What you need to do

If you were living in the UK on or before 31 December 2020, you should:

• apply to the EU Settlement Scheme by 30 June 2021, if you are eligible
• apply for a frontier worker permit by 1 July 2021, if you are eligible
• apply for an S1 certificate if you are eligible and do not have one
• register your S1 certificate

If you are moving to the UK, you should:

• check if you need a visa or permit to come to the UK
• check if a family member needs a visa or permit to join you in the UK
• pay the immigration health surcharge, if required
• apply for an S1 certificate if you are eligible and do not have one
• register your S1 certificate

Getting healthcare in England

Except where otherwise stated, this information is about getting healthcare in England. The way you access healthcare in Scotland, Wales and Northern Ireland could be different from England.

The NHS operates a residence-based healthcare system. Most NHS services are free to people who are ordinarily resident in the UK. This means living in the UK on a lawful and properly settled basis for the time being. You may be asked to prove this when seeking healthcare.

If you are not ordinarily resident in the UK, you will be an overseas visitor and may be charged for NHS services.

For a detailed definition of what being ordinarily resident means, see the GOV.UK guidance.

Living in the UK before 31 December 2020

If you are a citizen of an EU country, Norway, Iceland, Liechtenstein or Switzerland, and were living lawfully in the UK on or before 31 December 2020, you will be able to use the NHS in England.

If you wish to continue residing in the UK, to maintain your entitlement to free NHS healthcare after 30 June 2021, you must apply to the EU Settlement Scheme. Once you have been granted either pre-settled or settled status, or while your application is pending, you will not be charged for your healthcare, as long as you continue to be ordinarily resident in the UK. You may be asked to show that you hold pre-settled or settled status when seeking healthcare.

If you do not apply by 30 June 2021, you could lose your right to access free healthcare.

In line with our longstanding commitments under the Common Travel Area, Irish citizens do not need to apply to the EU Settlement Scheme, although they may do so if they wish. Irish citizens living in the UK will continue to access healthcare in the UK on the same terms as a UK resident.

For more information on the EU Settlement Scheme, see the Home Office guidance.

You may be entitled to NHS healthcare paid for by an EU country, Norway, Iceland, Liechtenstein or Switzerland, if you were living lawfully in the UK on or before 31 December 2020, and hold an S1 certificate, for example because you receive either a state pension or certain ‘exportable’ benefits from that country, or if you are a frontier worker (someone who lives in an EU country, Norway, Iceland, Liechtenstein or Switzerland, and works in the UK), or a posted worker (someone who usually works in one country but is sent temporarily to work in to another).

If you do not have an S1 certificate, you can apply for one from the relevant health insurance authority.

If you began studying in the UK on or before 31 December 2020, you may use your EHIC for medically necessary healthcare until the end of your course in the UK. You must apply to the EU Settlement Scheme if your course extends beyond 30 June 2021.

Moving to the UK

If you move to the UK to work, study or to settle, you will be subject to immigration control. This means you will need a visa or permit from the Home Office in order to be lawfully in the UK. You may need to pay the immigration health surcharge as part of your visa application.

You can only be considered ordinarily resident if you’ve been given the immigration status of indefinite leave to remain (the right to live here on a permanent basis).

Immigration health surcharge

If you are coming to the UK for stays of more than 6 months, you may be required to pay an immigration health surcharge at the time of your visa application. The full amount will be paid upfront for the duration of your visa.

In line with our longstanding commitments under the Common Travel Area, Irish citizens will not be subject to the immigration health surcharge.

See full details about the immigration health surcharge, including exemptions.

If your healthcare is paid for by an EU member state, you may be eligible for a full or partial reimbursement of your immigration health surcharge.

Find out when you can have your immigration health surcharge reimbursed

If you’ve paid the surcharge or are exempt from paying it, you will be entitled to free NHS hospital treatment in England on a similar basis to an ordinarily resident person, with the exception of NHS-funded assisted conception services. Your entitlement will apply from the date your visa is granted until it expires. You will have to pay some charges, such as prescription or dental charges.

If you are coming to England for 6 months or less or fail to pay the surcharge when you are required to, you’ll be charged for certain NHS services unless an exemption applies or you are covered by a reciprocal healthcare agreement.

Working in the UK

If you are an EU frontier worker (someone who lives in an EU country and works in the UK), you can access NHS healthcare.

If you are an EU or Norwegian posted worker (someone employed or self-employed in an EU country or Norway but temporarily sent to work in the UK), you can access healthcare in England.

Family members of citizens of EU countries, Norway, Iceland, Liechtenstein or Switzerland

If you are a citizen of an EU country, Norway, Iceland, Liechtenstein or Switzerland and have a family member who wishes to join you in the UK, they must apply for a family visa or permit.

If you were living in the UK on or before 31 December 2020 and you are eligible for the EU Settlement Scheme, your eligible family members will need either to apply for a family permit to come to the UK and then apply to the EU Settlement Scheme. In certain circumstances, they may be able to apply direct to the EU Settlement Scheme from overseas. This will secure their entitlement to free healthcare in the UK.

