OBTAINING OUR CARTÃO EUROPEU DE SEGURO DE DOENÇA (CESD) EUROPEAN HEALTH CARD
I had an absolute nightmare obtaining my CESD. I cannot begin to tell you how happy I am to eventually receive it in the post after months of stress. I thought it would be beneficial to write a blog post about my experience as I know very well that others are fighting the exact same battle as me and may not be winning the fight. Firstly let me briefly explain what a CESD is because some folk are unclear. In simple terms it is the equivalent to the UK EHIC (European Health Insurance Card). The card allows you to receive medical assistance during a temporary stay in a country in the European Union, Iceland, Liechtenstein, Norway or Switzerland. CESD stands for Cartão Europeu de Seguro de Doença. This European Health Insurance Card is an individual card, so each beneficiary/holder and family member must have one each. It is only accepted in public hospitals or health centres.
You can apply for the European Health Insurance Card if you live in Portugal, are registered as a resident and are registered with SNS (Portugal’s National Health Service) and have a user number (Utente). You DO NOT need a Portuguese Social Security Number (NISS). This Gov.PT Website gives a full list of who can apply and different categories: https://eportugal.gov.pt/en-GB/servicos/requerer-o-cartao-europeu-de-seguro-de-doenca-da-seguranca-social
It clearly became evident to me whilst trying to apply for this card that the staff at the Social Security offices in Portugal do not understand their own rules and who is entitled to the CESD card. It should be a simple procedure but unless you are retired or working here and paying towards Social Security contributions, it is not always an easy process.
Please note that there is a different process for UK State pension holders and other S1 holders resident in Portugal. I am not going to share this information because I have limited knowledge of this process and we are below state pension age. For the purpose of this blog post I am going to refer to the Portuguese Social Security (Segurança Social) as Social Security. I am not going to list step by step instructions on how to apply as I am no expert and procedures change as often as the wind and I would not want to mislead or miss inform anyone. If you want a full and comprehensive guide on how to apply for every type and age of person please refer to the wonderful Facebook Group: British in Portugal and search the files or key in CESD/EHIC in the search bar and you will find the informative post with everything you need.
Firstly I’d like to clarify that we are a married couple both aged 49 and under retirement age. Hubby had a completely different experience to me. He is working here in Portugal and contributing towards social security which is directly taken from his salary. He obtained his Social Security number by visiting the Tábua Social Security Office. Apparently you can do this online now but he got his in 2022 and he physically had to visit the office and they gave him a sheet of paper confirming his Social Security Number. If you have a Social Security Number (usually if you are employed) you are supposed to be able to apply for the CESD online. This does not work for everyone. If you don’t have a Social Security Number you have to physically pay a visit to the Social Security Office. Hubby applied online and kept getting error messages but persistence paid off because after a couple of weeks of re-trying his online application was successful and he received his CESD in the mail.
With a UK trip pending I decided to apply for my CESD. I visited the Tábua Social Security Office with all my relevant documents including my residency proof (WA Biometric Card), original NIF document, original SNS Utente document and my Passport. I took hubby with me and he had his CESD card with him. Before I visited I made sure that I read up on the application process. I found useful information on the Facebook Group “British in Portugal”. This helpful support group is run by an amazing admin team including Tig James. These kind souls work relentlessly hard and volunteer their own time for free to help and support others and I will be eternally grateful for their invaluable advice. There is an amazing post on their Facebook Page outlining the whole process of how to apply. I am just sharing my own personal experience. I remember Tig’s post saying that I had to mention the words “Private Pension” or “Private Income” and NOT “Work Pension” because they will think that this is a state pension. Tig also suggested that if they refuse your application to show them the relevant pages of their own Manual de Acolhemento dos Cidadões Estrangeiros – SNS. The bit at the bottom of Page 16 is the most important part. I took this advice on board but I didn’t even get that far (ha ha).
The offices have a ticket system but you can check on a phone app how long the queue is and the approx. waiting time. In my experience it is never a long time at the Tábua office. The man on reception directed me to a computer in the corner of the office and said I had to do it online. We were lost in translation but he would NOT issue me my CESD and was adamant that I had to apply online. The online application he directed me to was to apply for a Social Security Number (NISS) not a CESD. I tried to explain that I did not need a NISS Number to apply for a CESD but he said that I did. I am not working here in Portugal and have no intention of working unless my language skills improve dramatically then I might look for PT job options but seeing as my language learning is pants even after a year of school tuition I doubt that I will be seeking employment any time soon in the near future so I didn’t really want to apply for a NISS Number as I have heard that it can or may cause complications re tax. We file a joint tax return each year. Having a NISS Number shouldn’t have any negative impact so I decided to apply as it seemed the only way to then apply for my CESD. I tried to complete the online form in the office in front of the member of staff but it kept coming up with an error message. The member of staff shrugged his shoulders and told me to go and apply online from home.
