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This publication is available at https://www.gov.uk/government/publications/how-the-nhs-charges-overseas-visitors-for-nhs-hospital-care/how-the-nhs-charges-overseas-visitors-for-nhs-hospital-care
Within England, free NHS hospital treatment is provided on the basis of someone being ‘ordinarily resident’. Being ordinarily resident 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.
Those who are not ordinarily resident in the UK, including former UK residents, are overseas visitors and may be charged for NHS services.
Treatment in A&E departments and at GP surgeries remains free for all.
There are exemptions in place to protect the most vulnerable in society and for key services essential to public health. This ensures that urgent or immediately necessary treatment will always be provided, regardless of an individual’s ability or willingness to pay for that treatment.
This guidance sets out how NHS charges for overseas visitors’ healthcare are applied.
The rules are set out in the National Health Service (Charges to Overseas Visitors) Regulations 2015 (as amended).
The regulations apply only in England. Accessing healthcare in Scotland, Wales and Northern Ireland could be different from England. For more information, visit the websites for health services in each country:
Visitors to the UK from the EU
Visitors to the UK from an EU country who fall ill or have a medical emergency during a temporary stay in England can use a valid European Health Insurance Card (EHIC) issued by their home country to access healthcare.
The EHIC (or a Provisional Replacement Certificate (PRC)) will cover treatment that becomes medically necessary during a visit to England. It also covers the treatment of pre-existing medical conditions and for routine maternity care, providing the reason for visiting is not specifically to give birth or receive treatment.
An EHIC is not an alternative to travel insurance and we always advise that visitors should have both when travelling to the UK. An EHIC will not cover any private medical healthcare, being flown back home, or lost or stolen property.
Planned treatment is not covered by the EHIC. Visitors from the EU will need to arrange an S2 form from the relevant organisation in their home country before travelling to England.
The S2 only covers state-provided treatment. The only charges which will apply are any mandatory patient contributions that patients in England would have to pay, such as prescription costs.
Visitors may have to pay for treatment if:
- an EHIC cannot be provided
- a PRC cannot be obtained from the relevant EU member state
- an S2 form has not been issued
Charges will be calculated at 150% of the national NHS rate.
Providers should continue to follow existing guidance on upfront charging.
Visitors to the UK from Norway, Iceland, Liechtenstein and Switzerland
Visitors to the UK from Norway will be able to access medically necessary care in the UK by presenting a valid Norwegian passport.
Visitors from Iceland, Liechtenstein and Switzerland who fall ill or have a medical emergency during a temporary stay in England may have to pay for NHS healthcare. Any treatment that has to be paid for will be charged at 150% of the national NHS rate.
People living in the EU, Norway, Iceland, Liechtenstein or Switzerland whose healthcare costs are funded by the UK
People living in an EU country, Norway, Iceland, Liechtenstein or Switzerland on or before 31 December 2020 whose healthcare costs are funded by the UK (such as those with a UK-issued S1 that has been registered in another member state) will be entitled to free NHS hospital treatment in England, should they return temporarily to the UK. UK nationals living in the EU on or before 31 December 2020 can also apply for an S1 upon reaching state pension age and drawing their state pension.
UK nationals who no longer live in the UK
Because the NHS is a residency-based system, under NHS rules UK nationals who move abroad on a permanent basis lose their entitlement to free NHS healthcare.
UK nationals living and working in EU countries, Norway, Iceland, Liechtenstein or Switzerland on or before 31 December 2020 and their family members may be eligible to use NHS services without charge. They are advised to check with the relevant authority in the member state where they live for further information before travelling to the UK.
UK nationals who moved to the EU on or after 1 January 2021 should not expect to use NHS services for free when visiting the UK unless they have an EHIC, PRC or S2 to show that their healthcare costs are funded by the EU country where they reside, or another exemption applies.
Any treatment that may have to be paid for will be charged at 150% of the national NHS rate.
The UK government always advises visitors to the UK to take out travel or health insurance that has the necessary healthcare coverage for their needs. This is particularly important for those with pre-existing health conditions. Appropriate insurance means visitors may be able to recoup any treatment costs from their insurer.
EU citizens working in the UK
EU citizens seeking to work in the UK as a frontier worker or a posted worker will be subject to immigration control and may be required to pay the immigration health surcharge.
