NHS hospital services are for residents of the UK only, regardless of holding a British passport, having an NHS number, having an NHS doctor or paid taxes or national insurance contributions in the past.
Most NHS services are free to people who live in the UK permanently. You must live here lawfully and on a settled basis to receive free treatment. If you are not ordinarily resident in the UK, you may have to pay for your hospital treatment.
What is the hospitals statutory obligation?
NHS trusts have a statutory obligation to identify patients who are not entitled to free NHS treatment and to charge them for the treatment they receive (under the NHS Charges to Overseas Visitors Regulations, 2015).
We will always provide treatment that is immediately necessary or urgent but we reserve the right not to provide treatment that, in the opinion of a clinician, is not immediately necessary or urgent unless the cost has been paid in full, in advance.
Emergency and maternity treatment is regarded as ‘immediately necessary or urgent’ and NHS care will always be provided. Treatment given in our Emergency Department (ED) is exempt from charge, however, patients receiving emergency care, (including maternity), anywhere else in the Hospital, ie CDU, SAU, AAU, Ambulatory care, will be charged if they are not exempt from charge.
Validation Process at East and North Herts
The East and North Herts NHS Trust receives vast amounts of referrals every day and is not able to assess every patient referred or who walks through the door. Therefore, to ensure that the Trust fulfils its legal obligation, a number of processes have been implemented to identify possible chargeable patients; the emphasis is primarily focussed on the following:
- new registrations
- patients without NHS numbers
- patients with overseas addresses, and
- patients with NHS numbers of 650 and above who are over the age of 20
(The rationale behind the latter is because NHS numbers are issued at the time of birth and stay with a patient for life; in 1997 the system changed to a 10 digit number which relates to when a person registers with a GP in addition to a number of other factors. If a patient’s number falls within this validation category, it may be that they have come to England later in life; this will also include patients from Scotland, Ireland, members of the armed forces, transgender patients or witness protection patients – however, it does not mean that they will not be entitled once checks have been made).
In order to exempt patients from NHS charges, any patient who falls into the above pool of validations, will be requested by the Trust, prior to accessing treatment (where possible), to provide evidence that they are living in the UK on lawful and permanent basis. They will be asked to provide a copy of their passport/ID to demonstrate that they have status in the UK, and documentation with name and address to verify their residency. If patients are not able to supply documentation, it is very likely that they will be charged for their secondary care in an NHS hospital if they are not able to fulfil another exemption category. The Trust accepts that it may sometimes be difficult for a person to access documentation relating to residency and each case will be assessed on its own merits.
What type of documents can I show?
The following documents can be used as proof of identity:
- Current signed passport
- Biometric Residence Permit – (BRP) issued by UK Border Agency
- For patients who are claiming asylum, an IND and ARC card
- EU or Swiss National Identity Photo-card
- Valid armed forces or police photographic Identity Card
If entry to the UK is dependent on a spouse or a family member of an EU national, then please also sends their documents as above (plus a copy of any marriage certificates if sponsored by your spouse)
The following documents can be used as proof of address. They must contain your current address and be dated within the last six months:
- Recent original utility bill (gas, electric, water, telephone). Mobile phone bill is not acceptable.
- Council tax bill (current year)
- Bank, building society or credit union statement or passbook
- Recent original mortgage Statement from recognised lender
- Current council or housing association rent book or tenancy agreement
- Notification letter from Department for Work and Pensions confirming your right to benefit or state pension
What happens if I am just visiting the UK, do I have to pay for treatment if I am unwell?
There are a number of circumstances when you might still be entitled to free healthcare.
- If you are visiting the UK and you normally live in a country with a bilateral healthcare agreement with the UK, ie Australia, New Zealand, you might be entitled to free healthcare if you become unwell during your visit.
- If you are visiting the UK and you normally live in a country that is a member of the European Economic Area healthcare arrangement you will be entitled to free healthcare if you have a valid European Health Insurance Card (EHIC). This card covers emergency treatment only (not pre-planned). You need to bring this card with you to hospital – it must be in your name and within the expiry date. If you do not have an EHIC card, it is very likely that you will be charged for any treatment received
- If you are a refugee or an asylum seeker whose formal application to the Home Office is being considered. (A refugee is someone who has been granted asylum in this country). If you are a refugee or an asylum seeker, you will still have to pay for all prescribed medications.
- You may be entitled to free healthcare if you have come to study or take up employment in the UK. You need to show evidence, such as a payslip, that you are working for a UK-based employer. Your ‘right to work’ does not count as evidence in this case. If you are studying full-time you need to show evidence that you are attending a full-time course lasting at least six months.
If I am chargeable, what can I expect to pay?
NHS charges are based on the National Tariff set by NHS England. You will have to pay the full cost of all treatment you receive; this includes treatment that is deemed urgent or immediately necessary. Listed below are exceptions, which are free to everyone (except where the overseas visitor has travelled to the UK for the purpose of seeking that treatment).
