Guidance

Overseas visitor charging: guidance for NHS service providers on updates to regulations

How changes to charging regulations will affect how you recover costs from overseas visitors and migrants if the UK leaves the EU with no deal.

If the UK leaves the EU with no deal, visitors from the European Economic Area (EEA) or Switzerland who visit the UK will not be covered for healthcare in the same way they are now.

There will be no change to rules relating to visitors or migrants from outside the EU.

Services that we do not currently charge for will remain exempt from charges. This includes accident and emergency services and GP services.

The changes outlined will only happen if the UK leaves the EU with no deal and will only apply in England. For more detailed information see the summary at the end of this guidance.

EEA and Swiss citizens living in the UK

EEA and Swiss citizens 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.

EEA and Swiss citizens who move 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
  • hold European Temporary Leave to Remain from the Home Office once freedom of movement ends

Irish citizens will only need to meet the ordinarily resident test to be eligible for free NHS care.

EEA and Swiss citizens visiting or studying in the UK

EEA or Swiss visitors will be chargeable, as they are now, unless either of the following applies:

  • a healthcare agreement is in place with their country of residence
  • any exceptions within the charging regulations apply to them (for example if they are accessing an exempt service)

EEA or Swiss residents 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 until their education or training is complete.

Visitors from EEA countries and Switzerland with authorisation for planned treatment

EU visitors 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.

EEA or Swiss citizens working as frontier workers in the UK

EEA or Swiss citizens 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 we leave the EU with no deal. 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 EU Exit 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.

We are working with NHS England and NHS Improvement to develop more detailed operational guidance to support you.

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 now reached agreement on citizens’ rights with Switzerland. Broadly, the terms of this agreement protect the rights of 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.

UK–EEA-EFTA citizens’ rights agreement (Norway, Iceland and Liechtenstein)

The UK has now reached agreement on citizens’ rights with the EEA-EFTA states of Norway, Iceland and Liechtenstein. Broadly, the terms of this agreement protect the rights of EEA-EFTA citizens in the UK and UK nationals in the EEA-EFTA states on exit day. Those entitled to free NHS care under the agreement will not be charged.

Visitors to the UK from the EEA and Switzerland

Where the UK government has agreed a reciprocal healthcare agreement with an EEA country 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.

EEA or Swiss citizens working in the UK as frontier workers on or before exit day will remain exempt from charging for NHS care.

EEA or Swiss visitors 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) and provided the need for such treatment arose during their stay in the UK.

The NHS should continue to record the EEA or Swiss-issued EHIC on the portal as usual.

Irish citizens and UK citizens who are resident in the Republic of Ireland will be exempt from charging for needs-arising treatment when visiting England.

EEA and Swiss visitors 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, without charge to them as a patient. The S2 treatment should be recorded in accordance with the current arrangements, as some of these costs may be recoverable from the relevant country.

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 agreements with Switzerland or the EFTA states for after exit day), after exit day new visitors from that country to the UK will no longer automatically be entitled to free NHS funded healthcare. 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 health or travel insurance to recover costs paid to the NHS for treatment received. Providers should continue to follow existing guidance on upfront charging.

Should an EEA and Swiss visitor (other than an Irish visitor) who arrives after exit day want to stay in the UK for longer than 3 months, they will need to apply to the Home Office for European Temporary Leave (see below).

EEA and Swiss residents in the UK

EEA and Swiss citizens who are lawfully resident in the UK by exit day will be protected by the citizens’ rights arrangements (as well as, for those in scope, the Swiss and EEA-EFTA citizens’ rights agreements). 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.

After exit day

EEA and Swiss citizens who arrive after exit day and want to stay in the UK for more than 3 months will (after free movement ends) need to obtain European Temporary Leave to Remain from the Home Office. If they also meet the ordinarily resident test, they will be exempt from charging for relevant NHS services for the duration of that leave period.

EEA and Swiss citizens who arrive after exit day and who, after the introduction of this scheme, don’t have leave to remain (because their 3 months’ leave has expired, they haven’t applied to or have been refused by the Home Office) will be chargeable at the NHS national tariff.

Published 8 April 2019