Overseas Visitors

We understand that your visit to our hospital may be very stressful for you and we would like to make it as easy as possible when it comes to your understanding of the information that may be required by our staff to establish entitlement to NHS services.

Hospital treatment is free to people classed as ordinarily resident in the UK. Determining residency isn’t as straight forward as where you were born, payment of UK taxes, National Insurance contributions, being registered with a GP, having an NHS Number, or owning property in the UK. 

To be considered ordinarily resident, you must be living in the UK on a ‘lawful and properly settled basis for the time being’ – you may be asked to prove this.

The Department of Health Overseas Charging Regulations place the responsibility on individuals to prove entitlement to free NHS treatment. We would ask for your co-operation in providing the evidence requested, to avoid your liability for the cost of any treatment provided to you now or in the future.

 

Our Approach

Lancashire Teaching Hospitals NHS Foundation Trust is committed to implementing the Hospital Charging Regulations consistently across the Trust, using a robust and common sense approach.

NHS services are provided free of charge to people who are deemed to be "ordinarily resident".

Ordinary residence is defined as when a person is:

Living lawfully in the United Kingdom voluntarily and for settled purposes, as part of the regular order of their life, for the time being

In order to ascertain a person's eligibility, the Trust applies baseline questions to all new patients. These include, but are not exclusive to,

  • "Where have you lived in the last 6 months?"
  • “Do you have a non UK EHIC?”


Common misconceptions

A person is not ordinarily resident in the UK simply by:

  • Having a British Passport
  • Having an NHS number.
  • Being registered with a GP
  • Owning property in the UK
  • Having paid (or currently paying) National Insurance Contributions and taxes in this country.

The regulations are based on residency so if you have been living outside of the UK you may still be chargeable.

Services exempt from charging

The following services are free at the point of use to everyone. A charge cannot be made or recovered from any overseas visitor for:

  • Accident and Emergency (A&E) services, this includes all A&E services provided at an NHS hospital.
  • This does not include those emergency services provided after the overseas visitor has been accepted as an inpatient, or at a follow-up outpatient appointment, for which charges must be levied unless the overseas visitor is exempt from charge in their own right. 
  • Services provided outside an NHS hospital, unless the staff providing the services are employed by, or working under the direction of, an NHS hospital. 
  • Family planning services (does not include termination of pregnancy) 
  • Palliative care services provided by a registered palliative care charity or a community interest company.
  • Services that are provided as part of the NHS111 telephone advice line.
  • Diagnosis and treatment of specified infectious diseases. 
  • Diagnosis and treatment of sexually transmitted infections. 
  • Treatment required for a physical or mental condition caused by: 
    • Torture
    • Female Genital Mutilation
    • Domestic Violence
    • Sexual Violence 

Except where the overseas visitor has travelled to the UK for the purpose of seeking that treatment.

 

Visitors from the European Economic Area (EEA)

If you are a visitor from the EEA, you will need to present a valid European Health Insurance Card (EHIC) or other healthcare documents (such as S2 or S1 forms) or you may be charged for your care.

If you do not have an EHIC card you can apply for one from the country where you normally live through visiting https://ec.europa.eu/social/main.jsp?catId=563&langId=en#nationalinfo
Under National Information and contacts; select your country's national flag for further information.

It’s also possible to get a Provisional Replacement Certificate (PRC) if you don’t have your EHIC, this is an emergency document and will provide the same level of cover as the EHIC and is normally dated for the period of your visit to the country.Please contact your national healthcare provider to request this document

 

Countries with a Reciprocal Healthcare Agreements 

The UK has reciprocal healthcare agreements with some non-European Economic Area (EEA) countries.

Within the reciprocal agreements there are a number of variations in the level of free treatment provided to visitors travelling to the UK. Generally, only immediate medical treatment* is to be provided free of charge, to allow the overseas visitor to return home for other needs i.e. follow up treatment or outpatient appointments.

Please ensure you check with the Overseas Visitors Team to ensure your financial responsibilities are clear and DO NOT ASSUME all your treatment will be covered.

If you’re being treated under a reciprocal agreement and it is terminated during the course of your treatment then you will become liable for all further costs.

*Immediate treatment is defined as to save the patient’s life/prevent a condition from becoming immediately life-threatening or needed promptly to prevent permanent serious damage occurring

 

Visitors from Non EEA Countries

If you are visiting England from a non-EEA country, you need to ensure you are covered for healthcare through personal medical insurance for the duration of your visit, even if you are a former UK resident. This is a requirement of your entry conditions to the country.

If you are coming for more than six months, you may need to pay the immigration health surcharge ( IHS ) as part of your visa application.This means you will be receive treatment on the same basis as an ordinary resident of the country.

Should you need NHS treatment and you have not arranged insurance, or paid the health surcharge, you will be charged at 150% of the standard NHS rate, unless an exemption category applies to either you or the treatment.

 

Maternity services

Overseas patients planning on having their baby during their UK visit.

If you are not ordinarily resident meaning someone who is living lawfully in the UK, and you do not meet an exemption you will be liable for your maternity care.

You are required to show evidence to support your exemption, examples include:

  • A valid European Health Insurance Card (EHIC) or S2 certificate issued in your European country of residence
  • A Biometric Residence Permit (BRP) which shows you have either paid or are exempt from paying the Immigration health Surcharge
  • A guarantee of payment issued by your insurance company covering maternity services
  • A valid passport or identity card, and evidence of residence, if you are a resident of a bilateral agreement country

For more information on the maternity exemptions and charges, please contact the Overseas Team.

