Patients From Abroad

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. This includes British nationals who live abroad.  A person will be ordinarily resident in the UK when their 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 there are exemptions from NHS Hospital treatment charges.

Overseas visitors who are in the below categories will be charged for services they receive beyond the emergency department (A&E), unless an exemption applies:

  • Visiting the UK for six months or less (including those on multiple entry visas).
  • Non-resident UK nationals.
  • Those who are in the UK without immigration permission.

If you are not ordinarily resident in the UK, you will be subject to the National Health Services (Charges to overseas Visitors) Regulation 2015. 

Types of Treatment:

Healthcare treatment received within the Emergency Department (A&E) is free of charge for all patients, no matter their immigration status within the UK. 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.

Assessing NHS eligibility: 

To carry out these assessments, the North West Anglia NHS Foundation Trust has a dedicated Ordinary Residence Team who specialise in assessing patients to establish whether they are liable for charges or if an exemption applies. This will involve asking the patient to provide documentation to prove or support their eligibility for NHS treatment without charge.

Patients who are assessed as not being ordinarily resident within the UK and thus not eligible to receive NHS healthcare without charge, will be required to pay for their treatment and asked to make an upfront payment towards the initial estimated cost of treatment, if that treatment is deemed to be of a non-urgent nature or not immediately necessary.

It is the responsibility of the patient to provide evidence, when requested, to demonstrate they are entitled to NHS treatment without charge. When evidence is not provided, the patient will be deemed chargeable for NHS treatment and an invoice issued.

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.

For more information, please see below.

I am just visiting the UK. Do I definitely have to pay for treatment if I become unwell?

No, there are a number of circumstances under which you may be entitled to free healthcare.

  • If you are visiting the UK and you normally live in a country that has a bilateral healthcare agreement with the UK.    
  • 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 provided that you have a valid European Health Insurance Card (EHIC). However, this card only covers free treatment when the need for it arises during a visit and pre-existing conditions that acutely exacerbate here, or in the opinion of a Clinician need prompt treatment to prevent them from acutely exacerbating. 

The routine monitoring of chronic/pre-existing conditions is NOT included and free treatment will be limited to that which is urgent in that it cannot wait until the patient can reasonably return home.

The Trust will charge a patient for treatment if a valid EHIC card is NOT present.

How can I prove that I am entitled to free hospital treatment?

In order to receive free hospital treatment, you will need to provide evidence that you are legally living in the UK. All patients admitted to this hospital, whatever their nationality and living status, are required to provide examples of evidence 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 evidence:

  • Proof of right to live in the UK
  • UK national or EEA/Swiss national right of abode in accordance with immigration (European Economic Area) Regulations 2006
  • If the patient has right of abode in the UK
  • non-EEA family member of EEA national excising EU treaty rights
  • has a route to settlement with a spouse/civil partner/fiancé visa
  • has appropriate entry clearance by Home Office i.e. indefinite leave to enter/remain stamp in passport
  • resuming permanent residence - evidence confirming this intention

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

NHS bodies are legally obliged to charge liable patients for treatment, and recover all money. You will be charged for any treatment given to you outside of the Emergency Department, both in the hospital and the community.

Are certain diseases exempt from charge?

Certain diseases where treatment is necessary to protect the wider public health, are exempt from charge. This exemption will apply to the diagnosis, even if the outcome has a negative result. A list of exempt diseases are available from the Department of Health.

What happens if I attend the accident and emergency department (ED)?

You will not be charged for treatment that you receive in our emergency department. However, where emergency treatment is provided after admission to the hospital as an inpatient or outpatient, this will be chargeable to a non-exempt overseas visitor.

What is immediately necessary, urgent and non-urgent treatment?

Only clinicians can make an assessment as to a patient's need for treatment. However, no matter what category, liable patients are expected to pay all treatment costs.

Immediately necessary—is the treatment a patient needs (including maternity treatment), to save their life, to prevent a condition from becoming life-threatening, to prevent permanent serious damage from occurring.

NHS Bodies must provide treatment, whether or not the patient has been informed of, or agreed to pay.

Urgent treatment— treatment cannot wait until the patient can reasonably be expected to return home. Payment should be secured before treatment is scheduled.

Non-urgent treatment—routine elective treatment, could wait until the patient returns home. NHS bodies should NOT provide non-urgent treatment if the patient does not pay in advance.