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High levels of confusion among holidaymakers about how the European Health Insurance Card works is revealed in new research.
More than half of travellers who tried to use the card to cover medical treatment ran into problems, according to the study by Post Office Travel Insurance.
Separate research found that more than a third (37.5%) - around 4.4 million holidaymakers - suffered injuries that cost a over £1.1 billion.
Most common problems using the EHIC were encountered in Spain and France.
More than half of those who tried to use their EHIC in Spain and France encountered monetary problems, which led to their paying for all or part of their medical treatment.
In the case of Spain this follows a series of incidents in 2013 when UK tourists were denied free emergency medical treatment. In some cases the cost of treatment ran into thousands of pounds.
Although three-in-five people hold an EHIC, 27% do not understand what it is for or where and how it can be used.
More than half (55%) of those surveyed thought that an EHIC is valid only in the European Union whereas the card, available free from the NHS, entitles holders to state-funded healthcare throughout the European Economic Area.
Although treatment can be free, in many places it is offered at a reduced cost. However, only a third of those polled understood that they might have to make a financial contribution. Another third (32%) were under the impression that presentation of an EHIC would entitle them to free NHS-style treatment.
More evidence of confusion came as a quarter of people thought an EHIC could only be used for emergency treatment. Conversely, almost one-in-20 believed it would cover the cost of being flown back to the UK and similar numbers though it would cover them for private as well as state treatment.
Around one-in-nine holidaymakers said they had used or tried to use their EHIC abroad but 57% ran into problems that cost them money. Nineteen per cent had to pay towards the cost of treatment; 15% had to pay their bill and reclaim it via travel insurance, 15% had their EHIC accepted for treatment but had to claim on their travel insurance to return home and almost 10% tried to use their EHIC in a country that was not part of the scheme.
A separate poll into accidents and injuries to UK holidaymakers abroad found that more of these happened in Spain than anywhere else.
A quarter of people surveyed who needed treatment for sunburn or sunstroke and 28% who slipped or fell by swimming pools were on holiday in Spain.
They were among 38% of people who had an accident on holiday abroad in the past three years.
Animal bites and insect, jellyfish or stingray stings were the most frequent incidents, suffered by a quarter of the holidaymakers polled. However, potentially serious issues like food poisoning (14%) and sunstroke or severe sunburn requiring medical treatment (8%) were also commonplace.
Most injuries cost holidaymakers relatively small amounts of money. These ranged from an average of £47 for bites and stings to £118 for sunstroke or sunburn, £121 for a rental motorbike or scooter accident and £150 for a bathroom fall.
Post Office Travel Insurance found examples of individual injuries caused by bicycle accidents costing around £850 and of a sunburn victim paying around £1,500 for treatment. Some people were particularly accident prone and suffered multiple accidents costing them up to £7,500.
Nick Kennett, Post Office director of financial services, said: “The EHIC should certainly form part of your travel documentation when holidaying in Europe but you really do need to understand its rules.
“Our research shows that if you rely on an EHIC alone, you could suffer financially at a time when you are likely to feel vulnerable.
“The EHIC is far from being a substitute for travel insurance, which provides benefits for a wide range of issues including holiday cancellation or curtailment, theft, damage to property and private health treatment.”
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