC) will eplace them. UK issue of these cads will stat in Septembe Futhe infomation egading the EHIC and the diffeent methods available fo applying will be available in summe 2005 on the Depatment of Health website ( o you can contact the Depatment of Health Custome Sevice Cente on You will need to apply fo anothe E111 if you use it to claim fo teatment and it is not given back to you, o if you mislay it. Please note that you E111 will cease to be valid if you go to live outside the UK. What teatment is coveed The Fom E111 coves you fo any teatment that becomes necessay duing the couse of you visit. This includes all matenity cae, enal dialysis and oxygen theapy. Teatment of chonic diseases and pe-existing illnesses that equie ongoing medical cae is included, but not if the pupose of you visit is to obtain medical teatment aboad. Fo example, blood tests, injections o medications ae coveed on the same tems as that available to insued esidents of the county you visit. Pe-existing conditions that equie advance aangements: Renal dialysis Renal dialysis can be povided as emegency health cae in all EEA counties and Switzeland unde the E111 aangements, subject to availability of places. Howeve, you must make advance aangements befoe leaving the UK. Contact you UK NHS enal unit fo futhe details. Please note that due to the lage numbe of visitos to Spain each yea, it is essential that you obtain Spanish Fom P10 befoe you depatue fom the UK. You UK enal unit will aange this fo you. Oxygen supplies Oxygen supplies can be povided as emegency health cae in all EEA counties and Switzeland unde the E111 aangements, subject to availability of places. A pio aangement with the destination county is equied to ensue availability of supplies, paticulaly in emote aeas. Futhe limited infomation on sevices available can be obtained by inging

39 Obtaining teatment geneal advice Always keep a photocopy of you Fom E111 with the oiginal. This is impotant if you apply fo teatment in Fance, Gemany, Hungay, Italy, the Nethelands, Slovakia and Spain, as a photocopy is equied as well as you oiginal E111. You will usually be given back you E111 but the photocopy will be kept. Howeve, in some counties the authoities may keep the oiginal E111. Chages fo teatment Each of the EEA counties and Switzeland has thei own ules fo state medical povision. In some, teatment is fee. In some, you have to pay pat of the cost. In othes, you have to pay the full cost and then claim a full o patial efund. Details fo each of the counties ae given on pages Follow the ules of each paticula county o you may have to pay chages that cannot be efunded. At the time of publication, the infomation about each county was accuate but changes do occu. Claiming efunds You claim any efunds to which you ae entitled by applying, eithe in peson o by post, to the elevant authoity in the county you ae visiting while you ae thee. You must enclose the oiginal document, theefoe keep photocopies fo you ecods. If you leave you claim until you etun to the UK, you should wite to o telephone the following section and ask fo claim fom POD 1679: 37 The Depatment fo Wok and Pensions The Pension Sevice, Intenational Pension Cente, Medical Benefits Section, Tyneview Pak, Whitley Road, Newcastle-upon-Tyne NE98 1BA. Tel: , Monday to Fiday They will liaise with the authoities of the othe county on you behalf. Send you E111, oiginal bills, pesciptions and eceipts. If possible, keep copies fo youself. Howeve, you may face long delays until the foeign authoity esponds. NON-EMERGENCY TREATMENT IN AN EEA COUNTRY OR SWITZERLAND: FORM E112 Fom E111 will not cove you fo fee o educed-cost teatment if you ae going to anothe EEA county o Switzeland specifically fo medical cae. Fo this, you will need Fom E112, which is not issued automatically but equies authoisation fom the Depatment of Health. Unless you have an E112, you will have to pay fo the teatment you eceive and you will not be able to obtain a efund of the costs. Please note, howeve, that Fom E112 is only available whee a clea need fo teatment is established. The fom is not available on a just in case basis. If you ae going to anothe EEA county (o Switzeland) specifically to give bith, and ae not etuning to the UK, wite to the elevant addess below explaining why you want cae outside

40 38 the UK and enclose a copy of you E111 and evidence fom you GP o midwife of you expected date of confinement. O, fo Nothen Ieland: Depatment of Health Depatment of Health Intenational Division Social Sevices and Public Safety Room 621 Geneal Medical Sevices Banch Wellington House Room D3, Castle Buildings Wateloo Road Stomont London SE1 8UG Uppe Newtownads Road Tel: Belfast BT4 3SQ Tel: Inteim guidance on obtaining medical teatment outside the UK This is inteim guidance, based on the Depatment s undestanding of the law as stated in the case of Watts v. Secetay of State fo Health and Anothe. It is unde appeal and what follows may change. The issue of Fom E112 fo people going to anothe EEA county specifically fo medical teatment will not usually be consideed unless: you UK NHS consultant ecommends teatment in the othe county; you pimay cae tust (PCT), you local health boad in Wales, o NHS Boad in Scotland o Nothen Ieland agees to meet the cost of the teatment; the teatment is available unde the othe county s state health insuance scheme; you ae entitled to Fom E111. To apply fo Fom E112 in these cicumstances, wite a lette explaining you easons fo seeking teatment outside the UK. Send this lette to you PCT o Boad togethe with a lette fom you NHS consultant explaining why they ae ecommending teatment in anothe EEA county o Switzeland. The decision about whethe to issue an E112 is made by officials of the Depatment of Health o its Nothen Iish equivalent. Once they eceive you application, the PCT o Boad should send you application togethe with the lette fom you consultant and thei ageement to fund the teatment to the appopiate addess on this page. Authoisation may not be efused whee the teatment is of a kind povided by the NHS and whee the peson concened cannot obtain the teatment within the UK without undue delay. In consideing the question of undue delay, account must be taken of all the cicumstances of the individual case, including, if appopiate, the degee of pain o the natue of the patient s disability, which might, fo example, affect his o he ability to cay out his o he job. Account must also be taken of intenational medical pactice.

41 In cases whee the PCT o boad efuse to ecommend issue of an E112, you can wite diectly to the Depatment of Health o its Nothen Iish equivalent. Thee ae othe possibilities, besides use of the E112 pocedue, fo people to go to an EEA county fo elective teatment and fo the costs to be met in pat o in total by the NHS. PCTs and boads have discetion to efe you diect to a povide with which the NHS has an ageement fo sevices. The diffeence between this oute and the E112 pocedue is that the NHS oganisations involved in this type of scheme will know about the quality of cae povided by the Euopean povide, and thee will be established links between the clinicians thee and in the NHS. Also, thee will be no up-font payment equied by the patient fo teatment, as the costs will be met between the NHS and the contacted povide. This oute is moe likely to be available whee a local PCT has identified sufficient numbes of patients with a simila condition. It is usual fo patients to be contacted diectly by thei local NHS povide whee such schemes ae active. You may check if this is available in you aea with you local PCT. Patients will only tavel to mainland Euope fo teatment unde these schemes whee this is what they want and afte a full clinical assessment shows that it meets thei needs. Following decisions by the Euopean Cout of Justice and ou domestic couts, a patient can also appoach a povide in an EU county diectly, i.e. outside the E112 pocedue o NHScommissioned sevice. As you would have to pay fom you own esouces fo such teatment and then claim eimbusement fom the NHS etospectively fo such teatment, you ae stongly advised to seek advice fom you PCT o boad befoe poceeding. As this is a complex aea of developing law you ae also stongly advised to take you own legal advice. If you go ahead without both a ecommendation fom you consultant and the ageement of the PCT, you may find that you ae subsequently unable to obtain eimbusement. You ae also advised to check the Depatment s website (see back cove) fo any updating of this guidance. 39 Appeals If you application fo an E112 is efused by you PCT o Health Boad, the easons should be made clea to you. If you ae unhappy with the explanation, you should aise the matte in the fist instance with the Depatment of Health (at the addess on page 38). You will need to: 1. send a detailed lette outlining the issues and enclosing any elevant backgound infomation; and 2. povide a epot fom the NHS consultant giving his/he opinion as to whethe o not they ecommend teatment be povided aboad. A decision should be communicated to you within 20 woking days of eceiving you lette.

