Overseas NHS visitors: implementing the charging regulations

Information for NHS bodies who need to make and recover hospital charges from overseas visitors.



Help and advice on the implementation of the National Health Service (Charges to Overseas Visitors) Regulations 2015, which have been amended most recently by the National Health Service (Charges to Overseas Visitors) (Amendment) (EU Exit) Regulations 2020.

Published 1 August 2018
Last updated 24 May 2022 + show all updates
  1. Addition of information in chapter 9: on EU and Swiss students that have received a reimbursement of their HIS; and on the temporary 3 month protection for joining family members of EU settlement Scheme holders.

  2. Updated with information concerning the UK-Switzerland Convention on Social Security Coordination, which involves the reciprocal healthcare agreements. The amendments ensure that those covered by the Convention are not charged for NHS healthcare. These changes are made throughout the guidance but primarily in chapter 9. In addition, chapter 4 includes information that NHS-funded nursing care, continuing healthcare and aftercare services provided under section 117 of the Mental Health Act are not chargeable under the Charging Regulations.

  3. Updated to clarify how charges for NHS healthcare will apply in England from 2021, following the end of the EU Exit transition period.

  4. Updated document to reflect that the rules on family reunification for people of Northern Ireland are being brought into line with the arrangements currently available to Irish citizens in the UK. Relevant family members of a person of Northern Ireland will, from 24 August 2020, be able to join that family member in the UK without paying the Immigration Health Surcharge. They will also have the opportunity to apply for settled status under the EU Settlement Scheme and if living in the UK with pre-settled or settled status will be entitlement to access NHS secondary care without charge.

  5. Updated with information on healthcare access during the transition period and added novel coronavirus (2019-nCoV) to the list of exempt services in chapter 4.

  6. Updated to clarify how the charging regulations will change if the UK leaves the EU without a deal. These changes are throughout the document but mainly in chapter 9. Updates have also been made to guidance on the use of e-gates by certain non-EU citizens (chapter 5), the interviewing of patients who may lack mental capacity (chapter 11) and transplant/organ donation rules (chapter 13).

  7. Document updated with the following changes: Changing the term 'NHS services' to 'relevant services' and 'NHS charges' to 'charges for relevant services'. Further clarification of how to determine whether a service is a 'relevant service'. Clarification that relevant bodies should take reasonable steps to investigate a patient's claim that an exemption applies, where there is a lack of evidence. Addition that, as of the 8 January 2019 an increase in the health surcharge to £400 per year per applicant, with a discounted rate of £300. Clarification that a greater range of treatment should be regarded as urgent in cases where overseas visitors are unlikely to leave the UK in the near future. Clarification of the circumstances in which termination of pregnancy services may be considered to be urgent. Clarification that issues relating to charging must never prevent or delay a patient being assessed by a clinician. Addition of a reciprocal healthcare agreement with Denmark for visitors from the Faroe Islands. Clarification that the transfer of a patient to a new provider should not be delayed on the basis that their chargeable status has not yet been determined. Clarification of the complaints procedure relevant bodies should have. Clarification that a written-off debt remains in the relevant body's records. Removal of the addendum publicising the review of the National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017.

  8. Change made to the date in paragraphs 13.32 and 13.45. Since 23 October 2017 relevant bodies should only be using the risk-share agreement with commissioners in the case of treatment said by clinicians to be immediately necessary or urgent. Changes also made to the contact details for the Visitor and Migrant NHS Cost Recovery Programme on page 2.

  9. First published.