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So what happens if skiers contract CV19 on holiday?

 Poster: A snowHead
Poster: A snowHead
rob@rar wrote:


If a non-UK resident has an accident which requires, for example, admission to A&E, x-rays, fractures being set and plastered, are they simply discharged at the end of the process, or is there some identity check and confirmation of liability so that funds can be claimed back under EHIC?


The NHS don't have any real structure in place for claiming back under EHIC rules given the system is free at the point of use and AnE treat everyone. I expect the 50 million reclaimed is for more organized treatment than AnE. The whole UK welfare system is a poor fit with the EU. The issue with AnE is pretty well documented. You (UK politicians) can either reform your system given you are members of a club and have entered into agreements or you can rant at the EU and flounce around Europe demanding something should be done like Cameron did.


Last edited by Poster: A snowHead on Tue 4-08-20 8:56; edited 1 time in total
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@rob@rar, Payment offices do exist, (or used to) there is/was one in our local hospital. I can`t remember why I had to find it once but I did.
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Well, the person's real but it's just a made up name, see?
The UK Government set a target of recovering £500m from overseas patients by 2017/8, but has come nowhere near that. (Not sure what proportion would be EU). Many UK hospitals don't even attempt the process. Many UK doctors say it's not in their their job description. Last year, the British Medical Association (GPs' union) voted at its annual conference, held that year in Belfast, to abandon the concept of charging overseas patients for using the NHS.
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davidof wrote:
The NHS don't have any real structure in place for claiming back under EHIC rules given the system is free at the point of use and AnE treat everyone. I expect the 50 million reclaimed is for more organized treatment than AnE. The whole UK welfare system is a poor fit with the EU. The issue with AnE is pretty well documented. You (UK politicians) can either reform your system given you are members of a club and have entered into agreements or you can rant at the EU and flounce around Europe demanding something should be done like Cameron did.
Thanks, that's what I though was the case.

I was impressed by how efficiently the discharge system at Albertville hospital operated for non-residents, EU and non-EU citizens. No involvement form the medical staff, and the bit of the office that I saw didn't seem to be rammed full of 'faceless bureaucrats' sucking the finances out of the system. Just a few staff with a well ordered procedure for ensuring payment as necessary.
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rob@rar wrote:


I was impressed by how efficiently the discharge system at Albertville hospital operated for non-residents, EU and non-EU citizens. No involvement form the medical staff, and the bit of the office that I saw didn't seem to be rammed full of 'faceless bureaucrats' sucking the finances out of the system. Just a few staff with a well ordered procedure for ensuring payment as necessary.


The French hospitals are very good at getting their money !

but don't be fooled, one of the things the Covid-19 crisis has shown is how poor the health system is now and how much money vanishes in bureaucracy.
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There are two separate issues here:
(1) does the government get the NHS to recover EHIC costs adequately; and
(2) is the EHIC card a benefit to UK nationals when skiing in Europe.

The second is obviously the case: denial of it speaks to the motives of those who attempt it.

If the first is an issue, it could easily be fixed without affecting the second.

--
The NHS's "billing system" (HES / SUS) is a little creaky, but functional. Everything in a UK hospital
has a tariff and is billed electronically. None of this has anything to do with the EU, other than that
right wing people like to try to connect the two.
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Quotes from the NHS website: the first most of us know, but the second was a surprise to me:

1. "The EHIC is not an alternative to travel insurance. It will not cover any private medical healthcare or costs, such as mountain rescue in ski resorts or being flown back to the UK."

2. "You may not be able to use the card in some parts of the EU, Norway, Iceland, Liechtenstein or Switzerland, as state-provided healthcare may not be available in certain areas."

Can anybody shed any light on this second point? Does eligibility vary by canton, or commune, or something?
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@mitcva, some hospitals/clinics are private.
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So, if you happen to be skiing in an area which doesn't have public medical facilities, your EHIC card is useless? Do we know which resorts this might include?
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mitcva wrote:
2. "You may not be able to use the card in some parts of the EU, Norway, Iceland, Liechtenstein or Switzerland, as state-provided healthcare may not be available in certain areas."

Can anybody shed any light on this second point? Does eligibility vary by canton, or commune, or something?


Private medical facilities, such as the minor injury clinics you find in many ski resorts, are not included in the EHIC scheme. Far from being a red herring, this is just a question of finding out what you are covered for, just like you should do with insurance of all kinds.
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mitcva wrote:
So, if you happen to be skiing in an area which doesn't have public medical facilities, your EHIC card is useless?

Correct.

mitcva wrote:
Do we know which resorts this might include?

It would be easier to know where you are going and then check.

