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What is Trust guidance on overseas visitors?
The Department of Health overseas visitor charging regulations require all Trusts in England to identify and charge overseas visitors for the treatment they receive.
NHS hospital treatment is not free for everyone. If you are visiting the United Kingdom (UK) and require treatment in our hospitals you may have to pay for your treatment.
Anyone of any nationality who is not ordinarily resident in the UK at the time of treatment is regarded as an ‘Overseas Visitor’. This means that they may be charged for the treatment they receive at The Royal Liverpool University Hospital NHS Trust.
NHS hospitals have a legal obligation to establish whether a person is an overseas visitor, and whether charges apply or they have an exemption. Where there is no exemption, we must charge the person liable and recover the costs from them.
An overseas patient is someone who is not ordinarily resident in the UK and does not permanently live in the UK. If you are visiting the UK or have been living outside the UK for more than twelve months, you may have to pay for the NHS hospital treatment whilst you are here. This is regardless of whether you are a British citizen or have lived or worked here in the past.
NHS services and treatments which are free for everyone
- Family-planning services (this does not include maternity treatment and termination of pregnancy)
- Treatment at the Emergency Department (A&E) If you attend the A&E and are in receipt of a NON UK EHIC, 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.
- Diagnosis and treatment of certain infectious diseases (see below for a list of diseases exempt from NHS charges or click here)
Who is exempt from charges?
Some visitors to the UK are entitled to NHS hospital treatment free of charge. These include people who have paid the Health Surcharge or are working for UK-based employers and students on courses of at least six months duration and who have paid the Health Surcharge.
How can I prove that I am entitled to free hospital treatment?
NHS hospitals have a duty to identify and charge overseas patients for hospital treatment they receive. Hospitals are required to check documentary evidence of entitlement to prove that you are ordinarily resident in the UK.
To help us check if you are entitled to free healthcare, you will need to bring two separate documents to your appointment - one to prove your identity, and one to prove your address. See below for which documents you can bring.
What types of document can I show?
The following documents can be used as proof of identity:
- Current signed passport
- Residence permit issued by UK Border Agency
- Valid UK photo-card driving licence
- EU or Swiss national identity photo-card
- Valid armed forces or police photographic identity card
- Photographic disabled blue badge
- Citizen card
The following documents can be used as proof of address. They must contain your current address and be dated within the last six months:
Recent original utility bill such as gas, electric, water, landline (mobile not acceptable)
- Council tax bill for the current year
- Bank, building society or credit union statement or passbook
- Recent original mortgage statement from a recognised lender
- Current council or housing association rent book or tenancy agreement
- Notification letter from the Department for Work and Pensions confirming your right to benefits or a state pension.
A person does not become ordinarily resident in the UK and entitled to free NHS treatment simply by:
- Having an NHS number
- Having British nationality
- Holding a British passport
- Being registered with a GP
- Owning property in the UK
- Paying or previously paying National Insurance contributions and taxes in this
Whether a person is ordinarily resident is based on a number of factors which will be
taken into account and evidence required.
If you can’t provide the documents you will have to pay a deposit equal to the estimated cost of your treatment before you receive an appointment or treatment.
The Trust accepts the following forms of payment:
- Credit/Debit Card
- Bank transfer
- Cheque (only if submitted and cleared in advance of treatment)
When you pay you will be provided with a receipt for your records.
If you are unable to pay the full amount prior to receiving your treatment, it will not affect the level of urgent care you will receive.
If I am not exempt, how much will I have to pay?
You will be provided with an estimated cost for the treatment which you receive. These costs are based on the Standard National HRG Tariffs which is applied throughout the UK. We must and will always provide immediately necessary or urgent care, including maternity care, to any chargeable patient, regardless of whether or not they have yet paid for that care.
Maternity services, or treatment which the doctor or nurse thinks is immediately necessary or urgent, will not be withheld. However charges will still apply and you will receive an invoice after your treatment.
Overseas visitors are not entitled to receive an NHS subsidised prescription therefore they must pay the same charge for a private prescription.
Where a patient dies without making or completing a payment to the Trust the debt then becomes recoverable from the deceased's estate.
European Economic Area (EEA)/Swiss patients
If you access our services because the need arose during your visit to the UK, you will need to provide a copy of your European Health Insurance Card (EHIC), Provisional Replacement Card (PRC) or S1 (certificate of entitlement to health care in another EEA country, provided via the social security authority in your home country). If you are coming to the UK for elective treatment then you will need to provide a copy of S2 (NHS funded treatment in another European Economic Area (EEA) country or Switzerland). If you do not have these documents with you and you cannot demonstrate that you have an exemption to charges, you will be required to pay for your treatment and recover the costs from your ‘healthcare abroad team’ when you return home. Students from EEA/Swiss countries are also required to provide copies of their EHIC/PRC.
How can I obtain a Provisional Replacement Certificate (PRC)?
The onus is on the visitor to apply for a PRC and provide it to the Trust. Please go to the European Commission website and enter your search criteria, you must contact your institution and make the necessary arrangements in order to obtain your PRC. Alternatively you can download the EHIC app to your smartphone and within the “I lost my card” section, select your country and your health insurance fund contact telephone, email and website address will be made available.
What does my European health care card look like?
Other reciprocal healthcare agreements
Several countries and territories outside the EEA also have reciprocal healthcare agreements with the UK which cover their nationals for health costs.
Patients who can show they are lawfully resident in one of those countries (and a national of that country if applicable) will be exempt from charges providing the need for treatment arose during their visit to the UK.
You will also be asked for documented proof to establish eligibility of this exemption.
Please note: Reciprocal and bilateral agreements do not apply if you are having elective (planned) treatment or treatment which can be carried out in your country of origin.
List of countries with reciprocal healthcare agreements
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.
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.
If you need more information, please e-mail OVM@rlbuht.nhs.uk or call 0151 706 5483
Voluntary Returns Service – Get help to return home if you’re a migrant in the UK
Telephone: 03333 004 0202 Monday to Friday, 9am to 5:30pm – https://www.gov.uk/return-home-voluntarily
Infectious diseases exempt from NHS charges
The treatment and diagnosis of certain infectious diseases is available to all patients free of charge, including overseas visitors.
The conditions to which this exemption applies are:
- Acute encephalitis
- Acute poliomyelitis
- Enteric fever (typhoid and paratyphoid fever)
- Food poisoning
- Haemolytic uraemic 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
- 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 April 2017
- Severe acute respiratory syndrome (SARS)
- Viral haemorrhagic fever (which includes Ebola)
- Viral hepatitis
- Whooping cough
- Yellow fever
- Middle Eastern Respiratory Syndrome (MERS)
- The exemption also applies to the diagnosis and treatment of sexually transmitted infections.
How to recognise a European Health Insurance Card (EHIC)
Non-European Economic Area (EEA) countries that have reciprocal healthcare agreements with the UK