Being unwell in another country can quickly become expensive. So, how do the type of employment contract and your health coverage determine your protection abroad? What exactly should you do if you need sick leave?
Sick leave abroad: What health coverage will you have?
To know what protection you can expect while on sick leave abroad, you first need to clarify your legal status: are you classified as a posted worker or as an expatriate?
You are a posted worker if your employer sends you on a mission abroad for a short, predetermined period. Each country sets the maximum posting period, sometimes with the option to renew. You must respect the limit imposed by your home country. Generally, you remain affiliated with your home country's health insurance system. That means it is your home country that pays your daily sickness benefits while you are on leave.
By contrast, if you are legally considered an expatriate, you are no longer affiliated with your home country's health insurance system. Instead, you are covered under your host country's system. In most cases, your contract with your original company is suspended or terminated. You then depend fully on the laws of your host country.
Your status, whether as a posted worker or expatriate, has a direct impact on your protection when you need sick leave abroad.
If you are a posted worker abroad
To make sure your medical expenses are reimbursed while on sick leave, check that your employer has completed all the necessary procedures to register your posting with the relevant institutions. Confirm that a bilateral social security agreement exists between your home country and the host country.
Your employer must give you a certificate proving that you remain under the protection of your home country's social security system. Keep this certificate safe, as you will need to present it to the social security body in your host country. You may remain abroad, but compensation still comes from your home country.
Submitting your medical certificate
For your sick leave to be recognized, you must send the certificate quickly to both your employer and your health insurance body at home. The certificate must include:
- The name of the healthcare professional issuing the sick note;
- Your full name;
- Your employer's name;
- The start date and length of the sick leave—the note must be issued on the day of the medical consultation, after your examination;
- Whether leaving your home is permitted or not. If outings are authorized, the doctor must indicate the time slots allowed.
You remain subject to medical checks, both in your host country and in your home country. You are required to attend any compulsory follow-up consultations.
Payment of daily sickness benefits
It is your home country's health insurance system that examines your sick leave and determines your entitlement to daily benefits. Payment is made under the rules of your home country (including any waiting periods before compensation begins).
Reimbursement of medical expenses
Reimbursements are calculated based on your home country's health insurance rates. It is your country's legislation that applies. Medical costs you incur abroad are reimbursed according to your home system's conditions.
Family members
If you relocate with your family, they too remain affiliated with your home country's social security scheme. Their medical expenses can also be reimbursed by your home country's system.
Posting within the EU or outside the EU
If you are a European posted worker within the EU/EEA or Switzerland, you remain covered by your home country's health insurance. Request your European Health Insurance Card (EHIC) free of charge to access care at no cost.
If you're posted outside the EU, your employer must check whether a bilateral social security agreement exists between your home country and the host country. If no agreement exists, you remain affiliated with your home system, but you may also have to pay social security contributions in the host country.
If you are an expatriate worker
If you are considered an expatriate, your sick leave is covered by the health system of your host country. You can also choose to take out private health insurance. This rule applies even if you are a European citizen living in another EU/EEA country or in Switzerland. Unlike posted workers, expatriates fall under the system of their host country.
Submitting a medical certificate and receiving compensation
The requirements for a valid sick note are the same as for posted workers. However, the rules for compensation differ. Since you depend on the host country, daily sickness benefits are paid by the host country's system. These are calculated according to local legislation (duration of benefits, waiting days, etc.).
Be cautious, however, as compensation rules can vary within the same country. In the United States, for example, there is no federal standard for paid sick leave. Regulations vary by state. To avoid unpleasant surprises, many expatriates purchase private health insurance in addition to the mandatory local coverage.
What you should do in case of sick leave abroad
Even though your employer is responsible for handling most of the formalities, you should still take steps to prepare:
- Research the health insurance system of your host country, especially if you are moving as an expatriate.
- Contact your home country's health insurance body and your family doctor. Ask whether your medical condition (such as ongoing treatment) is compatible with relocation. Is a long-term stay feasible given your health?
- Depending on your situation, look into private health insurance. Medical costs can quickly become a major financial burden.
Doing your research in advance will help you anticipate potential healthcare expenses more effectively.
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