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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) and Urgent Treatment Centre (UTC) departments, 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.
Different types of treatment
Healthcare treatment received within A&E and UTC departments are 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.
We do not turn any patients away.
However, NHS treatment is not free of charge just because it is provided on this basis. An invoice for treatment will still be raised and payment requested later, should an overseas visitor be treated beyond the A&E and UTC departments.
Assessing NHS eligibility
To carry out these assessments, the Royal Free London NHS Foundation Trust 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 will likely 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.
Contact us
Barnet Hospital and Chase Farm Hospital
Tel: 020 8216 4323
North Middlesex University Hospital
Email: nmu-tr.
Royal Free Hospital
Tel: 020 7472 6636
Email rf.
Methods of payment
Patients personally liable for charges
The Department of Health and Social Care charging regulations and UK parliamentary Law 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 and eligibility team at the Royal Free London NHS Foundation Trust 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 receive NHS care without charge, you will be asked to pay a deposit towards the estimated cost of your treatment which must be paid in full prior to your receiving any treatment of a non-urgent nature.
If your treatment is deemed to be immediately clinically necessary and of an urgent nature, your treatment will not be delayed or prevented if payment for NHS treatment is not received beforehand, however, the Trust reserves the right to pursue payment for any treatments provided retrospectively.
Treatment prices
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 your hospital treatment will have been updated on the hospital system and a final invoice can be raised, with payment due immediately.
If you fail to pay any outstanding invoice owed to the NHS, the Trust is legally obligated under immigration rules 320, 321, 321A and 322, to report a person with outstanding debts of over £500 for NHS treatment (that are not paid within two months of invoicing) to the UK Home Office and UK Border Agency, which may result in you being denied further immigration applications to enter and remain in the UK or to re-enter the UK on an existing one at a later date.
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)
A European Health Insurance Card (EHIC) is available to people who are insured by a public health system in the European Union, Iceland, Liechtenstein, Norway, or Switzerland.
If you are resident and travelling from any of these areas of Europe to the United Kingdom, you will need to show a valid EHIC alongside a copy of your passport and / or National ID card to the AandE / UTC reception staff when registering with the hospital.
If you do not have a valid EHIC, you can apply for a provisional replacement certificate (PRC) from the Ministry of Health from your respective country. The EHIC or PRC must be produced prior to discharge from hospital or prior to an outpatient appointment, or you will be liable to pay all fees associated with your NHS care.
Dependent on your nationality, you may be able to 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.
Insurance
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.
