NHSiS guidance manual for overseas visitors

NHSiS Manual of Guidance: Overseas Visitors

Appendix B: Patients’ Guide to NHS Hospital Charges
Patients’ Guide to NHS Hospital Charges
1. This guide summarises the background to the rights, or otherwise, of overseas visitors to exemption from National Health Service (NHS) charges for hospital treatment.
2. *Unless* ordinarily resident in this country patients are liable to NHS charges for hospital treatment. The amount to be charged in each case is determined in Scotland by Health Boards, NHS Trusts or Directly Managed Units.
3. NHS charges do *not* apply for:
3.1. those who at the time of receiving NHS treatment have been in the UK for "not less than 1 year" and where that stay was legal and lawful.
3.2. those who have come to the UK to take up permanent residence.
3.3. those who have come to the UK to take up employment (whether as an employed or self-employed person): unpaid workers with voluntary organisations providing certain services similar to those of Health Boards and local authority social services.
3.4. members of HM UK Forces and other Crown servants and British Council or Commonwealth War Graves Commission staff serving overseas, and others working overseas under arrangements sponsored by HM Government.
3.5. those working overseas who have previously had at least 10 years continuous residence in the UK and have *either* been working abroad for *not* more than 5 years, or have taken home leave in the UK at least once in every 2 years or have a contractual right to do so, or have a contractual right to the cost of their passage to the UK at the end of their employment.
3.6. (a) nationals of the European Economic Area (EEA) and resident in any of the member states (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Republic of Ireland, Italy Luxembourg, the Netherlands, Portugal, Spain, Sweden and the UK (including Gibraltar), Iceland, Liechtenstein and Norway); refugees and stateless persons living in the member State and the dependants and survivors of these people regardless of nationality. (This exemption from NHS charges applies only to "treatment the need for which arose during the visit.").
(b) nationals of the EEA member state, refugees, stateless persons and their dependants or survivors living in a member state (as detailed in 3.6.(a) above) who are referred to the UK specifically for treatment under the relevant EC exemption form (E111D, E112, E119, E123 or E128).
3.7. nationals of List 1 Countries (over page) and residents, irrespective of nationality of List 2 Countries (over page) with which the UK has reciprocal health care agreements:
*List 1 Countries*	*List 2 Countries*
Bulgaria	Anguilla1
Czech Republic	Australia
Gibraltar1	Barbados
Hungary	British Virgin Islands1
Malta1	Channel Islands1
New Zealand	Falkland Islands1
Russian Federation	Iceland2
Slovak Republic	Isle of Man1
former Soviet Union states1(i)	Montserrat1
former Yugoslavia1(ii)	Poland
	Romania
	St Helena1
	Sweden2
	Turks and Caicos Islands1
1 Under the terms of the reciprocal health care agreements with these countries, exemption from NHS charges also applies to citizens or nationals who have been referred to the UK specifically for NHS treatment. Such referrals normally occur where the home country *cannot* provide the treatment required.
i. *former Soviet Union: Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kirgizstan, Moldova, Tajikstan, Turkmenistan, Uzbekistan, Ukraine. This does not* include the Baltic States (Estonia, Latvia and Lithuania).
ii. *former Yugoslavia*: Serbia and Montenegro and successor states Croatia, Bosnia, Slovenia, Macedonia.
2 Non -EEA nationals resident in Iceland and Sweden may also be covered for emergency health treatment in the UK under separate reciprocal health care agreements with these countries. Visitors will need to produce their home health or benefits authority medical card to qualify for exemption from NHS charges on the same basis as any other UK resident.
Note: The UK's reciprocal health care agreement with Hong Kong was terminated at midnight on 30 June 1997. From 1 July 1997, therefore, Hong Kong residents are no longer entitled to exemption from NHS charges under the terms of the former agreement, although they may qualify for exemption on other grounds.
List 1 Countries
The agreements with these countries cover nationals who are resident in the country concerned. People who can present a passport or other credible evidence showing that they are nationals of these countries should be treated as exempt from NHS charges in respect of "treatment the need for which arose during the visit".
List 2 Countries
The agreements with these countries cover all residents of these countries regardless of nationality. People who can present *either* a passport or residence permit, identity card or home health or benefits authority document showing that they are resident in a listed country are exempt from NHS charges in respect of "treatment the need for which arose during the visit".
3.8. seamen on UK-registered ships, offshore workers on the UK sector of the Continental Shelf.
3.9. UK war disabled pensioners and war widows.
3.10. UK state pensioners living overseas. (This exemption from NHS charges is limited to "treatment the need for which arose during the visit.")
3.11. refugees and others seeking refuge in the UK.
3.12. (a) anyone formally detained by the Immigration Authorities. (b) anyone detained as a prisoner.
3.13. diplomatic staff appointed to Embassies and Commonwealth High Commissions in the UK.
3.14. EEA nationals working in another EEA member state but paying compulsory UK class I or II national insurance contributions (see paragraph 3.4. (a) for definition of EEA national).
3.15. nationals of countries that are signatories to the European Social Charter but with which the UK has no reciprocal health care agreement - currently Cyprus and Turkey. (This exemption from NHS charges is limited to those nationals who are genuinely without resource to pay for medical "treatment the need for which arose during the visit.")
3.16. NATO service personnel (posted to the UK) *not* using their own country or UK armed forces hospitals.
3.17. the husband or wife, and children (under the age of 16, or under the age of 19 if at school or at college of further education) of any person described above in 3.1. to 3.16. and below in paragraph 6.
3.18. An overseas student "who is pursuing a full time course of study" is exempt from NHS charges from the first day of arrival in this country as are their dependants.
4. Services exempt from NHS charges: 4.1. treatment in Accident and Emergency (A&E) or Casualty Departments. Note: A patient who is admitted to hospital as an in-patient including those referred from an A&E department, as would generally happen for serious injuries, is liable to NHS charges for the continuing care element of treatment, as is a patient referred to an out-patient clinic.
4.2. diagnosis and treatment of certain communicable diseases including sexually transmitted diseases (for HIV/AIDS see paragraph 6 below).
4.3. compulsory psychiatric treatment (ie those detained, or when it is a condition of a probation order that the patient should receive psychiatric treatment).
5. There are no NHS charges for community nursing, midwifery or health visiting, for the emergency ambulance service transport, or for family planning services.
HIV/AIDS
6. Exemption from NHS charges for treatment for HIV/AIDS at a special clinic for the treatment of sexually transmitted diseases is limited to a diagnostic test for the evidence of infection with HIV and counselling associated with that test or its result. Those with HIV/AIDS referred to a hospital from such a clinic will be liable for charges unless otherwise exempt. Hospital out-patient must pay for any drug or medicine related to the HIV treatment given.
7. Further advice is available from the Patient Services Manager at the NHS hospital where treatment is being sought.