Overseas Visitors

County Durham & Darlington NHS Foundation Trust has a legal obligation to follow the Department of Health and Social Care Overseas Visitors Charging Regulations 2021 and establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charges.

Definition of an Overseas Visitor

An Overseas Visitor is any person of any nationality (this includes British Citizens who no longer live in the UK, including pensioners who move abroad to live  who are no longer 'ordinarily resident' in the UK and therefore potentially liable for NHS hospital treatment.

There are criteria that need to be considered and certain documents that you should bring with you when attending our Trust:

• Do you have the right to reside in the UK (documents required passport, visa, EHIC, settled/pre settled status, EUSS code)
• Do you actually reside in the UK (documents such as utility bill, bank statement, DWP letter, housing contract with your name and UK address (valid within the last 3 months)

Ordinarily Resident in the UK

NHS services are provided free of charge to people who are deemed to be 'ordinarily resident' in the United Kingdom (UK). Ordinarily residence is defined as when a person is living lawfully in the UK voluntarily and for settled purposes, as part of the regular order of their life, for the time being and in the case of non-UK nationals subject to immigration control, has indefinite leave to remain in the UK. A person who is ordinarily resident will be so in their own right, and it is not transferable to other family members (except in certain circumstances regarding children). Therefore, if a spouse or civil partner of someone who is ordinarily resident here in the UK normally lives overseas and requires treatment during a visit to the UK, they will not be ordinarily resident or automatically entitled to free treatment.

A person is not ordinarily resident in the UK simply by:

• Having British nationality (including holding a British passport)
• Being registered with a GP
• Having an NHS number
• Owning property in the UK
• Having paid (or currently paying) National Insurance Contributions and taxes in this country.

European Union (EU) or EFTA (European Free Trade Association)

All citizens, need to provide satisfactory documentary evidence of entitlement in order to receive free hospital care; otherwise, they will be charged for their treatment.

If you are resident in an EUmember state and are visiting in England you can access free NHS treatment that is medically necessary (this does not included planned care) during your stay by showing a valid European Health Insurance Cared (EHIC) from your country of origin. This allows the UK to recover the cost of your care from your home country.

If you are covered for healthcare in another country and eligible for an EHIC but have lost or forgotten to bring it with you, and you need hospital treatment, you should apply for a Provisional Replacement Certificate (PRC) immediately. You will need to contact your domestic healthcare provider and ask them to email a PRC to the NHS hospital where you require treatment. It is your responsibility to make these arrangements. Once a valid PRC is received by the hospital, you will be eligible for the same free medical treatment as you would using an EHIC.

If you cannot show a valid EHIC or PRC you may be charged for your hospital care during your visit. The hospital trust will require payment from any patient who cannot produce an EHIC or PRC, or who cannot prove entitlement under UK domestic regulations at the time of their treatment.

Non-EEA Citizens

If you are studying, working or residing in the UK for longer than 6 months, you will need to pay a health surcharge, which will cover you for any NHS healthcare you receive. This will be paid to the Department of Health as part of  your visa application. This excludes assisted conception services

If you are studying for 6 months or less or you have family members or friends, who visit in the UK for less than 6 months and have not paid the health surcharge you will need to purchase health insurance before they travel to the UK. 

Overseas visitors with personal medical or travel insurance will be required to pay for their treatment upfront and then claim back from their insurer on their return home. 

Outpatient Appointments

When a patient is referred to our Trust for a new medical condition, in the referral letter certain information may indicate that you are a possible overseas visitor to our Trust. In this case a letter will be sent to the patient requesting further information to determine their eligibility to free NHS Treatment.

All overseas visitors who are referred for routine appointments will be required to pay upfront before any treatment can commence.

All patients referred for a new medical condition will receive a pre attendance form that has a series of questions. The patient or guardian should complete this form and present to the receptionist on arrival of their appointment. The receptionist will check the form and ascertain whether a member of the overseas visitor's team will need to carry out an overseas visitor interview before your appointment.

Inpatient

Patients accepted as an inpatient in our Trust as part of their admission will be asked 'where have you lived for the last 6 months?' If a patient has lived outside of the UK during the last 6 months, the ward staff will contact the overseas visitor's team to carry out an overseas interview.

Once a patient is identified as an overseas visitor and it has been determined they are required to pay all NHS fees, they will be asked to pay an estimate of their treatment. 

A final invoice will be raised upon discharge and any over payment refunded or under payment requested from the patient.

Role of Overseas Visitor Team 

The Overseas Visitors Team have a legal obligation to make reasonable enquiries to make and recover NHS charges from overseas visitors. They must ensure that patients who are not ordinarily resident in the UK are identified, that their liability for charges and those liable to pay are assessed in accordance with the Charging Regulations and that those charges are recovered. 

It is vitally important that no person is discriminated against in the application of the regulations providing for charges for NHS treatment. (Article 14 of the European Convention on Human Rights Act, which is now incorporated into UK law as part of the Human Rights Act, prohibits discrimination against a person in the exercise of their rights under the convention, on any ground, such as: sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.) 

