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This information is for guidance only. If you have any queries please do not hesitate to contact the overseas visitors department:

Tel: 01268 524900 ext 3304

E-mail Btu-tr.servicedevelopment@nhs.net

If  you are unwell and it is not an emergency, the first point of contact is usually primary care such as family doctors (general practitioners (GPs)), dentists, pharmacists, optometrists, NHS walk-in centres and the NHS 111 telephone service.

For more information see: www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/access-services-in-England.aspx

This information is for guidance only. If you have any queries please do not hesitate to contact the overseas visitors department:

Tel: 01268 524900 ext 3304

E-mail Btu-tr.servicedevelopment@nhs.net

If  you are unwell and it is not an emergency, the first point of contact is usually primary care such as family doctors (general practitioners (GPs)), dentists, pharmacists, optometrists, NHS walk-in centres and the NHS 111 telephone service.

For more information see: www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/access-services-in-England.aspx

If you need to go to hospital

If you need to go to hospital

If you need to go to hospital (secondary care), all hospitals have a legal responsibility to ensure that any patient given NHS treatment is entitled to receive that care without charge. This is usually based on where you are ‘ordinarily resident’ (see ‘determining ordinary residence’ section below).

In turn, the patient has a duty to provide evidence, when asked, to confirm that entitlement otherwise they will be charged.

For patients whose entitlement to secondary NHS care (treatment delivered in hospital and some community services) is unclear we will write to them asking for evidence that confirms they are able to access NHS secondary care free of charge, or to pay for their treatment. 

Please note that GPs do not provide information about your entitlement to the hospital.

From Monday 23 October 2017 all hospital Trusts are required to charge overseas patients in advance for any non-urgent treatment.  The hospital will endeavour to provide an accurate estimate of the cost. If the final amount will not be finalised until after you leave hospital; any adjustment will appear on your invoice/credit note.

All urgent care outside Accident & Emergency (A&E) will be invoiced when treatment is completed (where appropriate).

Please note that if your entitlement to NHS care is not established, or we do not receive payment before your non-urgent appointment, it may be cancelled.

 

 

What if I receive a letter asking for proof to access NHS care?

What if I receive a letter asking for proof to access NHS care?

In accordance with the charging regulations, where the overseas team cannot assess your NHS status the hospital will write to you asking for documentary evidence of your entitlement to NHS care.

This will include where there has not been continuous registration with a GP in England for 6-months, or where the overseas team have been unsuccessful in tracing any information that would establish your entitlement to NHS treatment.

Any non-urgent treatment will be cancelled if either NHS entitlement is not established by the hospital or payment is not received in advance of the appointment.

Examples of documentation include:

  • Identity: Passport and visa; national ID card; driving licence or a biometric residence permit (BRP)

  • Residency: utility bill; tenancy agreement; council tax demand

  • Visitor Visa: For those subject to immigration control and have a visitor visa a quick reminder that the signed declaration states that with the issue of this type visa the recipient is aware that they may be billed for NHS medical treatment in the UK and that any unpaid NHS debts may adversely affect future entry clearance applications.

 

Determining ordinary residence

Determining ordinary residence

There are four questions that must be satisfied before a person can be deemed as being ordinary resident in the UK

  • ·           They are lawfully in the UK

  • ·           They are in the UK on a voluntary basis

  • ·           They are properly settled here for the time being and
  •  In the case of non-EEA nationals, subject to immigration control, has ILR (Indefinite Leave to Remain) in the UK

A person does not become ordinarily resident in the UK simply by having:

  • British nationality
  • British passport
  • A registered GP
  • An NHS number
  • Property
  • Paid National Insurance contributions

I’m a UK citizen although I don’t live in Britain

NHS entitlement is based upon UK residency and not on nationality. This is known as being ordinarily resident which means that individuals are living lawfully in the UK voluntarily and for settled purposes as part of the regular order of their life for the time being, whether of a short or long duration.

Settled purpose: “There must be an identifiable purpose for their residence here, there can be one purpose or several and it may be for a limited period.  The purpose for living in the UK must have a sufficient degree of continuity to be properly described as settled”

UK Pensioners

UK Pensioners ordinarily resident in the European Economic Area (EEA) will need to produce an S1 form to qualify for NHS treatment.  UK Pensioners ordinarily resident outside the EEA are no longer entitled to NHS care and will be charged for treatment.

