| Chapter 11: Overseas Visitors Exempt from NHS Charges |
Statutory/Manual
References |
| In the UK for a
period "not less than 1 year" |
|
| 1. An overseas
patient who, at the time of receiving treatment has been in the UK for "not less than
1 year" and that stay has been both legal and lawful is exempt from NHS charges. |
1989 Reg 4(b) |
| 2. Any single absence
abroad during that period of not more than 3 months should be counted as
part of the 12 month qualifying period. |
|
| Taking up or
resuming residence in the UK |
|
| 3. An overseas
visitor who has satisfied the Home Office of their intention to take up permanent
residence is exempt from NHS charges from the day they arrive in the UK. Someone who
returns to the UK and has the right of abode is exempt from NHS charges. |
1989 Regs 4(a) (iv) |
| 4. In the case of
asylum seekers and refugees - a pending application for residency with the HO is
sufficient evidence in itself for the applicant to be exempt from NHS charges. If an
application has been refused the patient is liable, but NHS charges should be repaid if a
subsequent appeal is lodged and the outcome is successful. A patient who appears to be
exempt from NHS charges as an immigrant should be asked whether permission is required to
reside in the UK permanently and, if so, whether permission has been applied for or
obtained (see paragraphs 25-28). |
Chapter 7 |
| Note:
If the overseas visitor is exempt from NHS charges, so also are his or her dependants.
Documentary and other evidence may be sought to support the patients intention to take up
or resume permanent residence. |
Chapter 2
& Appendix G |
| In the UK for
employment |
|
| 5. A person is exempt
from NHS charges if the primary purpose of his or her presence in the UK is that they are
currently in employment. This includes: |
|
|
i. working for an employer (whether the employer is based
in the UK or not), irrespective of whether they are paying NI contributions/UK tax;
Posted Workers - Workers posted temporarily to another EEA member state
and any member of their family who accompany them. Form E128 entitles the holder to NHS
care without charge for immediately necessary treatment and for known pre-conditions.
This entitlement extends only in respect of their period of employment.
|
1989 Reg 4(a)(i)
EC Reg 1408/71, Art. 22b &
Chapter 12 |
|
ii. employment as a self-employed person; and 65 of the
Health Services and Public Health Act 1968, or services to which Article 71 of the Health
and Personal Services (Northern Ireland) Order 1972 applies.
|
1989 Reg 4(a)(i) |
| Note:
1 The regulations do not define a minimum period of employment. 2
If the overseas visitor is exempt from NHS charges, so also are their dependants |
|
| Students and
Trainees |
|
| 6. An overseas
student "who is pursuing a full time course of study" is exempt from NHS charges
from their first day of arrival in this country as are their dependants. Temporary
students - Students temporarily in another EEA member state to study and any
accompanying members of their family. Form E128 is required in every case. Form E128
entitles the holder to NHS care without charge for immediately necessary treatment and
for known pre-conditions. This entitlement extends only in respect of their period
of study. |
1998 Reg 4 (q)
EC Reg 1408/71, Art. 22c & Chapter 12 |
Note: 1
For students an introductory course and a main course are regarded as one course of study.
- The exemption from NHS charges should continue for one month after the conclusion of the
course of study.
- The exemption from NHS charges should continue for one month after the conclusion of the
course study.
- 2 The exemption from NHS charges should continue for one month after the
conclusion of the course of study.
