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The Department of Health overseas visitor charging regulations require all Trusts in England to identify and charge overseas visitors for the treatment they receive.

Hospital Treatment for Overseas Visitors

You can call 111 when you need medical help fast, but it's not a 999 emergency.  NHS111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones in England.

NHS services and treatments which are free for everyone

These include: Treatment at the Emergency Department (A&E) If you attend the A&E and are in receipt of a NON UK European Health Insurance card,  Provisional Replacement Certificate or an S1 Certificate, please make this known at reception. This is free only up to the point an overseas visitor is admitted as an inpatient, or given an outpatient appointment. It does not, therefore, include emergency treatment given after admission to the hospital as an in-patient or out-patient. Treatment at this point is chargeable to non-exempt visitors.

Detailed list of services which are exempt from charges

The NHS provides healthcare for people who are usually lawfully resident in the United Kingdom. People who do not normally live in this country are not automatically entitled to use the NHS free of charge, no matter their nationality or if they hold a British passport.

There is a legal obligation on Liverpool University Hospitals NHS Foundation Trust to check if people are normally lawfully resident in the UK. Guidance from the Department of Health and Social Care, Implementing the Overseas Visitors Hospital Charging Regulations – February 2021 states that all NHS trusts have a legal obligation to ensure that patients who are not lawfully ordinarily resident in the UK are identified and their liability for charges assessed.

If they are not lawfully ordinarily resident in the UK then charges may be applicable for NHS services. When this is the case, the Hospital must charge the person liable (usually the patient) for the costs of the services.

Clinical staff will not be able to confirm whether you are eligible for charges – this can only be provided by the Overseas Visitors Team. The NHS does not provide itemised invoices; invoices are prepared in the same way as we charge the Clinical Commissioning Group and it is based on a Health Resource Group coding. Please do not ask for a breakdown of charges, as it is not possible – this is not a private invoice, it is a chargeable invoice.

Paying for your care

If you are not eligible for free treatment, you will be charged for any treatment we provide – whether that’s in hospital or in the community.  We are legally required to collect payment before any planned care (elective treatment) takes place.

Eligibility for treatment

If you have any queries you can contact the overseas visitor team staff on 0151 706 5483 during office hours.  Alternatively, please email: OVM@rlbuht.nhs.uk.

To receive free hospital treatment, you will need to provide evidence that you are legally living within the UK. All patients admitted to our hospitals may be asked to provide details. If you live in the UK on a settled basis then you may be asked to provide evidence of this.

If you have any of the following you will be entitled to free NHS care:

  • NON-UK European Health Insurance card that is in date, front and back required
  • Residence Permit, Application Registration card, EU Settlement Status or EU Settlement Scheme application (all have to be in date)
  • Or any other evidence that proves you are entitled to free NHS care.

Patients with travel insurance

If you have insurance cover, the cost of treatment will be charged to the individual who

remains responsible for payment.  A full breakdown of charges will be provided after the

patient has been discharged. It is the patients responsibility to contact their insurance company should the need arise. 

Overseas visitors & counter fraud

Here at Liverpool University Hospitals NHS Foundation Trust we take fraud seriously. In our area of work, we encounter patients ‘borrowing’ other people’s NHS number, bringing family into the UK solely to use the NHS without intending to pay, and overstaying on VISA’s and not telling the truth. In the case of borrowing peoples NHS number, this is dangerous to the person whose ID has been used as it could interfere with their existing care pathway. We will report any patient or friends and relatives, purposely trying to defraud the NHS to our local count fraud specialist.  If escalated to involve the police, you could end up with a criminal record.

Failure to pay

If you fail to pay for NHS treatment for which charges are appropriate, your future application to enter, or remain in the UK may be denied. Necessary (non-medical) personal information may be passed via the Department of Health to the Home Office for this purpose. It is the responsibility of the Overseas Visitor to pay for their medical treatment in the UK; also, the fact that a person was not informed that charges would apply does not alter the fact that, and under the Charging Regulations they are still liable for that charge.

Further information

If you need more information, please e-mail: OVM@rlbuht.nhs.uk or call 0151 706 5483.

Voluntary Returns Service

The Voluntary Returns Service (VRS) is a Home Office unit that offers practical support for people who are in the United Kingdom with no right to reside, as well as people who have or who are claiming asylum, and who have decided that they wish to return home. The Home Office recognises that there will be people who choose to return to their home country, but who have no means of doing so, or who need some assistance, depending on their personal circumstances. It is the role of the VRS to provide practical support to assist those who wish to return. The level of support available depends on individual circumstances.