If returning to the UK on a settled basis the individual will be asked for evidence to confirm their new status before attending hospital. Failure to do so may result in any non-urgent appointment being cancelled or the treatment being charged.

British citizens visiting the UK/Ex-pats

Former UK ordinary residents who have emigrated and no longer reside in the UK are usually chargeable on visits to the UK.

If resident in the EEA you will be asked to provide a copy of your passport and European Health Insurance Cared (EHIC) or provisional replacement certificate (PRC) to avoid being charged or the appointment cancelled.

Ex-pats returning to the UK on a permanent basis will need to provide evidence before attending hospital that they are moving back to the UK indefinitely before qualifying for NHS treatment. Failure to do so may result in any non-urgent appointment being cancelled or the treatment being charged.

Is all treatment chargeable?

Is all treatment chargeable?

Treatment provided in an accident and emergency department (A&E) is not part of the charging regulations and is free to all.

If a patient is liable for the cost of their treatment, charges will start either on admission to hospital as an inpatient, or on attendance to the hospital for an outpatient appointment. These charges cannot be waived (NHS Charging Regulations 2015 and their amendments).

This does not mean that treatment can be withheld if a clinician deems it to be immediately necessary under the Trust’s human rights obligations, but the treatment received will be chargeable.

Exemptions:

  • Specified diseases, including sexually transmitted, where treatment is necessary to protect the wider public health.
    This exemption from charge will apply to the diagnosis even if the outcome is negative, and the treatment of the exempted disease. It does not apply to any secondary illness that may be present. Regulation 6 update 2012 allows for free HIV treatment and care as defined in the HIV Outpatient Clinical Care Pathway and in line with the NHS HIV care and treatment commissioning arrangements.  This does not include any other HIV treatment
  • Treatment, including prescribing of antiretroviral (ARV) therapy, is available only for the duration of a person's stay in the UK.
  • Family planning services (not including termination of pregnancy).
  • Treatment given to people detained under the mental health act 1983 or other legislation authorising detention in a hospital because of a mental disorder.

Patients from the European Economic Area (EEA)

Patients from the European Economic Area (EEA)

Overseas visitors who ordinarily reside in one of the EEA member states must have a valid European Health Insurance Card (EHIC) or be in possession of a Provisional Replacement Certificate (PRC) to qualify for NHS care.

For patients living in the UK that are state pensioners from an EEA country they will need to provide a copy of their S1 card.

In addition to the card patients will be asked to provide a copy of their passport and confirmation of their home address.If you are a resident of an EEA country or Switzerland (this includes British citizens living in an EEA country), you can find information about using the NHS while in England by downloading the healthcare information leaflet here: www.gov.uk/government/uploads/system/uploads/attachment_data/file/467655/nhsleaflet-visitor-student.pdf 

Any non-urgent treatment will be cancelled if either NHS entitlement is not established by the hospital or payment is not received in advance of the appointment. 

Patients from the European Economic Area (EEA): Planned Treatment

Patients from the European Economic Area (EEA): Planned Treatment

There are currently three potential ways for people from another EEA country or Switzerland to receive planned healthcare in England:

- The Directive route (the Directive does not apply to Switzerland);-

The S2 route;

- Holders of a UK-issued S1 form registered with the relevant authorities in another EEA country or Switzerland may also be able to return to England and obtain planned healthcare

Directive Route

The Directive operates on a principle of purchase and reimbursement. Patients are able to purchase state or private healthcare in England and seek reimbursement for this treatment from their home country up to the cost of the treatment in that country.  

The EU Directive grants a fundamental right to purchase healthcare services across the EEA for its residents and to apply for reimbursement from their home system on their return. The patient will also bear the financial risk of any additional costs which may arise, for example travel and accommodation costs.   

Payment must be made in advance of any care. 

S2 Route

The S2 (formerly E112) route is an arrangement for people from another EEA country or Switzerland who want to come to the UK expressly to seek treatment. These patients will need to obtain prior authorisation from their social security institution, which bears the cost, meaning that the patient should not be charged for that treatment.

