Working or retiring abroad? Your healthcare rights with the S1 Procedure

Regulations (EC) 883/2004 and 987/2009 on Social Security Coordination – S1

The so-called Twin Regulations on Social Security Coordination govern the rights of cross-border workers and their families. When it comes to medical care, those are regulated with the so-called S1 Procedure, named after the main administrative form (standardised for all member states) in use. With this procedure, cross-border employees have a right to routine and emergency care as needed, along with the members of their immediate family.

The S1 form ensures the medical rights of cross-border workers and their children and spouses in the country of employment, even when they contribute to the health insurance system of another member state. The procedure also extends to pensioners. The form has to be issued by the health insurance authority of the system the citizen contributes to and to subsequently be submitted to the relevant authority in the country of residence. 

There are multiple scenarios in which a European citizen might be insured in one country while living in another. It might be the case for an Austrian citizen working in Germany, who contributes to the German health insurance system while still living in Austria with his family. Should they decide to visit a doctor in Austria, the S1 procedure will substantiate their right to do so as a part of their healthcare package. Or it might be the case for a Bulgarian mother working in Germany, whose husband and children visit for an extended period of time and might need medical assistance. Furthermore, the S1 procedure regulates the right of pensioners who have contributed to the healthcare system of one country to enjoy their retirement years in another, without having to worry about losing their access to healthcare.

You can find more information on this subject and also on emergency or planned healthcare at www.europa.eu/youreurope.

What’s behind S1? 

The first step towards the coordination of social security schemes dates back all the way to 1971, with Regulation 1408/1971, concerning the rights of European citizens working and relocating between countries within EU borders.. The signing of the Single European Act in 1985 came and went without introducing any major additions or changes to the existing Regulation, which still only concerned itself with scenarios of unplanned (emergency) healthcare across European borders or with the still rare cases of planned treatments the cost of which was covered conditional on receiving a prior authorization. In the years to follow, this lack of change and adaptation to the developing single market started drawing the attention of both policy-makers and experts [1].

 In 2004, a revised version of the Regulation on the coordination of social security systems was drawn: Regulation 883/2004. This coincided with the first drafting of the now-infamous “Bolkestein Directive” concerning the service sector. While a separate entity, namely a High Level Group (HLG) on Health Services and Medical Care was developing Regulation 883/2004, the European Commission included said services in the proposal for the Directive as well, but after being met with widespread resistance abandoned the idea. Thus, 883/2004 remained the sole regulator of necessary medical care as part of the provision of social services and for the first time clearly differentiated them from all other services that could possibly be provided to a consumer. Five years later, Regulation 987/2009 was adopted as well in its function of implementation guideline for 883/2004 [2].

[1] Leidl, R., Rhodes, G., (1997). “Cross-border healthcare in the European Union” European Journal of Public Health Vol. 7(3), 1-3

[2] Baeten R. (2012) “Europeanization of national health systems, National impact and EU codification of the patient mobility case law.” EPSU and OSE.