Policy and Guidance for Overseas Patients

Foreign nationals and Overseas Visitors to the UK eligibility for free NHS Treatment

UK Residents - Introduction

Eligibility for treatment is not defined by nationality, payment of taxes, NI etc but based on residency. If you are ordinarily resident in the UK (see below for definition) you are eligible for free treatment. If you are a visitor then you may have to pay – see the section on overseas visitors.

  • Overseas students on full time courses do not have to pay.
  • Asylum seekers and refugees do not have to pay.
  • Ordinarily resident – living in the UK for 90 days or more in a year.

 Detail

Free GP treatment is based on residence in the UK, not on nationality, the payment of UK taxes or National Insurance contributions. A person who is regarded as ordinarily resident in the UK is eligible for free treatment by a GP. A person is 'ordinarily resident' for this purpose if lawfully living in the UK for a settled purpose as part of the regular order of his or her life for the time being. Anyone coming to live in this country would qualify as ordinarily resident.

Overseas visitors to the UK are not regarded as ordinarily resident if they do not meet this description. For example, a person who emigrated from the UK, but returns sometimes for visits is not seen as ordinarily resident, regardless of any previous UK taxes or contributions they have paid or receive. He or she would not normally be entitled to free NHS treatment from a GP. Any person who leaves this country to live abroad should be removed from his or her GP list after 3 months.

There are however some circumstances which entitle overseas visitors to free treatment:

  • Asylum seekers and refugees given leave to remain in the UK, or awaiting the results of an application to remain, are regarded as ordinarily resident and entitled to full NHS GP treatment.
  • EEA nationals carrying form E128 (short-term posted workers or students and their accompanying dependants) are entitled to free NHS GP treatment. EEA member states include Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Netherlands, Norway, Portugal, Spain and Sweden.
  • EEA nationals carrying form E112 (specified medical conditions) are entitled to free NHS GP treatment for that condition.
  • Any person, whether ordinarily resident or not, requiring treatment that a GP regards as emergency or immediately necessary shall receive that treatment free of charge, whether registered with a GP or not.

GPs have the choice of accepting patients either as fully registered patients or as temporary residents if they are in the area for more than 24 hours but less than three months. They may offer to accept non-qualifying patients as private patients, liable to pay fees for treatment

Below is taken from the Department of Health Website:

What if I should need hospital treatment?

Under the current Regulations, anyone who comes to the UK on holiday or for a short term visit will have to pay for any NHS hospital treatment they may need while they are here, unless they meet the criteria for one of the exemptions from charges.

This includes people coming to visit relatives who are ordinarily resident in the UK. Their entitlement to free treatment does not extend to you, even if you are going to be staying with them for several weeks or months. If you think you will have to pay for treatment, you are strongly advised to take out health insurance before you travel.

  • Visiting from a country with which the UK has a bilateral healthcare agreement? If you come from a country with which the UK holds a bilateral healthcare agreement then you will be exempt from charges for treatment that is needed promptly for a condition that arose after you arrived in the UK. Please contact the relevant authorities in your own country for further details of the arrangements covered by the bilateral healthcare agreements.

In common with those ordinarily resident in the UK, anyone who meets the criteria of ordinary residence or is exempt from charges will have to pay statutory NHS charges, eg prescription charges, unless they also qualify for exemption from these, and will have to go on to waiting lists for treatment where appropriate.

If I should need hospital treatment what documents will I need?

The Regulations place a responsibility on individual hospitals to determine whether, in accordance with the Regulations, a patient is liable to be charged for treatment or not. In order to establish entitlement, hospitals can ask you to provide documentation that supports your claim that you have come to the UK on holiday or to visit relatives. It is for you to decide what to supply, however examples of evidence could include:

  • passport or identity card;
  • travel documents.

Am I entitled to access primary care services?

While visiting the UK you may approach any GP practice within the area you are residing and ask to be accepted as a NHS patient. GP practices are free to decide which patients they accept on to their list of NHS patients. They are, however more likely to accept you if you are intending to live in the UK on a settled basis. If the practice does not wish to accept you on to its list of NHS patients, the practice may offer to treat you as a patient on a private, paying basis.

During your visit to the UK, if you require treatment that a GP or healthcare professional regards as emergency or immediately necessary, you will receive that treatment free of charge, regardless of whether you are registered with a GP practice or not.

Do I have to pay for emergency treatment if I have an accident?

Regardless of residential status or nationality, emergency treatment given at Primary Care practices (a GP) or in Accident and Emergency departments or a Walk-in Centre providing services similar to those of a hospital Accident and Emergency department is free of charge.

In the case of treatment given in an Accident and Emergency department or Walk-in Centre the exemption from charges will cease to apply once the patient is formally admitted as an in-patient (this will include emergency operations and admittance to High Dependency Units) or registered at an outpatient clinic.

Am I entitled to help with the costs of non-emergency NHS treatment?

Appendix 1 - Full list of exemptions from charges for hospital treatment

The following exemptions from charges apply to hospital treatment.

Services for which a charge cannot be levied

  • Services provided in an Accident and Emergency department, unless and until the patient is admitted as an in-patient or registered at an out-patient clinic
  • services provided at a walk-in centre providing services similar to those of an accident and emergency department of a hospital
  • treatment of certain specified illnesses on public health grounds, e.g. notifiable diseases and those to which specific public health enactments apply
  • services provided otherwise than at, or by staff employed to work at, or under the direction of a hospital
  • family planning services
  • treatment at a sexually transmitted disease clinic, but in the case of HIV, only in relation to diagnostic testing and associated counselling
  • compulsory treatment under the terms of the Mental Health Act 1983, or psychiatric treatment included by the Court as part of a probation order under the terms of the Powers of the Criminal Courts Act 1973.