A person who has obtained permission from their social security institution to seek treatment in the UK under EU Regulations will be issued with an S2. They must make advance arrangements with the treating provider for their treatment and be given the same clinical priority as NHS patients. This means that if there is an NHS waiting list, they are subject to it.

Patients referred under scheduled treatment arrangements will continue to be covered for all medically necessary treatment for any other conditions if they show a valid EHIC/PRC.

Holders of S1/UKA1

Under EU Regulations, some people who are resident in other EEA member countries or Switzerland (for example frontier and posted workers, and pensioners) may have their healthcare costs paid for by the UK by virtue of the UK being the ‘competent country’ for them and therefore responsible for their healthcare costs. These persons should have a valid UK-issued S1 registered in their EEA country of residence or Switzerland (except some posted workers, who will have a UK A1 and UK EHIC).

Please note that if your entitlement to NHS care is not established, or we do not receive payment before your non-urgent appointment, it may be cancelled.

Patients from countries with reciprocal arrangements with the UK

Patients from countries with reciprocal arrangements with the UK

Several countries and territories outside the EEA also have reciprocal healthcare agreements with the UK covering their nationals, or sometimes all residents regardless of nationality. Patients who can show they are lawfully resident in one of those countries (and a national of that country if applicable) are exempt from charges providing the need for treatment arose during their visit to the UK.

The hospital will ask for documented proof to establish eligibility for free NHS hospital treatment.

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.

Any non-urgent treatment will be cancelled if either NHS entitlement is not established by the hospital or payment is not received in advance of the appointment. 

Asylum Seekers

Asylum Seekers

Anyone who has made a formal application with the Home Office to be granted asylum, temporary protection or humanitarian protection which has not yet been determined is exempt from charges, as are their dependants as part of the application. Formal applications are those made under the 1951 UN Convention and its 1967 Protocol and also any other request for humanitarian protection, such as some claims made on protection from serious harm grounds under Article 3 of the European Convention on Human Rights.

A person, and their dependants, who makes an application for leave to remain which relates to a claim for asylum or humanitarian protection, or on the basis that that their removal from the UK would be contrary to Article 3 of the European Convention on Human Rights, will be exempt from paying the health surcharge and will be entitled to NHS healthcare on the same basis as an ordinary resident.

The following should be provided as evidence having made an application for asylum, temporary protection or humanitarian protection:

  • Application Registration Card (ARC) issued by the Home Office; or
  • Confirmation from the Home Office that the person has made such an application and that it is still under consideration.

A person who has had their asylum/humanitarian protection application and all appeals rejected becomes a ‘failed asylum seeker’. They will become liable for charges for their NHS community or secondary care at that point, unless one of the following situations applies to them.

 

Persons who are being supported by the Home Office under section 95 of the Immigration and Asylum Act 1999 are exempt from charges

Some failed asylum seekers are supported under other provisions of the 1999 Act whilst making reasonable efforts to leave the UK

Failed asylum seekers being supported by a local authority under section 21 of the National Assistance Act 1948 or Part 1 (care and support) of the Care Act 2014 by the provision of accommodation are exempt from charges

Any non-urgent treatment will be cancelled if either NHS entitlement is not established by the hospital or payment is not received in advance of the appointment.

Patients who have paid the health surcharge

Patients who have paid the health surcharge

Under the Immigration Act (section 38) an immigration health charge, known as the health surcharge, is to be paid by non-EEA nationals, subject to immigration control, who apply for temporary residence in the UK for six months or more.

An individual who pays for the health surcharge is only entitled to free treatment once their application for a visa has been granted, and NOT from when the health surcharge has been paid.  The exemption from NHS charges applies to the period of leave to enter or remain in the UK granted to the person.  Once their leave expires or is curtailed the person becomes liable for charges from that date, including where a person is part-way through their treatment. Payment will be expected in advance of attending hospital, otherwise the appointment may be cancelled.

Patients who have paid the health surcharge seeking assisted conception services

Those exempt from NHS charges as they have paid the health surcharge will no longer be entitled to receive assisted conception services through the NHS.

