Impact of Brexit on Healthcare

For the present, Brexit – Great Britain’s withdrawal from the European Union (EU) on 1 February 2020 – will not lead to any changes in the area of healthcare for citizens or companies. Such are the stipulations of the Withdrawal Agreement.

The transition period, during which EU legislation on social law coordination and the recognition of professional qualifications generally still applies, will last until the end of 2020. As the United Kingdom will continue to remain within the EU’s Single Market and the customs union during this time, there will also be no changes to the movement of medicinal products and medical devices until the end of 2020.

Health and long-term-care insurance

Healthcare coverage, the uptake and billing of health and long-term care insurance services in the respective other country, as well as the recognition of insurance periods, will all stay the same until the end of 2020.

The European health insurance card (EHIC) or the Provisional Replacement Certificate (PRC) for instance, will remain valid over this period. Additionally, the Withdrawal Agreement stipulates that people who have already commenced planned care in the United Kingdom or in Germany before the end of the transition period, will continue to possess the right to pursue that treatment.

From Germany's perspective, health insurance contracts with German private health insurers (substitute health and long-term care insurance as well as state-subsidised supplementary long-term care insurance) signed before the end of the transition period can continue as before if the relevant person was already resident in the United Kingdom on 31 December 2020. The prerequisite for the continuation of a supplementary long-term care insurance with state funding is, however, the eligibility for benefits, in other words, basically, the person to be insured must be a member of the statutory or private long-term care (compulsory) insurance. However, a person can lose this membership if the obligation to be insured ends after 31 December 2020, for example in the wake of a stay abroad without continuation of the insurance or without a “special agreement”, or the insured person cancels his/her private long-term insurance contract, for instance because he/she wishes to switch to the insurance system of the United Kingdom or to a private insurance there. At best, there exists the possibility of signing an entitlement insurance, as long as no need for long-term care and no insurance case has yet occurred. Since individual cases can differ greatly, particularly with long-term care insurance, it is recommended that insured persons consult their insurance companies for further advice.

Recognition of professional qualifications

Until the end of 2020, there will be no changes with regard to the recognition of professional qualifications in healthcare. Until then, an application for recognition of professional qualifications filed by an EU or UK citizen to a competent authority in the receiving country or country of employment will still be determined according to EU rules. The citizens concerned are therefore urged to apply for recognition of their professional qualifications as early as possible and in good time before the end of the transition period. Professional qualifications recognised before the end of the transition period retain their validity within the other country, including the right to exercise the profession on the same terms as nationals.

Further information on the recognition procedure can be found at: Informationsportal der Bundesregierung für berufliche Anerkennung.

Medicinal products and medical devices

Goods, therefore also medicinal products and medical devices, which were legally placed on the market before the end of the transition period, will retain the right to be traded in the markets of the EU and the United Kingdom after the transition period until they reach their end consumers, without requiring product changes or renewed labelling.

According to the Higher Federal Authorities within the remit of the Federal Ministry of Health, there is currently no concrete evidence that the United Kingdom's withdrawal from the EU will lead to serious problems with the supply of medicinal products or vaccines in Germany.

Depending on the risk class of a medical device or an in vitro diagnostic medical device, manufacturers must work together with a Notified Body when pursuing the conformity assessment of their device. During the transition period, British Notified Bodies are able, in principle, to continue to issue certificates for medical devices and in vitro diagnostic medical devices.

Frequently asked questions

During the transition period until the end of 2020, agreements should be negotiated on the future partnership between the European Union and the United Kingdom. These negotiations on the future partnership have been ongoing since March 2020. To date, nine rounds of negotiations have been held. However, the positions of the EU and the United Kingdom on major issues are partially far apart. As chief negotiator for the EU, the European Commission is working intensely to successfully conclude the negotiations within the narrow time-frame set. However, the outcome of the negotiations is open. Here you can find an overview of the negotiation.

Irrespective of the outcome of the negotiations on the future partnership, a fundamental change in the relationship between the European Union and the United Kingdom will take place at the end of the year. Compared with its present status, it will be fundamentally different from the United Kingdom’s membership of the Single Market. This applies, for example, with respect to the movement of goods, to the henceforth required customs formalities, product certifications and many other aspects, to data protection requirements, to services and mobility in general. The EU member states, economic operators and citizens must therefore, in any event, prepare for the end of the transition period on 31 December 2020 – regardless of whether or not, by that date, an agreement has been reached on the future partnership.

To provide assistance for all of those affected, the European Commission published on 9 July 2020, a Communication on readiness at the end of the transition period between the European Union and the United Kingdom. It contains recommendations for action, as well as information on changes in the movement of goods, the recognition of professional qualifications and mobility/coordination of the social security systems.

a) Citizens' rights with respect to health and long-term care insurance and coverage in case of illness or long-term care needs

According to relevant European Union regulations for EU citizens, there is currently coordination of social security systems between member states. Since, in the absence of an agreement on the future partnership, the relevant legal provisions of the EU will no longer apply to the United Kingdom from 1 January 2021, comprehensive cross-border social security protection will no longer exist in the same way. This will apply, first and foremost to EU citizens who do not fall under the protection of the Withdrawal Agreement, but under the new British immigration and settlement rules. The same applies to British citizens in the EU, unless they fall under specific Union provisions relating to third-country nationals. The precise details will depend on the outcome of the ongoing negotiations.