|
Chapter 2 |
| Au pairs |
|
| 7. Au pairs as such
are not exempt from NHS charges, unless exemption is due to residency,
length of stay or other conditions apply. In terms of these regulations au pairs are not
regarded as employees or students. |
|
| 8. Au pairs are
persons who come to the UK to learn the English language and to live for up to 2 years as
a member of an English speaking family. Au pairs are unmarried, aged between 17 and 27,
without any dependants in terms of these arrangements and come from one of the following
countries: |
|
|
|
| EEA Countries |
Non-EEA Countries
|
|
| Austria |
Andorra |
|
| Belgium |
Bosnia-Herzegovina1
|
|
| Denmark |
Croatia2 |
|
| Finland |
Cyprus |
|
| France |
Czech Republic1 |
|
| Germany |
Faroe Islands |
|
| Greece |
Greenland |
|
| Iceland |
Hungary1 |
|
| Irish Republic |
Macedonia1 |
|
| Italy |
Malta1 |
|
| Liechtenstein |
Monaco |
|
| Luxembourg |
San Marino |
|
| Netherlands |
Slovak Republic1 |
|
| Norway |
Slovenia1 |
|
| Portugal |
Switzerland |
|
| Spain |
Turkey |
|
| Sweden |
|
|
| 1 Au
pairs from non-EEA countries marked above are covered under the terms of the
individual reciprocal health care agreements with these countries. Note:
EEA member states, include dependent territories bound by EC Regulations. |
Chapter
13 |
| 9. Au pairs from EEA
countries or any of the non-EEA countries listed above will enjoy the same
rights to exemption from NHS charges as any other visitors or residents of
that country. Au pairs are exempt from NHS charges after they have completed "not
less than 1 years" residence in the UK. |
Chapter 12 |
| Note:
In cases of doubt, au pairs may be asked to produce a letter from their host family, or
the letter which he or she has shown to immigration officials on entering the UK to
support their entitlement to exclusion from NHS charges. |
|
| Overseas visitors
seeking employment |
|
| 10. An EEA national,
stateless person or refugee, who is unemployed and from another EEA member state, and who
has come to seek employment in the UK, is exempt from NHS charges if he or she has EC form
E119. In such cases the E119 should be forwarded to the DSS at the address provided on the
form. |
Chapter 12 |
| Offshore Work
(including structures) |
|
| 11. Offshore
employees working in UK territorial waters or in the UK sector of the Continental Shelf
are exempt from NHS charges as are offshore employees working elsewhere on the Shelf if
his or her employer, or the operator with whom he or she is in contract, has a principal
place of business in the UK. The name of the vessel (including off-shore or in-shore
structures) and registration details should be established. |
1989 Reg 4(a) |
| Seafarers |
|
| 12. Crew members
employed on UK registered vessels are exempt from NHS charges. |
1989 Reg 4(d) |
| 13. A person employed
on any other vessel is exempt from NHS charges if he or she: |
|
|
i. is either an EEA national residing within the EEA; or
|
|
|
ii. comes from a reciprocal health care agreement country;
|
|
| and in either case
the need for treatment arose on the voyage to or during their stay in the UK. |
|
| Note:
Overseas visitors arriving with a known pre-condition and without a relevant EC exemption
form are liable to NHS charges for the NHS services they require. |
|
| Diplomatic Staff |
|
| 14. People who are
present in the UK as accredited diplomats, or as any other member of an embassy, consular
establishment or Commonwealth High Commission are exempt from NHS charges. |
1989 Reg 4(f) |
| 15. People who come
to the UK as a visitor and later obtain employment with the embassy, consular
establishment or Commonwealth High Commission are not exempt from NHS
charges. |
|
| Crown servants and
others employed or sponsored overseas by HM Government |
|
| 16. The following are
exempt from NHS charges except where otherwise provided for in legislation (for example,
prescriptions): |
|
|
i. members of HM UK Forces;
|
1989 Reg 4(g) |
|
ii. any other UK Crown servants who have been recruited in
the UK;
|
1989 Reg 4(h) |
|
iii. employees of the British Council or the Commonwealth
War Graves Commission recruited in the UK;
|
1989 Reg 4(i) |
|
iv. those recruited in the UK by the Overseas Development
Administration to work overseas under a Supplemented Scheme; and
|
1989 Reg 4(j) |
|
v. volunteers recruited to work abroad under the British
Volunteer Programme.