What is the issue though? You would just pay for the treatment and claim it back of your insurance.
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@mitcva, ah so you are in no way an expert in EHIC but were so keen to denigrate your fellow citizens who actually understand where and how is is used and therefore the true consequences of ideological withdrawal from the scheme.

Got it.
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@mitcva, ah so you are in no way an expert in EHIC but were so keen to denigrate your fellow citizens who actually understand where and how is is used and therefore the true consequences of ideological withdrawal from the scheme.

Got it.
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You know it makes sense.
rob@rar wrote:
mitcva wrote:
2. "You may not be able to use the card in some parts of the EU, Norway, Iceland, Liechtenstein or Switzerland, as state-provided healthcare may not be available in certain areas."

Can anybody shed any light on this second point? Does eligibility vary by canton, or commune, or something?


Private medical facilities, such as the minor injury clinics you find in many ski resorts, are not included in the EHIC scheme. Far from being a red herring, this is just a question of finding out what you are covered for, just like you should do with insurance of all kinds.


Actually they are, but indirectly. The clinic in our village is private. Mrs t_m had a course of treatment last winter that resulted in a bill for about CHF500. This we paid. We then filled in a form and made a copy of her EHIC and mailed it off to the relevant Swiss authority. Within a couple of weeks we got a refund of about 90% of the cost directly into her bank account. EHICs are awesome.
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So, the NHS website is correct. EHIC is not an alternative to travel insurance. And you could end up skiing in a resort where EHIC isn't even used. Got it.
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 Poster: A snowHead
Poster: A snowHead
Having used resort clinics in France and heli-evac in Switzerland: you need to be aware of

0. What is automatically covered by the Skipass insurance - this is never billed to you
1. The local process for what is charged immediately and what is billed - both of which you pay for
2. the elements covered by EHIC immediately - no charge made to you at all, and
3. the elements covered by EHIC subsequently - you're charged and pay, and the insurer reclaims the EHIC element of their refund.

So a few points I'd make.

Always take out the assurance you're offered at the caisse. Even if you are certain you're covered by your insurance. This avoids you having to pay the helicopter evac bill, for example (about £100/minute for us in March, just for the helicopter), and then claim it back form the insurer. And the bill for the pisteurs, the paramedics and the on-board doctor. Much less hassle to just fork out the £3.50/day. And you never know, your insurer may start to quibble when you present them with a £5K bill for a particularly lengthy helicopter excursion.

Be aware, if you can, of the distinction between any EHIC-covered and non-EHIC clinics in a resort. Private clinics will charge you for everything. Whether you'll get refunded may be questionable if the insurer can't reclaim the costs that would have been covered by EHIC.

In any event, be prepared for what is a very strange process in some places where you don't get secondary treatment (say application of a cast) until you've taken the doctor's prescription to the pharmacie, paid for the whatever, and brought it back for them to use.

At the hospital, you will probably be asked to sign various things. Which if you're injured badly and alone, and it's in French/German, you will do. So it's always useful for a group to have someone nominated to drive to the hospital if they can't go in the ambulance. There isn't usually room in a medical helicopter for anyone to accompany the patient. With luck, if you have your EHIC details with you (or they're brought by your designated helper) then a big chunk of the hospital charges will never be presented to you - they'll just get reclaimed in the background.

It's also useful, especially in a group, to get in contact with the insurer ASAP. We found that ours (LV=) were really helpful re the admissions and treatment process e.g. they told the patient's helper to make sure they got a full discharge doctor's report and ask for a Declaration of Fitness to Travel if one wasn't provided. A good insurer will translate this and get it checked to make sure the hospital isn't just shoving you out to get rid of you. It also allows them to get tickets on and outbound and return flight, and hire car, for a Helper if someone from the UK needs to accompany the patient on a flight back. Obviously, this is much easier if the insurance emergency helpline and policy number is readily available (actually, not a bad idea to have these on you when skiing - some insurers email a PDF with the details for everyone to print off and carry).

For a serious incident, you'll find bills will trickle back to you for some time afterwards. For us, these were the heli-evac (£3K), the medics (£350) and pisteurs (£200), and the Swiss State charge (£75). Our insurer paid all but the last directly, so we didn't have to pay first. The last one for some reason had to be paid by the patient and we claimed it back. These all came in over a 3 month period after the accident. The hospital charges got reclaimed by their EHIC internal process.

I'm sure other people will add their advice.


Last edited by Poster: A snowHead on Tue 4-08-20 11:25; edited 1 time in total
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That's very helpful. Thanks.
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The EHIC, just like Carre Neige, never has been a substitute for taking out Travel Insurance.

