Moving to the UK: the National Health Service

22 December 2015

When advising employees and business visitors who come to the UK, we are often asked about access to the National Health Service (NHS).

The National Health Service (NHS) is a residence based health care system operating within the UK. Access to the NHS is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a doctor, having an NHS number or owning property in the UK.

The NHS provides free or subsidised treatment to individuals who ordinarily reside in the UK. The term ‘ordinarily resident’ is defined by case law and refers to an individual who is living in the UK “lawfully, voluntarily and for settled purposes as part of the regular order of their life for the time being”.

NHS primary care is free for all eligible individuals at the point of delivery. However there may be other costs involved, especially if secondary care treatment, dental treatment, eye care or prescriptions are required. 

If you lawfully reside in the UK and are classified as ‘ordinarily resident,’ family members including your spouse, civil partner and dependent children will also become eligible for free NHS healthcare whilst they too are living lawfully in the UK. Most other individuals are must pay to access the NHS although emergency primary care is generally free of charge to everyone who needs it.

Coming to the UK

If you are moving to the UK from outside the European Economic Area (EEA) the following will apply: 

  • If you have been given an immigration status of ‘indefinite leave to remain’ (i.e. if you have the right to live in the UK on a permanent basis) you will be classified as ‘ordinarily resident’ and be eligible for free healthcare. 
  • If you are relocating to the UK on a temporary basis but for more than 6 months, you will generally be required to pay a healthcare surcharge when you apply for your visa. This amount can be calculated online at www.gov.uk/browse/visas-immigration and it must be paid upfront before you submit your visa application. Once your UK visa is granted, you will be eligible for free healthcare from the date it is granted until it expires. 
  • If you are only visiting the UK for a short period (e.g. under a visitor, tourist or short stay visa) you are unlikely to be eligible for free healthcare and should ensure that you have sufficient personal, medical or travel insurance cover for the duration of your visit. 
  • If you applied for your visa before 6 April 2015, a different set of rules applies. 
  • If you are moving to the UK from inside the European Economic Area (EEA) or Switzerland the following will apply to you: 
  • If you plan to reside in the UK on a permanent basis, you will be classified as ‘ordinarily resident’ and will be eligible for free healthcare.
  • If you plan to visit the UK temporarily and require healthcare, you will need to provide a valid European Health Insurance Card (EHIC) to avoid being charged for treatment. 

UK citizens who return to the UK permanently after a period of absence will be classed as ordinarily resident and will immediately become eligible for free healthcare. Certain other categories of visitors such as students, asylum seekers or detainees may also receive free healthcare. 

Reciprocal agreements

In addition to the domestic rules outlined above, the UK has a number of reciprocal healthcare agreements that enable medical treatment to be provided free or at a reduced charge to visitors from specific countries. The terms of each agreement vary but they generally only provide for urgent or immediate treatment and are only intended to cover visitors, not those who live or work in the UK for a longer period. 

A number of the UK’s agreements are due to expire in January 2016 so be sure to check whether any agreement is still in force before relying on its provisions. For more information on these agreements, click here.

In summary......

The question of whether or not an individual is ordinarily resident in the UK can be a subjective matter. There is no link between residence for tax purposes and ordinary residence for healthcare purposes. This can lead to uncertainty regarding the availability of free NHS healthcare. However, in practice, most individuals who come to work in the UK will either be from an EEA country and thereby able to obtain an EHIC, or from outside the EEA but in possession of a valid work permit which generally entitles them to healthcare. In the latter case a surcharge may be payable as part of the visa application process.

Notwithstanding the above, it is common for employers who send staff to work in the UK to provide private medical insurance as this gives the employee peace of mind as well as reduced waiting times. Employer provided medical insurance is a taxable benefit to the employee in the UK.

Please note that this information is only a general guide. For further information on the NHS please visit www.gov.uk  or www.nhs.uk or visit your local doctor in the UK. 

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