Overseas visitors – information for patients and families

Section 175 of the National Health Service Act 2006 allows the Secretary of State for Health to make rules for recovering costs for NHS services provided to any person who is not ordinarily resident in the UK.

The National Health Service (Charges to Overseas Visitors) Regulations 2015 place a legal obligation on the Trust to make and recover charges for NHS treatment provided by that relevant NHS body. By law, the Trust must make sure that:

• patients who are not ordinary resident in the UK are identified
• a check is done to see if the patient needs to pay charges
• if the check shows that a patient needs to pay, the charges are made in line with the Charging Regulations
• charges are recovered

If you are visiting the UK or living here for a limited period you may still be eligible for free NHS care. For example if:

• Your child is visiting the UK and they normally live in a country with a reciprocal healthcare agreement with the UK, they may be entitled to free healthcare if they become unwell during their visit. Check this table at NHS.uk to see the list of agreements.
• Your child is visiting the UK and they normally live in a country that is a member of the European Economic Area healthcare arrangement, they will be entitled to free healthcare if they have a valid European Health Insurance Card (EHIC). This card covers emergency treatment only (not pre-planned). You need to bring your child’s card with you to hospital – it must be in their name and within the expiry date.
• Your child is a refugee or an asylum seeker whose formal application to the Home Office is being considered. A refugee is someone who has been granted asylum in this country.
• You have paid the International Health Surcharge when applying for a visa for your child. To prove this, you will need to present the Biometric Residency Card for your child that was issued to you.

We are required to confirm if someone qualifies for free treatment based on a set of guidelines published by the Department of Health and Social Care. This list of documents does not cover every situation and each case is assessed on the information and documents provided. However, evidence from three main areas is normally enough. Please remember that even though your child is the patient, we will have to check both parents and the child to confirm access to free care.

Proof of Identity

• Passport/Passport with valid entrance visa
• EU/EEA Identity (I.D.) photo card
• Biometric Residence Permit
• Asylum Registration Card
• National ID card
• Driving licence
• Armed forces/NATO/Government I.D. card
• Asylum Registration Card/Section 95 support

Proof of address

• Bank Statement (UK)/Council Tax, Tenancy/Mortgage Agreement/Utility Bill
• Wage slip/Contract of Employment
• Telephone bill
• All documents must be less than three months old, and your full name and address must be included on the document

Any other useful documents

• European Health Insurance Card or Provisional replacement card
• Wage slip/Contract of Employment/ P60
• HMRC or DWP letter or statement
• Settled status scheme registration
• Copy of birth / marriage certificates
• Any other home office issued documents which are relevant to your situation.

Immediately necessary treatment is where a patient needs treatment:

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

This will always be provided – it does not matter whether or not the family have been informed of costs, or agreed to pay. Also treatment will not be delayed or withheld while checks are done to see if a patient qualifies for free care, or while requesting payment.

Urgent treatment is when doctors do not consider treatment immediately necessary, but which still cannot wait until the patient can be reasonably expected to return home.

Non-urgent treatment is routine optional treatment that could wait until the patient can return home.

The Trust will not provide non-urgent treatment to patients who do not qualify for free care unless the full estimated cost of the treatment has been paid in advance. However, clinicians will need to know when a patient can reasonably be expected to return home to decide if a patient’s need for NHS hospital treatment is urgent or if they can safely wait to return home..

However, the decision will be reassessed if the family informs the Trust that their return date has been postponed for valid reasons or if their medical condition unexpectedly changes.

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, e.g. those provided at walk-in centres or urgent healthcare centres. This does not include those emergency services provided after the patient has been accepted as an inpatient, or at a follow-up outpatient appointment. In these cases, costs must be paid.
• Services provided outside an NHS hospital, unless the staff providing the services are employed by, or working under the direction of, an NHS hospital.
• Diagnosis and treatment of specified infectious diseases (diagnosis remains exempt even if the outcome is negative).
• 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

If the Trust decides that the patient is not eligible for free treatment then the Trust must recover costs from the legally responsible adult. This will be done using the relevant charging route for the NHS services provided.

Overseas visitors with travel insurance will be required to pay for their treatment and then claim back from their insurer on their return home. This is because the Trust cannot be sure that the insurance company will make full payment in all cases.

Treatment is not made free of just because it is provided on an immediately necessary or urgent basis. If charges are found to apply, they cannot be cancelled. However, any patient undergoing “immediately necessary” treatment will be reassured that this will not be withheld or withdrawn in the event of the family being unable to pay.

If there are any doubts over whether a patient qualifies for free care, the legally responsible adult will still need to pay charges for their treatment. If it is subsequently established that the patient is eligible then a refund will be made.

All costs are based on NHS tariffs and will be calculated in line with the NHS charging guidance and relevant law.

For payment in advance on planned treatment we will provide an estimate of costs based on advice from doctors. However it is only once treatment has been provide that we will be able to calculate the correct costings and provide a final invoice.

As part of the screening process undertaken by the trust we may share data with the Home Office. This is explained in our Data Privacy statement and in line with the relevant law.

For more information about this process please see:

• Department of Health and Social Care leaflet
• Overseas visitor charging regulations
• How to access NHS services in England
• NHS cost recovery programe

While we try to make sure that all patients receive the same level of service and information, sometimes mistakes may be made. If you have any concerns or require help and advice you can contact our Patient Advice and Liaison Services (PALS) manager Julie Mather.

PALS attempts to resolve your problems quickly, however if you feel the need to make a formal complaint, they will be happy to advise and guide you through the complaint procedure.

More information about the formal complaints procedure can be found in the leaflet ‘Are we getting it right? How to make a complaint’ or by contacting the Complaints Team on 0114 271 7194.

During this uncertain period we will refresh our information as soon as we can. However, please be aware that details relating to EEA nationals on these pages may be out of date from time to time. All decisions are made based on the appropriate laws that apply at the time of treatment.

Our current understanding is that current arrangements will continue during the transition period and existing EHIC and S2 processes will remain.