42 40 If the teatment is not appoved and you wish to appeal against the Depatment of Health s decision, you can apply fo a judicial eview of the decision though the UK couts. STUDYING IN ANOTHER EEA COUNTRY OR SWITZERLAND If you ae nomally esident in the UK but ae studying in anothe EEA county, as an integal pat of a ecognised UK couse, an E111 is needed fo you and fo each of the dependants who accompany you. If you ae in the UK, the fom can be obtained fom the Post Office o, if you ae aboad, please apply to: Inland Revenue Cente fo Non-Residents Room BP1301 Benton Pak View Newcastle-upon-Tyne NE98 1ZZ Tel: Fom outside the UK: If the studies ae not a compulsoy pat of a UK couse, students ae coveed by an E111 fo up to 12 months if it is a one-yea couse. Howeve, if you know in advance that a voluntay couse will last longe than a yea, you ae not entitled to an E111 at all, but must get cove in the county you ae studying in. Please give couse details when applying fo Fom E111. You will only be entitled to use an E111 in Switzeland if you ae an EU national. If you ae a Swiss national esident in the UK, you will only be coveed in EU counties and Switzeland, not in Iceland, Liechtenstein o Noway. Non-EEA nationals esident in the UK can only be coveed in EU counties (except Denmak). If the studies ae pat of a couse leading to a qualification awaded by anothe EEA county, you must become insued in the county of study. Students on wok expeience A student, as descibed above, who is studying in anothe EEA county as an integal pat of a ecognised UK couse, and who is undetaking some wok that specifically elates to his o he studies, is entitled to Fom E111 if the county they go to povides no compulsoy cove. If you ae in the UK, the fom can be obtained fom the Post Office o, if you ae aboad, please apply to the above Inland Revenue addess.

43 WORKING TEMPORARILY IN ANOTHER EEA COUNTRY OR SWITZERLAND FOR A UK EMPLOYER OR AS A SELF- EMPLOYED PERSON If you ae an EEA national and go to wok in anothe EEA county fo up to a yea, and it has been confimed by the Inland Revenue Cente fo Non-Residents that you (and you employe if you ae an employee) continue to pay UK National Insuance contibutions, you ae entitled to Fom E111. You will only be entitled to use an E111 in Switzeland if you ae an EU national, and if you ae a Swiss national you will only be coveed in EU counties. Non-EEA nationals esident in the UK can only be coveed in EU counties (except Denmak), not in Iceland, Liechtenstein, Noway o Switzeland. Those employed on a tempoay posting, and any dependants who accompany them, ae entitled to teatment equied fo any condition duing the posting, using an E111. If you ae in the UK, the fom can be obtained fom the Post Office o, if you ae aboad, apply to the Inland Revenue addess on page 40. If you employment/self-employment unexpectedly lasts longe than 12 months, and the appopiate insuance authoities of the EEA county in which you ae woking agee, you may emain unde the UK scheme fo a futhe peiod of not moe than 12 months. Fo moe infomation, please wite to the Inland Revenue addess on page Othe cicumstances: Au pais and nannies If you ae nomally esident in the UK and ae going to wok in anothe EEA county o Switzeland as an au pai o nanny fo up to 12 months, you may be entitled to Fom E111. Apply to the Post Office o, if you ae aleady aboad, apply to the Inland Revenue addess given on page 40. Sevice pesonnel If you ae a membe of the Amed Sevices, you and you dependants ae each entitled to an E111. Howeve, you cannot use you E111 in Gemany if you ae stationed thee. If you ae stationed aboad, you can obtain an application fom fom you Bitish Foces Post Office (BFPO). If you ae in the UK, the fom can be obtained fom the Post Office. WORKING PERMANENTLY IN ANOTHER EEA COUNTRY OR SWITZERLAND If you go to wok in anothe EEA county o Switzeland fo a foeign employe, Fom E111 is not appopiate, as you will nomally become insued in the county in which you wok. Wite to the Inland Revenue addess on page 40 and give you full name; you addess in the UK and aboad; you National Insuance numbe; and you poposed date of depatue. Futhe infomation is available in Depatment fo Wok and Pensions leaflet SA29, available fom local Jobcente Plus/social secuity offices.

44 LIVING IN ANOTHER EEA COUNTRY OR SWITZERLAND If you decide to live pemanently in anothe EEA county o Switzeland, o to take up wok thee, you ae not entitled to a UK-issued Fom E111. Send any Fom E111 you hold to the Depatment fo Wok and Pensions, The Pension Sevice, Intenational Pension Cente, Medical Benefits Section (the addess is on page 37) with full details of you cicumstances. They will advise you as to whethe you ae entitled to health cae cove in you new county of esidence at UK expense and, if appopiate, issue you with a diffeent fom. If you have an industial injuy o occupational disease, and intend taking up esidence in anothe EEA county o Switzeland, special ules apply. Wite fo details to the following: 42 The Depatment fo Wok O, fo Nothen Ieland: and Pensions Social Secuity Agency The Pension Sevice Oveseas Benefits Unit Intenational Pension Cente Block 2, Castle Buildings Industial Injuies Section Stomont Room TC013 Belfast BT4 3SP Tyneview Pak Tel: Whitley Road Newcastle-upon-Tyne NE98 1BA Tel: /1

45 EEA and Switzeland: county-by-county checklist (Figues quoted ae the latest available) AUSTRIA Whee to obtain infomation and efunds The Regional Health Insuance Office (Gebietskankenkasse) esponsible fo the aea whee you ae staying. Fo UK nationals on a tempoay visit to Austia, an E111 is not equied poduction of a Bitish passpot is sufficient to obtain medical teatment. Fo othe nationals (including Austians) esident in the UK, an E111 is equied. If you consult a pivate docto, you may eceive a efund fo pat of the costs, but not fo the pivate fee. Doctos, dentists and pesciptions Contact the Regional Health Insuance Office. If the Office agees to the need fo teatment, you will be given a health insuance scheme vouche and the addesses of medical pactitiones. Pescibed dugs may be obtained fom any phamacy. You will be chaged a fixed amount. Hospital teatment Out-patient teatment can be obtained in hospital casualty wads. Fo in-patient teatment, a docto will nomally efe you to a public hospital, whee you must pesent an admission vouche povided by the docto. In an emegency, give you passpot to the hospital administation, which will then confim with the Insuance Office that the costs of standad class teatment will be met. A small daily chage will be made fo each of the fist 28 days in hospital. If you ae teated pivately, whethe at you own equest o because of an emegency, you may be entitled to a efund fom the Regional Health Insuance Office of special amounts, which vay fom hospital to hospital. BELGIUM Whee to obtain infomation and efunds The egional offices of the Auxiliay Fund fo Sickness and Invalidity Insuance (Caisse auxiliaie d assuance maladie-invalidité/hulpas voo Ziekte-en Invaliditeitsvezekeing), o the office of the Local Sickness Funds (Mutualité/ Ziekenfonds). Auxiliay Fund offices ae usually located in each povincial capital. The office fo the Babant egion is at Rue du Tône 30B, 1000 Buxelles/ Toonstaat 30B, 1000 Bussels. Tel: +32 (0)

