How changes to charging rules will affect how you recover costs from overseas visitors and migrants if there is a no-deal Brexit.
Visitors from the EU, Norway, Iceland, Liechtenstein or Switzerland who visit the UK will not be covered for healthcare in the same way they are now if there is a no-deal Brexit.
There will be no change to rules relating to visitors or migrants from outside these countries.
Services that are not currently charged for will remain exempt from charges. This includes accident and emergency services and GP services.
The changes outlined will only happen in a no-deal Brexit and will only apply in England. For more detailed information see the detailed summary of the changes at the end of this guidance.
Citizens from the EU, Norway, Iceland, Liechtenstein or Switzerland
Living in the UK
Citizens from these countries living lawfully in the UK on or before exit day will still be eligible for free NHS care after the UK leaves the EU.
Their families will also be eligible for free NHS care, even if they arrive after the UK leaves the EU.
Moving to the UK after exit day
To be eligible for free NHS care, citizens who move to the UK after exit day must:
- meet the ordinarily resident test
- comply with relevant immigration requirements, once freedom of movement ends
Irish citizens will only need to meet the ordinarily resident test to be eligible for free NHS care.
Visiting or studying in the UK
Visitors from these countries will be chargeable, as they are now, unless either of the following applies:
- a healthcare agreement is in place with the country of residence
- any exceptions within the charging regulations apply to them (for example if they are accessing an exempt service)
Visitors from the EU, Norway, Iceland, Liechtenstein or Switzerland whose visit to the UK starts before exit day will not be charged for treatment in England for as long as their temporary stay continues.
For tourists, this will be until the end of their holiday.
For students, this will be for the duration of the course, as long as they stay on it.
Visitors with authorisation for planned treatment
Visitors from these countries who have requested authorisation before exit day from their country of residence will be able to have that treatment in England without being charged, even if that treatment takes place after exit day.
Working as frontier workers in the UK
Citizens from these countries working as frontier workers in the UK before exit day will not be charged for treatment.
People living in the EU whose healthcare is funded by the UK
People living in the EU whose healthcare is funded by the UK under the current EU reciprocal arrangements will be eligible for free NHS care in England when returning temporarily, for example to visit friends and family.
When the changes will happen
The changes to the charging regulations will come into force immediately after exit day if there is a no-deal Brexit. You should make sure that any changes to your operational practices are implemented from that point forward.
Preparing for leaving the EU
You should work closely with your organisation’s senior responsible officer for Brexit preparation and their teams, to make sure that you are operationally ready to implement the new charging regulations after exit day.
Make sure that your overseas visitor management team and other staff understand the new regulations and have been trained to put them into practice.
Check the NHS visitor and migrant cost recovery page regularly to see the latest guidance, or set up an email alert subscription to receive all the latest updates from the Department of Health and Social Care.
NHS Improvement will continue to support NHS providers through their overseas visitors cost improvement programme.
Detailed summary of the changes
UK–Swiss citizens’ rights agreement
The UK has reached an agreement on citizens’ rights with Switzerland. The terms of this agreement protect the rights of both Swiss citizens in the UK and UK nationals in Switzerland on exit day.
Those entitled to free NHS care under the agreement will not be charged.
Citizens’ rights agreement with Norway, Iceland and Liechtenstein
The UK has reached an agreement on citizens’ rights with Norway, Iceland and Liechtenstein. The terms of this agreement protect the rights of citizens from Norway, Iceland and Liechtenstein in the UK and UK nationals in Norway, Iceland or Liechtenstein on exit day. Those entitled to free NHS care under the agreement will not be charged.
Visitors to the UK from the EU, Norway, Iceland, Liechtenstein or Switzerland
Where the UK government has agreed a reciprocal healthcare agreement with an EU country, Norway, Iceland, Liechtenstein or Switzerland, visitors from that country will have access to NHS care under the terms of that agreement – potentially using an EHIC/S2 issued by that country to avoid being charged directly.
Similarly, people residing in the UK with an S1 issued by that country can continue to rely on this document, subject to the terms of the agreement.
Citizens from the EU, Norway, Iceland, Liechtenstein or Switzerland working in the UK as frontier workers on or before exit day will remain exempt from charging for NHS care.
Visitors from the EU, Norway, Iceland, Liechtenstein or Switzerland who arrive before exit day in the UK will be able to use their non-UK EHIC in England for treatment provided on or after exit day until the end of their stay, where the need for treatment arose during their visit.
For tourists, this would be until the point their holiday ends. If they leave and subsequently return to the UK, they will be chargeable at the NHS national tariff or will have to rely on personal health or travel insurance.
Students who began their education or training in the UK before exit day will be able to use their non-UK EHIC until the end of their education or training (regardless of whether they leave the UK temporarily, for example during term holidays) as long as they stay on it, and provided the need for such treatment arose during their stay in the UK.
The NHS should continue to record the non-UK EHIC on the portal as usual.
Visitors from the EU, Norway, Iceland, Liechtenstein or Switzerland who have requested prior authorisation before exit day for planned treatment under the S2 route will be able to complete that course of treatment in England, even if that happens after exit day. The S2 treatment should be recorded in accordance with the current arrangements, as some of these costs may be recoverable from the relevant country.
Visitors to the UK from the Republic of Ireland
Irish citizens and British citizens who are resident in the Republic of Ireland will be exempt from charging for needs-arising treatment when visiting England.
Visitors from Spain
If there’s no deal, the UK and Spain have each taken steps to ensure that people living in each country can continue to access healthcare as they do now until at least 31 December 2020.
This means that that UK and Spanish citizens who are resident in Spain and visiting the UK will be able to use their Spanish-issued EHIC, S1 or S2 form after exit day until at least 31 December 2020.
Visitors from the EU whose healthcare costs are funded by the UK under the current EU arrangements
People living in the EU whose healthcare costs are funded by the UK under the current EU arrangements (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.
After exit day
In the absence of a reciprocal healthcare agreement with an EU country or a broader agreement with Norway, Iceland, Liechtenstein or Switzerland, after exit day new visitors from that country to the UK will no longer automatically be entitled to free NHS-funded healthcare in England. They will be chargeable at the standard NHS tariff unless they fall within one of the existing exemptions. They may, however, choose to use private healthcare, or travel insurance to recover costs paid to the NHS for treatment received. Providers should continue to follow existing guidance on upfront charging.
Should a visitor from the EU, Norway, Iceland, Liechtenstein or Switzerland (other than an Irish visitor) who arrives after exit day want to stay in the UK for longer than 3 months, to be exempt from charging for relevant NHS services, they will need to meet the ordinarily residence test. They may also be required to comply with any immigration requirements set by the Home Office.
Citizens from the EU, Norway, Iceland, Liechtenstein or Switzerland who are lawfully resident in the UK by exit day will be protected by citizens’ rights arrangements. They will likely meet the ordinarily resident test and will continue to receive access to NHS-funded healthcare as they do now. They will need to provide evidence that they were residing in the UK on exit day.
Getting healthcare in Scotland, Wales and Northern Ireland
This guidance is about NHS entitlements in England. For information about accessing healthcare in Scotland, Wales and Northern Ireland, visit the websites for health services in each country: