Are you taking up or resuming permanent residence in the UK?
What if I should need hospital treatment?
Under the current Regulations, anyone who is taking up or resuming permanent residence in the UK is entitled to free National Health Service (NHS) hospital treatment in England.  If your intention is to live permanently in the UK you will be exempt from hospital charges from the date of your arrival in the country but you should expect to be asked to prove your intention and that you are legally entitled to live here. This exemption applies to your spouse, civil partner and children (under the age of 16, or 19 if in further education) if they are living here with you on a permanent basis.

If you do not have an automatic right to take up permanent residence but have applied to the Home Office for leave to enter/remain on a settled basis, you will be chargeable for any hospital treatment up to the point your application is granted or until you accrue 12 months lawful residence in the UK.

Once you are living here permanently you will become ordinarily resident and the Regulations will cease to apply to you. Your spouse, civil partner and child will also be considered ordinarily resident if they are living permanently in the UK with you and have the right to do so.  If they are not living permanently in the UK then the Regulations will apply and in order to be entitled to free hospital treatment they will have to meet one of the categories of exemption in their own right.

In common with those ordinarily resident in the UK, anyone who meets the criteria of ordinary residence or is exempt from charges for hospital treatment will have to pay statutory NHS charges, e.g. prescription charges, unless they also qualify for exemption from these, and will have to go onto waiting lists for treatment where appropriate.

If I should need hospital treatment what documents will I need?
The Regulations place a responsibility on individual hospitals to determine whether, in accordance with the Regulations, a patient is liable to be charged for treatment or not.  In order to establish entitlement, hospitals can ask you to provide documentation that supports your claim that you intend to live permanently in the UK.  It is for you to decide what to supply, however examples of evidence could include:

• documentation to prove you are entitled to live in the UK such as British Passport, permission from the Home Office;
• documentation that proves your intention is to reside here permanently such as sale of goods/property overseas, receipts showing shipping of goods, looking for work, application for benefits, children are attending school.

Am I entitled to access primary care services?
Any person living here lawfully and on a settled basis is regarded as resident in the UK and therefore entitled to free primary medical services. On taking up residence in the UK it is advisable to approach a GP practice and apply to register onto its list of NHS patients. The practice may choose to accept or decline your application. An application may be refused if the practice has reasonable grounds for doing so, such as if you are living outside their practice area. A practice would not be able to refuse your application on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

Do I have to pay for emergency treatment if I have an accident?
Regardless of residential status or nationality, emergency treatment given at primary care practices (a GP) or in Accident and Emergency departments or a Walk-in Centre providing services similar to those of a hospital Accident and Emergency department is free of charge.

In the case of treatment given in an Accident and Emergency department or Walk-in Centre the exemption from charges will cease to apply once the patient is formally admitted as an in-patient (this will include emergency operations and admittance to High Dependency Units) or registered at an outpatient clinic.

Hospital treatment is free to people who live in the United Kingdom (UK). If you do not normally live here and you do not meet one of the exemptions from charges then you will have to pay for treatment you might need. This is regardless of whether you are a British citizen or have lived or worked here in the past or have been issued with an HC2 certificate.

If you are not covered by any of the exemption categories listed in this leaflet it is advisable to ensure you adequate health insurance to cover the duration of your stay in the UK.

How do I know if I have to pay?
The law says that the hospital providing treatment must decide if each patient is entitled to free NHS hospital treatment. The hospital will ask you to provide evidence to confirm your eligibility. If the hospital decides that you can receive free NHS treatment you will still have to pay for statutory NHS charges such as prescription charges unless you are otherwise exempt. If the hospital decides that you are not entitled to free NHS treatment, charges will apply and cannot be set aside. This will include the full cost of any prescribed medication even if you are in possession of an HC2 exemption certificate.

What do I have to pay for?
You will have to pay the full cost of all the treatment you receive, including emergency treatment, given by staff at a hospital or by staff employed by a hospital. However, there are some services that are free of charge to everyone:

• Treatment given only in an Accident and Emergency (A&E) department or in a NHS Walk-in Centre providing services similar to those of an A&E department (excludes emergency treatment given elsewhere in the hospital);
• Treatment for certain infectious diseases (excluding HIV/AIDS where it is only the first diagnosis and connected counselling sessions that are free to everyone);
• Compulsory psychiatric treatment;
• Family planning services.