46 44 Doctos, dentists and pesciptions Consult any docto o dentist and show Fom E111. You will be chaged fo teatment. Obtain a eceipt on the official fom (Attestation de soins donnés/getuigschift voo vestekte hulp). Take a pesciption to any dispensing chemist. Show you E111 and pay fo the medicines. Obtain a eceipt and ensue that you copy of the pesciption is stamped. Aound 75% of the cost of teatment and appoved medicines will be efunded if you apply to a Sickness Fund Office with you E111, you eceipts and you copy of any pesciptions. Hospital teatment Take Fom E111 to a local Sickness Fund Office, which will authoise payment of a pecentage of hospital costs excluding ambulance chages, which ae not efundable. Ask them whee to obtain teatment at the most favouable ates. If you cannot contact the Sickness Fund Office fist, give you E111 to the hospital authoities and ask them to obtain a cetificate fom the office stating that it will pay pat of you costs. CYPRUS Impotant note: Euopean Community law is not yet opeable in the nothen (Tukish) pat of Cypus, theefoe you ae not coveed by you Fom E111. You ae, howeve, coveed in the southen (Geek) pat of Cypus. You ae stongly advised to take out compehensive pivate health insuance if tavelling to nothen Cypus. Whee to obtain infomation The Ministy of Health 10 Makou Dakou Pallouiotissa 1448 Nicosia Cypus Documentation equied Fom E111. Doctos, dentists and pesciptions You can only get fee o educed cost teatment fom a docto in a state health cente o govenment hospital. Teatment povided by pivate doctos o pivate medical institutions is not coveed, unless you ae efeed by the Medical Boad fo sevices not povided in a state facility. You will have to pay a patient contibution (co-payment of CY 1.00 at the time of pinting) fo each visit to a docto o dentist. A patient contibution of CY 40 is also paid fo each dentue. These fees ae not efundable. Pesciptions ae issued by a state docto, and you must then pesent them to a state phamacy. You will need you Fom E111. Thee is no chage fo pesciptions. If you do not have a Fom E111, you will have to get you pesciption fom a pivate phamacy. Hospital teatment and ambulance costs In-patient teatment is only available if you ae efeed to a hospital by a state docto, o if you ae admitted though the Accident & Emegency Depatment of a state hospital.

47 Thee may be a non-efundable chage fo ambulance tanspotation. Whee to obtain efunds Not applicable patients ae only chaged thei shae of the doctos/dentists costs, which ae not efundable. Any pivate medical chages ae not efunded. CZECH REPUBLIC Whee to obtain infomation Centum mezistátních úhad (Cente fo Intenational Reimbusements) nám. W. Chuchilla Pague 3 Tel: +420 (0) [email protected] Documentation equied Fom E111. (Pesent it at the time of equesting teatment.) Doctos, dentists and pesciptions Make sue the docto o dentist you see is contacted to the health insuance fund, i.e. the public health sevice. Most ae but in cases of doubt contact the Cente fo Intenational Reimbusements. You ae entitled to all necessay teatment fee of chage. Pesciptions ae issued though doctos and ae dispensed by phamacies. You will be asked to pay a shae of the costs, which ae not efundable. Hospital teatment and ambulance costs You can go staight to a hospital in an emegency. Whee necessay, a pactitione may also issue a ecommendation efeing you to a hospital. Ambulance tanspotation is povided fee of chage. DENMARK Whee to obtain infomation and efunds The local council (Kommunen). Fo UK nationals on a tempoay visit to Denmak, an E111 is not equied poduction of a Bitish passpot is sufficient to obtain medical teatment. Fo othe EEA and Swiss nationals esident in the UK, an E111 is equied. Doctos, dentists and pesciptions Consult any docto o dentist egisteed with the Danish Public Health Sevice and show you passpot o if you ae not Bitish you E111. If chaged fo teatment, obtain a eceipt. All the cost of a medical consultation and a popotion of dental costs will be efunded if you apply to the local council with you eceipts befoe you leave Denmak. Refund ates fo appoved medicines depend on the yealy expenditue. Thee ae no efunds of expenditue unde 520DKK fo pesons ove 18 (fo childen, 50% is efunded). You will be given a special cad to egiste you puchases on you fist visit to a phamacy if you show you passpot o E111. If not, keep 45

48 46 all you pesciptions and eceipts and apply fo a efund to the local council. Hospital teatment Fee hospital teatment will be aanged by a docto. If you cannot see a docto fist, show you passpot o E111 to the hospital authoities and ask them to aange fee teatment fo you. Geenland and the Faoe Islands ae not pat of the EEA, but ae coveed by sepaate ecipocal health cae aangements with the UK. UK esidents will be entitled to emegency cae on the same basis as local people. ESTONIA Whee to obtain infomation and efunds Eesti Haigekassa (Estonian Health Insuance Fund) Intenational Relations Depatment Lembitu 10, Tallinn (Local offices also in Tatu, Jõhvi and Pänu.) Tel: [email protected] Documentation equied Fom E111. Doctos, dentists and pesciptions You can get emegency teatment fom a docto (family pactitione) o in the emegency section of a hospital. Altenatively, you can call an ambulance. The docto will decide whethe you need hospital in-patient teatment. You will be equied to pay a contibution towads the cost of you teatment and any pesciptions. These fees ae not efundable. GP consultations ae fee. Howeve, thee is a visit fee of up to EEK 50, when making a home visit. Dental cae: childen below 19 fee of chage. Adults pay the full amount fo dental teatment (except in two kinds of emegencies: the emoval of a tooth and the lancing of an abscess). UK visitos will be chaged a standad contibution ate of between EEK 20 and 50 towads the cost of any medicines they ae pescibed and additionally they will sometimes have to pay a pecentage of the cost above the EEK 20 and 50 contibution. The pecentage they pay will vay accoding to the cost of the medicine pescibed but will be between 10% and 50%. If the medicine is not on the Health Insuance Fund s list of medicinal poducts, the patient will have to pay the full cost, which is not efundable. Hospital teatment and ambulance costs If you ae admitted as an in-patient, you will have to pay an in-patient fee of up to EEK 25 pe day fo up to 10 days pe hospitalisation. Note: thee is no in-patient fee: fo childen below the age of 19; in cases elated to pegnancy and childbith;

