The Law in England
Section 175 of the National Health Service Act 2006 Allows the Secretary of State for Health to make regulations for the making and recovery of charges in relation to any person who is not ordinary resident in Great Britain. It also gives the Secretary of State the power the power to calculate charges on an appropriate commercial basis.
The Charging Regulations place a legal obligation on providers of relevant services to establish whether a person is an overseas visitor to whom charges apply or whether they are exempt from charges. Prior to 23 October 2017 this legal obligation applied only to NHS Trusts, Foundation Trusts and local authorities in the exercise of public health functions in England, but since then it also applies to any provider of relevant services including non-NHS organisations such as private and voluntary providers supplying relevant services. Organisations that are required to make and recover charges under the Charging Regulations are referred to as relevant bodies.
Therefore has a legal obligation to ensure that patients who are not ordinarily resident in the UK are identified, that their liability for charges for relevant services is assessed in accordance with the Charging Regulations, that those liable to pay are charged in accordance with the Charging Regulations and that those charges are recovered.
When a person who is not ordinarily resident in the UK (an "overseas visitor") needs relevant services, they will be subject to the National Charges to Overseas Visitors Regulations 2015 (regulations as amended 2017 & 2018) and may incur a charge for treatment.
Kingston Hospital NHS Foundation Trust is committed to implementing the Hospital Charging Regulations consistently across the Trust, using a robust and common sense approach.
We understand that your visit to our hospital may be very stressful for you and we would like to make it as easy as possible when it comes to your understanding of the information that may be required by our staff to establish entitlement to relevant services.
Hospital treatment is free to people classed as ordinarily resident in the UK. Ordinary residence is defined when a person is:
Determining residency isn’t as straight forward as where you were born, payment of UK taxes, National Insurance contributions, being registered with a GP, having an NHS Number, or owning property in the UK.
To be considered ordinarily resident, you must be living in the UK on a ‘lawful and properly settled basis for the time being’ – you may be asked to prove this.
Anybody who can demonstrate that they lawfully reside in the UK is unlikely to incur treatment charges.
We would ask for your co-operation in providing the evidence requested, to avoid your liability for the cost of any relevant treatment provided to you now or in the future.
Services Exempt from Charging
The following services are free at the point of use to everyone. A charge cannot be made or recovered from any overseas visitor for:
o Female Genital Mutilation
o Domestic Violence
o Sexual Violence
Non-urgent services are routine elective services that could wait until the patient can return home.
Relevant bodies will not provide non-urgent services unless the patient pays the full estimated cost of the service in advance. However, in order to decide if a patient's need for relevant services is urgent or can safely await their return home, clinicians will need to know when a patient can reasonably be expected to return home. The decision can be made on the basis of this information.
However, the decision will be reassessed if the patient informs the relevant body that their return date has been postponed for valid reasons or if their medical condition unexpectedly changes.
Care of Overseas Visitors
The relevant body will ensure that a relevant service which is immediately necessary is provided to any patient even if they have not paid in advance. Failure to provide immediately necessary relevant services may be unlawful under the Human Rights Act 1998.
Immediately necessary relevant services is that which a patient needs:
This will always be provided irrespective of whether or not the patient has been informed or agreed to pay, charges. In addition, it will not be delayed or withheld to establish the patient's chargeable status or to seek payment.
All maternity relevant services, including routine antenatal treatment, are treated as being immediately necessary. Clinicians and other relevant staff will be especially careful to inform pregnant patients that further maternity care will not be withheld, regardless of their ability to pay.
Urgent relevant services are that which clinicians do not consider immediately necessary, but which cannot wait until the person returns home.
The hospital body does make every effort to secure payment in the time before treatment is scheduled but if that proves unsuccessful the treatment will not be delayed or withheld for the purposes of securing payment, the patient will however be required to settle their bill during or after relevant services.
Visitors from the EEA and Switzerland
If you are a visitor from the EEA, you will need to present a valid European Health Insurance Card ( EHIC) or other healthcare documents (such as S2 or S1 forms) or you may be charged for your care.
If you don’t have a EHIC card you can apply for one from the country where you normally live through www.ehic.europa.eu and selecting your national flag.
It’s also possible to get a Provisional Replacement Certificate (PRC) if you don’t have your EHIC, this is an emergency document and will provide the same level of cover for relevant services as the EHIC and is normally dated for the period of your visit to the country. Please contact your national healthcare provider to request this document.
Visitors from the Rest of the World
If you are visiting England from a non-EEA country, we recommend you are covered for healthcare through personal medical insurance for the duration of your visit, even if you are a former UK resident. Visitors that do not meet exemption from charge in line with The Charging Regulations will be expected to pay for all relevant services they access outside of Accident & Emergency.