Private health insurance contracts (substitute health and long-term care insurance as well as state-subsidised supplementary long-term care insurance) are not subject to the above-mentioned social law coordination. In line with the explanations above, there will be no changes in this area. After the end of the transition period – in the absence of an agreement on the future partnership – third-country regulations will apply to new life situations, in accordance with the insurance conditions of private health insurance/long-term care insurance carriers.

b) Recognition of professional qualifications in healthcare

From 1 January 2021, the United Kingdom will no longer be subject to EU regulations on the recognition of professional qualifications, with the result that the recognition by the United Kingdom of qualifications acquired in EU member states will be subject to British law. From January 2021, EU citizens with qualifications acquired in the United Kingdom must have these recognised on the basis of the regulations valid in Germany for qualifications acquired in third countries. The same applies to British citizens who have not obtained their qualifications in a member state of the EU.

c) Movement of medicinal products and medical devices

Ensuring the population’s uninterrupted supply of medicinal products, vaccines and medical devices is of utmost priority to the Federal Government. However, irrespective of whether an agreement on the future partnership is concluded by the end of the year, the relationship between the EU and the United Kingdom will change fundamentally and will be quite distinct from the United Kingdom’s membership in the Single Market to date, as the United Kingdom will be leaving the regulatory system of the European Union for medicinal products and medical devices on 1 January 2021. This will have the following effects:

  • All holders of marketing authorisations must be established in the European Union.

  • Testing and batch release sites must be located in the European Union.

  • The qualified persons responsible for pharmacovigilance and batch release (including investigational medicinal products) must be established in the European Union.

  • All clinical trials authorised in the European Union must show proof of a sponsor or a legal representative established in the Union.

  • The information and labelling must comply with the requirements of the European Union.

  • Certification of medical devices must be conducted by a notified body established in the European Union.

Furthermore, the European Commission has published over 80 sector-specific communications that are regularly updated and meant to assist the public administration, enterprises and citizens in preparing for the inevitable changes that will take place at the end of the transition period, irrespective of the outcome of the negotiations. This applies, among other things, to changes in clinical trials, medicinal products, substances of human origin and industrial products including medical devices.

No, you do not need to do anything. If, on 31 December 2020, you are the holder of an S1 form, the United Kingdom will continue to fund your healthcare and the benefits-in-kind in case of care, even after the transition period comes to an end. Pensions and other benefits can be exported. This applies as long as you continue to live in Germany and are covered by the regulations contained in the Withdrawal Agreement.

Yes, if you fall under the Withdrawal Agreement (for example legally resident in Germany on 31 December 2020, or a general cross-border situation involving the United Kingdom and a member state of the EU at the same time), the rules on the coordination of social security systems, and consequently also your European health insurance card  will continue to apply for holidays ongoing at the end of the transition period as well as beyond. This applies to travel to the United Kingdom as well as to trips to other EU member states.

Yes, you have the right to apply for a portable S1 document as soon as you have applied for your state pension in the United Kingdom and have proven that, at the end of the transition period, you were legally resident in Germany and continue to live in Germany or a general cross-border situation applies simultaneously involving the United Kingdom and a member state of the EU. Through the S1 form, you will have access to the same health insurance benefits and services as German pensioners and to benefits-in-kind in case of care, but at the expense of the United Kingdom.

Good to know

Guidance on Brexit for all those affected (Deutsche Verbindungsstelle Krankenversicherung – Ausland).

Since the specifics of each case and the questions asked frequently vary, we recommend that affected citizens contact their health insurance fund or health insurance carrier in Germany directly.

For general information related to health insurance, please contact the citizens’ hotline of the Federal Ministry of Health at: +49(0)30340606601. A contact form is also available.

Current information on the state of the negotiations can be found on the website of the Federal Foreign Office.

An Overview of Brexit preparations by the Federal Government, the EU Commission and trade associations can be found on the website of the Federal Government.

The EU Commission publishes questions and answers on the withdrawal of the United Kingdom from the European Union.

In addition, the EU Commission has published Guidelines on citizens’ rights in the context of the Agreement on the Withdrawal of the United Kingdom from the EU that, among other things, explain the rules on the coordination of social security systems and the recognition of professional qualifications.

Furthermore, the EU Commission has published a communication as well as, in the meantime, over 80 so-called Readiness Notes in preparation for the ending of the transition periord at the close of 2020. The documents identify legal changes that stakeholders will have to adapt to regardless of the outcome of the ongoing negotiations between the EU and the UK on a future relationship and that will be necessary in any case after the transition period. The documents describe legal amendments that stakeholders will have to cater for and which will be necessary in any case at the end of the transition period, irrespective of the outcome of the ongoing negotiations between the EU and the United Kingdom on a future partnership. This applies, among other things, to amendments governing clinical trials, medicinal products, substances of human origin and industrial products including medical devices as well as the area of data protection.

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