49 in the case of intensive cae. Tanspotation by ambulance, in an emegency, is fee of chage. Whee to obtain efunds Not applicable patients ae only chaged thei shae of any medical o pesciption costs, which ae not efundable. Payment fo any teatment eceived pivately is not efundable. FINLAND Whee to obtain infomation and efunds Local offices of the Sickness Insuance Depatment (Kansaneläkelaitoksen Paikallistoimisto KELA). Fo UK nationals on a tempoay visit to Finland an E111 is not equied poduction of a Bitish passpot is sufficient to obtain medical teatment. Fo othe nationals esident in the UK, an E111 is equied. In Finland, health sevices (doctos and hospitals) exist as a balance between public and pivate povides and sevices ae egionalised to a geat extent. Chages vay depending on the municipality that you ae staying in. If you eceive pivate teatment eithe with a docto o at a hospital you should obtain a eceipt, which you should submit to the local KELA as you may be entitled to a patial efund. Refunds fo medical expenses must be claimed within six months of the oiginal payment. Doctos, dentists and pesciptions Fo teatment within the Finnish State health system, go to a municipal health cente and pesent you passpot o Fom E111. The teatment will eithe be given fee of chage o fo a standad fee, depending on the municipality. Fo emegency dental teatment, contact the dentist on duty at the municipal health cente and pesent you passpot o you E111. A standad fee will be chaged, depending on the sevice povided. You may, howeve, find that dental sevices ae seveely esticted in the public secto. Pescibed dugs may be obtained fom any phamacy. The full amount is chaged but you may claim this back fom the local KELA. Fo most pescibed medicines you will eceive a efund of 50% of the costs above a fixed ate. Hospital teatment A docto will nomally efe you to a public hospital whee you must pesent you passpot o E111. In an emegency you can seek teatment fom the neaest public hospital without consulting a docto fist. Fo in-patient teatment thee is a fixed daily chage, which is not efundable. Fo out-patient visits to a hospital, thee is a fixed chage, which again is non-efundable. 47

50 48 FRANCE Whee to obtain infomation Cente des Liaisons Euopéennes et Intenationales de Sécuité Sociale (CLEISS), 11 ue de la Tou des Dames, Pais Cedex 09. Tel: Whee to obtain efunds Local Sickness Insuance Offices (Caisse Pimaie d Assuance-Maladie, CPAM). Doctos, dentists and pesciptions Ensue that the docto o dentist you consult is conventionné, that is, they wok within the Fench health system. Afte teatment, obtain a signed statement of the teatment given (feuille de soins) you cannot claim a efund without it. You will be chaged fo the teatment you eceive, as well as fo any pescibed medicines, and the amount(s) should be shown on the feuille. When you ae getting pescibed medicines, the phamacist will hand you back you pesciption and you should attach it to the feuille in ode to claim a efund. Medicine containes also cay detachable labels (vignettes), showing the name and pice of the contents. Stick these in the appopiate place on the feuille, and sign and date the fom at the end. Send you application fo a efund (the feuille de soins, any pesciption and you E111) to the neaest Sickness Insuance Office (CPAM) while you ae still in Fance. The efund will be sent to you home addess late, but it may be subject to a bank chage. Befoe sending the money ode, the Fench authoities will send you an itemised statement of the amount to be efunded. This efund pocess nomally takes aound two months. Aound 70% of standad doctos and dentists fees ae efunded, and between 35% and 65% of the cost of most pescibed medicines. The cost of common emedies and items such as bandages is efunded at the lowe ate. The cost of medicines maked with a vignette is not ecoveable. Hospital teatment You must pay fo out-patient teatment and then claim a efund fom the local Sickness Insuance Office (as above). Fo in-patient teatment, the docto you have consulted o the hospital docto will issue you with a cetificate (attestation). The hospital should then send a Notice of Admission Acceptance of Responsibility (Avis d admission pise en chage) fom to the local Sickness Insuance Office along with you E111. If not, you should send it youself. If you ae teated in an appoved hospital, the office will pay 75% o moe of the cost diect to the hospital. You pay the balance. You must also pay a fixed daily hospital chage (fofait jounalie). The 25% balance and the fofait jounalie ae non-efundable.

51 GERMANY Whee to obtain infomation You can obtain infomation fom any insuance company you contact whee you ae staying. These include any Allgemeine Otskankenkasse (AOK local health insuance fund) and the Esatzkassen (substitute health insuance funds). These companies ae geneally open fom Monday to Fiday. Doctos, dentists and pesciptions The insuance fund you contact will have a list of doctos and dentists that teat patients unde the state scheme (including hospitals). You should pesent you passpot and E111 wheneve you need teatment. You will need to pay a fixed chage to see a docto o dentist, which is not efundable. Medicines pescibed by the docto can be obtained fom any phamacy in exchange fo the pesciption. You will be liable fo a pesciption chage depending on the size of the packaging. These costs ae non-efundable. Fo mino dugs and medicines, such as painkilles and cough mixtues, you may be chaged the full amount. Hospital teatment If the docto consides that you equie hospital teatment, you will be sent to a hospital. In an emegency, you can go diectly to a contacted hospital. The hospital will then contact the insuance fund so that they can confim you teatment costs will be met. Fo the fist 14 days of hospital in-patient teatment, you will have to pay a fixed daily hospital chage, which will not be eimbused. (Patients up to the age of 18 do not have to pay this chage.) GREECE Whee to obtain infomation The Social Insuance Institute (I ÚÓÌ KÔÈÓˆÓÈÎˆÓ ÛÊ ÏÈÛÂˆÓ known as IKA), 8 Aghiou Constantinou Steet, Athens; o its egional o local offices ( appleôî Ù ÛÙËÌ Ù ), o banches (apple Ú ÚÙËÌ Ù ). People seeking teatment though IKA may face long waits in its offices, hospitals and sugeies. Wads may be cowded and may not povide all the sevices usual in othe EEA counties. If you ae chaged fo any sevices povided though IKA, make sue you secue a eceipt with a numbe pefoated acoss it. Doctos, dentists and pesciptions Take you E111 and passpot to the local IKA office, whee you will be given a health sevices book and diected to an IKA clinic o a docto o dentist in the IKA scheme. Consultations and teatment ae fee. Howeve, you will have to pay pat of the cost of seconday examinations, such as X-ays. You will also have to pay fo supplementay teatment, such as physiotheapy, and fo dentues. Fo pescibed medicines, hand the pesciption and the health 49

52 50 sevices book to any chemist in the IKA scheme IKA offices will povide a list. You will have to pay a small standad chage, plus 25% of the actual cost of the medicine, which is nonefundable. If you ae chaged in full, obtain a eceipt and ask fo the pesciption back. Keep the self-adhesive labels fom the medicines and stick these on to the docto s pesciption you will not get a efund without them. Hospital teatment Following an IKA docto s diagnosis you must ask fo a ticket, which is you appoval of admittance to a hospital within the IKA scheme. If you go into the hospital befoe obtaining the ticket, show the administation you E111 and ask them to contact the IKA. If you obtain medicines o any kind of teatment pivately, you must pay the full cost. Then go to the IKA within one month with the eceipts, the health sevices book and you E111, and they will eimbuse you up to the limit allowed fo simila teatment by the IKA. If you ae staying in a emote pat of the county o on a small island, thee may be no IKA office o facilities within easy each. In this case you must pay the full cost of pivate teatment and apply fo a efund on etun to the UK. HUNGARY Whee to obtain infomation and efunds Osazagos Egeszsegbiztosita Penzta (National Health Insuance Fund) Depatment of Intenational Relations and EU Integation Vaci Steet 73/a 1139 Budapest Tel: [email protected] Documentation equied Fom E111 and you passpot. Doctos, dentists and pesciptions You can only obtain teatment fom sugeies that have a sign saying they ae contacted with the National Health Insuance Fund in Hungaian: OEP-pel szeződött szolgaltato. Docto s consultations ae fee of chage. Emegency dental teatment is geneally fee. Any chages incued ae not efundable. Pivate chages fo seeing a docto o dentist ae not efundable. Whee a docto o dentist issues a pesciption, it should be taken to the phamacy; no othe documentation is equied. Fo medicines, you pay all, pat o none of the cost. Whateve you ae chaged is not efundable. Hospital teatment and ambulance costs Ambulance tavel is fee of chage. In-patient and out-patient hospital teatment is nomally povided though a efeal fom a GP. Thee ae a few cases

