Getting Health Treatment in the UK
Tuesday 05 April 2016
The UK has substantially restricted access to free healthcare in the UK to non-residents, in the process clarifying the rights of EEA nationals.
Access to the health system in the UK is free at the point of delivery; there is no need to pay for treatment and obtain reimbursement, as occurs in France.
Although, in theory, non-residents have been required to pay for their treatment, the regulatory framework in the UK has not been clear and administrative and accounting systems have been weak or non-existent.
According to a UK government report published last year, "cost recovery..... is poor because the NHS struggles to identify patients holding EHICs and other European forms. Consequently, the UK is unable to invoice the appropriate Member State for the costs of treatment."
Since the introduction of National Health Service (Charges to Overseas Visitors) Regulations 2015 all that has changed, for the NHS has been instructed by the government to set up systems for invoicing those upon whom a charge should be imposed.
The government says the law has been introduced because it "believes that the NHS can no longer afford to be so open and generous to non-permanent residents."
Since 1st January this has meant that eligibility to free NHS services has only been available to those who were 'ordinarily resident' in the UK.
No definition of 'ordinarily resident' is given in the regulations, but according to the government it does not mean that the individual is permanently or habitually resident.
The definition they provide is someone "living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration."
Under this definition they concede that in certain circumstances (which they do not define) a person can be ordinarily resident in more than one country at a time.
However, they make it clear that "a person is not ordinarily resident in the UK simply because they have British nationality; hold a British passport; are registered with a GP; have an NHS number; own property in the UK; or have paid (or are currently paying) National Insurance contributions and taxes in the UK."
In considering how the test of 'ordinarily resident' test might operate they state:
"There is no requirement that the time be equally split between the UK and another country in order to maintain ordinary residence in the UK............", but, "If they are only here as a visitor, not as a resident, then they will not meet the ordinary residence test."
Although, in theory, non-residents have been required to pay for their treatment, the regulatory framework in the UK has not been clear and administrative and accounting systems have been weak or non-existent.
According to a UK government report published last year, "cost recovery..... is poor because the NHS struggles to identify patients holding EHICs and other European forms. Consequently, the UK is unable to invoice the appropriate Member State for the costs of treatment."
Since the introduction of National Health Service (Charges to Overseas Visitors) Regulations 2015 all that has changed, for the NHS has been instructed by the government to set up systems for invoicing those upon whom a charge should be imposed.
The government says the law has been introduced because it "believes that the NHS can no longer afford to be so open and generous to non-permanent residents."
Since 1st January this has meant that eligibility to free NHS services has only been available to those who were 'ordinarily resident' in the UK.
No definition of 'ordinarily resident' is given in the regulations, but according to the government it does not mean that the individual is permanently or habitually resident.
The definition they provide is someone "living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration."
Under this definition they concede that in certain circumstances (which they do not define) a person can be ordinarily resident in more than one country at a time.
However, they make it clear that "a person is not ordinarily resident in the UK simply because they have British nationality; hold a British passport; are registered with a GP; have an NHS number; own property in the UK; or have paid (or are currently paying) National Insurance contributions and taxes in the UK."
In considering how the test of 'ordinarily resident' test might operate they state:
"There is no requirement that the time be equally split between the UK and another country in order to maintain ordinary residence in the UK............", but, "If they are only here as a visitor, not as a resident, then they will not meet the ordinary residence test."
EEA Nationals
In practice, for most UK nationals resident elsewhere within the EEA the definition is largely irrelevant, for they qualify for medical treatment in the UK by virtue of reciprocal arrangements in place throughout Europe.
Thus, those resident in France who are of State retirement age and who obtain health care through an S1 certificate of exemption remain entitled to free healthcare in the UK.
Similarly, those living in France and affiliated to the French health system through employment or business are entitled to health cover when visiting the UK through the European Health Insurance Card (EHIC).
However, in the case of those seeking treatment through an EHIC it is only for treatment that is 'medically necessary' before their return; it is not a right to unlimited, non-urgent healthcare.
The situation is trickier for those living in France with a private health insurance policy, for the government have removed the previous entitlement of free healthcare in the UK for anyone living in the EEA with at least 10 years' previous residence in the UK.
If such persons cannot meet the 'ordinarily resident' rule when staying in the UK they would need to be covered for health through their private policy.
The same applies for those living in France without any health cover whatsoever, and who may be doing so on the false assumption that they had a continuing right of free treatment in the UK.
This occurred recently to one of our readers who, having left the UK to become resident in France, returned to the UK for a holiday and were unexpectedly hospitalised. They were not affiliated to the French health system, held no EHIC, and were not covered by a private policy. They have been billed over £7,000 by the NHS.
Thus, those resident in France who are of State retirement age and who obtain health care through an S1 certificate of exemption remain entitled to free healthcare in the UK.
Similarly, those living in France and affiliated to the French health system through employment or business are entitled to health cover when visiting the UK through the European Health Insurance Card (EHIC).
However, in the case of those seeking treatment through an EHIC it is only for treatment that is 'medically necessary' before their return; it is not a right to unlimited, non-urgent healthcare.
The situation is trickier for those living in France with a private health insurance policy, for the government have removed the previous entitlement of free healthcare in the UK for anyone living in the EEA with at least 10 years' previous residence in the UK.
If such persons cannot meet the 'ordinarily resident' rule when staying in the UK they would need to be covered for health through their private policy.
The same applies for those living in France without any health cover whatsoever, and who may be doing so on the false assumption that they had a continuing right of free treatment in the UK.
This occurred recently to one of our readers who, having left the UK to become resident in France, returned to the UK for a holiday and were unexpectedly hospitalised. They were not affiliated to the French health system, held no EHIC, and were not covered by a private policy. They have been billed over £7,000 by the NHS.
Planned Treatment
Within Europe there exist regulations that permit its citizens to obtain planned health care in another EEA country from the one where they are resident.
These rights have existed since 2004, but were considerably extended in 2011 when EEA citizens were granted the right to purchase healthcare in another EEA country and seek reimbursement from their home system.
Strictly speaking, no prior authorisation is required, although Member States are permitted to put in place authorisation procedures, as has occurred in France and most other countries, including the UK.
Although medical prescriptions obtained abroad are reimbursed without too much difficulty in your home country, prior authorisation for planned hospital treatment is always required.
Related Reading:
These rights have existed since 2004, but were considerably extended in 2011 when EEA citizens were granted the right to purchase healthcare in another EEA country and seek reimbursement from their home system.
Strictly speaking, no prior authorisation is required, although Member States are permitted to put in place authorisation procedures, as has occurred in France and most other countries, including the UK.
Although medical prescriptions obtained abroad are reimbursed without too much difficulty in your home country, prior authorisation for planned hospital treatment is always required.
Related Reading:
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