Concerns over so called health tourism in in the UK has led the government to introduce changes to treatment provided to overseas visitors. The government’s aim is to recoup as much as £500 million a year by 2017-2018 from overseas visitors’ and migrants’ use of the UK National Health Service (NHS). Consequently, in April 2015, the first of these changes were made to the way the UK National Health Service (NHS) charges overseas visitors for NHS hospital care. These regulations were amended most recently on 23rd October 2017 by the NHS (Charges to Overseas Visitors) (Amendment) Regulations. This Article provides an overview of the circumstances in which a person may be subject to NHS charges.
Who is an overseas visitor?
Within the UK free NHS treatment is provided on the basis of an individual being ‘ordinarily resident’ in the UK. It is not dependent on one’s nationality, payment of UK taxes, national insurance contributions, having an NHS number or owning property in the UK.
A person is said to 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’.
In practice, one is ‘ordinarily resident’ in the UK if they are living and working in the UK and are:
- A British citizen
- Naturalised within the UK
- Settled within the UK i.e. holding Indefinite Leave to Remain.
The Charging Regulations place a legal obligation on any provider of relevant service including non-NHS organisations such as private and voluntary providers supplying NHS services to establish whether a person is an overseas visitor to whom charges apply or whether they are exempt from charges.
How will this change affect NHS users?
From 23rd October 2017, overseas visitors requiring treatment will be told upfront if their care/treatment is chargeable before treatment begins. Providers of relevant care are required to recover these charges in full in advance of providing them unless to do so would prevent or delay provision of urgent or emergency care. All treatment received at an NHS facility will be chargeable unless it is an exempt service such as:
- Treatment at GP surgeries
- Accident and emergency (A & E) services (whether provided at an A & E department or similar e.g. at an urgent care centre, minor injuries unit, walk-in centre etc.) This does not include A & E services provided after an overseas visitor has been admitted as an in-patient or at a follow-up outpatient appointment.
- Family planning services – this excludes termination of an established pregnancy as this is not considered to be a method of contraception or family planning and also excludes infertility treatment.
- Services provided as part of the NHS 111 telephone advice line
- Treatment required for a physical or mental condition caused by torture, female genital mutilation, domestic violence or sexual violence -except where the overseas visitor has travelled to the UK for the purpose of seeking that treatment
Exempt Categories of person- who will not be charged for NHS hospital treatment?
There are also some special groups who will not have to pay for NHS treatment
- Those who have paid the Immigration Health Surcharge
- Those with an enforceable EU right to free health care
- Vulnerable patients (including refugees and asylum seekers) and those detained
Evidencing your entitlement to NHS treatment
NHS providers have a duty to check evidence of entitlement from those patients who assert that they qualify for NHS treatment under a specified exemption. It is imperative that NHS users have the correct documentary evidence to avoid being charged for NHS treatment received. The NHS provider may ask for both evidence of immigration status and address. For applicants whose immigration status documents have expired but they have submitted an in time application for further leave to remain, the NHS providers’ Overseas Visitor Managers (OVMs) are authorised to make enquiries about a patient’s immigration status. Such enquiries are sent via email to the Home Office’s Evidence and Enquiry Unit who will respond to such enquiries within 5 working days. OVMs are not required to obtain a patient’s consent before sharing non-clinical data with the Home Office for purposes of determining the patient’s immigration status. However, the patient must be notified that their data is being shared and how this data may or will be used
Travel and Health insurance
People living outside the EEA including former UK residents are advised to make sure that they are covered by personal health insurance unless an exemption applies to them. The lack of personal health insurance could be very costly as any chargeable treatment received will be charged at 150% of the NHS national tariff. Failure to pay this charge may have an effect on any future immigration applications for entry clearance or leave to remain that an individual makes.
It can be seen from the level of fees generated through the introduction of these provisions, that they are relevant to many coming to the UK. It is important that one does not owe a debt to the NHS as this could impact upon one’s ability to qualify for leave to enter or remain in number of categories such as a spouse. In our experience, people are not always aware that they owe a debt to the NHS as they may not have been advised of the charges at the point of service. Since 6 April 2016, the NHS has an obligation to inform the Home Office of certain debts where they are outstanding for more than two months. As such we would suggest that applicants may wish to make enquiries of the NHS to pre-empt a refusal of leave to enter or remain and to check that why do not have an outstanding debt with the NHS. Where an applicant is unsure whether their immigration status in the past allowed them to access free NHS treatment then we can advise on this prior to contact being made with the relevant NHS body.
If you have any queries about this article, please contact Emma Okenyi at firstname.lastname@example.org