In April 2015, changes were made to the way the NHS charges overseas visitors for NHS hospital care. These changes also affect some former residents of the UK. The changes were made so that the NHS does not lose out on income from migrants, visitors and former residents of the UK, who may be required to pay for their hospital treatment costs while in England.
Within England, free NHS hospital treatment is provided on the basis of someone being ‘ordinarily resident’. It is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK. The changes which came into effect from April affect visitors and former UK residents differently, depending on where they now live.
Treatment in A&E departments and at GP surgeries remains free for all.
Holders of a valid UK Pensioner S1 form living in an EEA country or Switzerland
If you are in receipt of a UK pension and have registered a valid UK S1 form with the relevant authorities in your country of residence, and your healthcare is paid for by the UK by virtue that S1 form, then you are now entitled to return to England to receive free NHS hospital treatment, just like someone who is ordinarily resident in England.
People living outside the EEA
People who live outside the EEA, including former UK residents, should now make sure they are covered by personal health insurance, unless an exemption applies to them. Anyone who does not have insurance will be charged at 150% of the NHS national tariff for any care they receive.
An immigration health charge (or ‘surcharge’) is now payable by non-EEA nationals who apply for a visa to enter or remain in the UK for more than 6 months. People with indefinite leave to remain in the UK and those not subject to immigration control (e.g. diplomats posted to the UK) are not liable to pay the surcharge, but may be ordinarily resident here and entitled to free NHS healthcare on that basis.
Payment of the health surcharge entitles the payer to NHS-funded healthcare on the same basis as someone who is ordinarily resident, from the date their visa is granted and for as long as it remains valid. They are entitled to free NHS services, including NHS hospital care, except for services for which a UK ordinary resident must also pay, such as dentistry and prescriptions in England.
Payment of the health surcharge is mandatory when making an immigration application, subject to exemptions for certain categories of people and the discretion of the Home Secretary to reduce, waive or refund all or part of a surcharge payment. Most of these groups also receive NHS-funded healthcare on the same basis as an ordinarily resident person.
There are several groups of people who are exempt from charging. UK Crown servants, British Council or Commonwealth War Graves staff and those working in UK government-funded posts overseas are exempt from charging if they were ordinarily resident prior to leaving the UK for that purpose, as are their spouses/civil partners and children under 18. Those who were not ordinarily resident in the UK before taking up such a post will be charged, unless they were recruited in the UK and are in the UK for the purpose of this employment.
There is also no change for armed forces members, war pensioners and armed forces compensation scheme recipients and their families, who are not required to have formerly been an ordinary resident of the UK.
Furthermore, people will be entitled to free care if, on all the facts, they remain ordinarily resident in the UK despite spending time outside the UK.
Victims of violence
An overseas visitor who has been subjected to certain types of violence must not be charged for treatment or services needed to treat any condition caused by that violence, in recognition of the particularly vulnerable position they may be in. The types of violence are:
- female genital mutilation
- domestic violence
- sexual violence
The conditions include physical or mental illness, or an acute or chronic condition. The exemption applies wherever the violence has been experienced, provided that the overseas visitor has not travelled to the UK for the purpose of seeking that treatment.
Returning to the UK to settle
Citizens who return to the UK on a settled basis will be classed as ordinarily resident, and will be eligible for free NHS care immediately.