There is still confusion about how and where the EHIC is obtained. Recent letters in the Costa del Sol News have only served to compound this confusion.

The rules for issue of this card changed on 1st May 2010 whereby, essentially, the card is issued by the country where you have paid your NI and receive or will receive your pension. For UK pensioners this is the UK and, despite many other comments to the contrary, it is free. Every registered overseas UK pensioner received a letter from Newcastle at the time of the change, together with an application form, in order to get the card. If you are resident outside UK then you need this card to get treatment in UK, or any other country within the EU. If you have or are paying into the Spanish NI system and have, or will receive, a Spanish pension, then the card can be issued by your local Spanish Social Security office. Don’t be tempted to apply for your UK-issued EHIC card online as some sites look official but charge up to £20 for the card.

As a basic rule, if you receive a UK pension then the card is issued from UK, if you are paying into the Spanish NI system or are in receipt of a Spanish pension, then the card can be issued by Social Security in Spain.

The official line for UK pensioners is as follows.

The NHS is a residence-based healthcare system. Therefore, once you have moved permanently away from the UK you are no longer entitled to medical treatment under normal NHS rules.

However, if you're receiving a UK state pension or long-term incapacity benefit, you may be entitled to healthcare paid for by the UK. You will need to apply for form S1 (or an E121 if you are moving to Iceland, Liechtenstein, Norway or Switzerland), which you need to present to the health authorities in your new country of residence. You will then be treated on the same basis as a resident of that country.

To apply for your S1 or E121 contact the Department for Work and Pensions (DWP) or The Pension Service.

You cannot apply online for your UK-issued European Health Insurance Card (EHIC) if you live abroad. You must apply by post using form EHICE, which should be sent to you automatically with your S1 or E121. If you haven’t received an EHICE application, please contact the relevant organization. This also applies if you wish to renew your existing EHIC card, which lasts for a period of 5 years.