From 1st July 2021 EEA nationals can access the VRS service, except those who:

are an EEA national, a Swiss national or a   family member of an EEA national who has been granted EU Settled or Pre-Settled Status;

Are someone who have been granted leave as a Swiss service provider, are a protected frontier worker or are holding (or accompanying someone who holds) an S2 healthcare certificate;

If someone has an open EUSS application and wishes to continue with this application

From 19 April 2021 the levels of reintegration assistance changed as follows: Reintegration will be linked to the country of return, with more support being available for those who return to a country that is classified as developing as defined by the Organisation for Economic Co-operation and Development (OECD).  The list of countries defined as developing is reviewed annually and is available at www.gov.uk/return-home-voluntarily

People who are returning to countries that are categorised as a developing country will be eligible for reintegration support to the value of £3000 per returning person.

Those returning to a country that is not defined as developing can apply for help with reintegration costs if they have additional needs. If eligible, reintegration support will be based on personal circumstances, and will start at £1,500 (capped at the rate for those returning to developing countries).  Additional needs can include: long term illness; failed asylum seeker; rough sleeper; victim of modern slavery; families; being an unaccompanied child or care leaver. This list is not exhaustive.

Contact the Voluntary Return Service

0300 004 0202: (General Public) General enquiries or to start the voluntary returns process: (General Public) What the service offers; Eligibility; On-line application form - https://www.gov.uk/return-home-voluntarily.

The current list of exempt services comprises:

Accident and emergency (A&E) services (whether provided at an A&E department or similar e.g. urgent care centre, walk-in centre or minor injuries unit) but not including services provided after the overseas visitor is accepted as an inpatient or at a follow-up outpatient appointment. So, where emergency treatment is given after admission to the hospital, e.g. intensive care or coronary care, it is chargeable to a non-exempt overseas visitor. Note that some walk-in centres provide primary care services rather than A&E-type services and overseas visitors cannot be charged for such services either because primary care services are not within the scope of the regulations;

Family planning services, which means services that supply contraceptive products and devices to prevent pregnancy (termination of an established pregnancy is not a method of contraception or family planning)

The diagnosis and treatment, including routine screening and routine vaccinations, of the conditions specified in Schedule 1 to the Charging Regulations which is necessary to protect the wider public health. This exemption from charge will apply to the diagnosis of the condition, even if the outcome is a negative result. It will also apply to any treatment provided for a suspected specified condition, up to the point that it is negatively diagnosed. It does not apply to any secondary illness that may be present even if treatment is necessary in order to successfully treat the condition;

The conditions to which the exemption applies are:

  • Acute encephalitis
  • Acute poliomyelitis
  • Anthrax
  • Botulism
  • Brucellosis 
  • Cholera
  • Diphtheria
  • Enteric fever (typhoid and paratyphoid fever)
  • Food poisoning
  • Haemolytic uremic syndrome (HUS)
  • Human immunodeficiency virus (HIV)
  • Infectious bloody diarrhoea 
  • Invasive group A streptococcal disease and scarlet fever
  • Invasive meningococcal disease (meningococcal meningitis, meningococcal septicaemia and other forms of invasive disease)
  • Legionnaires’ disease
  • Leprosy
  • Leptospirosis 
  • Malaria 
  • Measles
  • Middle East Respiratory Syndrome (MERS)
  • Mumps
  • Pandemic influenza (defined as the ‘Pandemic Phase’), or influenza that might become pandemic (defined as the ‘Alert Phase’) in the World Health Organization’s Pandemic Influenza Risk Management Interim Guidance
  • Plague
  • Rabies 
  • Rubella 
  • Severe acute respiratory syndrome (SARS) 
  • Smallpox
  • Tetanus 
  • Tuberculosis 
  • Typhus
  • Viral haemorrhagic fever (which includes Ebola) 
  • Viral hepatitis 
  • Whooping cough 
  • Wuhan novel coronavirus (2019-nCoV) 
  • Yellow fever.

The diagnosis and treatment, including routine screening and routine vaccinations, of sexually transmitted infections;

Palliative care services provided by a registered palliative care charity or a community interest company;

Services provided as part of the "NHS 111" telephone advice line commissioned by a Clinical Commissioning Group or the NHS England;

Services provided for treatment of a condition caused by

  •  Torture
  •  Female genital mutilation
  •  Domestic violence
  •  Sexual violence.

Including treatment of both physical and mental illness, or an acute or chronic condition. The exemption applies wherever the violence has been experienced (including violence that occurred abroad), provided that the overseas visitor has not travelled to the UK for the purpose of seeking treatment. Any other treatment that they need that is not caused by that violence is not free, unless covered by another exemption.