Overseas Visitors - Shortened Guidance

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SECTION 2 CATEGORIES OF OVERSEAS VISITORS EXEMPT FROM NHS CHARGES

12. Visitors are not "exempt from NHS charges", irrespective of their country of origin ( EEA or non- EEA) unless they can provide acceptable evidence that the purpose of their visit falls within one of the relevant categories as explained below.

A PERSON TAKING UP PERMANENT RESIDENCE IN THE UK

A. UK Passport Holders - Right of Abode

13. Since UK passport holders and others with the right of abode do not require leave to remain in the UK, other forms of evidence will need to be seen to confirm that they are taking up permanent residence. If this cannot be verified they will not receive any NHS treatment on the same basis as those ordinarily resident until they have been living in the UK for at least 12 months.

B. European Economic Area ( EEA) and Swiss Passport or Identity Card Holders (see Annex 1)

14. Nationals from EEA member states have the right to take up residence and, with some qualifications for the A8 countries, Bulgaria and Romania, to work in the UK. The following people will be exempt from NHS charges if they can prove they have taken up residence.

  • a worker (including those who have ceased to work)
  • self employed
  • a person who has been posted to the UK by an employer in another EEA country or Switzerland
  • a family member (see the definition at paragraph 41) of a worker or self employed person
  • self sufficient (i.e. have enough means to support themselves without the help of the state social security system) and their family members
  • a student on a full-time course of further or higher education and their family members

15. Proof of nationality must be provided as evidence, e.g. passport, national identity card, or a European Health Insurance Card ( EHIC2) to receive care and services on the same basis as those ordinarily resident in Scotland. A letter from an employer confirming employment or a matriculation card or letter from a University or College confirming acceptance on a course of study would also be acceptable. Anyone who cannot provide such proof should be charged, but told that charges will be refunded if proof is provided.

16. EEA and Swiss Nationals automatically acquire a permanent right of residency if:

  • they have been lawfully resident for 5 years, or
  • they have ceased to work (e.g., if they have been lawfully resident and working or self employed for at least a year then retired after having resided in the UK for 3 years or have been working or self employed in the UK for 2 years and have stopped working there as a result of permanent incapacity to work or have been made a lawful resident through marriage and are not in employment, or
  • they are the family members (see the definition at paragraph 41) of a lawfully resident worker who has died.

They have been working or self employed in the UK for 3 years and now work in another Member State but retain their place of residence in the UK and return to the UK at least once a week

17. ANYONE with a right of residency is "exempt from NHS charges" and therefore can register with a GP, dentist or community pharmacist for the minor ailments service. They will receive the SAME benefits/exemptions as a UK national who is ordinarily resident.

Persons not falling under A or B above

18. Any person taking up permanent residence in the UK who is not an EEA/Swiss national and without a UK passport must either have a "no time limit" stamp in their passport or a letter from the Home Office confirming that permanent leave to remain is granted.

Examples of Evidence

Evidence of taking up permanent residence will be, e.g., lease/ mortgage of home in UK, contract of employment, pay slips, council tax documents, TV license, school registration documents, bill for shipping goods to the UK, one way tickets, letter from previous healthcare provider confirming intention to move to UK and reside permanently etc.

Evidence required to support a right of abode or residence can be a persons UK passport, their passport or identity card from a member state of the EEA, or a passport containing either a "Residence Permit" stamp with no time limit therein or a letter from the Home Office confirming that permanent leave to remain is granted.

LAWFULLY RESIDENT FOR MORE THAN ONE YEAR

19. Someone who has been lawfully resident in the UK for not less than 1 year is entitled to "exemption from NHS charges" provided they have been resident in the UK for the whole of that time. (Short holidays abroad are permitted) Evidence of this would be:

  • a stamp in the passport (for non- EEA/Swiss nationals)
  • a residence permit or evidence of registration under the Worker Registration Scheme (for EEA nationals)
  • other evidence is the same as above for permanent residence e.g., lease/ mortgage of home in UK/ contract of employment etc.

Examples of Evidence

Proof of being lawfully resident in the UK:

Has right of abode ( UK passport holders and certain commonwealth countries), leave to enter documents from Home Office (including documents allowing long-term leave to stay eg a fiancé visa), work permit or student visa if still valid.

Proof of residence:

Utility bills, lease, mortgage arrangement (doesn't need to be the same address for the whole 12 months).

HOLDERS OF AN EUROPEAN HEALTH INSURANCE CARD ( EHIC)

20. Visitors (ie people intending to stay for less than 90 days) from another EEA member state or Switzerland should have a European Health Insurance Card ( EHIC) issued in their country of origin. Images of the EHICs of different countries can be found at http://ec.europa.eu/employment_social/healthcard/cards_en.htm.