53 whee a efeal is not necessay. Teatment is fee of chage, except whee exta sevices ae equested, e.g.: a) obtaining pesciption teatment without a efeal fom a pimay health cae povide; b) using a health cae povide othe than the one specified by the pescibing docto; c) unnecessaily changing the contents of pesciption teatment, causing exta costs; d) exta sevices (bette oom, meals, conditions etc.). Chages fo exta sevices ae not efundable. If you ae teated pivately in a hospital, none of the chages ae efundable. Whee to obtain efunds Thee ae no efunds available. Geneal infomation A sepaate Fom E111 is equied fo each episode of teatment. It must be submitted to the physician teating you, o the patient s egistation desk in hospitals o out-patient medical centes. It will not be given back to you. You may wish to take a photocopy. You will need to apply fo anothe fom, on you etun to the UK, o if you ae tavelling to anothe EU membe state you will need to contact the Medical Benefits Section of The Pension Sevice in Newcastle thei contact details ae on page 37. ICELAND Whee to obtain infomation and efunds State Social Secuity Institute, Laugavegu 114, Reykjavik. Tel: Nomally patients will be chaged only a standad fee, which is not efundable. Howeve, if you think that you have been wongly chaged as a pivate patient, you can apply fo a efund by pesenting any eceipts to the main office of the State Social Secuity Institute. Doctos, dentists and pesciptions Go to a health cente o a docto egisteed within the State scheme, state that you ae an EEA national, esident in the UK, and pesent you E111. You will have to pay a fee of IKR 700, which is not efundable. Fo dental teatment the full cost is payable, except fo childen unde 16, who pay only 25%. Pescibed medicines can be obtained fom any phamacy. A medical pesciption must be pesented with Fom E111. You will be chaged a set amount depending on the type of medication pescibed. Ask the docto fo a geneic dug if possible, as these ae geneally cheape than band name medicines. Hospital teatment Patients can only be admitted to hospitals when they ae efeed by a docto. Howeve, in emegencies, patients may be admitted immediately to the 51

54 52 hospital seving as the emegency hospital at the time. Hospital in-patient teatment is fee if you pesent you Fom E111. Othewise, you will be chaged. Patients must pay the full cost of ambulance tanspotation within Reykjavik. Elsewhee, the cost of ambulance tanspotation is limited to a maximum of IKR Non-EEA nationals esident in the UK may also be coveed fo emegency health teatment in Iceland unde a sepaate ageement. You will need to poduce you NHS medical cad. THE REPUBLIC OF IRELAND Whee to obtain infomation The local Health Boad of the aea whee you ae staying. Doctos, dentists and pesciptions Contact the local Health Boad, which will aange fo you to see a docto o dentist pactising within the public health sevice. Make it clea to the pactitione that you wish to be teated unde the Euopean Union s social secuity aangements. Fom E111 is not equied. Evidence of esidence in the UK is equied, fo example, an NHS medical cad o a diving licence. You may be asked to complete a simple statement. Emegency teatment and medicines ae fee if you attend a Geneal Medical Sevices (GMS) docto and the pesciption is on GMS pape. Hospital teatment A docto will aange fo you to be admitted to a health sevice hospital, whee teatment in public wads is nomally fee. If you cannot contact a docto befoe admission, explain to the hospital authoities that you wish to be teated unde the EU aangements. If you need emegency medication on dischage fom a public hospital, you must go to a Health Boad docto fo the pesciption, othewise it will not be dispensed fee of chage. ITALY Whee to obtain infomation The Local Health Authoity (Azienda Unita Sanitaia Locale ASL, also known as AUSL). You can obtain thei numbe fom a telephone diectoy, hotel eception, phamacy, o in an emegency, by phoning the police on 112 o 113. Doctos, dentists and pesciptions You will need to pesent you E111 wheneve you need teatment. Make sue the docto you go to is a National Health Sevice (NHS) docto. Thei sevices ae nomally fee. Sugeies ae open fom Monday to Fiday but thei times vay. At weekends and on weekdays between 8pm and 8am, emegency sevices ae available (Guadia Medica). If you incu any chages, keep the eceipts and apply at the local ASL fo a efund. If an NHS docto issues you with a pesciption, you should

55 pesent this, and evidence of you health cove (E111) to the phamacy. Some medicines ae fee, fo othes you will be chaged a standad fee, which is non-efundable. The cost of medicines bought ove the counte is not efundable. Most dentists ae pivate; to get state teatment you will need to go to an NHS hospital o a dentist who is woking in an ASL-managed cente. Hospital teatment The ASL can supply a list of the elevant hospitals; these will be NHS o pivate ones that ae affiliated to the state scheme. Depending on the egion you ae in, you may o may not have to pay fo medicines pescibed in a hospital o fo you ambulance tavel. Should you be unable to contact the ASL fist, show the hospital authoities you E111 and ask them to contact the local office at once about you ight to teatment unde the state health cae scheme. LATVIA Whee to obtain infomation You can obtain infomation fom local sickness insuance funds o: Compulsoy Health Insuance State Agency (Veselī bas obligātās apdos v inās v anas valsts ag entūa) Baznicas 25 Riga LV Tel: [email protected] Fo infomation concening health cae in Latvia in elation to EU citizens: Tel: [email protected] Documentation equied Fom E111 and you passpot. You will need to pesent you Fom E111 wheneve you need teatment o pesciptions. Ask pactitiones if they ae contacted with the state scheme. Pivate teatment will not be eimbused. Doctos, dentists and pesciptions Unde the Latvian health cae system, patients pay small standad contibutions towads the cost of vaious teatments up to a maximum. Cuently, standad patient fees ae: 0.50 LVL fo visiting a geneal pactitione; 5.00 LVL fo admission o the fist day in hospital (2.50 LVL in the case of a day cente); 1.50 LVL fo each following day in a hospital (1.00 LVL in the case of a day cente); LVL fo examinations made duing out-patient o inpatient cae (depending on the type of examination). These fees do not apply to childen unde 18 yeas o pegnant women when they ae eceiving teatment elated to thei pegnancy o emegencies. The maximum patient fee is 25 LVL fo each hospitalisation. The maximum sum of patient fees fo all sevices is 80 LVL pe yea. Patient fees can vay and ae not eimbused. Any dentist you see must be contacted with a sickness insuance fund, the Compulsoy Health Insuance State Agency. You will have to pay fo most dental sevices. 53