 

Assisted Conception

Whilst NHS treatment is free of charge for those Non EEA nationals who have paid the Immigration Health Surcharge (IHS) this no longer includes Assisted Conception services, which must be paid for in advance of any treatment commencing.

 

Chargeable Patients

If we are unable to ascertain your entitlement to free NHS treatment, or find that you are a chargeable patient, you will be asked to make payment for your treatment costs.This payment will be based on your initial clinical diagnosis and we will try to provide you with an idea of the cost in advance, please be aware that this can vary as the treatment progresses.

Whilst the Charging Regulations place a legal obligation on the Trust to make and recover charges for NHS treatment, the Trust will ensure that treatment which is:

Immediately necessary will be provided to any patient even if they have not paid in advance
Immediately necessary treatment is that which a patient needs:

  • to save their life, or
  • to prevent a condition from becoming immediately life-threatening, or
  • promptly to prevent permanent serious damage from occurring.

Urgent treatment will be provided to any patient, even if deposits have not been secured
Urgent treatment is that which clinicians do not consider immediately necessary, but which nevertheless cannot wait until the person can be reasonably expected to return home. 

Non-urgent or elective will not be provided unless the estimated full charge is received in advance of treatment.
Non-urgent treatment is routine elective treatment that could wait until the patient can return home

Pharmacy
Overseas visitors are not entitled to receive an NHS subsidised prescription therefore they must pay the same charge for a private prescription. 

Deceased Patients
Where a patient dies without making or completing a payment to the Trust the debt then becomes recoverable from the deceased's estate. An offer from relatives or another person to meet the debt can be accepted but this must not be actively pursued, unless it was they who had signed the undertaking to pay form. 

 

Recovery of Income

Non -Payment – We would ask that you settle your invoice as soon as possible after receiving it. If you have any financial difficulties please let us know so we can work with you to explore payment options; Unpaid invoices outstanding for 2 months may be referred to debt collection and in some circumstances if the debt is over £500 referred to the UK Border Agency; this may affect future applications to enter or remain in the UK.

 

FAQ

Who is eligible for free NHS treatment?
The NHS provides free hospital treatment to anyone who is ordinarily resident in the UK

How can I prove that I am entitled to free hospital treatment?
To receive free hospital treatment, you will need to provide evidence that you are legally living within the UK.
All patients who are treated at our trust, whatever their nationality and living status, are required to provide correct information when registering their details. If you are living in the UK on a settled basis then you should be prepared to provide evidence.
You will be asked where you have lived in the last 6 months and to provide ID along with evidence to support your ordinarily resident status. If your status is unclear or not enough documents have been provided, you may need a further interview with our overseas patients’ office.

What happens if I need to attend the accident and emergency department (A&E)?
You will not be charged for treatment that you receive in the A&E department. However, this does not include emergency treatment given in any other department in the hospital.

If I am not eligible for free treatment, what will I have to pay for?
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.

How will I know if I have to pay?
The overseas visitors team can provide you with more detailed information if you are unsure whether you are entitled to free hospital treatment. You will be asked to provide evidence of entitlement – the overseas visitors team can advise you of what documents are acceptable.

I am just visiting the UK. Do I have to pay for treatment if I become unwell?
If you live in a country that has a Reciprocal healthcare agreement with the UK, you may be entitled to free healthcare. Our overseas office can advise you

If you are a European national with a valid European Health Insurance Card (EHIC) you will be entitled to free emergency treatment, but not planned care. If you are unable to show a valid EHIC, you will need to pay for your treatment

If you have private healthcare insurance, you must provide us with a letter of guarantee from your insurer confirming they will cover the costs. If you are unable to present a letter of guarantee, you will need to cover the cost of the treatment and seek reimbursement from your insurer

If you are a refugee or asylum seeker whose formal application is being considered by the UK Border Agency, you will need to provide the overseas officer with documentary evidence of your asylum claim before treatment commences. If this is confirmed then you will be entitled to receive free treatment

Visitors from countries with no Reciprocal agreement and people who have no legal rights to be in the UK, including failed asylum seekers and illegal immigrants, are not entitled to free hospital treatment

 

The Overseas Visitors Team

Who we are:
We are a small, friendly team dedicated to ensuring that the Trust can recover money due following treatment of Overseas Visitors.

What we do:
It is the team's job to review a patients eligibility to free NHS treatment. We do this by collecting information on patients and, if necessary, asking for documents so that we can assess their status. This can be done by interview or letter.

Why we do it:
Department of Health charging regulations place a legal obligation on the Trust to recover the costs of NHS services where an individual is not entitled to free treatment. It is estimated that, as a whole, the NHS can recover some £500 million a year from Overseas Visitors treated by the NHS. This money is invested back into NHS Services.

How can we help?

If you think that you might be an Overseas Visitor let us know as soon as possible so that we can check whether you are liable to pay for your hospital treatment.

If you have any queries about Overseas Visitors accessing medical treatment within our hospitals, please do not hesitate to contact the Overseas Visitor Team.

 

Contact Details

Overseas Visitors Team
overseas.visitors@lthtr.nhs.uk

Tel: +44(0) 1772 522563

 

Further Information

https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations