LOGIN or JOIN
information for global expats



Features Archive

UK Curbs On Health Tourism Could Benefit British Expats

Expat Briefing Editorial Team
14 May, 2014


There remains much confusion over exactly who will have to pay the National Health Service’s new migrant levy, what they will have to pay for and how much they will have to pay. However, it seems that for expats originating from the UK, the situation with regard to NHS charging may be about to improve.


The Current Rules

According to existing guidance on entitlements to NHS care published by Public Health England (confusingly, different rules apply in Scotland and Wales), whether or not somebody is entitled to free hospital treatment depends on whether they are “ordinarily resident” in the UK, rather than on nationality, the amount of UK tax and national insurance contributions paid, or if they are registered with or referred by a general practitioner in the UK.

In this case, ordinary residence is broadly defined as living in the UK “on a lawful and properly settled basis”, although the principle is open to interpretation (see our previous weekly Expat Briefing on the new UK statutory residence test for an explanation of the UK’s residence rules).

Some people who are not considered ordinarily resident in the UK ('overseas visitors') are exempt from charges for NHS hospital treatment under the current Regulations, but all other patients are charged for treatment, except for treatment that is 'free to all'.

‘Free to all’ services include: treatment provided by a GP (including temporary patients who can register for between 24 hours and three months); emergency treatment at an Accident and Emergency department; family planning services; treatment for communicable and sexually transmitted diseases; diagnosis, treatment and counselling in relation to HIV; and those detained under the Mental Health Act or treatment for mental problems under the aegis of a court order.

As regards an individual taking up permanent residence in the UK and needing hospital treatment, they are normally exempt from any charge. However, they may be required to provide proof that they are legally entitled to remain in the UK and that they intended to live in the country on a permanent basis, as opposed to just visiting.

If the person does not have an automatic right to take up permanent residence but has applied to the Home Office for leave to enter/remain on a settled basis, they will be charged for any hospital treatment up to the point their application is granted or until they accrue 12 months lawful residence in the UK or are considered ordinarily, except for treatment that is ‘free to all’.

People who are visiting the UK from a country which has a bilateral healthcare agreement with the UK are exempt from charges for NHS hospital treatment in England, if the treatment is needed promptly for a condition that arose, or acutely worsened, after their arrival in the UK.

People from European Economic Area member states and Switzerland are also exempt from charge for treatment for chronic conditions, including routine monitoring, but must show a valid European Health Insurance Card (EHIC) or a Provisional Replacement Certificate. In neither case is pre-planned treatment included free of charge without special, prior arrangement.

In the UK, the EHIC provides access to free medical treatment which is seen, by a medical professional in the UK, to be clinically necessary and needed before the patient’s planned return to their home country. Visitors are also covered, with an EHIC, for the treatment and routine monitoring of pre-existing conditions.


The Changes

In July 2013, the Government launched a consultation into plans to "tighten up on who is entitled to free NHS treatment" by introducing a "migrant health levy" on temporary migrants from outside the European Economic Area (EEA), and in December new proposals were outlined by the Government which included the following:

  • Extending charging for primary care services, such as prescriptions. General practitioner and nurse consultations will remain free, which will mean that everyone will continue to have initial access to prevent risks to public health such as HIV, TB and sexually transmitted infections. Other types of primary care services that are being considered for charging include minor surgery that is carried out by a GP and physiotherapy that has been referred through a GP.
  • Overseas visitors paying higher charges for services that are subsidised for patients entitled to free NHS care. These include optical and dental services which are currently highly subsidised.
  • A new system for identifying and recording patients who should be charged for NHS services.
  • The introduction of charging for A&E services for visitors and migrants including emergency care. The Government says that no one will be turned away in an emergency, but the changes will allow the NHS to recoup money and will create a consistent charging system across the NHS whilst encouraging only those who need urgent and emergency care to attend.

The good news for expats in all of this is that, according to the proposal document, all expatriates who return to reside in the UK will resume automatic qualification to free NHS services, while those returning on a visit will be entitled to NHS treatment if they have amassed a certain amount of national insurance contributions.

The paper explains: “Some but not all will benefit from exemptions if they return on a visit. We intend to extend this entitlement to any expatriate or former UK residents who have an extensive record of National Insurance contribution, and for this to cover their full medical needs.”

It goes on to state that: “Expatriate UK citizens who move to reside abroad currently lose their entitlement to free NHS treatment. They regain this if they return to live in the UK permanently but usually not when returning to visit. In line with the principle that everybody makes a fair contribution, we propose to confirm the entitlement of any person who has previously paid at least seven years of National Insurance contributions.”

The Government reckons that by deterring ‘health tourists’ the NHS will save around GBP500m per year.

“Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hardworking British taxpayers who fund it,” said health minister Lord Howe. “We know that we need to make changes across the NHS to better identify and charge visitors and migrants. Introducing charging at primary care is the first step to achieving this.”