This is what you get:

"If you need medical treatment while you're in another EU country, presenting your European Health Insurance card (EHIC) can simplify payment and reimbursement procedures.

With your EHIC you can get healthcare - and claim reimbursement for the costs you incur - on the same terms as nationals of the country you are in . If the treatment you need is free for local residents, you won't have to pay. If you have to pay for your treatment, you can either ask for reimbursement from the national institution whilst still in the country and get reimbursement directly there, or ask for reimbursement from your health insurer when you get home.

Your expenses will be reimbursed according to the rules and rates of the country where the treatment was received . So you will either be reimbursed for the full cost of the treatment, or you will have to pay the patient's fee according to the rules of the country where you were treated. Alternatively, your insurer may decide to reimburse the full cost according to its own rules.

Each EU country has at least one National Contact Point that can assist you with questions on reimbursement

If you don't have your European Health Insurance Card (EHIC) or you are not able to use it (for example, at a private hospital which is not covered by the EHIC scheme), you may be asked to pay for your treatment. You can then claim reimbursement from your health insurer when you get home. This applies to both public and private healthcare providers. However, the terms will be different:

- Only treatments which you are entitled to receive at home will be reimbursed

- You will be reimbursed only up to the cost of treatment in your home country – which may be less than you paid for the treatment

If you need urgent treatment, your local health authority might be able to help by faxing or emailing proof of your health insurance coverage to avoid you having to pay upfront.

If you're not sure about your entitlements and want to check before getting treatment, each EU country has at least one National Contact Point that can inform you whether or not you will be entitled to reimbursement, and whether any ceiling applies.

The rules are different if you travel abroad specifically for medical treatment."
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mitcva wrote:
So, the NHS website is correct. EHIC is not an alternative to travel insurance.
I have house insurance and car insurance. I don't expect one to cover the other, that would be just stupid. Nor would I criticise one as irrelevant because it doesn't cover the other. People who don't understand the difference, on the other hand...


Last edited by You need to Login to know who's really who. on Tue 4-08-20 12:21; edited 1 time in total
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mitcva wrote:
And you could end up skiing in a resort where EHIC isn't even used. Got it.
You could be skiing in a resort with only private medical facilities, many in France for example, and have an accident which is serious enough to be flown to a public hospital which serves the region. This happens frequently.
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How many people from the UK will stop skiing in Europe if EHIC goes? I'd say that's the red herring test. We might find out later this season, although it may be difficult to isolate this particular factor alone. EHIC came in long after I started skiing, so its absence won't put me off.


Last edited by You'll need to Register first of course. on Tue 4-08-20 14:22; edited 3 times in total
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Uncertainty affects the assessment of risk though, doesn't it? Looking NOW at beach resorts is different from looking at beach resorts in six months time. It's not just about comparing beaches and ski resorts.
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Yes, I agree.

Also, consumer confidence is a fragile thing. I have no commercial interest in any aspect of skiing, but I have a feeling that if ski coaches etc make a huge Project Fear fuss about EHIC, they may scare the punters. It's a balance, perhaps.


Last edited by After all it is free Go on u know u want to! on Tue 4-08-20 14:32; edited 1 time in total
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mitcva wrote:
How many people from the UK will stop skiing in Europe if EHIC goes? I'd say that's the red herring test. We might find out later this season, although it may be difficult to isolate this particular factor alone. EHIC came in long after I started skiing, so its absence won't put me off.


But the point is it might be severely disadvantageous for many people - if travel insurance is probhibitive for cover for certain pre-existing conditions you could at least rely on EHIC if you needed a long and serious hospital stay. For that very reason many older people end up restricting their travels to EU countries. And for everyone the cost of travel insurance was kept down as the insurers knew say that most medical claims in the £1000s would be covered on EHIC i.e. patients are evacced to proper hospitals for major things.
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I have never heard anyone say they won't go skiing simply because the insurance is too expensive. Everything else, yes. (Perhaps I have led a sheltered life!)
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mitcva wrote:
How many people from the UK will stop skiing in Europe if EHIC goes? I'd say that's the red herring test. ...
But as discussed, it's 100% certain that the loss of the EHIC will increase the costs of every person who feels the need to insure when travelling to Europe.

It's irrelevant to go on about people who don't ski; people who ski on other continents; immigrants; those who don't insure; or those who are rich enough not to care.
Those are all your red herrings.
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mitcva wrote:
I have never heard anyone say they won't go skiing simply because the insurance is too expensive. Everything else, yes. (Perhaps I have led a sheltered life!)


