The NHS is a residency-based healthcare system and eligibility for relevant services without charge is based on the concept of ‘ordinary residence’.
An ‘overseas visitor’ is anyone who is not ‘ordinarily resident’ in the UK, and this includes British nationals who now live overseas.
A person will be ‘ordinarily resident’ in the UK when that residence is lawful, adopted voluntarily, and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration.
The Department of Health and Social Care charging regulations places a legal obligation on NHS trusts to establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charges.
Overseas visitors who are visiting the UK for six months or less (including those on multiple entry visas), non-resident UK nationals, or those who are in the UK without immigration permission, will be charged for services they receive beyond our emergency departments, unless an exemption applies.
Different types of treatment
Healthcare treatment received within an emergency department is free of charge for all patients, no matter their immigration status within the UK, and those who need care that is clinically deemed urgent or immediately necessary — such as maternity care — will always be treated promptly, even if a patient indicates they cannot afford to pay at the time of treatment. We do not turn any patients away.
But NHS treatment is not free of charge just because it is provided on this basis, and an invoice for treatment will still be raised and payment requested at a later date.
To carry out these assessments, the Royal Free London has a dedicated overseas and eligibility team who specialise in assessing patients to establish whether they are liable for charges or if an exemption applies.
This may involve asking the patient to provide documentation to prove or support their eligibility for NHS treatment.
Patients who are assessed as not being ordinarily resident within the UK and thus not eligible to NHS healthcare free of charge, will be required to pay for their treatment and asked to make an upfront payment towards the initial estimated cost of treatment.
It is the responsibility of the patient to provide evidence, when requested, to demonstrate they are entitled to free NHS treatment. When evidence is not provided, treatment will be charged for.
If you are unsure of your eligibility or status for NHS treatment, please do not hesitate to contact the overseas and eligibility department, who will be happy to assist you with any queries you may have.
Patients directly liable for charges
The Department of Health and Social Care charging regulations place a legal obligation on NHS trusts to establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charges.
The overseas visitors team at the Royal Free London will interview you to understand if you are liable for charges associated with receiving NHS care and will also ask you to provide documents to prove your entitlement.
If you are not entitled to free care, you will be charged a deposit for your treatment which must be paid in full prior to the treatment commencing.
As each NHS service is different, we are unable to provide you with an exact treatment price for your care until you have been discharged. This is when all of your hospital treatment will have been updated on the hospital system and a final invoice can be raised, with payment due immediately.
You should be aware that under immigration rules 320, 321, 321A and 322, a person with outstanding debts of over £500 for NHS treatment that are not paid within two months of invoicing, may be denied a further immigration application to enter and remain in the UK or to re-enter the UK on an existing one.
In the absence of prompt full settlement or a reasonable payment schedule, non-clinical information relating to this debt is provided to the Home Office and may be used by the Home Office to apply the above rules until the debt is settled.
European Health Insurance Card (EHIC)
If you are travelling from a European country to the UK, you will need to show a valid EHIC, otherwise you will have to pay for your care directly. You will also be asked to provide the following documents:
- a copy of your passport
- your full address abroad
The EHIC must be produced (or a provisional replacement certificate) prior to discharge from 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.
Please note your EHIC does not apply if you are having elective planned treatment or treatment that can be carried out in your country of origin.
Patients from countries with reciprocal or bilateral arrangements with the UK for healthcare
The UK has reciprocal healthcare agreements with some non-European economic area countries.
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.
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.
If you are liable for the charges associated with your care, you may choose to use your travel insurance or health insurance to fund your care.
If you have insurance cover, it is your responsibility to contact the company to gain a ‘letter of guarantee’ and authorisation numbers from your insurers authorising your treatment.