The National Health Service (Charges to Overseas Visitors) Regulations place a legal obligation on Trusts to establish whether a patient is an overseas visitor to whom charges apply (NHS Chargeable Patient), or whether they are exempt from charges.
The NHS is a residency-based healthcare system and eligibility for relevant services without charge is based on the concept of “ordinary residence”. A person is ordinarily resident if they are living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life.
Residency is therefore the main qualifying criterion applicable, regardless of nationality, ethnicity, whether the person holds a British or EEA passport, has registered with a GP and has an NHS Number, or has lived and paid taxes or National Insurance contributions in the UK in the past.
An "overseas visitor" is any person who is not “ordinarily resident” in the UK. Persons who are subject to immigration control must have indefinite leave to remain in the UK in order to be classified as being "ordinarily resident" otherwise they are considered as overseas visitors.
Overseas visitors who require healthcare while in the United Kingdom may be charged for their treatment. However, those who need care that is clinically deemed urgent or immediately necessary – such as maternity care - will always be treated promptly. We do not turn any patients away even if the patient indicates that they cannot afford to pay. Nevertheless, the treatment is not free just because it is provided on this basis.
Treatment provided within the Accident & Emergency department is free at the point of service and is never withheld for any patient that presents. However, patients may be charged for treatment once they are transferred to ambulatory care, to another service, admitted, and follow up on any outpatient setting.
UCLH has a dedicated Overseas and Eligibility team who specialise in assessing patient’s eligibility. They are required to establish whether a patient is liable for charges or if a relevant exemption applies. This may involve asking the patient to provide documents to prove or support entitlement.
It is the responsibility of the patient to provide evidence, when requested, to demonstrate that they are entitled to free NHS treatment. When evidence is not provided, treatment will be charged for.
Patients who are assessed as not entitled to free care will be required to pay for their treatment and may be asked to make an upfront payment.
If you are unsure of your entitlement or status – please contact the Overseas Visitors Officers on 07890 394840 / 07956 352034 / 07717 341088 or email uclh.
If you are travelling from a European country to the UK, you will need to show a valid EHIC or Provisional Replacement Certificate otherwise you will have to pay for your care directly. You will also be asked to provide the following:
- a copy of your passport
- your full home address in the country you routinely reside
The EHIC must be produced (or a provisional replacement certificate) prior to discharge from the hospital or prior to an outpatient appointment, or you will be liable to pay all fees associated with your care and claim your care back through your home country.
The EU Regulations apply to all countries within the European Economic Area, which is made up of the member states of the EU and EFTA:
Austria, Belgium, Bulgaria, Croatia, Cyprus (Southern), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Iceland, Liechtenstein, Norway and Switzerland.
Please note that your EHIC does not apply if you are having elective planned treatment. You will need to obtain an E112/S2 from your local Health Authority in your country of origin prior to an appointment being given in the UK. In the event, elective planned treatment is provided prior to receipt of an E112/S2, you will be charged for your treatment.
The UK has reciprocal healthcare agreements with the following non-EU countries:
Anguilla, Australia, Bosnia and Herzegovina, British Virgin Islands, Falkland Islands, Faroe Islands, Gibraltar, Isle of Man, Israel, Jersey, Kosovo, Montenegro, Montserrat, New Zealand, North Macedonia, Norway, Serbia, St Helena, Turks and Caicos Islands.
Overseas visitors who can present evidence that they are nationals, citizens or lawful residents of one of these countries may be treated as exempt from charges in respect of treatment that the relevant agreement entitles them to. Generally, only immediate medical treatment is to be provided free of charge, to allow the overseas visitor to return home for other needs. Also, the agreements do not usually apply when the person has travelled to the UK for the purpose of obtaining healthcare.
Please note that reciprocal and bilateral agreements do not apply if you are having elective planned treatment or treatment that can be carried out in your country of origin.
Assessment of eligibility under reciprocal or bilateral arrangements can be complex so please contact the Overseas team for advice.
If you have private health insurance, you will be required to cover the costs to the Trust for all treatment it provides and then subsequently seek reimbursement from your insurer.
You should be aware that under paragraphs 320(22) and 322(12), and 3.14 of Appendix V, of the Immigration Rules a person with outstanding debts of over £500 for NHS treatment that is not paid within two months of invoicing, may be denied a further immigration application to enter or remain in the UK.
In the absence of prompt full settlement or a reasonable repayment schedule, non-clinical information relating to this debt is provided routinely to the Home Office and may be used by the Home Office to apply the above Immigration Rules. The information will remain active for the purpose of the above rules until the debt is settled and a record of the settled debt will also be retained, both subject to normal limitation periods.
In the event that you may seek entry to the UK or make an advance immigration application after settling an NHS debt in the previous two months, you are advised to retain and carry evidence of payment for potential examination by Home Office officials.
Frequently Asked Questions (FAQ)
The NHS is a state-funded healthcare system which provides free hospital treatment to people who are legally living in the UK on a permanent basis. If you are not ordinarily resident in the UK, you may have to pay for your hospital treatment, even if you have a British passport, or have paid National Insurance contributions and taxes in this country in the past.
In order to receive free hospital treatment, you will need to provide evidence that you are legally living within the UK. All patients admitted to this hospital, whatever their nationality and living status, may be required to provide appropriate information when registering their details. If you are living in the UK on a settled basis then you should be prepared to provide evidence. Examples of acceptable documents can be found below.
You will not be charged for treatment you receive in A&E. However, if you are transferred to ambulatory care, another hospital location, admitted to the hospital as an inpatient, or follow up on any outpatient setting charges will apply.
Patients are admitted into ambulatory care when there is a need for further decisions, diagnostic tests to be made on their care and for observations, i.e., the initial critical emergency has been dealt with. An admission into the ambulatory care, therefore, is an admission into the Trust and separate to the A&E attendance and therefore chargeable.
Usually, you will have to pay for treatment unless particular circumstances apply, such as:
- If you are visiting the UK and you normally live in a country that has a bilateral healthcare agreement with the UK, you might be entitled to free healthcare if you become unwell during your visit to the UK.
- If you are visiting the UK and you normally live in a country that is a member of the EU or an EFTA country, you will be entitled to free healthcare, provided that you have a valid European Health Insurance Card (EHIC) or Provisional Replacement Certificate (PRC). This card / certificate does not entitle you to pre-planned treatment – only emergency treatment.
- If you have come from abroad and are planning to remain in the UK for six months or more and have paid the Immigration Health Charge (IHS) or are exempt from paying it, you will be entitled to relevant services on the same basis as a person ordinarily resident in the UK. The exception to this is that NHS-funded assisted conception services to surcharge payers (or equivalent) are not free when provided.
- If you are a refugee or an asylum seeker whose formal application to the UK Border Agency is still being considered, you will not have to pay hospital charges. 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.
- Treatment received in the Emergency Department (sometimes also known as Accident & Emergency or Casualty Department) is free of charge. However, if you are transferred to another hospital location, admitted to the hospital as an inpatient, or receive any outpatient appointments charges will apply.
The only person who can formally advise whether you are eligible for NHS treatment is a UCLH Overseas Officer. If a doctor or nurse tells you that you do not have to pay, they may be referring to the treatment you receive in the Emergency Department (sometimes also known as Accident & Emergency or Casualty Department) only.
The Overseas Visitors Team (contact details below) can provide you with more detailed information if you are unsure whether you are entitled to free hospital treatment.
Please contact the Overseas Visitors Officers on 020 3447 8348, 020 3447 9763, 020 3447 9653 or email uclh.
You will be charged for any treatment given to you, by any member of staff in any of our services, both in the hospital or in the community. Exceptions may apply under certain circumstances, but we will discuss this with you if it applies to you.
If a patient states that they cannot afford to pay for their treatment, the Accounts Receivable Team may be able to offer arrangements for the patient to pay in instalments in some circumstances. Charges will not be waived. Patients will be given details of how to contact the Accounts Receivable Team when they receive an invoice.
NHS Commissioners (usually Integrated Care Boards) are responsible for commissioning healthcare on behalf of their local population who are eligible for NHS services. As part of this duty, ICBs generally publish a Fertility Policy which provides guidance on clinical eligibility criteria and pathways. All individuals seeking NHS funded Assisted Conception Services (ACS) – whether ordinarily resident, an Immigration Heath Surcharge (IHS) payer or other overseas visitor - will be assessed by the relevant commissioner on their suitability and if they can then proceed to treatment. This is not a Trust responsibility.
Patients who do not ordinarily reside in the UK, who are subject to immigration control and assessed as Overseas Visitors cannot access ACS free of charge and the following services are chargeable.
Assisted conception services are defined as any medical, surgical or obstetric services provided for the purpose of assisting a person to carry a child. Broadly speaking, this means any medicines, surgery or procedures that are required to diagnose and treat infertility so a person can have a child. It includes procedures such as intrauterine insemination (IUI), in vitro fertilisation (IVF) and egg and sperm donation.
People who pay the Immigration Health Surcharge (IHS) or are exempt of paying the IHS as part of their visa application can access NHS services free of charge on the same basis as other lawful residence of the UK except for ACS which is not covered by the IHS.
It’s important to note that if you (or your partner) are in the UK and subject to immigration control (defined as currently holding a valid visa to enter or to remain in the UK and without indefinite leave to remain), you are not eligible for free of charge Assisted Conception Service (ACS) on the NHS.
Any ACS for the purpose of assisting a person to carry a child (including all consultations, hospital encounters, diagnoses and treatments) will be charged.
If you are unsure if you are eligible or if you wish to discuss this further, please contact the UCLH Overseas and Eligibility Team who can confirm a patient’s eligibility and costs. Email: uclh.
List A: Acceptable documents that can be used as proof of identity (Obtain 1)
- Passport and Visa (if applicable).
- National identity card.
- Confirmation of settlement or pre-settlement Status in the UK for EU Nationals or dependents of EU Nationals.
- A Registration Certificate or Document Certifying Permanent Residence issued by the Home Office to an EEA / Swiss national.
- A Permanent Residence Card issued by the Home Office to the family member of an EEA / Swiss national.
- A passport endorsed to show, or a Biometric Residence Permit or Immigration Status Document showing, that the holder is exempt from immigration control, is allowed to stay indefinitely in the UK, has the right of abode in the UK, or has no time limit on their stay in the UK.
- A current Residence Card issued by the Home Office to the family member of an EEA / Swiss national.
- A current passport endorsed to show, or a Biometric Residence Permit or Immigration Status Document showing, that the holder has valid time limited permission to stay in the UK.
- A full UK birth or adoption certificate.
- A Naturalisation or Registration Certificate as a British Citizen.
List B: Acceptable documents that can be used as proof of address (Obtain 1)
- Utility bill (gas, electric, water, telephone) issued within the last 3 months, confirming address.
- Council tax bill issued within the last 12 months, confirming address.
- Current mortgage statement, confirming address.
- Current Tenancy agreement or rent book, confirming address.
- An official document confirming permanent National Insurance Number issued by a UK Government agency, or an employer, issued within the last 12 months, confirming address.
- Bank statement or passbook issued or updated in the last 3 months, confirming address.
- A letter from a UK Government agency issued within the last 3 months, confirming address.