I returned another time and had my ex husband on speed dial to help with the language barrier as he is fluent in the Portuguese language whereas I’m just fluent in Bristolian and bullshit (ha ha). I got nowhere and was told to go and apply online. At this point I wanted to bang my head against a brick wall. The office is located right next to a learner driving test school and when I vacated the building I looked equally as stressed as the folk taking their driving test (ha ha). I would like to point out that although the staff member obviously did not know the rules for the CESD application, he wasn’t rude or abrupt, just clueless. The staff are nothing like the receptionists at the Arganil SNS Centro de Saude who have blatantly been so rude and had me in tears on multiple occasions. The last man just walked away from me mid conversation when I asked to file an official complaint and he never came back! I would have registered a complaint in the official Yellow Book but I can not find the SNS Arganil Doctors surgery on the complaints list. I go somewhere else now and have an awesome family Doctor. I will never step foot inside that place ever again unless I am given 6 months to live, then I will return after a spicy curry and do a profound dirty protest on their reception floor (ha ha).
The nightmare continued on in the comfort of our home. First I registered and tried to apply for my NISS Number online by using this website: https://app.seg-social.pt/ptss/gus/adesao I kept receiving error messages, then just blank screens where the application should have been. Eventually after many attempts my application was successful and I received an email to say that my NISS Number was ready to collect from the Tábua Office. I am not sure the point of applying online if you then have to visit the office to collect it. Why can’t they post it or why can’t one apply in the office in person? It just doesn’t really make any sense. Once I collected my NISS Number from the Tábua Office I was delighted because I thought that now I had a NISS Number that I would be able to go home and apply for my CESD online, I was WRONG so VERY WRONG! (ha ha).
Once you have your NISS Number you can create a login and password to access the official Social Security website and apply for your CESD: https://app.seg-social.pt/sso/login You can also access your personal details and view any social security contributions etc. (if you have any). I tried several times over the next few weeks to apply online for my CESD but I kept getting error messages then eventually I received a message saying that I could not apply online and to visit my nearest Social Security Office. It was like Déjà vu or a bad case of Groundhog Day. I headed back to the Tábua Office feeling demorilised and drained like a deflated balloon. I did not hold high hopes for a positive outcome and my intuition was correct. They turned me away and guess what? They said I had to apply online! I didn’t even have the energy to rant and rave at them, I just left in total disbelief. The key word is FRUSTRATED! I may or may not have had a loud scream in our car (ha ha). I tried over the next few weeks to apply online with no success. I decided to message Social Security via the website message system. I received an automated message then they just didn’t respond.
At this point I was frustrated as hell, I think infuriated is a better word to describe how I felt. All I could see was 2 options, possibly 3. 1: Go handcuff myself to a Tábua Office radiator whilst singing “We shall not be moved” on repeat and risk a Crazy Brit standoff with the Police or 2: Try a different office. I did debate Option 3: A dirty protest (ha ha). One thing I know for sure after living here in Portugal for 3 ½ years is that although there should be one set of rules for everyone and the whole country, one’s experience can differ greatly depending on which government office you visit and which particular staff member you see. Everyone you speak to will tell you a slightly different story. My main issue was that hubby works long hours and doesn’t finish until after 5pm and by then all the offices are closed. I couldn’t find an office near me that was open on a Saturday and I don’t drive here so I am very limited with regards to trying different locations. I wrote a brief outline of my hellish ordeal on the British in Portugal Facebook Group and others shared their success which varied dramatically. Some folk managed to get their cards without a Social Security Number by obtaining the help of a lawyer who applied on their behalf. Others managed to get a Social Security Number by declaring themselves a “Trabalhador Independente” and then applying, then immediately closed down the activity once they had the number. Others were successful by contacting the British Embassy in Lisbon and a lot of people were successful by just trying different offices and arguing with the staff until they gave in and said yes. I also know of a person who was considering asking to voluntarily contribute some social security payments. It’s so crazy and naive thinking that you would only live in Portugal if you have retired or are working. It really shouldn’t be this hard to get something you are legally entitled to!
