The NHS is a residency-based healthcare system and eligibility for relevant services without charge is based on the concept of “ordinary residence”.
Only people who are living in the UK on a lawful, voluntary and properly settled basis are entitled to free NHS treatment.
British Citizenship is not the qualifying factor.
Who is an overseas visitor?
Any person of any nationality (including British) not lawfully settled or ordinarily resident in the UK.
What does the Law say?
The 2015 Charging Regulations & 2017 Amendments place a legal obligation on providers to establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charges.
Nationals of countries outside the European Economic Area (EEA) must also have indefinite leave to remain in the UK in order to be "ordinarily resident" here.
When charges apply, the relevant body must recover charges from the Overseas visitor in advance and in full, unless doing so would prevent or delay the provision of immediately necessary or urgent services.
The cost of overseas patients to the NHS
“Normal” use of the NHS - by overseas visitors who've ended up being treated while in England - is estimated to cost about £1.8 billion a year.
Only about 18% of that is recovered - that’s roughly £ 324 million.
This percentage has gone up since 2015, mainly thanks to the introduction of the Health Surcharge for Visa Holders - but we can do much better.
Main Charging Categories
EEA – European Economic Area Members
Non-EEA – Rest of the World
Within the European Economic Area there are a number of agreements in place whereby a EEA resident can receive treatment from the NHS and all costs will be claimed back from their country of origin.
We would expect patients to carry a European Health Insurance Card (EHIC), however, we may be able to assist them with requesting a replacement certificate (PRC) from their country of origin.
Non EEA residents
Visitors who come from outside the EEA will fall into three basic categories:
Visa Holders - Since 1 April 2015 Visa holders are required to pay a yearly Health Surcharge, currently £400.00 (£300.00 for students).
Visitor/Tourist Permits - Any visitor to the UK is liable for charges relating to treatment in hospital. If they don’t have the appropriate travel or health insurance then they have a personal liability.
British Expats – If a British citizen has been living outside of the EEA, they are liable to pay for any treatment received unless they can prove lawful residency or their intention to settle back in the UK.
Exempt categories of person
Patients from countries which have a reciprocal agreement with the UK, i.e. Ireland, Jersey, Australia, New Zealand.
Seasonal workers who come here year on year but aren’t resident in the UK may be exempt dependent on the evidence provided.
Asylum seekers, refugees, prisoners and immigration detainees.
Victims, and suspected victims, of modern slavery as determined by a designated competent authority.
UK armed forces members and NATO personnel plus their spouse/civil partner and children under 18.
Employees on ships registered in the UK (but not their families).
All primary (GP) care, A&E or Urgent Care Services.
Family planning services, excluding termination of pregnancy and conception services.
Diagnosis and treatment of specified infectious diseases and sexually transmitted diseases.
Treatment required for a physical or mental condition caused by:
- female genital mutilation
- domestic/sexual violence
The clinical need always comes first
If a patient requires treatment that is urgent or immediately necessary, we will always provide it regardless of the patient’s ability to pay. On the other hand, if the treatment can wait until the patient returns home, we will need to obtain upfront payment.
This will be a decision made by the clinician.