Assisted conception services are defined as any medical, surgical or obstetric services provided for the purpose of assisting a person to carry a child.  Broadly speaking, this means any medicines, surgery or procedures that are required to diagnose and treat infertility so that a person can have a child.  It includes procedures such as insemination (IUI), in vitro fertilisation (IVF) and egg and sperm donation

Payment will be expected in advance of attending hospital, otherwise the appointment may be cancelled.

Children born in the UK whose parent/s who have paid the health surcharge 

A child born in the UK to parent/s who has paid the health surcharge is exempt from charge up to the age of three months provided that the child has not left the UK since birth. Parents should ensure that they regularise their child’s immigration status in the UK during this three-month period, which may include the parent paying the surcharge on their child’s behalf. If the parent does not do this they will be liable for any charges for treatment provided to the child after the three-month period.

If the father is a UK citizen and the child does not require registration with the health surcharge, we will need evidence that the father is British and has parental responsibility of the child. 

Any non-urgent treatment will be cancelled if either, the child’s NHS entitlement is not established by the hospital or payment is not received in advance of the appointment.

Patients from countries outside healthcare arrangements with the UK, who have not paid the health surcharge

Patients from countries outside healthcare arrangements with the UK, who have not paid the health surcharge

Visitors to the UK from countries outside healthcare arrangements and who have not paid the health surcharge, including family visits, business trips, tourist, or living in the UK without proper permission, are not entitled to NHS care and will need to pay for their treatment.

Any non-urgent treatment will be cancelled if payment is not received in advance of the appointment

For individuals subject to immigration control, such as those with a visitor visa, the declaration in the application states that with the issue of this type visa the recipient is aware that they may be billed for NHS treatment in the UK and that any unpaid NHS debts may adversely affect future entry clearance applications.

Women expecting a baby -  where the father is a UK citizen, the child’s immigration status will be decided on the mother’s entitlement in accordance with the 2014 charging regulations.  If the mother has paid the health surcharge see the section on “Children born in the UK whose parent/s who have paid the health surcharge”

Emergency treatment in accident and emergency department (A&E), a minor injuries unit or walk-in centre is free of charge. However, admission to hospital for any other emergency treatment or attendance at an outpatient appointment may incur a charge.

It is recommended that patients seeking treatment for a non-emergency health condition should see a GP (family doctor).

Patients with travel insurance

Patients with travel insurance 

Patients with insurance cover will be invoiced for the cost of their treatment. The account will need to be settled and the costs reclaimed by the patient, from their insurers at a later date.

The Trust will only invoice the insurers direct if they are in possession of a letter of guarantee authorising treatment at Basildon and Thurrock University Hospitals NHS Foundation Trust.

Any non-urgent treatment will be cancelled if payment or letter of guarantee is not received.

Cost of treatment

Cost of treatment

From October 2017 all hospital Trusts are required to charge patients in advance of any non-urgent treatment.  The hospital will endeavour to provide an estimate, as accurately as possible however, if the final amount will not be finalised until after discharge; any adjustment will appear on your invoice/credit note

For patients receiving unplanned treatments, the exact cost of the care will not be available until after discharge, when information about all the treatment received has been updated on the hospital system. Once this has been collated, an invoice for the complete package of care will be sent. Any deposit paid towards the treatment will be included in the invoice to show that outstanding balance. 

No power has been given in the Charging Regulations or otherwise for any person, including a relevant NHS Trust's Chief Executive or Government Minister, to waive charges which are due. 

What happens if I don’t pay?

What happens if I don’t pay?

The National Health Service Act 2000 and the National Health Service (charges to overseas visitors) regulations 2011 and amendments set which visitors are required to pay for NHS treatment.

 

Any invoices not paid will be referred to a debt collection agency for recovery and may be reported the Home Office and may affect future visa applications.

 

Useful links

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Contact us

  • Basildon and Thurrock University Hospitals NHS Foundation Trust
    Nethermayne, Basildon
    Essex  SS16 5NL
    Switchboard: 01268 524900

  • The Essex Cardiothoracic Centre
    Nethermayne, Basildon
    Essex SS16 5NL
    Switchboard: 01268 524900

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