The jpoc guide to health cover when you work abroad
The E128 health care form

There is a form, the E128, that you can use for a short period of work outside the UK but the form is so hedged round with exemptions and get outs that you are foolish to rely on it and it is likely to be a very expensive way to receive cover.

Why? How can it be expensive to receive free cover?

The form is designed for an employee of a British company on, for example, a sales presentation trip to Paris. Or perhaps for the commissioning engineer at a British machine tool manufacturer who will be on site for a month while a system is installed and handed over to a customer in Germany. To be eligible, you must be on a short, temporary assignment in, for example, Germany, you must either be an employee of a UK company or a freelancer and you must expect to return to work in the UK at the end of the assignment. You must also remain Ordinarily Resident in the UK for tax purposes and pay full UK tax and National Insurance and you are also subject to the IR35 rules!

Being an employee of your one-man UK limited company will not work. Suppose that you try this for a contract in Germany. It will get you an E128 but then you will fall foul of all kinds of German rules when it comes to running a one-man limited company in Germany. Don't try and get smart about the company not being in Germany. German law says that if the person who does the work and exercises effective control of the business spends his time and does that work in Germany, then the company is being run in Germany and must be registered as a business and as an employer there in Germany. Even if you are not a director of your company, you will still be caught by this.

Strictly speaking, signing up with an umbrella company will not work either. You need to be working for them before you go to work overseas. Joining them just for the foreign work does not cut it although of course many people do just this and it often slips through.

OK, you could still try to go freelance but that will have its own costs. Not the least of which is that your freelance earnings in Germany will fall foul of IR35 rules in the UK.

Of course, if you already work through a UK umbrella company then you do have the option of continuing as their employee for a foreign posting and then, you can use an E128 for 12 months. It is possible to claim this form for another twelve months if your period of working outside the UK unexpectedly lasts for longer than twelve months. But this requires permission from the host country.

Note also that, in order to claim the E128 related benefit, you must be paying full UK contributions. Paying the small monthly voluntary contribution gets you an entitlement to the UK minimum benefits like a state pension but not health insurance.

Finally, if you do get an E128, remember that it is only valid for the country in which you are working. You will need an E111 for trips to other EU or EEA countries.
In Detail
Introduction General issues about the reciprocal agreement
E111 The E111 form
German Healthcare General Healthcare Issues to consider when working in Germany
My other links
Taxation General taxation issues of interest to UK expats.
Social Taxes Some more general information about social taxes
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