Well to fit your fact pattern of a world without EHIC how many people with heart conditions do you know who have investigated the cost of insurance for a ski holdiay in the US?
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Of course we don't know for sure that there won't be an EHIC equivalent in the future.
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You know it makes sense.
Loss of EHIC will indeed increase the cost of ski insurance in Europe, having been in place since 2004, but I wonder how expensive ski insurance has to be before it becomes prohibitive? What proportion of overall ski trip costs?
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mitcva wrote:
Loss of EHIC will indeed increase the cost of ski insurance in Europe, having been in place since 2004, but I wonder how expensive ski insurance has to be before it becomes prohibitive? What proportion of overall ski trip costs?


I think Dave's point is that for some people it will be prohibitive but overall, on average, the increase may not be huge.

That said you wouldn't want to stay long in a French hospital with an EHIC alone, you wouldn't want a Michael Schumacher like injury without good insurance, but I expect it would make complimentary insurance cheaper.

Access to certain benefits including long term health cover and income support actually becomes easier for long term French residents from non EU countries (due to treaties to reduce benefit tourism within the EU). That doesn't help holidaymakers but may help a few cases of destitute French resident Brits.
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One of the reasons why commercial insurance is so important on top of EHIC is that insurers are incentivised to fund expensive repatriation for you, when the NHS wouldn't. Even if the EHIC is covering your hospital bills, the insurer (if it's a decent policy) is still forking out money for your companion to stay there and for your recuperation and medicines once discharged. Bringing you back ends all those costs - £20K to hire a medical 'plane to repatriate you may sound a lot, but the bills associated with accommodation, taxis for hospital visiting, subsistence for your companion etc soon mount up. And bringing you home means no possibility of post-accident complications prolonging your stay, at yet more cost.

Many people mention 'previous conditions' as if this was something unusual. But advances in medicine mean that a lot of people start to acquire conditions (or rather, have them identified) in their 40s-50s. In the 45-54 age range 49% of men have high blood pressure; in the 55-64 range it's 65%; and in the 65+ it's 84%. There are many other conditions that aren't life-threatening but are very common in the over-50s and can mean a trip to the doctor's, or A&E if you're unlucky. Without the EHIC, insurers will have to factor all these in.

In some ways, not having EHIC might simplify the framework around travel insurance, as EU travel would just be like US travel - the insurer is liable for everything. So there's no misunderstanding about what the EHIC covers and what it doesn't. Trouble is, with US ICU nominally costing upwards of $20K a day for the most serious conditions, then we may find that this is a moving target i.e. non-EU cover goes up as well: looking at what you paid last year for you cover for the USA probably won't be a good indicator of the cost of European cover in 2021, with or without EHIC.
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mitcva wrote:
That's very helpful. Thanks.

How can a red herring be helpful? rolling eyes
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Just to resurrect this thread: having been in the 4 Vallées for just under a week now I think that the Thread title is of increased relevance. The social distancing impositions are quite light: apart from the usual physical distance in shared spaces, masks are only mandatory on public transport, and in gondolas and télécabine/télésiege facilities. Cafés, restaurants and bars have a lower density of seating, and supermarket checkouts and simillar have screens, but neither clients or staff are masked. What the Swiss do have is a working and apparently effective App. So the focus seems to be on rapid contact tracing (e.g. the App shows you shared a navette with someone who has just been diagnosed, or were in the same restaurant etc.) rather than being in an area where the 2-week-old stats have started to come through.

Which means that by 2021 the concern may shift away from being Quarantined on return, towards what happens when you're called/visited by a public health official, and told to self-isolate for 2 weeks.

It may be worth separating the logistics from the medical/epidemiological options. Logistically, if you're self-drive, you can get in a car and be at the Channel port/Eurotunnel in under 10 hours. You can also probably reschedule your crossing (albeit this may incur a charge). If you're fly/drive you can return the car early, and probably reschedule flights or just get new flights. If you're on a package, the whole thing is going to be much more uncertain.

Epidemiologically, it's hard to know what position the local authorities will take. They may insist you have a test, or organise one for you, and insist you and your group stay in situ for the full period. It may or may not be mandatory. On the other hand, they may not care and be happy for you to travel out of the country if you're self-isolated in a car. They may not be as happy about you going to an airport and getting on a 'plane.

And of course, there's the medical question. If you're feeling fine, then you will probably be happy to jump in a car / get on a 'plane and get home first, before isolating. But if you're not well, then you may not want to travel, and may be concerned about getting worse while in transit. And of course, your infectiousness re other travellers.

All of which is why we're booked on Eurotunnel, self-driving to self-catered accommodation next year. It's the most flexible option.