Visitors accessing relevant services that resided outside the EEA will be charged 150% of the standard NHS rate, unless an exemption category applies to either you or the treatment.
Immigration Health Surcharge
If you are coming for more than six months, you may need to pay the Immigration Health Surcharge as part of your visa application. This means you will receive relevant services on the same basis as an ordinary resident of the country (excluding fertility/assisted conception services).
If you are a Non EEA student on pre-sessional courses that have not paid the Immigration Health Surcharge could be liable to pay for any relevant services you access outside of A&E, unless the service is exempt in line with The Charging Regulations. If you have paid the immigration health surcharge your relevant service will not become exempt from charge until the Home Office has confirmed that your application has been granted. NB: You may be asked for a copy of your Biometric Residency Card (BRP) or a confirmation letter from the Home Office.
Students from EEA are required to bring a copy of their EHIC from their home country, Passport/ID and evidence of study.
Reciprocal Healthcare Agreements
The UK has reciprocal healthcare agreements with some non-European Economic Area (EEA) countries.
Within the reciprocal agreements there are a number of variations in the level of free relevant services provided to visitors travelling to the UK. Generally, only immediate medical service* is to be provided free of charge, to allow the overseas visitor to return home for other needs i.e. follow up services or outpatient appointments.
Please ensure you check with the Overseas Visitors Team to ensure your financial responsibilities are clear and DO NOT ASSUME all your relevant services will be covered.
If you’re being treated under a reciprocal agreement and it is terminated during the course of your relevant service then you will become liable for all further costs.
*Immediate relevant services is defined as to save the patient’s life/prevent a condition from becoming immediately life-threatening or needed promptly to prevent permanent serious damage occurring
If the Trust is satisfied that the patient is an overseas visitor then the Trust must charge the patient for the relevant services provided.
If there are any doubts over the validity of exemption for a patient the patient should also be charged for their service.
If the patient refuses to pay or states that they have no funds available to pay (this is treated as a refusal to pay) then a payment plan can be negotiated in order to settle the debt however this is at the discretion of the Trust and comes with conditions.
It is not acceptable for an invoice not to be raised for treatment because it is believed or claimed that there is an inability to pay.
Overseas visitors with travel insurance will be required to pay for their treatment and then claim back from their insurer on their return home.
Services are not made free of charge by virtue of being provided on an immediately necessary or urgent basis, (including secondary care provided after being admitted through A&E). Charges applied cannot be waived; however, any patient undergoing "immediately necessary" services will be reassured that this will not be withheld or withdrawn in the event of the patient being unable to pay.
We have several payment options available, some patients prefer to pay in full and seek reimbursement from their insurance companies and this is always our first approach. We accept not all patients are in a financial position to do this and pay via their insurers, so we await payment this way.
NB: The bodies providing relevant services has a legal duty to submit debtors to the Department of Health & Social Care after two months; the details are then passed to the Home Office and put on the patients immigration file.
We do allow payment plans with conditions and agreed with our finance department.
Reasonable measures are taken to pursue overseas visitors' debt and international debt recovery agencies will be employed.
Immigration Rules for NHS debtors
You should be aware that under paragraphs 320(22) and 322(12), and 3.14 of Appendix V, of the Immigration Rules a person with outstanding debts of over £500 for relevant treatment that is not paid within two months of invoicing, may be denied a further immigration application to enter or remain in the UK.
In the absence of prompt full settlement or a reasonable repayment schedule, non-clinical information relating to this debt is provided routinely to the Home Office and may be used by the Home Office to apply the above Immigration Rules. The information will remain active for the purpose of the above rules until the debt is settled and a record of the settled debt will also be retained, both subject to normal limitation periods.
In the event that you may seek entry to the UK or make an advance immigration application after settling a debt in the previous two months, you are advised to retain and carry evidence of payment for potential examination by Home Office officials.Guidance on Debt and Immigration Rules
Where a patient dies without making or completing a payment to the Trust the debt then becomes recoverable from the deceased's estate. An offer from relatives or another person to meet the debt can be accepted but this must not be actively pursued, unless it was they who had signed the undertaking to pay form.
For more information on this please visit http://www.nhs.uk/NHSEngland/AboutNHSservices/uk-visitors/Pages/accessing-nhs-services.aspx
If you have any questions please contact our Overseas Visitors Team who will be happy to help at firstname.lastname@example.org or call 0208 973 5245/5319.
Opening hours are 8-4 Monday to Friday