Why you need to know about Comprehensive Sickness Insurance

Facebook groups of EU citizens living in the UK are filled with questions on how to get permanent residence or citizenship, following Britain’s decisions to leave the European Union. One of the requirements for permanent residence is causing some headaches as it has often been neglected: Comprehensive Sickness Insurance (CSI). What is it and who needs it? Anne Wesemann, Lecturer in Law at the Open University in Milton Keynes, explains the details.

All of a sudden, comprehensive sickness insurance has become an important topic of discussion for EU citizens in the UK. Why is this the case?

The requirement of comprehensive sickness insurance comes from an EU directive, which is actually 12 years old. It has become important now, because in the aftermaths of the EU referendum EU nationals living in the UK are increasingly looking to prove their resident status or to gain British citizenship. In order to do so, they have to prove that they have been residing in the UK lawfully for five consecutive years. This is where the comprehensive sickness insurance plays a part, as it is a requirement for those EU nationals who live in the UK without being economically active (that is employed or self-employed). This means that EU nationals who moved to the UK as students or partners of British citizens and were able to support themselves financially, would have to have had comprehensive sickness insurance during that time. Otherwise, any of those years will not count towards the five-year requirement.

Who should worry about it now?

It can be most relevant to those whose employment status is about to change, for example someone who stops working to study or someone who quits their job to look after the family as the spouse earns enough. All EU nationals should check their position.

What are the consequences of not taking or not having taken this insurance?

For now, all it means is that those years in which an EU citizen was not economically active and had no comprehensive sickness insurance will not count towards the five-year requirement for residency.

Are there any alternatives to comprehensive sickness insurance?

It is worth checking how the insurance system in the EU country of origin works, as people might be covered by some insurance agreement between Member States. A legal case (Ahmad v Secretary of State for the Home Department) seems to suggest that if a EU national, moving to another EU country, remains insured in their country of origin and can prove the entitlement to healthcare there, this could fulfill the requirement of comprehensive sickness insurance. For example, if a German national married to a British national, moves to the UK to live with the spouse, but continues to pay for health insurance in Germany, this insurance contract could potentially qualify as CSI. This is due to the NHS being able to claim the cost for health care for that German national through the European Health Insurance system.

Added: in March 2022 the Court of Justice of the European Union found that the UK approach was wrong and people registered with the NHS should have been considered as covered for CSI. The Court said a member state could set requirements for economically inactive EU citizens, but the UK never imposed such conditions in practice, so the CSI requirement to prove legal residence would not be proportionate.

What is the principle behind the request to take this insurance?

With free movement of people, the EU Member States were worried that their domestic benefit system would be abused. There was a worry that individuals without any job prospect, qualification or even ambition to look after themselves would be moving from one country to another for assumed better health care or a more substantial welfare system. The Directive was a means to relief that fear, as the EU recognised that individuals should not become a burden to their host country.

Does it mean that the same requirement applies in every country?

Directives are EU laws that require Member States to pass domestic legislation to achieve a certain result. This means that the UK and all other EU countries had to approve own legislation to implement what the directive wants to achieve. So the general principle applies but the implementation may be different in each country.

Should there be more information about it, for example being told when registering with the National Health System or enrolling with a university?

Most UK university application forms for EEA nationals ask whether the student holds comprehensive sickness insurance or at least have a note to say “Please ensure that you have CSI.”

If in need of help, where to get professional advice?

Every good immigration lawyer would know about the requirement of comprehensive sickness insurance. Every individual will have to see how complicated their personal case is. It is also worth following the government websites to keep up to date with changes to the law.

Read more on this topic:

Using healthcare when living in another EU country: EU website.

Prove your right to live in the UK as an EU citizen: UK government website.

European Health Insurance Card: how to access state-provided healthcare during a temporary stay in another European Economic Area (EEA) country or Switzerland.

Why EU nationals in Britain are hurrying to get one piece of paper, Anne Weseman on The Conversation.

Interview by Claudia Delpero © all rights reserved

This article was updated with the addition of the EU Court of Justice decision (additions in italics). Photo: Norfolk and Norwich University Hospital by Francis Tyers via Wikimedia Commons.

11 thoughts on “Why you need to know about Comprehensive Sickness Insurance

  • 24th February 2017 at 12:58 pm

    I’m EU citizen, i live in UK from 2010.
    I work like self-employed from 2010 till present. Between 2012 to 2015 I was student. I didn’t know about this CSI before.
    I want to apply for Permanent Resident and my question is if I was self-employed and in same time student I will still need to have the CSI?

    • 26th February 2017 at 11:00 am

      We are not in a position to provide this advice, so the suggestion is to check the permanent residence pages on the UK government website or contact a migration lawyer in this regard.

    • 3rd March 2017 at 9:30 pm

      Yes you will still need it. As it has to be five continuous years years the time spent on study won’t count unless you were self employed over that time and you can prove that you paid taxes and NI. So if you can prove that you also were self employed over that time you won’t need it and be calm. That’s outcome of telephone conversation with HO info line.


  • 28th February 2017 at 9:03 pm

    I’m EU citizen. Since 2011, I live in the UK. Actually, I’m a student at uni.
    It is the first time when I heard about CSI. Nobody asked me or talked about it before. So, it means that the last 3 years will not count, if I would like to apply for a permanent resident card ?
    Or if I would like to go holiday to any country in the EU, probably I cannot come back ?
    I spent here nearly 6 years, my daughter as well. This is not fair that this news just come to the light and there is not enough information even now. Thanks for this article and for any comments !

    Kind regards,

    • 3rd March 2017 at 4:12 pm

      Melinda I’m afraid it won’t count I just spoke with HO info line you and my wife are in the same boat she stopped working when our second daughter was born and they said if we buy CSI her five years will start then. We bought house in this country so we screwed

  • 6th March 2017 at 10:39 am

    Hi I would like to know if I came in 2009, and was continues working till now, but in 2011 and 2012 was working and half self employer but also the same years was on maternity leave they will count this year’s or not ? And if you earning now 12000 in year do you need this comprehensive sick insurance?

  • 10th March 2017 at 2:00 pm

    My daughter was born in 1996 in the U.K. She and we her parents are all French citizens. She was just refused permanent residency (needed for obtaining a British citizenship) on the grounds of health insurance cover. How can we prove that she was covered: will the private insurance we had at work covering the whole family be sufficient?

  • 22nd March 2017 at 10:09 pm

    I came to the UK in 2011 to study( 3 years course), found my 1st job in 2012 and carried on working till now. Does this mean I’m not entitled to apply for a permanent resident card? Thanks

  • 27th March 2017 at 8:08 pm

    Hi i am a eea citizen and i obtained permanent residence card last year. My wife is also eea citizen and she currently work. If she stops working can she apply for permanence resident due to 4 years as a qualified person and one year as spouse of a eea citizen which holds a permanent residence?

  • 27th March 2017 at 9:04 pm

    We understand this is an issue affecting many people but we are not in a position to provide legal advice. If in doubt on a specific situation, please consult an immigration lawyer. You can find a directory on the website of the Immigration Law Practitioners’ Association.

  • 22nd April 2017 at 5:58 am

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    feel more intelligent afterwards. I shared this article on Facebook and my friends
    thought it was great too. Anyhow, I just wanted to let you know that I appreciate
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