To be honest I rarely travel outside of Portugal and my trip back to the UK this summer will likely be my last for a long while unless someone dies or one of my kids gets married or gives birth so I was thinking I might as well give up and just buy private medical insurance because I know that the CESD offers limited cover. Just as I was about to throw in the towel, the feisty menopausal beast inside of me decided to give it one last shot. I decided on option 4: To make a formal complaint. I have used Livro de Reclamações (The Official Complaints Red Book) here in Portugal on 3 separate occasions and I have been successful each time. Here is the link just in case you are interested: https://www.livroreclamacoes.pt/INICIO/ The red book really works and gets action fast and great results in my case. I couldn’t file a complaint via the red book because the Social Security Office is not a business but there is a similar Yellow Complaint Book for non businesses which includes Government Offices so I filed a complaint online: https://www.livroamarelo.gov.pt/home
Segurança Social (Tábua Social Security Office)
Enter at your own peril (ha ha).
My Chain of Communication with the Yellow Complaints Book
25/05/2023 My Initial Complaint
I obtained my NISS Number online and collected it from the office and whilst there I requested my CESD (European Health Insurance Card). The Tábua office said I had to apply online for my CESD. I have tried doing this several times over the past 3 months and the online system does not work. It says I need to visit the office but the Tábua office will not issue me my CESD. They issued my husband his CESD in 2022 but they refuse to issue mine. I am legally entitled to a CESD. Please help me rectify this situation.
31/05/2023 1st Yellow Book Email Response
Dear Ms. Helen Allen,
We received the complaint XXXXX, which you submitted on 25-05-2023, referring to the European Health Insurance Card (CESD), which deserved our best attention. We regret the dissatisfaction expressed by not being able to obtain the CESD, given that the Social Security Institute, I.P. (ISS) is making efforts to improve the service it provides to citizens. Analysing his exposure, it was found that she came to apply online for the issuance of the CESD, but does not have any qualification in the Portuguese Social Security, therefore not having any contributions registered in his name. For this reason, when she applied for the issue of the card, on the CESD platform of Social Security Direct, the system did not allow her to complete the request, as she did not meet the conditions required for obtaining the card and did not, as she claims, for not finding it working. As she refers, the system informed her that she should go to an attendance service, which she did, and the Tábua Local Service refused her to register the request for the card to be issued, although the same request had been made and accepted , in 2022, by your spouse. Indeed, a CESD was issued to his spouse, the request having been made through the Direct Social Security, but already in the current year of 2023. The corresponding card was issued, considering that, at the time of the request, the applicant had qualifications/contributions in the Portuguese Social Security. In these terms, you have concluded the Local Tábua Service, as our services also conclude, that you are not entitled to issue the required card. And that’s all there is to report. With your contribution, we will take the necessary measures to continue to improve the quality of the service we provide you. For more information, consult the portal www.seg-social.pt.
With our regards,
The Yellow Book Team
Basically they are saying I cannot apply because I do not fit the conditions/requirements as I am not working and have not made contributions/qualifications but hubby has made contributions and that’s why he got one issued. At this point I was thinking that I wasted my time and got my Social Security Number for nothing! Again I was about to give up but thought I would give it one last final try so I submitted a 2nd Yellow Book complaint online.
31/05/2023 My Second Complaint
I am dissatisfied with your response to my complaint (Number XXXXX). You confirm that I am not entitled to a CESD due to the fact that I have not met the conditions/requirements as I am not working and have not made contributions/qualifications. This is WRONG! I am LEGALLY entitled to receive a CESD as I have a PRIVATE PENSION (PENSÃO PRIVADA)/PRIVATE INCOME (RENDIMENTO PRIVADO). I am also entitled to a CESD based on my family FoM/Withdrawal Agreement rights and my health service registration. My husband pays SS here in Portugal and is working. Please refer to the relevant pages of your own Manual de Acolhemento dos Cidadões Estrangeiros – SNS. The section at the bottom of Page 16 reads as follows: “Estes cidadãos europeus têm direto ao Cartão Europeu de Seguro de Doença emitido pelo sistema de segurança social português, nos termos dos procedimentos definidos na Circular de Informação Técnica no 7. de 11.05.2012, da Direccão-Geral da Segurança Social.” “These European citizens have the right to an EHIC issued by the Portuguese social security system …” [“These European citizens” being economically inactive nationals of other EU countries who reside in Portugal, to whom the whole of section 1.4 on pp.15-17 refers.] SNS Manual: https://www.sns.gov.pt/…/CHLeiria_CidadaosEstrangeiro If you continue to refuse me my legal right I will have to resort to asking the British Embassy for urgent assistance. I look forward to your response.
In the meantime I managed to get a contact name at the British Embassy in Lisbon from a kind lady who went through the same ordeal as me in 2021 and this lady helped her. I emailed her politely requesting assistance but I am still awaiting a reply. To be honest I was reluctant to email my Embassy as I know they have bigger situations to deal with and families to support but it’s my legal right to have a CESD so I thought I’d give it a go.