21. Until 1 April 2008 such visitors may be asked to provide sufficient evidence of nationality and residency so as to prove that they are resident in their country of origin and engaged with the healthcare system there. After 1 April 2008 the production of an EHIC will be mandatory and anyone unable to show one should be charged and advised to take up the matter with their home health authorities on their return.

22. The EHIC provides limited cover free of charge for any person from another EEA state temporarily in the UK. It covers only the following:

  • any NHS medical treatment that becomes necessary during their trip because of illness or accident
  • any necessary NHS treatment needed for chronic disease or pre-existing illness (advance arrangements need to be made for kidney dialysis or oxygen therapy). Treatment given should be aimed at stabilising the condition until the person is able to return home.

23. The EHICdoes not cover any patient for whom getting medical treatment is the reason for their visit, e.g. who is seeking elective surgery, and, since such a person is not ordinarily resident in the UK, he/she is not "exempt from NHS charges".

Note: Patients from the EEA who do want to come to the UK specifically for treatment must have an E112 form signed by their Health Authority, which means that the healthcare provider in their country of origin has agreed to pay the UK Government for the cost of the treatment, or be exercising their rights under Article 49 of the Treaty of European Union in the limited circumstances as detailed in the case law of the European Court of Justice, in which case the patient would pay for treatment and should be given a receipt to claim reimbursement from the healthcare provider in their country of origin..

Examples of Evidence (Until 1 April 2008, when an EHIC will be required)

Evidence of EEA nationality would be a valid driver's license and passport or national ID card.

Evidence of residency within the respective member state of the EEA could be state health insurance documentation, ID card.

STUDENTS

24. Students in a full time course of study at a University or other institute of further education are "exempt from NHS charges" from the beginning of the course until, normally, one month after the end of the course. However, if graduates can prove that they are participating in the UK International Graduates Scheme or the Fresh Talent Working in Scotland Scheme they will remain exempt from charges while they seek employment. Information on both Schemes can be found at http://www.bia.homeoffice.gov.uk/workingintheuk/

25. There is no specified minimum course length. As a guideline, courses should not usually be less than 3 months in length, but this is not absolute. Preliminary courses taken before a degree course may be counted as part of the same course. Courses should lead to a nationally recognised degree, doctorate or certificate of higher education (eg recognised by the Scottish Qualifications Authority ( SQA)). If you are unsure about a particular course, please consult the SQA or the institution holding the course for further details.

26. EEA and Swiss students should have an EHIC.

27. Students on part-time courses are not "exempt from NHS charges."

Examples of Evidence

Evidence of studying:

  • if a national of the EEA or Switzerland they will require proof of nationality, such as a passport or EEA residence card or a European Health Insurance Card.
  • if not a national of EEA or Switzerland then they should have a valid student Visa, and
  • proof of attendance at a qualifying course of study, such as a letter of acceptance confirming the dates of duration of the course from the University or College or a matriculation card.

AU PAIRS

28. Au Pairs are not regarded as workers or students and therefore are only entitled to emergency or immediately necessary treatment free of charge, until they have been lawfully resident in the UK for one 1 year (paragraph 19) unless they are EEA/Swiss residents (paragraph 20).

ASYLUM SEEKERS

29. If a person has made a formal application for asylum which is still under consideration he or she, and any dependents, is "exempt from NHS charges".

30. Any course of treatment which has begun while a person was still in the asylum process must be completed or continued without charge until the person leaves the country, and treatment must still be given in an emergency and for the infectious and contagious conditions specified in Section 3. For all practical purposes this is likely to mean that failed asylum seekers who have previously been resident in Scotland and remain in Scotland will remain in the care of the NHS in Scotland until arrangements for their return home can be made.

Example of Evidence

All people lawfully seeking asylum will be issued with a letter of Temporary Admission (IS96) from the Home Office. They will subsequently receive an Application Registration Card ( ARC), a credit card-sized plastic identity card carrying a photograph. More information on the ARC can be found at: http://www.bia.homeoffice.gov.uk/asylum/support/arc/

IN exceptional circumstances when an ARC cannot be issued within three days a person may be given a Standard Acknowledgement Letter ( SAL) will be issued. This displays the person's name, date of birth, nationality, date of arrival in the UK, date of application, address and Home Office Reference number. Photographs of the applicant and any dependants are attached.

Either an ARC or an SAL would be sufficient proof that an individual had made a formal claim for asylum.

