NHS charges and people from abroad

Your entitlement to free NHS treatment depends on the length and purpose of your residence in the UK, not your nationality. There may be charges for some NHS services, for example, your dental treatment, and you may be entitled to help with these charges. Any free NHS treatment you receive, or any help with NHS costs, does not affect your immigration status.

If you are entitled to it, you can obtain free treatment immediately. There is no qualifying period.

If you have to pay for treatment because you do not meet the residence conditions, this does not count as discrimination. However, you must be given clear information about charges in a way you understand. This could include providing information in a foreign language or an interpreter, if necessary. If you aren't given clear information, this might be discrimination and you can complain about it.

For more information about making a complaint about the NHS in England, see NHS and local authority social services complaints. In Scotland, see NHS complaints. In Wales, see NHS complaints in Wales. In Northern Ireland, see HPSS complaints in Northern Ireland.
Treatment which is always free of charge

Some hospital treatment is free of charge for everyone who needs it, regardless of how long they have been or intend to stay in the UK. This is:-

* treatment for accidents and emergencies as an outpatient in a hospital’s accident and emergency department. Emergency treatment in a walk-in centre is also free of charge (England and Wales only). However, if you are referred to an outpatient clinic or admitted to hospital from an accident and emergency department, you will be charged
* compulsory psychiatric treatment
* treatment for certain communicable diseases, such as tuberculosis, cholera, food poisoning, malaria, meningitis and pandemic influenza. Testing for the HIV virus and counselling following a test are both free of charge, but any necessary subsequent treatment and medicines may have to be paid for
* family planning services.

Who can receive all NHS treatment free of charge

Some people from abroad can receive all NHS hospital treatment free of charge. If you are entitled to free NHS hospital treatment, your spouse, civil partner and dependent child(ren) will also be able to receive free treatment, but only if they live with you permanently in the UK.

You can receive free NHS hospital treatment if you:-

* have been living legally in the UK for at least 12 months when you seek treatment, and did not come to the UK for private medical treatment. Temporary absences from the UK of up to three months are ignored
* have come to the UK to take up permanent residence, for example, if you are a former UK resident who has returned from abroad, or if you have been granted leave to enter or remain as a spouse
* have come to the UK to work, either as an employee or self-employed person. This does not include people on short business trips
* normally work in the UK, but are temporarily working abroad, have at least 10 years continuous residence in the UK, and have been abroad for less than 5. However, if you are studying abroad you are not entitled to free NHS treatment
* are receiving a UK war disablement pension or war widows’ pension
* are an asylum seeker or have been granted exceptional leave to remain or refugee status. Proof of your immigration status from the Home Office may be required. In England and Scotland, if you're refused asylum, you do not have the right to free treatment if you have temporary admission. However, if you're a failed asylum seeker who was receiving a course of treatment, that course of treatment should continue until it is finished without you being asked to pay for it. In Wales, there are plans to change the rules and you might get free treatment. If you’re asked to pay, get advice about how to challenge the charge
* have been identified as having been trafficked from abroad or are believed to have been trafficked from abroad
* are imprisoned in the UK or detained by UK immigration authorities
* are a UK state pensioner who spends up to six months a year living in another European Economic Area (EEA) state, but are not a resident of that state
* are working in another EEA country, or in Switzerland, but are paying compulsory UK national insurance contributions
* are a student following a course of study which lasts at least six months, or is substantially funded by the UK government.

EEA countries are the European Union countries and Liechtenstein, Iceland and Norway.

To find out which countries are in the European Union, go to The European Union.
Visitors who can receive NHS hospital treatment free of charge

You and your dependants are entitled to free NHS hospital treatment if your need for it arose during your visit to the UK. A medical opinion may be needed in order to decide if treatment should be provided free of charge. You have the right to free NHS hospital treatment if:-

* you are a national of an European Economic Area (EEA) country, living in an EEA state or Switzerland, or a refugee or stateless person living in an EEA state or Switzerland, or you are a non-EEA national who lives in an EU state and pays national insurance contributions there
* you normally live abroad, and are receiving a UK state pension, and have lived in the UK in the past for at least ten years
* you have lived in the UK for at least ten years in the past, but now live in an EEA state, or in a non-EEA state with which the UK has a reciprocal agreement
* you are a national, or a resident of certain non-EEA countries, with which the UK has a reciprocal agreement.