Categories of patient who are fully exempt

  • In all cases, these exemptions extend to the spouse and school age children of an exempt person if they are living in the UK with the exempt person on a permanent basis.
  • people who are in the UK:
  • for the purposes of employment and where the employer's principal place of business is in the UK or is registered in the UK as a branch of an overseas company; or self employment where the employment is in the UK
  • to be a volunteer providing services similar to health or social services
  • pursuing a full time course of study of not less than 6 months in duration or pursuing a course of study of any duration that is substantially funded by HM Government
  • to take up permanent residence
  • people who have been living lawfully in the UK for 12 months immediately before requiring treatment (even if they have previously been charged for part of the same continuing course of treatment)
  • refugees and formal asylum seekers whose applications have not yet been determined
  • people working on ships registered in the UK
  • people who receive UK war pensions
  • diplomats working in UK embassies
  • members of HM armed forces
  • people working abroad for the UK civil service who were recruited in the UK
  • people working abroad for the British Council or the Commonwealth War Graves Commission who were recruited in the UK
  • people working abroad whose post is financed in part by the UK Government in agreement with another government or public body
  • people who have lived lawfully for 10 continuous years in the UK but who are now working abroad and have not been away for more than 5 years
  • people who work abroad in another EEA country (or Switzerland) who pay compulsory (not voluntary) National Insurance contributions in the UK
  • "insured" nationals of other EEA member states (or Switzerland) who have been referred to the UK for specific treatment; plus, non-EEA nationals who are legally resident in a European Union (EU) member state (except Denmark). They must have a form E112 issued by the state health authority in their 'home' country that covers (or insures) them for healthcare
  • prisoners and those detained under immigration laws
  • nationals of certain non-EEA countries with which the UK holds bilateral (or reciprocal) health agreements and which allows referrals to the UK to receive specific treatment with the agreement of their 'home' country. They will have formal documentation to cover them for their treatment
  • nationals of countries that are signatories of the European Social Charter who are genuinely without the money to pay for any necessary treatment
  • UK state pensioners living not less than 6 months in the UK and not more than 6 months in another EEA Member State and who are not registered as resident in another EEA Member State
  • a person who is serving with the armed forces of a country which is part of NATO but only where treatment cannot be readily provided by either his or her own medical service or the UK armed forces medical service.
  • Categories of patient exempt from charges for treatment the need for which arose during their visit to the UK
  • nationals, or refugees, or stateless persons and their family members resident in EEA member states and Switzerland; plus, non-EEA nationals who are legally resident and insured in an EU member state (except Denmark)
  • UK state pensioners who have either lived lawfully in the UK for 10 continuous years or have been employed by the UK government for 10 continuous years at some point, or their spouse or school-age children
  • people from non-EEA countries with which we hold bilateral (or reciprocal) health care agreements
  • people who are without sufficient resources to pay the charge and who are nationals of a country which is a contracting party to the European Convention on Social and Medical Assistance 1954
  • people who have lived lawfully for 10 continuous years in the UK but who are now living in an EEA member state or Switzerland, or a non-EEA country (other than Israel) with which we have a bilateral (or reciprocal) health care agreement, and their spouse and school-age children
  • an authorised companion (which need not be spouse) of an individual who has been designated exempt by Secretary of State on exceptional humanitarian grounds.

 

New regulation to exempt an individual on exceptional humanitarian grounds

The Secretary of State can designate an individual exempt from charges on exceptional humanitarian grounds as long as certain criteria are met.

 

What if I do not meet one of these exemptions from charges?

If you are not ordinarily resident or exempt under the regulations, charges will apply for any hospital treatment you receive and cannot be waived. If this is the case you are strongly advised to take out private healthcare insurance that would cover you for the length of time you are in the UK. There is no facility to purchase healthcare insurance from the NHS therefore any necessary insurance must be organised privately.

 

All EEA Members are eligible for treatment –

• Austria

• Belgium

• Cyprus

• Czech Republic

• Denmark

• Estonia

• Finland

• France

• Germany

• Greece

• Hungary

• Italy

• Latvia

• Lithuania

• Luxembourg

• Malta

• Netherlands

• Poland

• Portugal

• Republic of Ireland

• Slovakia

• Slovenia

• Spain

• Sweden

• UK

 

Plus Iceland, Liechtenstein and Norway. Switzerland by special arrangement.

 

Plus Nationals of, and UK nationals in, the following countries:

• Armenia

• Azerbaijan

• Belarus

• Bosnia

• Bulgaria

• Croatia

• Czech Republic

• Georgia

• Gibraltar

• Hungary

• Yugoslavia i.e. Serbia & Montenegro

• Kazakhstan

• Kirgizstan

• Macedonia

• Malta

• Moldova

• New Zealand

• Poland

• Romania

• Russia

• Slovak Republic

• Slovenia

• Tajikistan

• Turkmenistan

• Ukraine

• Uzbekistan.

 

Residents irrespective of nationality of the following countries:

• Anguilla

• Australia

• Barbados

• British Virgin Islands

• Channel Islands

• Falkland Islands

• Iceland

• Isle of Man

• Montserrat

• St. Helena

• Turks and Caicos Islands.