56 54 Fo childen up to 18 yeas, most teatments ae fee. Medicines ae pescibed by doctos and dispensed by phamacies. Hospital teatment and ambulance costs In an emegency you can go diectly to a hospital. In othe cicumstances you will need a efeal fom a geneal pactitione o medical specialist to be admitted as an in-patient. Thee is a hospital admission fee and a daily chage fo inpatient teatment fom the second day of an admission, up to a maximum. Day centes also equie an admission fee and a co-payment fom the second day of an admission. Use of an ambulance is fee if it is equested by the national immediate medical teatment sevice (the public health sevice). You will not get a efund if you pay to see a docto who is not contacted with a sickness insuance fund. LIECHTENSTEIN Whee to get infomation/efunds National Office of Economy (Amt fü Volkswitschaft), Austasse 15, 9490 Vaduz. Medical teatment To obtain necessay medical teatment fom a docto, Fom E111 and a passpot ae equied. Any docto coveed by a contact with the public health cae scheme can be seen. Based on the peiod of time that teatment is eceived, a standad fee of CHF 67 (CHF fo etied pesons) will be levied by the National Office of the Economy. This may be as late as 3 6 months afte eceipt of the teatment. Dental teatment Dental teatment is not pat of the state sickness insuance scheme, so costs of pivate dental teatment will need to be met in full. Hospital teatment Thee is only one hospital in Liechtenstein. The competent authoity needs to appove a patient s admission to hospital. In an emegency, no pio appoval is needed. Chages and efunds Medical bills, togethe with the Fom E111, should be sent to the National Office of Economy fo efunds. LITHUANIA Whee to obtain infomation You can obtain infomation about which doctos o dentists ae contacted to the state health sevice by contacting one of the five Teitoial Patient Funds. They ae: Vilnius Teitoial Patient Fund Placioji g. 10 Vilnius 2600 Tel: Kauno Teitoial Patient Fund Aukstaiciu g. 10 Kaunas 3005 Tel:

57 Klaipedos Teitoial Patient Fund Taikos p.28 Klaipeda 5802 Tel: Siauliu Teitoial Patient Fund Vilniaus g.267 Siauliai 5400 Tel: Panevezio Teitoial Patient Fund Respublikos g.66 Panevezys 5319 Tel: Documentation equied Fom E111 and you passpot. Doctos, dentists and pesciptions You can only get teatment fom doctos o dentists contacted to a Teitoial Patient Fund. Doctos consultations and teatment ae fee of chage. Thee is no chage fo a dentist s consultation but you will have to pay fo mateials used in teating you. 80% of dentists pactise pivately. If you see a docto o dentist pivately, thee is no efund of any chages you incu. Pesciptions can be obtained fom a docto using Fom E111. Some medicines ae povided fee of chage; fo othes the patient pays a co-payment (contibution) of between 10% and 50% of the cost. This is not efundable. If you ae pescibed a medicine that is not available unde the state scheme, you will have to pay fo it youself, pivately. Hospital teatment and ambulance costs In an emegency you can eceive teatment in the emegency section of a hospital. You can also be efeed to a hospital fo inpatient o out-patient teatment if you consult a docto and s/he efes you. Thee ae no chages fo in-patient o outpatient hospital teatment. If you ae teated pivately in a hospital, you will have to pay. This is not efundable. Thee is no chage fo ambulance tanspotation. Whee to obtain efunds Patients ae geneally only chaged thei shae of the costs, which ae nonefundable. Howeve, if you do not have you Fom E111 with you at the time you see a docto and ae chaged, keep all you eceipts and apply to the Depatment fo Wok and Pensions, Medical Benefits Section of The Pension Sevice. The addess is on page 37. LUXEMBOURG Whee to obtain infomation The Sickness Insuance Fund fo Manual Wokes (Caisse de maladie des ouvies), 125 Route d Esch, L-1471 Luxemboug Ville; o its local offices. Doctos, dentists and pesciptions Consult any docto and poduce you E111. You must pay fo teatment and pescibed medicines. Obtain 55

58 56 a eceipt fo eveything. You will be able to obtain a efund, although not necessaily fo the full amount, by applying to the local Sickness Fund Office. Hospital teatment If a docto thinks you need hospital teatment, you will be issued with a cetificate that you should give to the hospital authoities, togethe with you E111 if you have not aleady given that to the Sickness Fund Office. Teatment is nomally fee but you must pay a daily chage, which is not efunded. If you cannot contact a docto befoe being admitted, show you E111 to the hospital authoities and ask them to contact the Sickness Fund. MALTA Whee to obtain infomation Entitlement Unit Ministy of Health 24 St John s Steet Valletta Malta CMR02 Tel: Fax: [email protected] Documentation equied In an emegency, UK nationals only need to pesent thei passpots to obtain teatment. All othe nationals (legally esident in the UK) need to pesent thei Fom E111 and thei passpot. Doctos, dentists and pesciptions Emegency medical teatment is available fee fom doctos in govenment health centes. Acute emegency dental teatment is povided fee of chage in hospital out-patient wads o govenment health centes, but is not widely available. Most dental cae is paid fo pivately. A pesciption fom a licensed medical pactitione is equied to obtain medication. Any chage paid is not efundable. Hospital teatment and ambulance costs If you ae teated in an emegency, as an in-patient o out-patient, in the accident and emegency depatment of a govenment hospital thee will be no chage. Any medication you ae pescibed duing inpatient teatment, o fo the fist thee days afte you ae dischaged, will be fee but you will be chaged in full fo anything exceeding this time peiod. You will also be chaged fo any posthesis you ae pescibed. These chages ae not efundable. You will not be chaged fo tanspotation by ambulance in an emegency, as long as you can pove you entitlement to teatment. Whee to obtain efunds If you cannot povide poof of you entitlement to teatment, you will be chaged in full and should apply fo a efund on you etun to the UK. See page 37. Payment fo any teatment eceived pivately is not efundable.

59 THE NETHERLANDS Whee to obtain infomation AGIS Vezekeingen PO Box 8261, 3503 RG, Utecht Tel: +31 (0) o the local health insuance fund office (zogvezekeaa). Doctos, dentists and pesciptions Consult a docto who pactises within the health insuance scheme, if possible duing sugey hous. Povide a photocopy of you E111. Phamacists will also need a photocopy of you E111. Teatment by a docto is usually fee of chage. Some pescibed medicines ae fee, fo some you pay the full cost (non-efundable) and fo othes you pay patial costs. Dental cae in the Nethelands is limited to teatment fo childen. The local health insuance fund office (zogvezekeaa) can give infomation on how to obtain medical sevices. They can also give names and addesses of pactitiones, health centes and hospitals that opeate within the state system. Hospital teatment A docto must obtain AGIS Vezekeingen authoisation fo you to eceive fee hospital in-patient teatment. Fo authoisation, a photocopy of you E111 is equied. If you cannot contact a docto of AGIS Vezekeingen befoe admission, povide the hospital authoities with you E111 (o a photocopy) and ask them to contact AGIS Vezekeingen in Utecht immediately. If you needed ambulance tanspot, enclose a cetificate fom the docto confiming it was necessay. NORWAY Whee to obtain infomation and efunds Local Sickness Offices (Lokale Tygdekonto) o the National Office fo Social Insuance Aboad (Folketygdkontoet fo utenlandesake), PO Box 8138 Dep, 0033 Oslo 1. Tel: Fo UK nationals on a tempoay visit to Noway, an E111 is not equied. Fo othe EEA nationals esident in the UK, the E111 is equied. Doctos, dentists and pesciptions Medical teatment must be obtained fom a docto with a eimbusement aangement with the National Insuance Administation. This includes most medical pactitiones. Patients may consult a docto diect but must be able to poduce a UK passpot o an E111. A standad fee will be chaged by the docto and this is non-efundable. In geneal, you must pay the total cost of dental teatment and pescibed medicines. Howeve, if you ae pescibed medication by a docto on a blue pesciption (geneally medication fo chonic 57