Who does not have to pay?
People Entitled to Full NHS Hospital Treatment free of charge –

• Anyone who is working in the UK for an employer who is based in the UK or is registered in the UK as a branch of an overseas employer (this includes self employed people). You must be actually working, not just looking for work;
• Any unpaid worker with a voluntary organisation offering services similar to those of a Health Authority or Local Authority social services department;
• Any full time student on a course of at least 6 months duration, or, if less than 6 months, a course substantially funded by the UK government;
• Anyone who has come to live permanently in the UK. If you make an application for permanent residence after you get here you are chargeable until your application is approved;
• Anyone who has been lawfully living in the UK for twelve months immediately prior to treatment;
• Refugees and asylum seekers whose application is still being considered;
• Anyone employed on a ship or vessel registered in the UK or working offshore on the UK sector of the Continental Shelf;
• Anyone who receives a UK war disablement pension or war widows pension;
• Diplomatic staff working in embassies or Commonwealth High Commissions in the UK.
• Members of Her Majesty’s UK armed forces*;
• UK Civil Servants working abroad who were recruited in the UK and employed by Her Majesty’s Government*;
• Anyone recruited in the UK who works abroad for the British Council or the Commonwealth War Graves Commission*;
• Anyone who is working abroad in a job financed in part by the UK Government in agreement with the Government or a public body of some other country or territory*;
• Anyone working abroad for not more than 5 years as long as they have lived legally in the UK for ten continuous years at some point (including self employed people);
• Anyone working in an EEA country member state and contributing compulsory (not voluntary) UK national insurance contributions (class I or II);
• Anyone who is a national of an EEA member state, a refugee or stateless person or their dependant or survivor living in an EEA member state who is referred to the UK for specified treatment with an EC form E112 or E123;
• Anyone who is referred by their home country authorities for specified treatment in the UK under the terms of a bilateral agreement;
• Anyone who is detained in prison or by the Immigration Authorities in the UK;
• Serving NATO personnel, posted in the UK, who are not using their own or UK armed forces hospitals;
• UK state pensioners who have lived lawfully in the UK for 10 continuous years at some point, who now live for not more than 6 months each year in another EEA member state and not less than 6 months each year in the UK;
• Missionaries working overseas for an organisation principally based in the UK, regardless of whether they are receiving a wage or salary*;
• The spouse or civil partner and any dependent children of anyone who is exempt under the above criteria, if they are living permanently with the exempt person. Coming to visit the exempt person for a few weeks or months does not give exemption.

* These categories of exemption provide that the spouse/civil partner/dependent children are exempt from charge in their own right so that the principal exempt family member does not have to be in the UK with them at the time of their treatment.

People Entitled to Some NHS Hospital Treatment – this is limited to treatment required for any condition that occurred after arrival in the UK (including pre-existing conditions which acutely exacerbate whilst here).

• Anyone, including a refugee, stateless person or a member of the family of any of them, who normally lives in another EEA member state and is visiting the UK#;
• Anyone, or the spouse, civil partner or child of anyone, receiving a UK state pension who has either lived legally in the UK for 10 continuous years at some point or has worked as a UK Civil Servant for at least 10 continuous years;
• Anyone, or the spouse, civil partner or child of anyone, who is a national of a country that has signed the European Social Charter but is not entitled to be provided with services under a  bilateral agreement (currently Turkey) and is genuinely without the means to pay for their treatment;
• Anyone, or the spouse, civil partner or child of anyone, who has lived legally in the UK for 10 continuous years at some point but who is now living in another EEA member state or in certain countries with which the UK has a bilateral healthcare agreement;
• Anyone who is entitled to receive industrial injury benefit from Israel if the treatment is in connection with the industrial injury;
• Anyone living in a country with which the UK has a bilateral healthcare agreement (some bilateral healthcare agreements are limited to nationals of that country).

