Comprehensive Sickness Insurance Rules


To apply for British citizenship, applicants must show they meet an extensive range of eligibility criteria.

Proof of Comprehensive Sickness Insurance (CSI) is one such requirement for some, but not all, UK naturalisation applicants.

In particular, EU citizens with settled status may, depending on their circumstances, have to show they held CSI during their period of UK residence to be eligible for British citizenship.

In this article, we look at the rules on CSI for EU citizens applying to naturalise.


What is Comprehensive Sickness Insurance?

Comprehensive Sickness Insurance (CSI) is any form of insurance that will cover the costs of medical treatment.

For immigration purposes, acceptable evidence of the CSI requirement would usually include private health insurance, provided the policy provides comprehensive cover for the majority of risks whilst in the UK or proof that the individual is protected by reciprocal arrangements with their home country.

Types of insurance products that will not be accepted by the UK Home Office as proof of insurance include travel insurance policies or cashback health schemes, such as dental, optical or prescription charges.

Importantly, access to the UK’s National Health Service (NHS) does not count as comprehensive sickness insurance or meet any requirement under the immigration rules for an applicant to show they have or had CSI during any relevant period.


Is CSI needed for settled status?

On the 1 January 2021, following the end of the post-Brexit transitional period, a new immigration system will come into force in the UK. This means that all documentation issued under EU law to EEA and Swiss citizens, and their family members, such as permanent residence cards, will cease to be valid.

Instead, those living in the UK by 31 December 2020 will need to apply for immigration status under the EU Settlement Scheme.

Proof of comprehensive sickness insurance is not a requirement when making an application for settled status under the EU Settlement Scheme.

An applicant will be granted either settled or pre-settled status under the scheme. Settled status, or indefinite leave to remain, will be granted to those who have been resident in the UK for at least five continuous years. Pre-settled status will be granted to those who have been resident for less than five years, where a settled status application can be made having reached the necessary threshold.

For current holders of documentation confirming their permanent residence, this can be swapped for settled status under the scheme.


EU settled status to British citizenship

Settled status was introduced as a replacement for EU ‘permanent residency’.

Under the EU rules, UK permanent residence required EU or Swiss nationals to evidence a period of 5 continuous years’ residence in the UK “exercising their Treaty Rights”; typically this meant either being employed or self-employed.

If an individual was, during this period, economically inactive – eg studying, job seeking – they were required to prove they were self-sufficient and covered by CSI for the relevant period to attain permanent residence.

The permanent residence card was a mandatory  prerequisite to British citizenship for EU citizens.

Those who did not have CSI while economically inactive may therefore have been in breach of immigration law and ineligible to apply for British citizenship.

However, once granted pre-settled or settled status, EU, EEA and Swiss nationals “will not need to demonstrate that they were exercising a treaty right”, that, is, CSI is not required for this period.

EU citizens who cannot evidence self-sufficiency and CSI cover while economically inactive during the qualifying period may need to wait until they have attained the 5 years with pre or settled status to apply to naturalise. This means EU citizens settled in the UK may have to wait longer than anticipated to naturalise as British citizens.

Under government guidance issued in May 2020, however, holding settled status may not be sufficient in itself to prove an individual has been “legally resident” for the qualifying period.

CSI & applying for British citizenship

Despite much-needed government guidance being published on the role of CSI in citizenship applications, this remains a complex area. The specific facts of the application will determine decision-making as caseworkers have been afforded considerable discretion when deciding naturalisation applications where EU citizen applicants are not able to show the required CSI cover.

Under the guidance, while CSI is not a requirement for the new settled status, the rules for acquiring citizenship have not changed. EU applicants still have to prove they have been “lawfully resident” in the UK for 5 years under EU regulations.

The naturalisation application form asks for information to confirm the applicant was lawfully in the UK for the relevant three or five-year qualifying period.

This means providing evidence that they have been living in the UK lawfully throughout the relevant period by having been economically active during this qualifying period, or having CSI for periods of inactivity.

The Home Office guidance provides: “The grant of settled status (also known as indefinite leave to enter or remain) will not confirm that they were here lawfully under the EEA Regulations during that time, as defined by the British Nationality Act 1981 as this is not a requirement of the EU Settlement Scheme.”

Applicants must be able to show they have been in the UK lawfully during the qualifying residential period prior to settled or pre settled status being granted. They may therefore need to provide further information to evidence that they meet the requirement and were lawfully in the UK for the qualifying period of five years, or three years if married to or in a civil partnership with a British national.

This means EU nationals who have lived in the UK but during their qualifying period were without CSI while economically inactive will be deemed to have been in breach of the rules and therefore, ineligible for British citizenship.


Can I apply for British citizenship without proof of CSI?

Compliance with the EEA regulations is only relevant to residence prior to the grant of immigration status under the new scheme. This means that if you are prepared to wait before applying for citizenship, it should be possible to rely on the period of residence since being granted pre-settled or settled status without supporting evidence.

If, however, you are not willing to wait, you may be able to seek a discretionary decision on your application.

The Home Office recognises that many EU citizens with settled status may not have had CSI when required, and as such has granted caseworkers discretion to assess and decide naturalisation applications.

In circumstances where you have not had appropriate insurance in place, you will, for example, need to provide evidence to justify any discretion being exercised in your favour, not least by way of a satisfactory explanation as to why you were in breach of the regulations in the first place.

Each case will turn on its facts, but as this is a developing area and the guidance is recent, EU citizens are advised to take advice on their circumstances to ascertain eligibility and how their naturalisation application and evidence should be presented.

Need assistance? 

DavidsonMorris are UK immigration and nationality specialists. We have extensive experience helping citizenship applicants, advising on eligibility, compiling evidence and documents and guiding through the Home Office process. For advice on evidencing CSI, eligibility for British citizenship and making a naturalisation application, contact us.


Last updated: 2 June 2020


Founder and Managing Director Anne Morris is a fully qualified solicitor and trusted adviser to large corporates through to SMEs, providing strategic immigration and global mobility advice to support employers with UK operations to meet their workforce needs through corporate immigration.

She is a recognised by Legal 500 and Chambers as a legal expert and delivers Board-level advice on business migration and compliance risk management as well as overseeing the firm’s development of new client propositions and delivery of cost and time efficient processing of applications.

Anne is an active public speaker, immigration commentator, and immigration policy contributor and regularly hosts training sessions for employers and HR professionals

About DavidsonMorris

As employer solutions lawyers, DavidsonMorris offers a complete and cost-effective capability to meet employers’ needs across UK immigration and employment law, HR and global mobility.

Led by Anne Morris, one of the UK’s preeminent immigration lawyers, and with rankings in The Legal 500 and Chambers & Partners, we’re a multi-disciplinary team helping organisations to meet their people objectives, while reducing legal risk and nurturing workforce relations.

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