Any family member with whom you have a new relationship, formed after 1 January 2021, must apply for a visa. They may be eligible to do so under the family Rules, however, most family visas do not entitle the holder access to public funds or free healthcare.

If you were not living in the UK before 1 January 2021, and do not have status under the EU settlement scheme, both you and your family members need to apply for an appropriate visa.

See more information about family visas and permits.

Family members of people of Northern Ireland

If you have a family member who is an eligible person of Northern Ireland, and who lives in the UK, you may be able to join that person in the UK without paying the immigration health surcharge.

See the definition of an eligible person of Northern Ireland.

Instead, you may be eligible to apply for pre-settled or settled status under the EU Settlement Scheme on the basis of that relationship.

Once you have either pre-settled or settled status you will not be charged for your healthcare, as long as you continue to be ordinarily resident in the UK.

See more information about applying to join family living permanently in the UK.

Children born in the UK to those here lawfully for more than 6 months

If you give birth to a child in the UK, your child will be entitled to free NHS hospital treatment in England on the same basis as someone who is ordinarily resident.

Your child is covered until 3 months of age, but only if they do not leave the UK during that period.

You will also need to have either:

• a valid visa of more than 6 months and have paid the immigration health surcharge for that visa
• a valid visa of more than 6 months but were exempt from paying the immigration health surcharge
• a valid visa of more than 6 months, which you applied for prior to 6 April 2015

You should apply for a visa for your child during the 3-month period after your child’s birth. You may have to pay the immigration health surcharge for your child. Failure to do so means you may be charged for NHS services provided for your child after the 3-month period.

When your healthcare costs in the UK are covered by an EU country

S1 holders

You may be entitled to healthcare in the UK paid for by an EU country if you:

• live in the UK and receive either a state pension or certain ‘exportable’ benefits from that country
• live in the UK and work in an EU country (frontier worker)
• are posted to work in the UK by an employer in an EU country
• are an eligible family member or dependent of one of the above

You should be issued with an S1 certificate by the relevant member state, which shows that you are entitled to healthcare in the UK paid for by that country. If you do not know whether you are eligible, you will need to check with the relevant EU health insurance authority to see if they are responsible for your health costs in the UK.

You must register your S1 in the UK by sending it directly to the Overseas Healthcare team:

Email: nhsbsa.faregistrationsohs@nhs.net

Phone: 0191 218 1999, or +44 191 218 1999 from outside the UK

Immigration health surcharge reimbursement for S1 holders

If your UK visa starts on or after 1 January 2021 and you’ve registered an S1 document issued to you by an EU member state, you may be eligible for a full or partial refund of your immigration health surcharge payment.

To apply, contact the Overseas Healthcare Services team (details above).

You can apply for a refund for any dependants who have registered an EU-issued S1, where you have paid the immigration health surcharge on their behalf.

If they paid the immigration health surcharge themselves, they should apply for the refund.

If an employer or third party has paid the immigration health surcharge for you, you must begin the application on their behalf. The Overseas Healthcare Services team will then contact them for more information to process the application.

Students

If you begin a course of study in the UK that is longer than 6 months, you need to pay the immigration health surcharge as a part of your visa application. You may be eligible for a full or partial reimbursement if you meet the criteria.

If your course of study is less than 6 months, you do not need to pay the immigration health surcharge. If you have a valid EU-issued EHIC or are a Norwegian citizen with a valid Norwegian passport, you can access medically necessary treatment during your stay.

If you are a citizen of Iceland, Liechtenstein or Switzerland, you may have to pay for any NHS healthcare you receive. Any treatment that you need to pay for will be charged at 150% of the national NHS rate.

You should buy insurance to cover your healthcare as you would if visiting another non-EU country.

Immigration health surcharge reimbursement for students

You may be entitled to a full or partial refund of your immigration health surcharge payment if all of the following are true:

• you’re a full-time student in UK higher education
• your visa started on or after 1 January 2021
• you have an EHIC issued in an EU country
• you do not work in the UK

You will not be able to apply for a refund until 1 January 2022. However, your refund will be backdated to include any immigration health surcharge payments made for a visa starting on or after 1 January 2021.

You should consider carefully your healthcare needs before deciding whether to apply for a reimbursement.

If you intend to apply for a refund of your immigration health surcharge payment, you should use your EU EHIC for medically necessary treatment during your studies.

Once you have received your reimbursement, you may have to pay for any NHS healthcare you receive that is not deemed medically necessary.

If you obtain an immigration health surcharge reimbursement, you should not work in the UK. Working in the UK is very likely to invalidate your EHIC and you will need to be prepared to pay for any NHS healthcare you receive.

Getting healthcare in Scotland, Wales and Northern Ireland

This guidance is about NHS entitlements in England. For more information about accessing healthcare in Scotland, Wales and Northern Ireland, visit the websites for health services in each country:

• Wales
• Scotland
• Northern Ireland