Printable version: Information for overseas visitors (PDF, 396KB)
Overseas Visitors Patient Information
Not everyone is entitled to free NHS hospital treatment in England
We have a legal obligation under the NHS (Charges to Overseas Visitors) Regulations 2015 to identify patients who are required to pay for NHS hospital services they receive because they are not ordinarily resident or exempt of charges in the UK.
Whether a person is ordinarily resident in the UK is essentially assessing whether that individual:
- is lawfully in the UK;
- is here voluntarily – it will be rare for a person not to be in the UK voluntarily; and
- is properly settled here for the time being; and
- in the case of non-EEA nationals’ subject to immigration control, has Indefinite Leave to Remain (ILR) in the UK.
A person is not ordinarily resident in the UK simply because he/she:
- has British nationality or holds a British passport;
- is registered with a GP;
- has an NHS number;
- owns property in the UK;
- has paid (or are currently paying) National Insurance contributions and taxes in the UK.
If a person is found to not be ordinarily resident, circumstances of the individual will require investigation to determine if any of the exemptions in the above regulations applies.
EEA member states
Austria, Belgium, Bulgaria, Croatia, Cyprus (Southern), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, UK, plus Iceland, Liechtenstein and Norway. Switzerland by special arrangement.
- People visiting the UK from these countries will need to supply a valid European Health Insurance Card or replacement certificate for all necessary NHS hospital care to be free of charges to them. An S2 would be required for planned care in the UK
A UK State Pensioner living in any of these countries with a registered S1 document for residence overseas will be entitled to all types of NHS hospital treatment without charges
EEA people coming to the UK with the intention to stay may still be insured in their home country and hold a valid European Health Insurance Card – if we obtain it we can reclaim healthcare costs from the EEA country
Reciprocal Health Agreements (non-EEA)
For specific details please contact the Overseas Visitor Manager Evidence of coverage under the reciprocal agreement will be required.
Anguilla, Australia, Bosnia and Herzegovina, British Virgin Islands, Falkland Islands, Gibraltar, Isle of Man, Jersey, Kosovo, Macedonia, Montenegro, Montserrat, New Zealand, Serbia, St Helena, Turks and Caicos Islands.
Within the reciprocal agreements there are a number of variations in the level of free treatment afforded to visitors travelling to the UK. Generally, only immediate medical treatment is to be provided free of charge and they do not usually apply when the person has travelled to the UK for the purpose of obtaining healthcare. Further details can be provided on request.
This is not a full description of the NHS (Charges to Overseas Visitors) Regulations 2015 and more details can be obtained via - https://www.legislation.gov.uk/uksi/2015/238/contents
Overseas Visitors
Emergency Treatment
Any patient in the UK may access A&E for emergency medical treatment regardless of their entitlement or status.
Non urgent medical treatment
Any GP practice may provide medical treatment on an immediate & necessary basis.
Visitors from EU countries should present their GHIC card as their home country will have a reciprocal agreement with the UK for healthcare.
Visitors from other countries may be charged for their treatment. This can be reclaimed from your private travel healthcare insurance.
If you expect to be staying in the UK for 24 hours to 3 months, we have the option of registering you on a temporary residence basis.
UK patients returning from overseas
Patients who are returning from having lived overseas for a period of time will be asked for the following documents;
- Photographic proof of identity (passport, driving license, Government ID card)
- Proof of home address (utility bill, letter from your bank)
- Proof that you have been in the country for at least 6 months. This can be;
- Contract of employment or letter from your employer showing that you are in permanent employment.
- A letter from DWP confirming that you have registered with them and intend to seek work.
- A shipping order of goods from your overseas address to your intended UK address.
- The tenancy agreement for your new address.
This list is not exhaustive, but your proof should show dates covering a 6-month period.
We are able to register you on a temporary basis until you can provide all the documents required.
For Working Adults:
You will be asked to provide the following documents;
- Photographic proof of identity (passport, driving license, Government ID card)
- Proof of home address
- Proof that you have been in the country OR that you intend to stay in the country for at least 6 months.
This proof can be;
- A valid UK visa which allows you to stay in the UK for more than 6 months.
- Home Office work permit.
- Tenancy agreement in your name valid for 6 months or more.
- Contract of employment or letter from your employer showing that you are in permanent employment.