#  Also includes treatment for chronic conditions, including routine monitoring.

Bilateral Healthcare Agreement Countries –
European Economic Area countries (EEA):
Austria, Belgium, Bulgaria, Cyprus (Southern), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Republic of Ireland, Romania, Slovakia, Slovenia, Spain, Sweden, UK, plus Iceland, Liechtenstein and Norway. Switzerland by special arrangement.

Nationals of, and UK nationals in, the following countries:
Armenia, Azerbaijan,  Bosnia, Croatia, Georgia, Gibraltar, Yugoslavia i.e. Serbia & Montenegro, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, New Zealand, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan.

Residents irrespective of nationality of the following countries:
Anguilla, Australia, Barbados, British Virgin Islands, Channel Islands, Falkland Islands, Iceland, Isle of Man, Montserrat, St. Helena, Turks and Caicos Islands.

Please note the above information gives general guidance only and should not be treated as a complete and authoritative statement of law. In all cases the Regulations place the responsibility of deciding who is entitled to receive free hospital treatment with the hospital providing treatment.

Are you engaging in employment in United Kingdom (UK)?
What if I should need hospital treatment?
Under the current Regulations, anyone who is engaging in employment with an employer who has his principle place of business in the UK, or who is a self-employed person whose principle place of business is in the UK is fully exempt from National Health Service (NHS) hospital charges in England.

This exemption applies to your spouse, civil partner and children (under the age of 16 or 19 if in further education) if they are living with you in the UK on a permanent basis.

Please note that to be exempt from NHS hospital charges on this basis you must be in employment at the time you receive treatment.  If you are here on a work visa but currently unemployed you will be charged for your treatment, unless you are otherwise exempt from charges.

Also under the current Regulations, anyone employed on a ship or vessel registered in the UK or anyone working offshore on the UK sector of the Continental shelf would be fully exempt from NHS hospital charges in England.

In common with those ordinarily resident in the UK, anyone who meets the criteria of ordinary residence or is exempt from charges for hospital treatment will have to pay statutory NHS charges, e.g. prescription charges, unless they also qualify for exemption from these, and will have to go onto waiting lists for treatment where appropriate.

If I should need hospital treatment what documents will I need?
The Regulations place a responsibility on individual hospitals to determine whether, in accordance with the Regulations, a patient is liable to be charged for treatment or not.  In order to establish entitlement, hospitals can ask you to provide documentation that supports your claim that you intend to engage in employment in the UK.  It is for you to decide what to supply, however examples of evidence could include:

• if not an EEA* national or Swiss national then must have a valid work permit or;
• if EEA national or Switzerland proof of nationality;
• proof that employment is based in UK, e.g. confirmation from employer, or for self-employed invoices or receipts;
• proof of employment – e.g. recent letter from employer or contract of employment or current wage slip, for self employed invoices or receipts.
• Nationals from Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia will also need to be registered on the workers registration scheme. Nationals from Bulgaria and Romania must also a valid work permit.

Do I have to pay for emergency treatment if I have an accident?
Regardless of residential status or nationality, emergency treatment given at primary care practices (a GP) or in Accident and Emergency departments or a Walk-in Centre providing services similar to those of a hospital Accident and Emergency department is free of charge.

In the case of treatment given in an Accident and Emergency department or Walk-in Centre the exemption from charges will cease to apply once the patient is formally admitted as an in-patient (this will include emergency operations and admittance to High Dependency Units) or registered at an outpatient clinic.

Am I entitled to access primary care services?
Any person living here lawfully and on a settled basis is regarded as resident in the UK and therefore entitled to free primary medical services. On taking up residence in the UK it is advisable to approach a GP practice and apply to register onto its list of NHS patients. The practice may choose to accept or decline your application. An application may be refused if the practice has reasonable grounds for doing so, such as if you are living outside their practice area. A practice would not be able to refuse your application on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

Am I entitled to help with the costs of non-emergency NHS treatment?
Information about help with health costs is detailed in leaflet HC11 ‘ Are you entitled to help with health costs? HC11 is also available on the Internet at:
http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/NHScosts/index.htm

What if I do not meet one of these exemptions from charges?
If you are not ordinarily resident or exempt under the regulations, charges will apply for any hospital treatment you receive and cannot be waived. If this is the case you are strongly advised to take out private healthcare insurance that would cover you for the length of time you are in the UK.  There is no facility to purchase healthcare insurance from the NHS therefore any necessary insurance must be organised privately.