60 58 conditions) you will only pay 36% of the costs up to a maximum of NOK 360 pe pesciption. Hospital teatment Chages ae payable fo specialist consultations and out-patient teatment. Nomally a geneal pactitione will equest a patient s admission to hospital. In an emegency, you may seek teatment fom the neaest public hospital. Hospital in-patient teatment, including necessay medication, is fee of chage. POLAND Whee to obtain infomation Centala Naodowego Funduszu Zdowia (Head office of the National Health Fund) o (fo details) egional banches of the National Health Fund ul. Gójecka Waszawa Tel: +48 (22) o +48 (22) Fax: +48 (22) Documentation equied Fom E111. Doctos, dentists and pesciptions Health cae in Poland is povided by units that have a contact with the National Health Fund (NFZ). In an emegency you should go to the neaest basic health cae geneal pactitione (GP). Make sue they ae contacted to the NFZ. If they ae not contacted to the NFZ you will be chaged as a pivate patient and will not be able to get a efund. Make sue the dentist you go to is contacted to the NFZ, othewise you will be chaged pivately. Only basic dental cae, in an emegency, is povided fee of chage. Depending on the medication pescibed, patients pay 30% o 50% of the pice, the full amount o a fixed pice. This is not efundable. Hospital teatment and ambulance costs You can go diectly to a state hospital in an emegency. You will be teated fee of chage. If a GP thinks it is necessay he may also efe you to a hospital and decide if an ambulance should be called. If an ambulance is necessay, he will issue an ode in accodance with Polish law. Medicines povided in a hospital ae fee of chage. PORTUGAL Whee to obtain infomation Mainland Potugal: Regional Health Sevice Offices (Administação Regional de Saúde). The Azoes: Regional Health Sevice Diectoate in Anga do Heoismo. Madeia (Autonomous Region): Regional Health Diectoate in Funchal. Fo UK nationals on a tempoay visit to Potugal, an E111 is not equied. Fo othe EEA nationals, esident in the UK, the E111 is equied.

61 Doctos, dentists and pesciptions Available at health centes (cento de Saúde) on the mainland. Show you passpot to the Health Cente Sevices o if you ae not a UK national, a medical cae booklet issued in exchange fo the E111 at the Regional Health Sevice Office and ask to be teated unde the EU aangements. You will be chaged a standad fee, which is not efundable. Dental teatment is limited unde the state scheme. It is likely that you will have to pay and the chages ae not efundable. Fo some pescibed medicines, you pay between 30% and 80% of the cost. Thee is no chage in the case of pesciptions issued fo cetain seious illnesses listed as A Level. In Madeia (Autonomous Region), if you consult a pivate docto, you will be chaged. Ask fo an official geen eceipt and then claim a patial efund at the Dieccao- Regional de Gestao Rue das Petas, h 1 Funchal. Refunds of chages in Madeia must be claimed thee. The Health Sevice office will indemnify the local office, but the efund will cove only a vey small popotion of you bill you will have to pay the est youself. Hospital teatment Show you passpot o E111 if you ae not a UK national to the hospital authoities and ask to be teated unde the EU aangements. Basic hospital teatment is fee but you will have to pay fo seconday examinations, such as X-ays, and laboatoy tests. SLOVAKIA Whee to obtain infomation A numbe of health insuance companies have a contact with the State to povide medical sevices. Most medical pactitiones ae in tun contacted with them. A list of the companies is not cuently available. Fo an update, please visit ou website at Documentation equied You must pesent you Fom E111. It will be kept by the cae povide. Take a photocopy with you. If you go to a docto and do not have a Fom E111, you will be chaged fo teatment and may not be able to get a efund. If you ae admitted to hospital and you do not have a Fom E111, you can contact the Depatment fo Wok and Pensions, Medical Benefits Section of The Pension Sevice, fo one. Thei contact details ae on page 37. Doctos, dentists and pesciptions Teatment is available fom geneal pactitiones (GPs) o dentists contacted to the main health insuance company, but you will have to pay a contibution of SKK Some basic dental teatment is available fee of chage in an emegency but you will also be equied to pay a SKK contibution. This is not efundable. 59

62 60 Pesciptions: Thee is a flat fee of SKK pe pesciption. Some medicines also attact a contibution. Each phamacy can poduce a list of the nationally subsidised dugs. Hospital teatment and ambulance costs You can go to the casualty wad of a hospital to eceive teatment in an emegency. Altenatively you may be admitted diectly to hospital if a GP equests it. You will be equied to pay a patient contibution of SKK pe day (up to a maximum of 21 days pe episode of hospitalisation). This is not efundable. All othe sevices and medicines ae nomally fee of chage but fo complex pocedues a substantial contibution could be equied. This is not efundable. Fo individuals that go to hospital but ae not admitted, thee is a fee of SKK Only a docto can equest an ambulance. If they equest one, you will be chaged a non-efundable fee (appox. SKK 2.00 pe km). If the docto does not think you need an ambulance, you will have to make you own aangements. In a life-saving emegency thee is no chage fo ambulance tavel. Whee to obtain efunds None applicable you will only be chaged you shae of the costs. SLOVENIA Whee to obtain infomation Regional offices of the Health Insuance Institute of Slovenia ZZZS Zavod Za Zdavstveno Zavaovanje Slovenije. Documentation equied Fom E111. This will entitle you to emegency medical sevices fee of chage in all public health institutions and fom pivate doctos who have a contact with the ZZZS. Doctos, dentists and pesciptions The E111 will entitle you to emegency medical teatment fee of chage fom a geneal pactitione in a public health institution, o fom a pivate docto who is contacted to the ZZZS. Emegency dental teatment is available fom dentists who have a contact with the ZZZS. Addesses of pivate doctos and dentists contacted to the ZZZS ae available at egional offices of the ZZZS. Pesciptions: Fo some dugs you will be equied to pay 25 75% of the cost and in cetain cases you will have to pay the full cost. These costs ae not efundable. Thee ae also some dugs that ae povided fee of chage. Hospital teatment and ambulance costs If hospital teatment is equied, a geneal pactitione (GP) will efe you. In an emegency you can also go to the emegency depatment of a hospital. Emegency hospital teatment is povided fee of chage.