This list is not exhaustive, but your proof should show dates covering a 6-month period.
We are able to register you on a temporary basis until you can provide all the documents required.
Dependent Adults must provide:
- Photographic proof of identity (passport, driving license, Government ID card).
- Marriage certificate to the person you are dependent on.
- Visa granting you leave to remain in the UK either to join your spouse or as a person in your own right.
Dependent Children (Under 18 years of age);
The responsible adult should provide;
- Photographic proof of identity (passport, driving license, Government ID card).
- Birth certificate showing the name of at least one parent who has eligibility to register. Non parental guardians must provide evidence that they are the legal guardian of the child.
- Visa granting them leave to remain in the ULK either to join as a parent or as a person in their own right.
Overview
You might need to pay a healthcare surcharge (called the ‘immigration health surcharge’ or IHS) as part of your immigration application.
Whether you need to pay depends on the immigration status you’re applying for.
When you must pay
If you’re making your immigration application online, you pay the surcharge as part of your application or when you book an appointment.
If you’re applying by post, you pay the surcharge online before you send your application. You’ll need to include the IHS reference number on your application form.
When you can start to use the NHS
You can start using the National Health Service (NHS) when both:
- you’ve paid the healthcare surcharge (or are exempt from paying it)
- your visa or immigration application is granted
You’ll still need to pay for certain types of services, such as prescriptions, dental treatment, eye tests and assisted conception.
When you access healthcare in the UK, you may need to:
Who needs to pay
You usually need to pay the healthcare surcharge if you’re applying for a visa or immigration application:
- for more than 6 months, if you’re applying outside the UK
- for any length of time, if you’re applying inside the UK
You do not need to pay if you’re applying for a visitor visa or to remain in the UK permanently.
You still need to pay even if you have private medical insurance.
Who only needs an IHS reference number
You still need to use the payment service to get an immigration health surcharge (IHS) reference number but you will not need to pay if:
- you’re a child under 18 who has been taken into care by a local authority
- you’re a relevant civilian employee at NATO or the Australian Department of Defence in the UK (or you’re their dependant)
The service will tell you that you do not have to pay anything and will give you your healthcare surcharge reference number for your application.
You’ll be able to use the National Health Service (NHS) even if you’re exempt from paying.
Who does not need to pay or get an IHS reference number
You’ll be able to use the NHS without paying the surcharge or getting a reference number if:
- you’re applying for indefinite leave to enter or remain
- you’re a health and care worker who is eligible for a Health and Care Worker visa (or you’re their dependant)
- you’re applying to the EU Settlement Scheme
- you’re a diplomat or a member of a visiting armed forces and not subject to immigration control
- you’re a dependant of a member of the UK’s armed forces
- you’re the dependant of a member of another country’s armed forces who is exempt from immigration control
- you’re applying for a visa for the Isle of Man or Channel Islands
- you’re a British Overseas Territory citizen resident in the Falkland Islands
- you’re an asylum seeker or applying for humanitarian protection (or you’re their dependant)
- you’re a domestic worker who has been identified as a victim of slavery or human trafficking
- you’re applying for discretionary leave to remain in the UK as someone who has been identified as a victim of slavery or human trafficking (or you’re their dependant)
- the Home Office’s domestic violence concession applies to you (or you’re their dependant)
- being made to leave the UK would be against your rights under Article 3 of the European Convention of Human Rights (or you’re their dependant)
- you’re an S2 Healthcare Visitor
- you’re eligible for a Frontier Worker permit and have an S1 certificate
You need to pay the healthcare surcharge if you apply for indefinite leave to remain but are only given limited leave. You’ll need to pay before you’re given the leave.
Visitor visas and short-term visas
You do not need to pay the surcharge or get an IHS reference number if you’re applying for a:
You will need to pay for any NHS care you get at the point you use it - unless it’s a service that’s free.
How much you have to pay
The exact amount you pay depends on the length of the visa you’re given.
A visa may last longer than your course of study or period of employment.
Cost for a year
You’ll have to pay:
- £470 per year for a student or Youth Mobility Scheme visa, for example £940 for a 2-year visa
- £470 per year for visa and immigration applicants who are under the age of 18 at time of application
- £624 per year for all other visa and immigration applications, for example £3,120 for a 5-year visa
Cost for part of a year
The amount you have to pay depends on the length of the visa you’re given and where you apply from.