REFUGEES AND OTHER SUCCESSFUL APPLICANTS

31. An asylum seeker whose application for protection in the UK under the 1951 UN Convention on refugees is successful will be granted refugee status. An applicant may also be given another type of protection status: Humanitarian protection ( HP) or Discretionary Leave ( DL) or may be granted Indefinite Leave to Remain ( ILR). All such persons and their dependants are "exempt from NHS charges" and should be treated in the same way as permanent residents.

Examples of Evidence

People with Refugee, HP, DL, or IDL status will have either:

  • An Immigration Status Document , also known as a vignette" , which is a placed in the person's passport from the country of origin, if they have one; or
  • A "Notification of Grant" letter from the Home Office
  • ( Refugees only) A travel document which shows that it was issued in the UK in accordance with the Convention on the Status of Refugees - these are issued to look similar to a UK passport but are blue. More information can be found at http://www.bia.homeoffice.gov.uk/ukresidency/traveldocuments/;.

WORKERS

32. A person is "exempt from NHS charges" if the primary purpose of his/her lawful presence in the UK is the fact that they are currently in employment or self-employment. This is usually irrespective of whether he/she is paying NI contributions or UK taxes, or is unpaid employment e.g. people working abroad as volunteers or missionaries.

33. Other work-related circumstances in which persons are "exempt from NHS charges":

  • EEA nationals seeking work and in possession of an EHIC (people from outside the EEA seeking work are not covered)
  • persons employed on a UK registered ship or vessel
  • offshore workers (working in UK controlled waters of UK continental shelf)
  • HM Government employees (diplomatic staff, crown servants, UK armed forces)
  • EEA nationals paying class 1 or class 2 (national insurance) contributions
  • volunteer workers, e.g. those doing unpaid voluntary work for religious or charitable organisations

Examples of Evidence

If EEA or Swiss national they will require proof of nationality or an EHIC;

If not an EEA or Swiss National then they must have a valid workers permit, and

  • proof that employment is based in the UK, e.g. confirmation from UK employer or invoices or receipts for self employed persons; and
  • proof of employment, e.g. recent letter from employer, contract of employment or current wage slip;

or

  • proof of self employment, e.g. invoices or receipts; or
  • proof of working as a volunteer, e.g. a letter from the organisation to confirm what type of service is being provided.

FORMER UK RESIDENTS WORKING OVERSEAS

34. Certain persons who formerly lived in the UK but are now working overseas are "exempt from NHS charges". In order to qualify the following criteria need to be satisfied:

35. The person has previously been lawfully resident in the UK for 10 continuous years and

  • has not worked abroad for 5 or more years, or
  • has worked abroad for 5 or more years, but has taken home leave at least every 2 years or has the contractual right to do so, or
  • has a contractual right to passage home at the end of their employment

Examples of Evidence

  • proof of 10 years continuous residence, eg previous job, schools attended, previous addresses.
  • proof of employment, eg letter from employer, contract of employment
  • proof of not having been out of the UK for 5 or more years, eg letter from employer or history of employment, passport stamps.
  • proof of Home Leave taken/ offered, eg passport stamps, flight receipts, contract of employment.
  • passage home at end of employment, eg employment contract.

UK WAR PENSIONERS OR UK WAR WIDOWS PENSIONERS

36. If the person is in receipt of either the UK War pension or UK War Widow pension then they are "exempt from NHS charges" regardless of where they reside.

37. It should be noted that UK War pensioners, but not UK War Widow pensioners, are also entitled to exemption from prescription charges and charges for wigs and fabric support if they have a valid war pension exemption certificate. They are however required to pay dental charges and charges for glasses and contact lenses. They may be able to reclaim such charges, if the treatment is for an accepted disability, from the Veteran's Agency.

Examples of Evidence

Proof of pension, e.g. pension book/ slip, letter from Ministry of Defence or Department for Work and Pensions.

UK STATE PENSIONERS

38. UK state pensioners must spend at least 6 months of the year in the UK if they spend the other 6 months in an EEA member state, or at least 9 months of the year in the UK if they spend the rest of their time in a non- EEA country, to retain their "exemption from NHS charges".

39. UK pensioners living abroad permanently who have had more than 10 years continuous residency in the UK or more than 10 years service as a UKcrown servant are entitled to NHS treatment the need for which arose during a visit to Scotland . So are their spouses, registered civil partners and dependant children

Definition- Treatment the need for which arose during the visit

Treatment the need for which arose during the visit" means diagnosis of symptoms or signs occurring for the first time after the visitor's arrival in the United Kingdom and any other treatment which, in the opinion of a medical or dental practitioner employed by, or under contract with, an NHS Board, is required promptly for a condition which arose after the visitor's arrival in the United Kingdom, or became, or but for treatment would be likely to become, acutely exacerbated after such arrival.