EEA countries are the European Union countries and Liechtenstein, Iceland and Norway.

To find out which countries are in the European Union, go to The European Union.

In addition, people from some countries can get free hospital treatment if they have been referred to the UK for that treatment, under the terms of the reciprocal agreement. There are also special arrangements with certain countries which enable people from outside the UK to get free treatment. The Department of Health can give details of countries with which the UK has a reciprocal agreement and for which there are special arrangements.



GPs and dentists

It is up to the GP or dentist whether to accept you onto their list of NHS patients. They may accept you on their list if you are living in the UK, but they don't have to.

Visitors are not usually entitled to get non-hospital treatment. For example, if you used to live in the UK and then went to live abroad, you wouldn't normally get free treatment if you came back for a visit. There are some exceptions to these rules, for example, if you need emergency treatment.

A GP may, in practice, be flexible in deciding whether you are resident in the UK, in order to qualify for free treatment. You will usually have to show that your stay in the UK has some degree of permanence and stability.

If you are a visitor in the UK for less than three months, a GP may accept you as a temporary resident. Otherwise, a GP may offer to accept you as a private patient and you will have to pay for treatment.

You may have difficulty finding a GP or a dentist who is prepared to register you. In this situation you should contact your Primary Care Trust or local health board. In England and Wales, you can also get help to find a doctor from NHS Direct on 0845 46 47. In Scotland, you can contact NHS 24 on 0845 424 2424. In Northern Ireland, you should contact the Central Services Agency on 028 9032 4431, or a list of local GPs by Board area is available from the NHS Northern Ireland website at (New window) www.n-i.nhs.uk.

Even if you are accepted onto a GP or dentist's list of NHS patients, you have to pay charges for some things like prescription charges and dental treatment.

For more information about charges and the help you might get to pay for them, see Help with health costs.




How hospitals decide who should pay

Hospital staff will ask you whether you have lived legally in the UK for the past 12 months, when you arrive and whether you intend to stay permanently. The hospital will also ask for this information about your spouse or civil partner. If your dependant child is the patient you will be asked to provide these details about yourself. If you or one of these people have lived legally in the UK for the past 12 months or intend to stay permanently, you may be entitled to free hospital treatment.

You may be asked to provide documents, for example a passport, to show that you are in the UK legally.

If it is not clear whether you are entitled to free treatment, you will be interviewed more fully. Documentation and a medical opinion may be required.

In Northern Ireland, there is a more simple procedure to identify who should pay for treatment, and the above process may not apply. You may be asked questions to confirm your residency.


Paying for hospital treatment

Once the hospital has established that you must pay for treatment, you will usually be asked to pay the full cost in advance, unless emergency treatment is required immediately.

If you cannot pay in advance, the hospital will ask for a written undertaking to pay.

If you cannot provide proof that you can afford to pay, treatment will be refused and you may be offered the chance to be treated privately.




Refusal of treatment

If you are not entitled to receive free NHS hospital treatment you will not be refused medical treatment that stabilises a life-threatening condition, for example, for renal failure. Treatment will be given to deal with the emergency, but you will be expected to return home for it to be completed, once the emergency is over.

If there is not an emergency, but treatment has to start immediately, you may be asked to give an undertaking to pay. In these circumstances, it is very important that you find out the likely cost.

If it is not urgent, you will be given the opportunity to refuse the treatment if you cannot afford it. Treatment can be delayed until you can raise the money. If you cannot do so, treatment will be refused.


Complaints about charges

If you are entitled to free hospital treatment, but have been told that you will be charged, you should contact the Health Authority (England and Wales) or Health Board (Scotland and Northern Ireland) for a refund..