Health insurance in Europe

In principle, medical services are available for holders of the European Health Insurance Card (EHIC or e-card) within the European Union and/or the European Economic Area When you visit a doctor or have to stay at a hospital, you will be asked to fill in certain forms. This sounds very simply in theory and, in most cases, also works remarkably well.

However, due to the lack of harmonisation of social insurance systems, it is not always that easy. Often, medical services first have to be paid for on the spot and then have to be submitted for reimbursement to the insured’s health insurance institution at home. Given the differences in social systems, for instance regarding tariffs for medical services in various European countries, some services may not be accepted at all or the amounts reimbursed may vary.

An increasing number of people either work in a country different from their country of origin or in several countries. European regulations are in place to guarantee the cross-border coordination of pension entitlements and the payment of unemployment benefits.

As, however, the national systems have not been coordinated with each other, there is no true harmonisation in the form of uniform regulations. Therefore, individual advice regarding the general conditions that apply in the countries involved in a specific case has to be obtained.

In principle, the following applies:

Community rules on social security do not provide for harmonisation but only for a coordination of the national social security systems.

The special provisions of Regulation (EC) No. 883/2004 on the coordination of social security systems apply.

Basically, the following three principles apply:

  • The equal treatment of all nationals of the Member States is guaranteed by their national legislations.
  • All necessary periods of insurance, residence and employment are be taken into account (aggregation of periods of insurance).
  • Social benefits for employees and their family members are guaranteed irrespective of their place of employment or place of residence.

Please note

Community provisions apply to all European citizens enjoying free movement rights in other Member States, irrespective of the reason for or length of their stay. There are Community rules for statutory benefits in case of sickness and maternity, occupational accidents and occupational diseases, inability to work, old age and death, unemployment and family benefits. In contrast, welfare benefits, sickness benefits, benefits for war-disabled persons and their survivors, company pension schemes and early retirement rules are not covered by Community provisions.

The EU provisions are based on the following general principles of social insurance:

Insured persons are always subject to the legal provisions of a single Member State. This rule applies to all employed and self-employed persons, even if they pursue their gainful activities in several countries.

Persons are insured in the country in which they pursue their gainful activity.
This applies to employees as well as self-employed persons, even if they live in another Member State or if their employers have their registered offices in another Member State. 

Exemption for a limited period of time: temporary posting abroad

Find here a summary of exceptions and special cases

Temporary posting abroad

The following basic rule applies to persons who want to work in another country within the EU: During temporary activities of up to 24 months in another EU Member State, the employee’s country of origin remains in charge of social insurance. The term used in this connection is temporary posting abroad.

The A1 e-form has to be completed in advance.

Employees may be posted abroad by their employers; self-employed persons may also decide to temporarily work abroad.

Legal basis: Regulation 883/2004

General affiliation of the posted worker to the sending Member State

A posted worker is deemed to be affiliated with the sending state if, during the time period directly preceding the posting, the posted worker was (at least for one month) subject to the legal provisions of the Member State in which the sending company has its registered office. It is irrelevant in this connection whether the respective person pursued gainful employment, was co-insured as a family member, had opted for self-insurance or just resided in the sending state. That means that employees who are sent abroad to work for a company that just hired them are also considered posted workers. However, the prerequisite is that the posted workers’ connection to the country of origin is maintained in terms of labour law and organization and that the workers have the possibility to continue working for the sending company upon their return.

Please note

If it is planned from the outset that the person will stay abroad for more than 24 months, the social security system of the state in which the activity will be pursued will be in charge from the very first day onwards. However, exceptional provisions apply in special cases.

Frontier workers

If you work in several Member States of the European Union at the same time or in the course of one year, for instance because you live in an area close to the border or you are working on art projects in several countries, the social laws of your country of residence will apply provided that you pursue “substantial” employment there as well. Whether this is the case is decided by the social insurance authority of the state of residence.

Transferring unemployment benefits

In general, to receive unemployment benefits you need to stay in the country which pays your benefits so that you are available for the jobs you may be offered. However, under certain conditions, you may receive your unemployment benefits in another EU country during a limited period of three months (extension to six months is possible if certain criteria are met) if you can prove that you have realistic chances of finding employment in such country.

A summary of all relevant information on this topic, the eligibility criteria to be met, the forms to be completed and the deadlines to be observed are available at the following EU websites:

Transferring unemployment benefits

Click here for the respective forms

Pension entitlements in several countries

With business relations becoming increasingly international, the number of persons acquiring insurance periods both in Austria and abroad is on the rise as well. Special rules apply if EU Member States, EEA countries, Switzerland or contracting states, i.e. countries with which Austria has entered into respective agreements, are involved. Insurance periods acquired in countries for which no agreement exists are not considered when examining whether the criteria required for a pension entitlement have been met or when determining the scope of pension benefits owed in Austria.

Pension entitlement only if insurance periods acquired abroad are included

In the event that the criteria for a pension entitlement in Austria are only met when including insurance periods acquired abroad, the Austrian pension is, as a rule, calculated as if all insurance periods – including those acquired abroad – had been acquired in Austria (fictitious full pension [fiktive Vollpension]). 

In such case, the benefits are reduced in the proportion of the Austrian insurance periods to the overall insurance period (partial pension [Teilpension]). Foreign contribution bases are not included in this calculation.

Pension entitlement based on insurance periods acquired in Austria

In the event that the insurance periods acquired in Austria are sufficient to qualify for a pension, the amount of such pension is calculated exclusively on the basis of these Austrian periods unless the “pension calculation including insurance periods acquired abroad” leads to a more favourable result.

Social insurance outside the European Union

If Austrian artists pursue activities outside the European Union for a limited period of time and/or artists from non-European countries pursue activities in Austria for a limited period of time, it has to be examined whether Austria has entered into a social insurance agreement with the respective country – and, if so, which types of social insurance are covered by such agreement.

International Social Security Agreements Austria

If there is no social insurance agreement, the legal provisions of both countries have to be examined. If artists spend one year working in a country which has not signed an agreement with Austria, they will be subject to the social insurance laws of the host country as employees while compulsory insurance in Austria may continue to apply as well. This may result in double insurance. The same applies analogously for artists from non-EU countries.

EU – forms

European Union e-forms

Click here for a summary of living and working conditions within the European Union broken down by different aspects:

Detailed information