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Some families pay for or contribute towards the cost of medical insurance and it is essential to find out well in advance whether your employers are prepared to do this. In some countries they are compelled by law to provide insurance, so check this out. Even if you are allowed to participate in the national scheme of the country you are going to, you may find that there are important exclusion clauses such as for dental treatment, non-emergency treatment, prescription drugs and so on.
No matter what country you are heading for, but especially if it is an EU country, you should obtain the Department of Health leaflet T6 Health Advice for Travellers Anywhere in the World available from post offices or by ringing the Health Literature Line 0800 555777.
If you are a national of a European Economic Area country (namely the UK, Ireland, Netherlands, Belgium, Luxembourg, Denmark, Germany, France, Italy, Spain, Portugal, Greece, Sweden, Finland, Iceland, Norway and Austria) and will be working in another EEA country, you will be covered by European Social Security Regulations.
Advice and the leaflet SA29 Your Social Security Insurance Benefits and Health Care Rights in the European Community and in Iceland, Liechtenstein and Norway may be obtained free of charge from the National Insurance Contributions Office, International Services, Benton Park View, Newcastle-upon-Tyne NE98 1ZZ (08459 154811).
According to the Department of Health information (updated in 2000), `If you are an EEA national who is normally resident in the UK and are going to work in another EEA country as an au pair or nanny for up to 12 months, you are entitled to Form E111.' The E-111 (called the `E-one-eleven') is a certificate of entitlement to medical treatment in other member states. The application form is contained inside leaflet T6 mentioned above. Whereas ordinary tourists can have the form stamped and activated at their local post office, people who are intending to work abroad should send the application to the Contributions Office in Newcastle at the above address. Unfortunately they can take a long time to reply, so write off as early as possible. Take several photocopies of the certificate since in some countries you need to hand over a copy of the E-111 to any doctor or chemist with whom you deal.
Given the limitations of state-provided reciprocal cover, you may decide to take out comprehensive private cover which will cover extras like loss of baggage and, more importantly, emergency repatriation. The cost of bringing a person back to the UK from any overseas country in the event of illness or death can run to thousands of pounds. In all other countries not listed above comprehensive private medical insurance is essential.
Most insurance companies offer a standard rate that covers medical emergencies and a premium rate that covers personal baggage, cancellation, etc. as well as health. Always read the fine print.
In countries where no Social Security agreements exist, the leaflet NI38, Social Security Abroad, gives an outline of the National Insurance contributions and social security benefits in countries with no reciprocal agreement with the UK. If you work for an employer in another country you may be liable to contribute to that country's Social Security scheme; however if you become employed by a United Kingdom employer you may be required to pay UK National Insurance at the Class 1 rate during the first 52 weeks of employment abroad. Even if you are not obliged to pay, you may want to pay voluntary contributions (Class 3) so that you will still qualify for certain benefits upon your return to the UK. Leaflet N1208 gives the latest rates for contributions and is available at your local Jobcentre. These contributions may be paid at regular intervals or, alternatively, in a lump sum.
As mentioned above, it may be the family's responsibility to make contributions on your behalf (as it is in the UK for employees earning more than £87 a week) however one cannot assume that the family will automatically abide by the regulations.