Please note the above information gives general guidance only and should not be treated as a complete and authoritative statement of law. In all cases the Regulations place the responsibility of deciding who is entitled to receive free hospital treatment with the hospital providing treatment.

What if I should need hospital treatment?

Under the current Regulations, anyone who comes to the UK to pursue a full-time course of study of not less than six months’ duration, or a course of study that is of any duration but is substantially funded by the UK Government, will be fully entitled to free NHS hospital treatment in England. This exemption will apply to your spouse, civil partner and children (under the age of 16, or 19 if in further education) if they are living permanently with you in the UK for the duration of your course.

Students studying less than six months from countries with which the UK holds bilateral healthcare agreements:
Students studying in the UK for less than six months from countries with which the UK holds bilateral healthcare agreements will only be entitled to free NHS hospital treatment that is needed promptly for a condition that arose after their arrival in the UK. This exemption will apply to your spouse, civil partner and children (under the age of 16, or 19 if in further education) if they are living permanently with you in the UK for the duration of your course.

For a full list of bilateral healthcare agreement countries, see the list above.
If you are here to study for less than six months on a course that is not substantially funded by the UK Government and are from a country with which the UK does not hold a bilateral healthcare agreement, then you will be chargeable for any treatment you receive, unless you meet the criteria for one of the other exemptions.

In common with those ordinarily resident in the UK, anyone who meets the criteria of ordinary residence or is exempt from charges will have to pay statutory NHS charges, e.g. prescription charges, unless they also qualify for exemption from these, and will have to go onto waiting lists for treatment where appropriate.

If I should need hospital treatment what documents will I need?
The Regulations place a responsibility on individual hospitals to determine whether, in accordance with the Regulations, a patient is liable to be charged for treatment or not.  In order to establish entitlement, hospitals can ask you to provide documentation that supports your claim that you intend to study in the UK.  It is for you to decide what to supply, however examples of evidence could include:

• if not an EEA national or from Switzerland then you should have a valid student visa or;
• if EEA national or from Switzerland, proof of nationality – passport, EEA residence card;
• proof of attendance on a qualifying course of study, or that such a course of study has recently been completed
• confirmation from university or college or proof of attendance on a substantially UK government funded course –
• confirmation letter from government body confirming successful candidate and confirmation of attendance from university or college.

Am I entitled to access primary care services?
Any person living here lawfully and on a settled basis is regarded as resident in the UK and therefore entitled to free primary medical services. On taking up residence in the UK it is advisable to approach a GP practice and apply to register onto its list of NHS patients. The practice may choose to accept or decline your application. An application may be refused if the practice has reasonable grounds for doing so, such as if you are living outside their practice area. A practice would not be able to refuse your application on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

Do I have to pay for emergency treatment if I have an accident?
Regardless of residential status or nationality, emergency treatment given at primary care practices (a GP) or in Accident and Emergency departments or a Walk-in Centre providing services similar to those of a hospital Accident and Emergency department is free of charge.

In the case of treatment given in an Accident and Emergency department or Walk-in Centre the exemption from charges will cease to apply once the patient is formally admitted as an in-patient (this will include emergency operations and admittance to High Dependency Units) or registered at an outpatient clinic.

Am I entitled to help with the costs of non-emergency NHS treatment?
Information about help with health costs is detailed in leaflet HC11 ‘ Are you entitled to help with health costs? HC11 is also available on the Internet at:
http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/NHScosts/index.htm

What if I do not meet one of these exemptions from charges?
If you are not ordinarily resident or exempt under the regulations, charges will apply for any hospital treatment you receive and cannot be waived. If this is the case you are strongly advised to take out private healthcare insurance that would cover you for the length of time you are in the UK.  There is no facility to purchase healthcare insurance from the NHS therefore any necessary insurance must be organised privately.

Please note the above information gives general guidance only and should not be treated as a complete and authoritative statement of law. In all cases the Regulations place the responsibility of deciding who is entitled to receive free hospital treatment with the hospital providing treatment.