Healthcare for Visitors to the United Kingdom
As the United Kingdom has left the European Union, travel regulations are changing for British citizens and nationals of any of the EU and Schengen Area member countries. When part of the EU, British visitors to Europe required only a valid passport, and the same was true of Europeans wishing to visit any of the four United Kingdom countries of England, Wales, Scotland and Northern Ireland.
This remains the case but from the end of 2023, it will become mandatory for British citizens to have applied for and received ETIAS (European Travel Information and Authorisation System) approval before any European travel can be undertaken. In return, EU citizens wishing to enter, or pass through the United Kingdom will need a UK ETA (Electronic Travel Authorisation) from 2024.
As a consequence of these two new travel requirements being introduced, there will be a knock-on effect on UK-to-Europe travel, not the least of which will be with regard to healthcare. As a member of the EU, there was a reciprocal arrangement in place whereby Britons could be treated in European clinics and hospitals, and Europeans could receive medical attention in British hospitals if needed. In many cases, this treatment was free of charge or cost a minimal amount.
Now, however, as the United Kingdom and Europe have parted ways, there are questions regarding whether or not European visitors on a UK ETA-approved passport can avail of the United Kingdom’s National Health Service (NHS) and, if so, what services can be accessed and at what cost.
Paid and Free NHS Treatment
Much of the care and hospital treatment provided by the National Health Service is free for many British citizens, but this is not always the case. Free care is generally reserved for those on a lower wage or for emergency treatment only. Those who can afford treatment will have to pay some or all of the costs involved, and how much will depend on the individual circumstances.
As a general rule, treatment that is deemed “urgent or immediately necessary” is provided free of charge, and this would include a medical emergency, accident or maternity issues. If, however, the medical situation is not deemed urgent or life-threatening, the patient may be expected to pay the treatment costs in full or at least in part.
Foreign nationals presenting at an NHS facility will be treated, but checks will be made to see if the patient qualifies for free treatment or not. If the treatment being sought is not deemed to be urgent or of immediate concern, then the patient will not be treated until payment in full has been made for all planned treatment. The exception to this rule is treatment in an NHS Accident and Emergency (A and E) department, which is always provided free of charge to those in need of urgent attention.
Free Healthcare for Foreign Nationals
European citizens, that is, persons born in any of the EU member states, are entitled to receive medical treatment in any EU country, the cost of which will usually be covered by the EHIC (European Health Insurance Card) or by personal insurance.
Free NHS healthcare may also be provided to visiting non-nationals who:
- Are residents of a country that has a reciprocal agreement with the United Kingdom
- Possess a valid EHIC
- Are registered refugees or asylum seekers awaiting a decision on their status
Although no longer a member of the EU, a valid EHIC is still accepted by the NHS but only for emergency treatment. The card must be valid, not expired and must be presented when seeking medical care. Those asylum seekers or refugees who qualify for free treatment by the NHS must pay for any prescribed medications resulting from treatment as this expense is not covered.
Free treatment by the NHS may also be afforded to foreign students or workers, subject to certain criteria. Full-time students will need to show proof of enrolment in a course of at least six months duration while non-British workers must show evidence of employment such as a work contract or recent payslips.
Visitors from the European Union
The UK ETA requirement for visitors from any of the EU states is not yet in place but is expected to be rolled out later this year and become mandatory sometime in 2024. In the meantime, the same rules and regulations regarding travellers from Europe remain as they were when the United Kingdom was still a member of the European Union.
This means that EU visitors may still visit the United Kingdom with just a valid passport, and there is no change in how foreign nationals’ medical emergencies are handled. Visitors from the EU are still covered by their EHIC, and this card should always be carried and presented should a need for urgent treatment arise. It should be remembered, however, that the EHIC may not cover all costs involved and it is prudent for foreign visitors also to have personal travel and health insurance.
The same rules apply for visitors from any of the four Schengen Area member states that are not part of the European Union. The four countries covered are Norway, Switzerland, Liechtenstein and Iceland.
Accessing NHS Services
An accident or extreme illness may require a visit to a hospital, and such services are usually free of charge for both British citizens and non-nationals. However, there are different branches of medicine that fall under the auspices of the National Health Service, some of which may be provided for free and others which must be paid for.
The rules regarding access to the NHS may vary in the four different UK countries and whether payment must be made or not will depend on the individual circumstances but, as a guide, the following is generally the case.
General Practitioner (GP)
When a non-national visitor is feeling unwell, but it is not a medical emergency, the first call should be to a doctor or general practitioner. This is not always easy to do as a GP will usually only treat patients who are registered at that particular practice.
Consulting a GP is generally for those visitors on a UK visa who are in the country for a long period of time, such as students or workers who must first register with a local practice. This is done by completing a GMS1 form, which contains the same basic information as used on the visa application form. A GP is not obliged to accept new patients but there must be valid reasons for refusing to do so.
Short-stay visitors to the United Kingdom in need of medical attention may be able to register with a local GP temporarily but this is, again, at the discretion of the doctor. Temporary registration is available to non-nationals who are visiting the UK for more than one day but less than three months.
It should be noted that registration with a British practice may grant the visitor access to various free NHS-run screening services, but payment may still be expected for other medical attention, including hospitalisation. Once again, an EHIC will be required for any hospital stays and treatment of serious conditions.
British citizens and legal permanent residents are entitled to free NHS hospital care but there are different rules concerning foreign nationals who are only visiting the UK for a short period of time. Hospitalisation and treatment in a UK hospital is covered by the EHIC which is why any European visitor should ensure that the card is valid and readily available. Failure to produce the card when asked may result in having to pay for any hospital bills and medical costs in full.
Furthermore, those non-national visitors who are not entitled to free NHS treatment or do not possess an EHIC may be charged 150% of the current NHS rate.
It should be stressed, once again, that even possession of a valid EHIC does not mean that all medical bills will be fully covered and it is important that European visitors should also have personal travel health insurance to ensure any shortfall is covered.
One NHS service that is free to everyone, regardless of citizenship or status, is treatment at an Accident and Emergency Department. Victims of crime, accidents or unfortunate events will be treated free of charge at a hospital A&E department. However, this is only applicable to the immediate attention given at the hospital and fees will accrue if the patient requires hospitalisation, further treatment or long-term care.
Better Safe Than Sorry
Visitors to the United Kingdom from the European Union and further afield will soon require UK ETA approval before departing their homeland. This will be a mandatory requirement, whereas travel health insurance is not necessary, but perhaps it should be.
Nobody plans to fall ill or have an accident, but these things happen, and it is advisable to be prepared should the unexpected occur. Victims of crime or accidents will receive free treatment at an NHS hospital, but the free care only extends to immediate treatment and not to any subsequent care that will most likely be required.
Visitors from the European Union and Schengen Area should have a European Health Insurance Card as a bare minimum and this should be supplemented by even a basic personal health insurance policy. Both the EHIC and personal insurance are readily available and relatively inexpensive.
In all likelihood, neither the EHIC nor insurance will be required by the vast majority of overseas visitors to the United Kingdom but should the unexpected happen, it is always better to be safe than sorry!