The OVT will uphold the standards of the NHS by treating our patients, the public and staff fairly, frankly and honestly in their engagement with all parties. They will treat each person with respect and protect confidentially and data security and treat each person and case with sensitivity, discretion and integrity. 

The OVT will speak to the patient whilst they are in the hospital but if this is not possible, they will write to the patient to request documentation to verify their status in the UK. If the patient fails to provide documentation on their status in the UK then the patient will be deemed chargeable for the care delivered.

If you are required to pay for your treatment, the OVT will advise you on this. If you are liable to pay then the cost of your treatment will be explained and you will be asked to pay the full cost before you receive your treatment or at the earliest opportunity. If the complete cost of the treatment is not known at this point, they will ask for a deposit of equivalent to the full estimated cost of care in advance of providing treatment.

If the OVT are satisfied that the patient is an overseas visitor then the Trust must charge the patient of any NHS services provided. Treatment is not made free of charge by virtue of being provided on an immediately necessary or urgent basis. Charges found to apply cannot be waived. However, any patient undergoing immediately necessary treatment will be reassured that this will not be withheld or withdrawn in the event of the patient being unable to pay.

Immediately necessary treatment

County Durham & Darlington NHS Foundation Trust will ensure that treatment that is immediately necessary is provided to any person, even if they have not paid in advance. Failure to provide immediately necessary treatment may be unlawful under the Human Rights Act 1998. 

Immediately necessary treatment is that which a patient needs:

• To save their life, or
• To prevent a condition from becoming immediately life-threatening, or
• Promptly to prevent permanent serious damage from occurring

This will be provided irrespective of whether or not the patient has been informed of, or agreed to pay, charges, and it must not be delayed or withheld to establish the patient's chargeable status or seek payment. It must be provided even when the patient has indicated that they cannot afford to pay.

All maternity services, including routine antenatal treatment, are treated as being immediately necessary. All staff will be especially careful to inform pregnant patients that further maternity care will not be withheld, regardless of their ability to pay. 

Urgent treatment

This will be provided to any person, even if deposits have not been secured.

Urgent treatment is that which clinicians do not consider immediately necessary, but which cannot wait until the person can be reasonably expected to return home. The Trust will make every effort, taking into account of the individual's circumstances, to secure payment in the time before treatment is scheduled. However, if that proves unsuccessful, the treatment should not be withheld for the purpose of securing payment. 

For both immediate and urgent treatment for overseas visitors who are liable to charges the costs will not be waived. If payment is not obtained before or after, the treatment then every effort will be made to recover the debt. 

Non-urgent treatment

This is routine elective treatment that could wait until the patient can return home. A clinician will decide whether the treatment is urgent or non-urgent. The Trust will not provide non-urgent treatment unless the overseas patient pays the full estimated cost of the treatment in advance. 

Services exempt from charges 

There are certain NHS hospital services which are free at the point of use to everyone. Our Trust cannot charge overseas visitors for:

• Accident and Emergency services. This includes A&E department, walk-in centres, urgent care health centres. However, this does not include emergency care provided after the overseas visitor has been admitted onto a ward or into an outpatient appointment.
• Services provided outside an NHS hospital, unless the staff providing that service are employed by our Trust, or working under the direction of an NHS hospital.
• Family planning services (this does not include termination of pregnancy)
• Diagnosis and treatment of specified infectious diseases
• Diagnosis and treatment of sexually transmitted infections
• Treatment required for a physical or mental condition caused by: torture, female genital mutilation, domestic violence or sexual violence.

However, it should be noted that there is an exception to this rule if the overseas visitor has travelled to the UK for the purpose of seeking that treatment. 

Exempt categories of person 

The following categories of overseas visitors are exempt from charge:

• Those who have paid the health surcharge. (Since 21 August 2017, those exempt from charge under Regulation 10 (health surcharge arrangements) are no longer exempt from charge in relation to assisted conception services).
• A child born to an exempt person is also exempt from charge up to the age of three months
• Those with enforceable EU right to free healthcare
• Vulnerable patients and those detained
• UK Government employees and war pensioners
• Those covered by reciprocal healthcare agreements, other international obligations

  Recovery of Payments 

County Durham & Darlington NHS Foundation Trust will take reasonable measures to pursue overseas visitors' debt. National and International debt recovery agencies are employed to recover any unpaid invoice.

Overseas Visitors should be aware that under immigration rules 320, 321, 321a and 322 a person with outstanding debts of over £500.00 for NHS treatment that are not paid within three months of invoicing, may be denied a further immigration application to enter or remain in the UK. 

If no payment is received or a reasonable repayment schedule has not been agreed on maintained then the Trust (or debt collection agencies working on their behalf) will share non-clinical data relating to the debt with the Home Office, via the Department of Health. This information may be used by the Home Office to apply the above immigration rules. The information we send to the Home Office will remain active until the debt is settled. 

For further information/queries regarding Overseas Visitors, contact:

cddft.overseasvisitors@nhs.net

   To watch a video with information on overseas visitors please click here

For further information on the Guidance of Implementing the Overseas Visitor Hospital Charging Regulations click here