FAQ

What is the current situation with Comprehensive Sickness Insurance (CSI)?

CJEU Ruling

On 10 March 2022, the European Court of Justice [CJEU] issued a ruling which says that where people had access to the UK’s National Health Service (NHS), they met the requirement for Comprehensive Sickness Insurance (CSI).

This has not resulted in a change of UK legislation, but rather to changes to various guidance documents. As at August 2023, these are the main relevant guidance documents:

Treaty rights: caseworker guidance - this guidance tells HM Passport Office staff how to deal with a passport application for a customer whose claim is through an EEA national who exercised Treaty rights. The sections on CSI for students and self-sufficient EEA nationals were updated in August 2022. In March 2023, the guidance was further updated to include a new section on Comprehensive Sickness Insurance: refunds and compensation requests which includes: 

"In August 2022, we updated our guidance to confirm someone is covered by CSI if they supplied evidence they exercised Treaty rights as a student or self-sufficient person. This is because they would have been ordinarily living in the UK and had access to the NHS (National Health Service).

This means we may have refused or withdrawn a passport application before August 2022 because the person who exercised Treaty rights did not provide evidence of CSI that was previously listed in our guidance.

If a customer requests a refund or compensation because we previously refused or withdrew their passport application as they did not have CSI, you must send a guidance query to Guidance and Quality, Standards (through the Quality and Examination Support team referral process).

Guidance & Quality will check with Passport policy what action to take on a case by case basis."

Ways in which people can be lawfully resident in the UK - not yet updated though there is a banner at the top acknowledging that it must be updated in light of the judgment

User guidance: How to apply for citizenship by naturalisation if you are living in the UK - this has not been updated to take account of the CJEU ruling. However, it was updated to reflect an amendment to the Nationality and Borders Bill just a few weeks before the CJEU ruling, as a result of our campaign to fix the CSI legacy. It says:

“If you are an EEA national, supplying evidence of your settled status under the EU Settlement Scheme (EUSS) will also normally meet this requirement [of lawful residence]. That also means you will not need to send evidence of what you were doing in the UK prior to being granted settled status.

This includes people who did not hold comprehensive sickness insurance under the EEA regulations whilst either a student or a self-sufficient person. You can now meet the lawful residence requirement simply by showing you have been granted settled status under the EUSS. You also no longer need to explain why you did not hold comprehensive sickness insurance.”

Caseworker guidance: Naturalisation as a British citizen - this has been updated to take account both of the CJEU ruling, and the Nationality and Borders Bill amendment. It says

“You do not need to ask for evidence of the person’s status prior to them being granted ILE or ILR, or whether they were working lawfully, or what their basis of stay was in the UK. For example, you do not need to enquire what activity was being undertaken or whether EEA nationals with ILR needed or had comprehensive sickness insurance. This will apply to most cases”

and 

"The Court of Justice of the European Union (CJEU) held in the case of VI v HM Revenue and Customs C-247/20 (10 March 2022) that once an individual was “affiliated” to the NHS, they had CSI under the Free Movement Directive (or the equivalent under earlier Regulations) 

“Affiliated” to the NHS was not defined by the CJEU but is considered to mean entitled to comprehensive and free NHS treatment. Under domestic law, an individual has such an entitlement when they are “ordinarily resident” in the UK. As a result, if an individual was ordinarily resident in the UK, they will be considered to have held CSI. 

For those EEA and Swiss applicants who have been studying in the UK, or here as a self-sufficient person, you must check the guidance on European Economic Area nationals: qualified persons, to see what evidence is required to demonstrate that they were here lawfully.”

Immigration staff guidance: EEA nationals qualified persons - has a section on Comprehensive Sickness Insurance which has been updated in light of the CJEU judgment. It provides further clarification on what it means to be ‘ordinarily resident’: 

“Ordinarily resident” means that an individual’s residence in the UK is voluntary, lawful and for a settled purpose. To assess whether an individual was ordinarily resident in the UK, you must apply the following approach:

• EEA nationals – until 31 December 2020 EEA nationals living in the UK did not need to be exercising Treaty rights or have the right to reside under the Free Movement Directive in order to be considered ordinarily resident for the purpose of accessing the NHS free of charge - therefore, an EEA national could be regarded as ordinarily resident, and thus to have held CSI, even if they were not a qualified person

• non-EEA nationals – they must demonstrate that their EEA national family member was exercising Treaty rights, had a right to reside under the Free Movement Directive or had a right of permanent residence in order for the non-EEA national family member to be considered ordinarily resident - therefore, if a non-EEA national cannot demonstrate that their EEA national family member was so resident, they will not be regarded as having held CSI on the basis of being “affiliated” to the NHS (because they would not have been entitled to comprehensive and free NHS treatment)”