Family members of a frontier worker will be entitled to treatment that is medically necessary during a temporary visit to England.
Citizens of EU countries, Norway, Iceland, Liechtenstein or Switzerland resident in the UK on or before 31 December 2020
Citizens of EU countries, Norway, Iceland, Liechtenstein or Switzerland who were lawfully resident in the UK on or before 31 December 2020 will continue to receive access to NHS-funded healthcare as long as they meet the ordinary residence test. They must apply to the EU Settlement Scheme.
Once granted either pre-settled or settled status, or while an application is pending, they will then not be charged for healthcare, as long as they continue to be ordinarily resident in the UK. The NHS may ask for evidence of pre-settled or settled status.
The deadline for applications is 30 June 2021. If an application is not submitted by 30 June 2021, they could lose any entitlement to free NHS healthcare.
Eligible family members may apply for a family visa or permit to come to the UK to join a citizen of an EU country, Norway, Iceland, Liechtenstein or Switzerland who was living in the UK on or before 31 December 2020. They should then apply to the EU Settlement Scheme. In some circumstances, they may be able to apply directly to the EU Settlement Scheme from overseas.
Citizens of EU countries, Norway, Iceland, Liechtenstein or Switzerland working as a frontier worker (someone who lives in an EU country, Norway, Iceland, Liechtenstein or Switzerland but works in the UK) can continue to access NHS healthcare as they do now, using their registered S1. Those who were working as frontier workers on or before 31 December 2020 will need to apply for a frontier worker permit if they wish to continue to enter the UK for work as a frontier worker after 1 July 2021.
Posted workers (someone employed or self-employed in an EU country, Norway, Iceland, Liechtenstein or Switzerland but temporarily sent to work in the UK) can continue to access healthcare in England as they do now, using their EHIC or S1 form.
People living outside the EU
People who live outside the EU, including former UK residents, are not automatically entitled to free NHS care. They should make sure they are covered by personal health or travel insurance so that they can recover from their insurer any treatment costs that they are required to pay. They will be charged at 150% of the NHS national tariff, unless an exemption applies to them or the service they are accessing, or they are covered by a reciprocal healthcare agreement between the UK and their country.
Immigration health surcharge
Nationals of an EU country, Norway, Iceland, Liechtenstein or Switzerland are subject to immigration control. Those who are subject to immigration control (except Irish nationals) must pay the immigration health surcharge when applying for a visa to enter and remain in the UK for more than 6 months. They cannot be considered as ordinarily resident in the UK until they have been granted indefinite leave to remain.
People with indefinite leave to remain in the UK and those not subject to immigration control (for example, diplomats posted to the UK) are not liable to pay the immigration health surcharge but may be ordinarily resident here and entitled to free NHS healthcare on that basis.
Payment of the immigration 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, and assisted conception services.
Payment of the immigration 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 an immigration health surcharge payment.
There is no charge for certain types of treatment such as A&E outpatient treatment, treatment for infectious diseases specified in the regulations, treatment of sexually transmitted infections and family planning services.
It is worth noting that we have very clear exemptions in place to protect the most vulnerable and to ensure that treatment is always available to those in the UK who need it urgently regardless of their eligibility status. This has not changed following the UK’s departure from the EU. The exemptions are for those:
- granted refugee status in the UK
- seeking asylum or temporary or humanitarian protection until their application (including appeals) is decided
- receiving support from the Home Office under section 95 of the Immigration and Asylum Act 1999
- a failed asylum seeker receiving support from the Home Office under section 4(2) of the Immigration and Asylum Act 1999 or from a local authority under section 21 of the National Assistance Act 1948 or Part 1 (care and support) of the Care Act 2014
- a child looked after by a local authority
- formally identified, or suspected of being, a victim of modern slavery or human trafficking (this includes your spouse or civil partner and any children under 18 as long as they are lawfully present in the UK)
- receiving compulsory psychiatric treatment or treatment imposed by a court order
- detained in prison or by the immigration authorities in the UK
- NATO personnel (including spouses, civil partners or any children under 18 as long as they are lawfully present in the UK), where the service cannot be provided by armed forces medical services
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.
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.
However, since 2017, overseas visitors working on UK-registered ships are no longer entitled to free NHS care and their employer is liable for their NHS costs.
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
UK citizens who return to the UK on a settled basis will be considered as ordinarily resident and will be eligible for free NHS care immediately.