6 months or less
You do not need to pay the surcharge if you’re applying from outside the UK for 6 months or less.
If you’re applying from inside the UK, you’ll have to pay half the yearly cost. For example, £235 for a student, Youth Mobility Scheme or under-18 applications, and £312 for any other application.
More than 6 months but less than one year
Wherever you apply from, you’ll have to pay the cost of a full year.
Cost for more than one year
If your visa is for more than a year, you’ll have to pay:
- the yearly cost plus half the yearly cost, if it’s for 18 months or less
- the cost of 2 full years, if it’s for more than 18 months but less than 2 years
Paying for dependants
Dependants aged 18 or over usually need to pay the same amount as you.
The exact amount you pay depends on the length of the visa you’re given, which may last longer than your course of study or period of employment.
This may mean your actual payment is more than the calculator shows.
Refunds
You’ll automatically get a partial refund if you paid the healthcare surcharge for more years than you were granted leave.
When you must pay
If you apply for a visa online, you pay the surcharge as part of the application.
If you apply for a visa by post, you must pay the surcharge online before you send your application. You’ll need to include your IHS reference number on the application form.
If you do not pay
You’ll get an email from UK Visas and Immigration if you do not pay the surcharge (or do not pay enough) as part of your visa or immigration application.
Check your junk folder if you cannot see the email in your inbox.
Once you get the email, you must pay the surcharge within:
- 10 working days if you’re inside the UK
- 7 working days if you’re outside the UK
Your visa or immigration application will be turned down if you do not pay the full amount in this time.
Pay the healthcare surcharge
If you’re making an immigration application online you pay the healthcare surcharge as part of the application process. You must complete the payment and return to the online immigration application in less than 30 minutes.
If you’re making an immigration application by post you must pay the healthcare surcharge before you complete your application.
You must pay the healthcare surcharge by debit or credit card.
If you’re applying online, you’ll be asked for:
- the start and end dates on your certificate of sponsorship, if you have one
- your course dates, if you’re applying as a student
If you’re applying by post, you’ll also be asked for:
- the type of visa you’re applying for
- your passport or travel document number
- an email address
You need to pay by cash at the UK embassy if you’re in the Democratic People’s Republic of Korea.
Family members
You’ll need the same information that you used to pay for:
- any person applying for a visa or other immigration application with you, for example a dependant
- any person you’re applying to join or remain who is already in the UK (you do not need to add this person’s details if they are a UK or EEA citizen)
You’ll also need their leave expiry date if you’re joining someone in the UK (or IHS reference number if they have one).
Finish your visa or immigration application
- You’ll be sent an email with an IHS reference number. This will also be shown on screen when you’ve paid. You can only use this number once - you’ll need to get another one if you reapply.
- You’ll need to write this on the cover of your visa application if you’re applying by post. You need this reference even if you’re exempt from paying the healthcare surcharge.
- Finish your application form and pay your visa or immigration application fee.
Refunds
You’ll get a full immigration health surcharge (IHS) refund if:
- you paid twice
- your visa application is refused
- you withdraw your visa application
You’ll get a partial IHS refund if your visa application’s successful but:
- you get less time on your visa than you asked for
- any dependants on your visa application are refused
If you are due a full or partial refund for these reasons, you do not have to do anything to get it. It will be automatically paid to the account or card you paid with.
You will not get a refund if:
- your visa application is successful but you do not come to the UK
- you leave the UK before your visa ends, for example to make a new application
- you’re told to leave the UK before your visa expires
- you’re applying for indefinite leave to remain
How long it takes
You usually get your refund within 6 weeks of getting a decision on your visa application. It can take longer if you appeal or ask for an administrative review after your visa application is refused.
If you appeal or ask for an administrative review
If you applied from:
- inside the UK - you’ll get your refund up to 6 weeks after your appeal or administrative review is dismissed
- outside the UK - you’ll get your refund up to 6 weeks after your visa application is refused
You’ll have to repay the IHS if your appeal or administrative review is successful and you’ve already got your IHS refund.
You might have to repay a different amount if:
- the length of your stay changes
- you get less time on your visa than you asked for
Contact UK Visas and Immigration (UKVI) if your refund is not paid within 6 weeks.