National Contact Point for cross-border healthcare

You are here:

Brexit: Possible scenarios

The United Kingdom of Great Britain and Northern Ireland (hereinafter “the United Kingdom”) officially declared on 29 March 2017 that it was withdrawing from the EU after a majority had voted in favour of this in a referendum held in June 2016. According to the EU Treaty, the United Kingdom’s membership automatically ends on 29 March 2019, unless a withdrawal agreement comes into force beforehand. This deadline can only be extended via a unanimous resolution of the 27 Heads of State and Government of the EU, in agreement with the United Kingdom. No changes will take place until 29 March 2019 for insured persons, companies and institutions to which the regulations on the coordination of social security systems or the Patient Mobility Directive apply. Persons who are covered by statutory health insurance can also initially continue to receive treatment in the United Kingdom via their European health insurance card. This also applies to reimbursements on the basis of the Patient Mobility Directive when patients travel to the UK specifically in order to receive treatment.

What are the scenarios?

Scenario 1: A withdrawal agreement

The withdrawal agreement constitutes the agreement between the withdrawal candidate and the EU as provided for in the EU Treaty. It contains the conditions for separation and the arrangements for a transitional period. It is during this transitional period that the future relations are to be negotiated on. The withdrawal agreement negotiated between the EU and the United Kingdom provides for a transitional period until 31 December 2020, during which the regulations on the coordination of social security systems are to continue to apply (e.g. for tourists, posted workers, pensioners and students). These are Regulations (EC) No. 883/2004, (EC) No. 987/2009 and (EC) No. 859/2003 in conjunction with Regulation (EEC) No. 1408/71. The agreement does not provide for the Patient Mobility Directive (Directive 2011/24/EU) to continue to apply.

The 27 Heads of State and Government of the EU approved the withdrawal agreement negotiated with the United Kingdom on 25 November 2018. In order to enter into force, the withdrawal agreement must also be approved by the UK Parliament and the European Parliament.

The UK Parliament refused to approve the withdrawal agreement with the EU on 15 January 2019. The current version of the withdrawal agreement has thus failed. It can only succeed if there are renegotiations with the EU and if it is put to the vote again.

Scenario 2: A disorderly exit (no-deal Brexit)

After the UK Parliament refused to approve the withdrawal agreement with the EU on 15 January 2019, it is now quite possible that the United Kingdom will leave the EU in a disorderly manner, and that there will be a so-called “no-deal Brexit”. This would entail the United Kingdom leaving the EU on 29 March 2019 without an agreement. That means that there would be no rules for the separation and for a transitional period until such time as the future relations are settled.

Should it come to a disorderly Brexit, the Agreement between the Federal Republic of Germany and Great Britain, dated 20 April 1960, relating to social security, might have to be applied again from 30 March 2019 onwards, as the abovementioned regulations would cease to apply in relations with the United Kingdom from that time on. This legal question has not yet been conclusively resolved. We will provide you with up-to-date information on this as soon as we have it. If the German-British social security agreement is not applicable, the United Kingdom is to be regarded as a non-treaty foreign country, i.e. a country with which no agreement has been concluded on social security. The scope of the German-British social security agreement is not identical to that of the abovementioned European regulations. It does not for example cover unemployment and long-term care insurance.

The Federal Cabinet therefore introduced a supplementary Act in December 2018 in order to avoid such loopholes in the agreements. This Act creates legal certainty for those who are particularly affected by withdrawal with regard to their insurance status, claims and benefits in the event of a no-deal Brexit.

Scenario 3: An extension of the withdrawal period

The United Kingdom could apply for an extension of the withdrawal period, but this would require the approval of the other 27 EU States. The EU Heads of State and Government declared in December 2018 that compelling reasons would be needed for this. What exactly such compelling reasons might be is currently unclear; another Brexit referendum or new elections might be conceivable.

Scenario 4: Withdrawal from Brexit

The European Court of Justice has made it clear that the United Kingdom can unilaterally rescind its intention to leave the EU. Such a withdrawal from Brexit would be possible until 29 March 2019, provided that a withdrawal agreement had not yet entered into force. However, given the current political situation in the United Kingdom, this scenario, as well as a second referendum on whether or not to remain in the EU being held before the planned exit date of 29 March 2019, seems almost impossible.

What do the individual scenarios mean for me if I need treatment in the United Kingdom after 29 March 2019?

Should any of scenarios 1, 3 and 4 occur, there will be no legal changes for the time being. All the information provided on our website will therefore continue to apply unchanged.

Scenario 2: A disorderly exit (no-deal Brexit)

In the event of a disorderly departure on the part of the United Kingdom, the Patient Mobility Directive (Directive 2011/24/EU) will cease to apply after 29 March 2019.

The Federal Government has drafted a Bill (PDF, 384 KB)for this eventuality containing provisions on the coordination of social security (health, long-term care, accident, pension and unemployment insurance). The aim of the draft Bill is to cushion any unfair hardships that might be caused by the fact of European law ceasing to apply in order to be able to continue to insure persons who are covered by German statutory health and long-term care insurance in the United Kingdom, as well as anyone planning to return to Germany after Brexit, or in the event of illness or need for long-term care. The Act will however only enter into force in the event of a disorderly Brexit taking place without a withdrawal agreement. The corresponding transitional arrangement for the reimbursement of planned treatment is set out in section 14 of the draft Bill. In accordance with this section, costs will be reimbursed as before if

  • the first of the benefits were taken up by 29 March 2019 and continue beyond that date, or
  • if prior authorisation from the health insurance fund is required in order to have costs reimbursed/to claim benefits, provided that the application was submitted by 29 March 2019, but the authorisation was not given and the benefits were not taken up until after this date.

If a benefit is taken up in the United Kingdom after 29 March 2019, section 13 of the draft Bill also provides for reimbursement of costs under certain circumstances in the event of a disorderly withdrawal. Please ask your health insurance fund for detailed information regarding your individual case.

More information

You will find more information on the websites linked to below should you have any Brexit-related questions



Pennefeldsweg 12 c
53177 Bonn

+49 228 9530-802/800

+49 228 9530-801
Online contact form

Privacy Policy for enquiries to EU-PATIENTEN.DE