|
1989 Reg 4(j) |
| Note:
If doubt exists about the status of any such person, that person should be asked to
produce a letter or other document from a UK Government Department (for example, the
Overseas Development Administration or the British Council) about his or her overseas
employment. If no such letter can be produced, the HB, NHS Trust or DMU
should, with the person’s consent, approach the relevant UK Government Department or
the British Council on their behalf. |
|
| NATO Personnel |
|
| 17. NATO personnel
and attached civilians stationed in the UK are governed by the NATO Status of Forces
Agreement 1955. The countries to which this applies, apart from the UK, are Belgium,
Canada, Denmark, France, Germany, Greece, Iceland, Italy, Luxembourg, Netherlands, Norway,
Portugal, Spain, Turkey and the USA. |
1989 Reg 6 |
| 18. NATO personnel
stationed in the UK and their spouses and children are expected to use their home country
or UK armed forces hospitals when practicable. If NHS hospital facilities are used (for
example, because they are significantly more accessible) NATO personnel are exempt from
NHS charges. |
|
| 19. When NATO
personnel, or their spouses or children, have been in the UK for "not less than 1
years" residence, the normal rules for exemption from NHS charges apply. |
|
| Former UK
residents working overseas |
|
| 20. A UK resident
working overseas who in the past has had more than 10 years continuous residence in the UK
and is currently working abroad is exempt from NHS charges if the absence from the UK has
lasted: |
1989 Reg 4 (k) |
|
i. for less than 5 years; or
|
|
|
ii. for more than 5 years and home leave has been taken in
the UK not less than once in 2 years or there is a contractual right to do
so, or there is a contractual right to have the fare to the UK paid by the employer at the
end of the employment.
|
|
| Note:
If the patient is exempt from NHS charges, so also are their dependants. In cases of doubt
patients should be asked to produce letters from the employer, passports or proof of home
leave. |
Chapter 2
& Appendix G |
| Paying UK Social
Security contributions |
|
| 21. EEA nationals
employed or self-employed in another EEA member state, and paying compulsory UK Social
Security (National Insurance ) Class I or II contributions are exempt from NHS charges .
|
1989 Reg 4(l) |
| War Disablement
Pensioners and War Widows |
|
| 22. People in receipt
of a UK war pension or UK war widow’s pension are exempt from NHS charges. |
|
| Partial exemption
for UK State Pensioners living abroad |
|
| 23. UK state
pensioners who have at anytime had: |
Chapter 2 |
|
i. either more than 10 years continuous residence in the
UK; or
|
|
|
ii. more than 10 years continuous service as a UK Crown
servant
|
|
| are exempt from NHS
charges only in respect of "treatment the need for which arose during the
visit". |
|
| 24. The following UK
state pensions, to which there is entitlement under the Social Security Act 1975 or the
Social Security (Northern Ireland) Act 1975, can apply to persons not living
in the UK: |
|
|
i. current benefits:
|
|
|
|
|
|
ii. Former benefits which may still be relevant:
|
|
|
Industrial Death benefit
Child’s Special allowance
|
|
| Note:
In cases of doubt and if time allows, the patient should be asked to produce either a
pension book, or entitlement slip, or to state details of the UK pension (this is to avoid
confusion between state pensioners and recipients of other pensions) in support of their
entitlement to exemption from NHS charges. |
|
| Refugees |
|
| 25. People accepted
as refugees to the UK, ie under the Convention on the Status of Refugees (1951) and the
related (1967) Protocol, and anyone else taking refuge in the UK with permission of HM
Government are exempt from NHS charges, (see paragraph 4). |
1989 Reg 4(c) |
| 26. A refugee
claiming exemption from NHS charges should be accepted as a patient and
exempt from charging on the production of one of the following: |
|
|
i. A travel document which shows that it was issued in the
UK in accordance with the Convention on the Status of Refugees; or
|
|
|
ii. A letter from the Home Office stating that the patient
is a refugee or has been granted refuge in the UK; or
|
|
|
iii. An acknowledgement letter from the Home Office
confirming that the applicant has made an application for asylum. All applications lodged
since 1 November 1991 have been acknowledged by a security-printed, uniquely-numbered
form bearing the holder’s photograph.
|
|
| Note:
If the overseas visitor is exempt from NHS charges, so also are their dependants. |
Chapter 2 |
| Home Office
assistance |
|
| 27. Where a person
claims to be a refugee or to have a formal application pending, but is unable to produce
any of the documents mentioned NHS charges should be made with the onus placed on the
patient to produce the necessary documentation at a later date in order for them to
receive the appropriate reimbursement. |
Chapter 11 |
| Prisoners and
Detainees |
|
| 28. Anyone who is
detained by the UK immigration authorities or who is a prisoner is exempt from NHS
charges. |
1989 Reg 4 (n) |