PRISONERS AND DETAINEES

40. Any overseas national who is a prisoner in the UK is entitled to healthcare services on the same basis as prisoners who are UK nationals. Their care is generally arranged by the Scottish Prison Service. Anyone who is detained by the UK immigration authorities is "exempt from NHS charges". Their care would usually be arranged by the immigration authorities.

FAMILY MEMBERS OF ENTITLED PERSONS

41. Family members of an overseas visitor who is "exempt from NHS charges" are also exempt.

Definition - Family Member

In the context of exemption from NHS charges "family member" for the nationals of countries outwith the European Economic Area and Switzerland refers to the entitled person's spouse, registered civil partner and children (if under the age of 16, or 19 if still at school) . Older children, parents, siblings and other family members are not "exempt from NHS charges" unless they have a right of abode in their own right, or have been granted Home Office leave to reside permanently in the UK with an entitled person acting as their sponsor.

For the family members of nationals of European Economic Area Member States and Switzerland Family member who are resident in Scotland "family member" means the person's spouse, registered civil partner, direct descendants of the person, spouse or civil partner who are under the age of 21 or are dependant on the person, spouse or civil partner, and the dependant direct relatives in the ascending line of the person, spouse or partner. Siblings and other extended family members may be entitled if they have been granted entry to the UK as dependant relatives of the EEA national, spouse or partner

When Family Member has Right of Abode

42. If the family member has a Right of Abode and they are taking up permanent residence in the UK they will be "exempt from NHS charges" in their own right meaning that their right of residence is not limited to that of their entitled family member.

43. A family member of an EEA national or Swiss national who is resident in Scotland and who has entered the UK with an EEA family member residence permit is "exempt from NHS charges" as they are considered to have a right of abode.

Spouse or Registered Civil Partner

44. The spouse or registered civil partner of an overseas visitor, who is ordinarily resident here, has the right to reside with him/her in the UK and to be "exempt from NHS charges". People who are in informal relationships would not normally qualify to be "exempt from NHS charges", unless they have been permitted by the Borders and Immigration Agency/Home Office to enter the UK as a dependant of a qualified person or have an EEA family members residence permit.

45. A person entering the UK on a marriage or fiancée or partnership visa is usually "exempt from NHS charges".

Note: These rules apply whether the resident is a UK national or an overseas visitor who is exempt from NHS charges.

Children of non EEA or Swiss nationals

46. An overseas visitor who has lawfully taken up permanent residence in the UK has the right to have his/her dependant children reside with him/her and for them to be "exempt from NHS charges". The children must be under the age of 16 (or under 19 if still at school). Adult offspring must qualify in their own right.

47. Other family members (except spouse, registered civil partner and children as above) have no entitlement unless in their own right. If the spouse /registered civil partner of a UK resident has a child under the age of 16 (19 if at school) who is not related biologically or by way of adoption to the UK resident, the child will only qualify as "exempt from NHS charges" if they are dependent upon the resident and are considered 'part of the household'.

48. An unborn child whose mother is an overseas visitor and whose father is a UK national or permanent lawful resident does not confer any entitlement to "exemption from NHS charges" on the mother if she is not herself exempt from charges, e.g. if she is not married to the father and has not any right of abode. Prenatal care and delivery should in these circumstances be charged. The child will however be "exempt from NHS charges" as soon as it is born.

Parents, Grandparents and other Dependent Relatives of non EEA or Swiss nationals

49. Parents, Grandparents and other dependent relatives may be allowed leave to enter the UK if they are wholly or mainly financially dependent on the resident relative. The Home Office will consider the application and their case must satisfy strict criteria.

50. Some people, including EEA or Swiss family members and dependant relatives of the nationals of other countries, may have "No recourse to public funds" stamped on their passports. This does not mean they have to pay for all NHS care and services. If given indefinite leave to remain they will be "exempt from NHS charges" provided they are resident in the UK. Unless/until indefinite leave to remain is granted, such family members are only entitled to emergency healthcare unless they are from an EEA country or Switzerland.

51. Dependent relatives who live abroad and are visiting the UK are not entitled to exemption from charges unless they are from an EEA country or Switzerland and are carrying a European Health Insurance card. If they come from a reciprocal health care country they will be entitled only to treatment the need for which arose during the visit. If they come from a country outwith the UK and with which there is no reciprocal care agreement they should be charged.

Page updated: Friday, March 14, 2008