Last edited by Well, the person's real but it's just a made up name, see? on Wed 12-08-20 22:46; edited 1 time in total
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So is carrying a smartphone (and having it turned on, with a functioning battery) now mandatory in CH? Smile
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ecureuil wrote:
So is carrying a smartphone (and having it turned on, with a functioning battery) now mandatory in CH? Smile


@ecuril No. But we are happy to download it - we'd rather know that we shared a confined space with someone who was infected than not be aware. No news is good news, so to speak.

Strikes me as very Swiss. Downloading the app means the authorities can react faster to a local outbreak. As opposed to locking-down large areas of the country weeks after the public health data emerges, á là the UK. So why wouldn't you?

Of course, I can see that a visitor may not not see it that way. If they don't download the app, then they can't be involved in the contact tracing. So they're not presented with any notification. So they don't have to take any action or make any judgement. I suspect that if, like us, you're in an at risk group (over 65s) you'll be more inclined to want to know, whatever the consequences. If you were were less likely to be seriously affected, or were more of a libertarian, then you might not want to participate, even if it meant you might become a spreader.
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LaForet wrote:
If you were were less likely to be seriously affected, or were more of a libertarian, then you might not want to participate, even if it meant you might become a spreader.



Or 3rd option, you may already have had Covid19, had a recent antibody test to check you still have the antibodies, and be beginning to believe you will not catch it again at present because of those antibodies and potentially other acquired immunity's, and can`t therefore be a risk to anyone?
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@caravanSkier Yes, one to add to the list. But, wouldn't you need proof of such an assertion? Something like an official 'Covid Safe' Certificate? I don't think the present UK authorities are anywhere close to this sort of arrangement, but I suppose they may be by 2021 (...on reflection and past record, it seems unlikely). Is this the same as the Covid Passport idea that seems to have been forgotten?

Thinking about the App, one possibility is that countries with one, like France and Switzerland, may make it mandatory for visitors to download it. Technically, it wouldn't be hard to impose: the carrier knows you've entered the country, so if your number hasn't registered as downloading the app after, say, 24h, then they could just disable you. No download, no mobile service.
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LaForet wrote:
But, wouldn't you need proof of such an assertion? Something like an official 'Covid Safe' Certificate? I don't think the present UK authorities are anywhere close to this sort of arrangement, but I suppose they may be by 2021 (...on reflection and past record, it seems unlikely). Is this the same as the Covid Passport idea that seems to have been forgotten?

That sounds like a handy thing to have. I have no reason to suspect I've had Covid, so who's up for a party so I can rectify that? NehNeh

Quote:
Thinking about the App, one possibility is that countries with one, like France and Switzerland, may make it mandatory for visitors to download it. Technically, it wouldn't be hard to impose: the carrier knows you've entered the country, so if your number hasn't registered as downloading the app after, say, 24h, then they could just disable you. No download, no mobile service.

It sounds simple, but I'm not sure that it is. I have no experience with Android, but with Apple, the apps that you see in the store are specific to your region (country), which is taken from the address on your payment card. As a visitor, you won't see another country's apps in the store unless you re-register your account there. E.g. I don't see the NHS apps as my account is registered in Austria. In order to get around this, the apps would have to be made available in every country, which would be difficult given the privacy concerns of some of the apps, the different laws in each country, and the fact that it would be very confusing for customers if they search "corona app" in the store and are presented with 100 options. Afaik, the apps don't talk to each other either, so they don't work cross-border.
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@Scarlet Well, all I can say is that I downloaded both the French (StopCovid) and the Swiss (SwissCovid) apps on my UK iPhone and AppleID, in the UK and they worked in their respective countries. Although the French one seemed to stop when we entered CH. Perhaps F/CH collaborated with Apple to develop them, unlike the UK Government, who tried to set up a competing technology? If I recall, I got the Swiss App name via a page on the Swiss Embassy website re travel in CH, not an AppStore search: App developers seem to have become very adept at getting their app listed ahead of the one you're actually looking for on a search (other than by the specific name), so I generally try and get the app name through another route.
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Ski the Net with snowHeads
@LaForet, Yeah maybe. I just had a check, and I can see the Austrian and German ones, but couldn't easily see any others. The Austrian one hasn't been mentioned for a long time, so I don't think many people are using it. Not enough to be of use, anyway.

Contract tracing in Austria seems to be thorough but (understandably, if you are familiar with Austria) quite old school. As above, I don't think there is much reliance on the app, and details are not routinely taken in restaurants (I've been in quite a few and have not left my details once). However, there is currently a reported outbreak in the Innsbruck Somali community, and this has been tackled with press appeals for people who have visited the community centre and a multi-lingual leaflet drop in the locality. It will probably work well enough. Old school.
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