63 Ambulance tanspotation is also fee if a GP efes you to the hospital. If an ambulance is equested fo a non-ugent eason you will have to pay 70% of the cost, which is not efundable. Whee to obtain efunds Without a Fom E111 you will have to pay fo you medical cae in full and apply fo a efund though the Medical Benefits Section of The Pension Sevice, on you etun to the UK. Details of how to apply ae on page 37. Note: If you ae teated by a physician who is not contacted to the state health sevice (ZZZS) you will not be able to get a efund. SPAIN (including the Canay and Baleaic Islands) Whee to obtain infomation GENERAL: Health Sevice offices of the autonomous egions (Sevicio Regional de Salud), e.g. CATALONIA: Catalan Health Sevice (Instituto Catalan de la Salud). Doctos, dentists and pesciptions It is essential to establish that the medical pactitione you consult woks within the Spanish State Health Sevice. Teatment unde the E111 aangements is only povided by pactitiones within the Spanish State Health Sevice, and in some pats of the county, paticulaly the outlying islands, you may have to tavel some distance to attend a sugey (consultoio), health cente (cento sanitao) o hospital clinic (ambulatoio) opeating within the health sevice. If you need to call out a docto in an emegency, make it clea that you have an E111 and that you will want to be teated unde the EU aangements. Any time you need teatment, have a photocopy of you E111 eady; show the docto the oiginal and hand ove the copy. Dental teatment is not geneally povided unde the state system. The costs will not be eimbused. Impotant: In Spain, doctos, health centes and hospitals have sepaate sugey times fo pivate patients and those teated unde the health sevice. If you ae asked to pay, you ae not being teated unde the Spanish Health Sevice, but pivately, and you E111 will not be accepted. Medicines pescibed by health sevice pactitiones can be obtained fom any phamacy (famacia). You will have to pay up to 40% of the cost unless you ae a UK o othe EEA pensione, in which case the medicines will be fee of chage. Hospital teatment A docto will usually aange any hospital teatment you may need. If you equie ugent teatment, it will only be povided fee of chage in a public wad at a public hospital. Show you E111. If you fail to do this, you will be chaged as a pivate patient and will not get you money 61

64 62 back. Waning: Unde the stict tems of the Spanish Health Sevice, efunds of pivate patient chages ae not made. Make sue you have pivate medical insuance in case you ae teated in an emegency in a pivate hospital. Impotant: At the emegency sevices in hospitals foming pat of the public health netwok, the doctos pescibe medicines on the appopiate medical epot but they do not issue official pesciptions. It is necessay that you take the medicine epot to a pimay cae docto who will issue the official pesciption. SWEDEN Whee to obtain infomation and efunds Local Social Insuance Offices (Lokala Fösäkingskassan). Fo public health sevices, you will be chaged only a nonefundable fee, if you pesent you E111. If you use pivate health sevices, the costs ae not efundable. Doctos, dentists and pesciptions Consult a pactitione who is affiliated to the public insuance scheme. Pesent you E111, othewise you will be chaged the full cost of teatment. In any case, you will have to pay a popotion of the cost. Fo dental teatment you will have to pay the full cost at a given level. If the costs exceed this you will also have to pay most of the cost youself. Any eductions will be made befoe you ae given you bill. Fo pescibed medicines you will be liable to pay the full cost up to SEK 900. Any costs in excess of this ae gadually educed. Hospital teatment You can attend at any public hospital. The emegency unit is the akutmottagningen. You will have to pay a popotion of the cost of out-patient cae, but in-patient teatment is fee of chage, except fo a fixed daily hospital chage, which is non-efundable (SEK 80). Non-EEA nationals esident in the UK may also be coveed fo emegency health teatment in Sweden unde a sepaate ecipocal ageement. You will need to poduce you NHS medical cad o you passpot. SWITZERLAND Whee to obtain infomation The Common Institution unde the Fedeal Sickness Insuance Act, Solothun (Gemeinsame Einichtung KVG, Gibelinstasse 25, Postfach, CH-4503 Solothun/ Institution commune LAMal, Gibelinstasse 25, Case Postale, CH-4503 Soleue/ Istituzione comune LAMal, Soletta). Tel: +41 (0) Fax: +41 (0) A Fom E111 must be poduced wheneve any teatment o sevice is equested. You will nomally have to pay the full costs and claim a efund aftewads. You will have to pay a fixed chage fo each 30-day peiod of

65 teatment. This is known as the excess chage o patient s contibution and is not efunded. It is ecommended that all visitos take out adequate pivate tavel insuance. Doctos, dentists and pesciptions Go to any docto egisteed with the Swiss Health Insuance Scheme. If you ae given a pesciption, take it to any chemist. Only patent medicines ae coveed. Dental teatment is not coveed unless it esults fom seious illness o accident. Hospital teatment and ambulance costs Refeal to a public hospital is nomally though a docto. In an exteme emegency, go diectly to the emegency depatment of any public hospital. In-patient teatment in a geneal wad of a public hospital is coveed, but not in a semi-pivate o pivate wad, o in a pivate hospital. In addition to the excess chage, you will have to pay a small non-efundable fixed daily in-patient chage fo the cost of boad and accommodation. 63 You will have to pay 50% of the costs of ambulance tanspot within Switzeland, including ai ambulance. Whee to obtain efunds: Keep all you bills and eceipts. On you etun to the UK, apply fo a efund to the Medical Benefits Section of The Pension Sevice. The addess is on page 37.

66 64 FORM E111 How to complete the Fom E111 HEALTH CARE FOR VISITORS TO EEA COUNTRIES AND SWITZERLAND Please make sue you have ead pages 34 5 of this booklet, which tells you whethe you ae entitled to Fom E111. The E111 is the cetificate that entitles you to teatment that becomes necessay duing you visit to the EEA o Switzeland. This booklet also tells you what health costs the E111 will cove. Note that Fom E111 is not needed in all counties (see the county-bycounty checklist on pages 43 63). Some people entitled to an E111 ae not coveed in all counties (see pages 34 5). What you need to do Fill in the pull out application fom at the back of this booklet and the numbe of E111s you need. These ae available fom the Post Office. Give the completed documents to the Post Office Counte Office who, if you ae entitled, will stamp and sign the E111(s). Note: the Euopean Health Insuance Cad will eplace the E111 in If you tick the appopiate box on the E111 application fom you do not need to apply sepaately fo this, as the details that you have povided will be used to issue you with one automatically late in the yea, pio to the expiy of you E111. How to fill in an E111 If you ae only visiting and do not plan to eside pemanently aboad fill in the E111 in CAPITALS using the following instuctions: Instuctions In the section headed Infomation concening the beneficiay Pat 1. Ente you suname. Pat 2. Ente you foenames. Pat 3. Ente you date of bith in the following fomat: dd/mm/yyyy. Pat 4. Ente you NHS o National Insuance numbe. You do not need to ente anything in any othe box. Impotant infomation If you ae a student, o ae woking tempoaily in anothe EEA county o Switzeland, please efe to the infomation on pages Keep you E111 (and a photocopy) in a safe place, fo example with you passpot. If you change you addess you should obtain a new E111. You will need to apply fo a new E111 if you use it to obtain teatment and it is not etuned to you, o if you mislay it. REMEMBER, YOU MUST GET THE E111 STAMPED AND SIGNED BY THE POST OFFICE OR YOU WILL NOT BE ABLE TO USE IT.

67 Health advice fo tavelles Cown copyight 2005 Poduced by COI fo the Depatment of Health p 5.25m Ap05 (HOW) The text of this document may be epoduced without fomal pemission o chage fo pesonal o in-house use. If you equie futhe copies of this title, quote T6 Health advice fo tavelles and contact: DH Publications Odeline Tel: 0800* any time, fee of chage [email protected] Textphone (fo minicom uses) fo the had of heaing, 8am to 6pm, Monday to Fiday. *0800 calls made on opeato netwoks othe than BT may be chaged fo. The infomation contained in this booklet is now available, and constantly updated, on pages of CEEFAX (BBC 2). Health advice fo tavelles can also be made available on equest in Baille, on audiocassette tape, on disk and in lage pint. CHLORINE FREE PAPER