The Government was supposed to reveal further details of its proposals in March 2014 ready for introduction in April. However, the legislation needed to bring these new rules into force is  contained in the Immigration Bill, which is still in the final stages of passage in parliament, so many aspects of the new regime remain unclear. And although a politically popular move, the new NHS charging scheme is not loved by many doctors themselves, who say it will be difficult to administer and hard to enforce.

Dr Mark Porter, Chair of British Medical Association Council, says that the proposals “could create unintended drawbacks for the NHS and patients”.

“They are likely to create a complex patchwork of charging and access entitlements where some services remain free, such as GP appointments, while others will be chargeable, including A&E visits and other services provided via many GP practices, such as physiotherapy”, he cautioned.

“There remains a real risk that some migrants and short term visitors who desperately need care could be discouraged from approaching the NHS if they cannot pay the proposed charges”, Dr Porter added. “There is particular confusion over access entitlements to emergency care services, given the proposals introduce charging for A&E visits yet say no patient will be turned away if they need care”.


Insurance

Of course, the insurance industry says that the steady tightening of the rules determining who is and isn’t entitled to free care on the NHS merely underlines the necessity of health insurance for Britons living, or intending to live, abroad.

Research suggests that around 50% of those who leave the UK to live and work abroad do not take out international private medical insurance, thinking instead that they will automatically qualify for free NHS treatment, should an emergency arise.

Underlining the increasing cost of medical treatment at home and abroad for even the most apparently mundane complaints, Debbie Purser, managing director of Medicare International highlights two recent examples of on-going claims that MediCare International has settled on behalf of policyholders.

In the first, a 53 year old British male living and working aboard a luxury yacht went to a doctor in the USA complaining of chest pains. Extensive testing revealed a blocked artery which required an emergency stent to be fitted. The client continues to make a steady recovery, but obviously requires costly regular monitoring, with the result that medical bills of nearly GBP20,000 have been paid out over the last six months. The client is expected to make a good recovery.

In a second case, a 34 year old British male suffered a broken wrist following a fall whilst in Turkey. Although a full recovery is forecast, to date the costs of medical treatment and rehabilitation are nearly GBP13,000. 

Such cases are a constant reminder of the everyday value and importance of having international private medical insurance, but it is the cost of treating cancers which can produce medical bills running into the tens of thousands of pounds, especially where a patient is moved between countries to access treatment. Two clients of MediCare with cancers who are currently being treated have so far run up bills over GBP65,000 and GBP262,000 respectively. In one case, having taken out worldwide cover, the client elected to be flown from Europe and treated in the USA in order to be able to access the highest standards of care. In the other, chemotherapy was started in Hong Kong, with the client being flown to London to complete the treatment.

“Cancers are now far more treatable than was the case 20 years ago,” said Purser. “However the cost of that treatment can be very high. At MediCare International, we will meet the cost of cancer diagnosis and treatment, both today and into the future, giving clients immense peace of mind.”




 

Comments


Leave A Comment

Name:
Email:
Comment:
Validation:

My daughter and her husband, both UK citizens,are voluntary workers in Vietnam, getting financial support from church and friends. She is 34 wks pregnant and wanted to have her baby born in the UK so flew home to us 2 days ago, intending to stay til end of July before returning back to Vietnam. Today she went to register with the local GP and to arrange for the follow-up/birth in the local hospital. Not realising all the rules re living abroad and coming back as a 'visitor' she is now panicking (and us). She has always paid her taxes and N.I. contributions. Will she have to pay and if so, how much will that all cost? Thanks for any answer.

Thea Geach, 2 years ago.

national insurance number ZT 844247A

My question is related to health insurance .
I live in Canada and my family lives in Bradford Yorkshire. I am planning on visiting my family but I want to know if I would be covered by the NHS or do I need to take out medical Travel insurance . I tried to get the information on line but find it very confusing

Thank you
Ken Hodgson

Ken Hodgson, 2 years ago.

My wife and I are UK citizens, currently resident in South Africa. We have decided to return to our house in the UK from the beginning of April 2015 and have sold our house in South Africa. During the time we have been in South Africa I have paid UK tax on my pensions (Military, Old Age and 2 small private). I am 66 years old and have paid National Insurance contributions through put my working life - some 45 years continual employment. We are unsure whether on our return to the UK we are entitled to the benefit of the NHS immediately on our return. Grateful if anyone who knows about these matters could advise. Many thanks

Richard Self, 2 years ago.
« Go Back to Articles
 
 
 
 

Information

About | Useful Links | Global Media Partners | Media | Advertising And Sales | Banners And Widgets | Glossary | RSS | Privacy & Cookies | Terms And Conditions | Editorial Policy | Refer To A Friend | Newsletters | Contact | Site Map

Important Notice: Wolters Kluwer TAA Limited has taken reasonable care in sourcing and presenting the information contained on this site, but accepts no responsibility for any financial or other loss or damage that may result from its use. In particular, users of the site are advised to take appropriate professional advice before committing themselves to involvement in offshore jurisdictions, offshore trusts or offshore investments. © Wolters Kluwer TAA Ltd 2017. All rights reserved.

The Expat Briefing brand is owned and operated by Wolters Kluwer TAA Limited.