- treatment given in the Emergency Department, however, emergency treatment given elsewhere in the hospital is chargeable (e.g. clinical decision units, assessment wards Ambulatory care units and Intensive Care units)
- diagnosis and treatment of certain infectious diseases
- diagnosis and treatment of Sexually Transmitted Infections including HIV
- compulsory psychiatric treatment
- family planning services
- treatment required for a physical or mental condition caused by torture, female genital mutilation (FGM), domestic violence or sexual violence
As of April 2015 – All non EEA patients are charged 150% of the national tariff (with added MFF Market Forces Factor) and chargeable EEA patients (those without a European Health Insurance Card –EHIC) are charged the flat national tariff with MFF. Insured patient from the EU who hold a EHIC will be treated under the reciprocal healthcare agreement which the UK has with their respective health bodies.
What is the Immigration Health Surcharge (IHS)?
The Immigration Health Surcharge is a mandatory payment paid to the Home Office as part of an immigration application. The surcharge is paid by people from outside the European Economic Area (EEA) who are seeking to live in the UK for more than 6 months to work, study or join family.
If I’ve paid the IHS, when can you start to use the NHS?
You can start using the National Health Service (NHS) when:
- you have paid the healthcare surcharge (or are exempt from paying it) AND
- your visa or immigration application is granted.
(you will not be able to use NHS services until you are receipt of BOTH the above)
Once you have been granted your visa and have your Biometric Residence Permit (BRP) you will still need to pay for certain types of services, such as prescriptions, dental treatment, eye tests and assisted conception – unless you are deemed exempt from charge for these services via another exemption category.
You should bring your biometric residence permit (BRP) with you when you access healthcare in the UK.
If you have an outstanding application with the Home Office, even though you may have paid the IHS, you will remain chargeable until you have been issued your BRP.
If you do not have a BRP, you can still access services given in the Emergency Department* and your local GP, this are free of charge, regardless of status.
(*treatment received only in the ED is free, if admitted to any other wards associated with ED i.e. ambulatory care, medical assessment units, surgical assessment unit, charges may apply).
How much is the Immigration Health Surcharge?
Expect to pay:
- £300 per year for a student or Tier 5 (Youth Mobility Scheme) visa, for example £600 for a 2-year visa
- £400 per year for all other visa and immigration applications, for example £2,000 for a 5-year visa
Dependents usually need to pay the same amount as you.
European Health Insurance Card (EHIC)
With the exception of visitors from the Republic of Ireland, a valid European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC) can demonstrate that a visitor (including a student) is exempt from charge under the EU Regulations, and therefore entitled to free NHS treatment that is medically necessary during their visit.
The UK is able to recover the cost of treatment provided to any patient who is insured by another European Economic Area (EEA) state or Switzerland.
Visitors from Switzerland or the EEA (except Ireland) who do not provide an EHIC/PRC will be charged for their NHS hospital treatment.
Frequently Asked Questions:
If I have a British passport how can I be classed as an overseas visitor?
Free NHS Hospital treatment is a residency based system. People who do not normally live in this country are not automatically entitled to use the NHS secondary care free of charge – regardless of their nationality or whether they hold a British passport or have lived, paid national insurance contributions and taxes in this country in the past. This includes British Citizens who are no longer resident in the UK.
I am a temporary visitor from the EEA/Switzerland; can I use an EHIC (or PRC) for maternity care?
Yes, those with valid European Health Insurance Cards (EHICs) or Provisional Replacement certificates (PRCs) are covered for all maternity care, including antenatal and postnatal care, providing the reason for their visit was not specifically to give birth or receive maternity treatment.
I live both in the UK and Spain, can I qualify as Ordinarily Resident?
A person can be ordinarily resident in more than one country at once. As long as they are properly settled here, despite spending more time in their other place of residence, they will meet the ordinary residence test. There is no requirement that the time be equally split between the UK and another country in order to maintain ordinary residence in the UK. Where a person has lived in more than one country for several years, consideration needs to be given to whether there is a pattern of regular trips to the UK over the years that demonstrates a sufficient degree of continuity to establish ordinary residence in the UK. The length and number of trips to the UK, family and other relationships with people in the UK, financial, property and other connections to the UK will all be relevant factors in determining if the person is ordinarily resident in the UK despite spending time living in another country. If you live only in Spain, and are only here as a visitor, not as a resident, then they will not meet the ordinary residence test.
I am an EU national wishing to visit the UK for a holiday – am I entitled to free NHS healthcare?
Visitors who are residents in the EEA and hold a valid European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC) are entitled to receive all immediately necessary treatment free of charge or that the need of which arises whilst visiting the UK. If EEA/Swiss visitors do not have a valid EHIC or PRC and no other exemption applies, then they will be personally liable for any treatment other than A&E that they access. Your European Health Insurance Card will not cover you for elective treatment.
Is it true that emergency treatment is free?
Emergency healthcare is free to everyone ONLY when received/given in the Emergency Department; this does not include transfers from the Emergency Department to any other ward, including; medical decisions units, assessment units, ambulatory care units, critical care units or any other ward within the Trust.
- How to access services in England
- Guidance on overseas visitors hospital charging regulations
- Recovering the cost of NHS treatments given to overseas visitors
- EU directive on patients’ rights in cross-border healthcare
NHS entitlement and overseas visitors team
NHS entitlement administrator
NHS entitlement administrator
NHS entitlement administrator
Lister – 01438 288469 |4434 | 6635 | 5262