I did not expect a positive outcome from my 2nd Yellow Book complaint so I was debating if I should get hubby to book a day or afternoon off of work and try the Tondela Office where another Facebook lady had a positive result and obtained her CESD. I was planning to go fully equipped with the section of the handbook printed out and explain that it’s my legal right to have one. I don’t like to admit defeat especially when I know I’m right and I am entitled to something but my health is not great at present and I’m frustrated beyond belief. After a few strong coffees and a scream in the garden I had enough energy to commence the battle. Then my medical needs took priority and I had to deal with the SNS (equivalent to the UK NHS) and try and get an urgent appointment for CT/MRI scan so that took priority so I put my CESD on the back burner. I think the Yellow Book says it will respond within 14 days and I knew it was approaching this time frame when by complete surprise, I received the following email!
13/06/2023 2nd Yellow Book Email Response
Dear Helen Allen,
We received the complaint XXXXX, which you filed on 31/05/2023, referring to the European Health Insurance Card (CESD), which deserved our best attention. We regret your dissatisfaction for not being able to obtain the document you wanted, clarifying that the Social Security Institute, I.P. (ISS) is strongly committed to improving the service it provides to citizens. Thus, after re-examining her CESD request, it was concluded that she was right. You are a citizen of English nationality, as covered by BREXIT: • British citizens who were residing in Portugal, under the right of freedom of movement, until 31 December 2020, are covered by the Withdrawal Agreement. • British citizens, covered by the Withdrawal Agreement, thus maintain their rights to healthcare in the European Union country where they live, including the right to CESD, when the requirements for that purpose are verified. Therefore, the CESD request is already registered, using your National Health Service (SNS) user number, and should reach your possession (at the address registered in the Social Security Information System (SISS), within about of 8 (eight) days. We apologise in advance for any inconvenience caused. With your contribution, we will take the necessary measures to continue to improve the quality of the service we provide you. For more information, consult the portal www.seg-social.pt.
The Yellow Book Team
What can I say, I was bloody ecstatic and on a high for the whole day. I didn’t share my news with anyone except hubby until I had my CESD in my sweaty little hand. I thought I was happy when I received my WA Biometric Card but this challenge was fierce so I’m over the moon. Hubby and I were dancing in the kitchen, we choregraphed our very own VICTORY dance (ha ha).
18/06/2023 Response from Lady at the British Embassy in Lisbon
I was so grateful to receive a speedy response from the lady at the British Embassy. She confirmed that she would normally call the office that I was dealing with and try to speak with officials there, but unfortunately it’s not possible to call individual Social Security Offices as their numbers are not available to the public as all calls are handled by their Contact Centre. However, she did think that I had a strong case to challenge the information I had been given by showing the member of staff the guide which she kindly sent me via email. It has been produced by the Portuguese Ministry of Social Security. She also sent me an application form with the sections completed for people who do not make social security contributions, but who have a “Numero de Utente”. She suggested that I could complete the application form (if I haven’t already) and take it with me. There is also information on the Social Security website which very clearly states that beneficiaries of the Portuguese national health service are entitled to a Portuguese-issued EHIC. This information is here – https://www.seg-social.pt/pedido-cartao-europeu-seguro-doenca#. Any family members in the same situation, should complete a form too and you can download a blank one from the Social Security website here – Formulários – seg-social.pt
She also confirmed that she will inform officials at the Ministry that there seems to be some confusion on the frontline about who is entitled to the card, and how they can apply for it. What an amazing lady and such a result.
My CESD Card Arrived! (22/06/2023)
It took 9 days for it to arrive in the post via CTT but look at my little face. I’m over the moon! The next challenge will be renewing it in 3 years time (ha ha). Believe it or not I have read horror stories where people have been denied their CESD even after showing their old expired one. Yes, I know, huge sigh and WTF! Welcome to Portugal my friend (ha ha). If you can get over the BS bureaucracy then it’s a wonderful place to live. We are still living the dream, I just have a few more grey hairs (ha ha). I let the lady at the British Embassy know that I now have my CESD card and she was very happy for me.
What have I learnt from this nightmare experience? I have learnt that the Tábua Social Security office like to tell people to go home and apply online (ha ha). The main thing I have learnt is to try not to to get angry and take long deep breaths. Tomorrow is another day and one can start a fresh so to speak. There is no point in making yourself ill over something that is out of your control. Some processes take longer than others. The main thing I have learnt overall is not to give up when you are 100% sure that you are right and legally entitled to something. Keep fighting the fight.