Within England, free NHS hospital treatment is provided on the basis of someone being ‘ordinarily resident’. It is not dependent upon nationality, payment of UK taxes, National Insurance contributions, being registered with a GP, having an NHS number or owning property in the UK.

Treatment in A&E departments and at GP surgeries remains free for all.

This guidance sets out how the NHS charges for overseas visitors’ healthcare. The rules are set out in the National Health Service (Charges to Overseas Visitors) Regulations 2015 (as amended).

The regulations apply only in England. Accessing healthcare in Scotland, Wales and Northern Ireland could be different from England. For more information, visit the websites for health services in each country:

• Northern Ireland
• Scotland
• Wales

The principle remains that the NHS is, and will remain, free at the point of delivery for those who are ordinarily resident. There are exemptions in place to protect the most vulnerable in society and provide key services essential to public health. This ensures that urgent or immediately necessary treatment will always be provided, regardless of an individual’s ability or willingness to pay for that treatment. Treatment in A&E departments and at GP surgeries remains free for all.

Visitors to the UK from the EEA/Switzerland

There will be no changes to healthcare access for residents from the EEA and Switzerland who visit the UK before the end of 2020.

They can continue to use their EHIC during this time, as they do now. An EHIC is not an alternative to travel insurance and we always advise that visitors should have both when travelling to the UK.

From 1 January 2021, EEA/Swiss visitors may not be covered for healthcare as they are now and may become chargeable.

Providers should continue to follow existing guidance on upfront charging.

People living in the EU whose healthcare costs are funded by the UK

People living in the EU whose healthcare costs are funded by the UK under the current EU arrangements (such as those with a UK-issued S1 that has been registered in another member state) will be entitled to free NHS hospital treatment in England, should they return temporarily to the UK.

EEA and Swiss citizens resident in or moving to the UK

EEA and Swiss citizens who are lawfully resident in the UK by the end of 2020 will continue to receive access to NHS-funded healthcare as they do now as long as they meet the ordinary residence test. They may be asked to provide evidence of this.

People living outside the EEA and Switzerland

People who live outside the EEA and Switzerland (non-EEA nationals), including former UK residents, are not automatically entitled to free NHS care. They should make sure they are covered by personal health or travel insurance so that they can recover from their insurer any treatment costs that they are required to pay. They will be charged at 150% of the NHS national tariff, unless an exemption applies to them or the service they are accessing or they are covered by a reciprocal healthcare agreement between the UK and their country.

Health surcharge

An immigration health charge (or ‘surcharge’) is payable by non-EEA nationals who apply for a visa to enter or remain in the UK for more than 6 months. People with indefinite leave to remain in the UK and those not subject to immigration control (e.g. diplomats posted to the UK) are not liable to pay the surcharge, but may be ordinarily resident here and entitled to free NHS healthcare on that basis.

Payment of the health surcharge entitles the payer to NHS-funded healthcare on the same basis as someone who is ordinarily resident, from the date their visa is granted and for as long as it remains valid. They are entitled to free NHS services, including NHS hospital care, except for services for which a UK ordinary resident must also pay, such as dentistry and prescriptions in England.

Payment of the health surcharge is mandatory when making an immigration application, subject to exemptions for certain categories of people and the discretion of the Home Secretary to reduce, waive or refund all or part of a surcharge payment. Most of these groups also receive NHS-funded healthcare on the same basis as an ordinarily resident person.

Exemptions

There is no charge for certain types of treatment such as A&E outpatient treatment, treatment for infectious diseases specified in the regulations, treatment of sexually transmitted infections and family planning services.

It is worth noting that we have very clear exemptions in place to protect the most vulnerable and to ensure that treatment is always available to those in the UK who need it urgently regardless of their eligibility status, this has not changed following the UK’s departure from the EU. The exemptions are for those:

• granted refugee status in the UK
• seeking asylum or temporary or humanitarian protection until their application (including appeals) is decided
• receiving support form the Home Office under section 95 of the Immigration and Asylum Act 1999
• a failed asylum seeker receiving support from the Home Office under section 4(2) of the Immigration and Asylum Act 1999 or from a local authority under section 21 of the National Assistance Act 1948 or Part 1 (care and support) of the Care Act 2014
• a child looked after by a local authority
• formally identified, or suspected of being, a victim of modern slavery or human trafficking (this includes your spouse or civil partner and any children under 18 as long as they are lawfully present in the UK)
• receiving compulsory psychiatric treatment or treatment imposed by a court order
• detained in prison or by the immigration authorities in the UK
• NATO personnel (including spouses, civil partners or any children under 18 as long as they are lawfully present in the UK), where the service cannot be provided by armed forces medical services

There are several groups of people who are exempt from charging. UK Crown servants, British Council or Commonwealth War Graves staff and those working in UK government-funded posts overseas are exempt from charging if they were ordinarily resident prior to leaving the UK for that purpose, as are their spouses/civil partners and children under 18. Those who were not ordinarily resident in the UK before taking up such a post will be charged, unless they were recruited in the UK and are in the UK for the purpose of this employment.

There is also no change for armed forces members, war pensioners and armed forces compensation scheme recipients and their families, who are not required to have formerly been an ordinary resident of the UK.

People will be entitled to free care if, on all the facts, they remain ordinarily resident in the UK despite spending time outside the UK.

However, since 2017, overseas visitors working on UK-registered ships are no longer entitled to free NHS care and their employer is liable for their NHS costs.

Victims of violence

An overseas visitor who has been subjected to certain types of violence must not be charged for treatment or services needed to treat any condition caused by that violence, in recognition of the particularly vulnerable position they may be in. The types of violence are:

• torture
• female genital mutilation
• domestic violence
• sexual violence

The conditions include physical or mental illness, or an acute or chronic condition. The exemption applies wherever the violence has been experienced, provided that the overseas visitor has not travelled to the UK for the purpose of seeking that treatment.

Returning to the UK to settle

UK Citizens who return to the UK on a settled basis will be considered as ordinarily resident and will be eligible for free NHS care immediately.

See more information for people visiting or moving to England on the NHS Choices website.