I saw from UK Visitors and NHS Health Services that visitors receive emergency care for free, but they must pay for secondary care and someone can get a pejorative history by not paying.

I have also seen that Parliament is imposing a much stricter regime which more or less replaces most of the current information on the net. The bill has received Royal Assent and is now an 'Act of Parliament'. For visa-nationals who have paid the Health Surcharge, secondary care should be no problem. But for non-visa nationals, like Americans, Canadians, and so forth who did not pay the Health Surcharge, the case may be different...

Question: Are Americans, Canadians, and other non-visa nationals who are visiting the UK subject to up front payment for secondary care? Including a standard visit to a GP? If so how is the up front payment calculated? What happens if they do not want to pay or cannot pay?

Secondarily: Are those using the Treaty of Rome (i.e., free movement) similarly affected? If so, how can they find out if there is a reciprocal arrangement in force?

This is the first of three questions about this momentous (and vehemently emotive) bill affecting tourists and other visitors.


Clarifying question: Who pays the Health Surcharge?

The Health Surcharge applies to non-visa nationals as well, if they fall into the category of temporary migrant:

  • you’re a national of a country outside the European Economic Area (EEA)

  • you’re applying for a visa to work, study or join your family in the UK for more than 6 months (but you’re not applying to remain in the UK permanently)


As far as I am aware, non-visa nationals need a visa to do any of those things, or stay in the UK for a period exceeding 6 months (the equivalent of the Standard Visitor Visa period). I may stand corrected on this fact, however.

OP: Are non-visa nationals who are visiting the UK subject to up front payment for secondary care?

Yes and no.

UKVI's guidance on the matter is that you have to pay for any chargeable NHS service at the point you use it, but UKVI is not the NHS.

Visitor visas and short-term visas You don’t need to pay the surcharge or get an IHS reference number if you’re applying for a:

  • visitor visa
  • visa for 6 months or less from outside the UK

You will need to pay for any NHS care you get at the point you use it - unless it’s a service that’s free.

Citizens Advice has issued the following guidance for non-EEA overseas visitors using the NHS:

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.

The NHS themselves have issued the following guidance (emphasis mine):

If you need NHS treatment and you have not arranged insurance, you will be charged at 150% of the standard NHS rate, unless an exemption category applies to either you or the treatment.

From October 23 2017, you will need to pay in advance the full estimated cost if the treatment you need is non-urgent, otherwise the treatment will not be provided.

If you are a non-EEA national, failure to pay this charge may have an effect on any future immigration application you make, and you risk being turned down.

Thats pretty clear as it stands.

OP: Including a standard visit to a GP?

There is currently no guidance issued to GPs as to how they handle this, because some services GPs provide is actually exempt from charges to overseas visitors, but the practice cannot ascertain this until the actual consultation.

It is the opinion of several prominent GP groups that the government is not interested in recouping the cost of the GP appointment itself, for the above reason - it will be absorbed into any daily costs by the GP Practice itself.

The GP will act as gate keeper to any ongoing treatment, and the guidance issued to GPs in this area is that this cost needs to be recouped prior to the treatment beginning.

OP: If so how is the up front payment calculated?

This is the difficult one - the above guidance issued says that the full estimated cost will be chargeable upfront.

But what are the charges? There is no central price list of NHS services, as each Trust and each hospital within that Trust is free to set its own prices based on its own costs.

You should ask for an estimated price up front before agreeing to pay any amount.

OP: Are those using the Treaty of Rome (i.e., free movement) similarly affected?

For the purposes of this portion of the answer, I will assume you mean members of the EEA pre-Brexit. Please comment if you do not and I will amend the answer if possible.

European Health Insurance Card

EEA members visiting the UK receive free healthcare on the basis of the European Health Insurance Card, which allows the NHS to bill the cost of treatment back to the visitors EEA country of residence.

S2 Route

For long term EEA visitors, there is also the option of transferring your healthcare benefits from your EEA country of residence to the UK via the S2 route (link is to the NHS version, from the point of view of a UK resident seeking treatment elsewhere in the EEA under the S2 route, but other EEA countries will have a similar page for their own residents).

EU Directive Route

Another option open to EEA visitors to the UK is to pay for the healthcare they receive in the UK up front, and seek reimbursement from their EEA country of residence under the EU Directive Route (again, linking to the NHS page for UK residents, other EEA countries will have similar pages).

Post-Brexit, its anyones guess what survives and what doesn't.

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