Healthcare in the UK, if you're not entitled to free use of the NHS?

Question

In the UK, almost everyone is covered by the National Health Service (NHS), the publicly funded healthcare system. One of the things about it is that it's free at the point of use, for those who're covered by it (the odd statutory fee excepted).

With all Brits and permanent residents covered, along with EEA nationals, and short term visitors from various countries via reciprocal agreements, as a local you could be forgiven for thinking that everyone is covered. However, that's not the case, and a new expat arriving in the UK could well not be.

So, two parts to this question:

• As a non-EU-citizen moving newly to the UK, how can you check to see if you would be covered by the NHS?
• If the answer is that you won't be, how do you go about getting healthcare coverage?

Answer 1

NHS has a page where you can check whether you are eligible for free treatments or not. Note, that GPs are free, but they don't have to accept new patients. Also going to an A&E, Walk-in centre or a Minor injuries unit is also free unless they need to admit you to a hospital. In the hospital some treatments are still free, for example infection treatments, including STDs.

Hospital treatments are a bit more complex.

To get free healthcare at the hospital you either need to be in one of the exception categories (like living in a country which has a bilateral healthcare agreement, being an EEU citizen, etc.), or be an ordinary resident in the country.

The latter part can be hard to prove, as there are no strict guidelines on who counts as ordinary resident, and who not. According to HMRC you have to be:

• In the country legally
• With an intent of actually staying in the country

Note, that the latter part does not talk about having to work or studying in the UK (actually being employed or being enrolled in an educational institution does not mean you are an ordinary resident).

Also to determine whether you can be considered an ordinary resident or not the government issued some guidance about it. Basically it's up to the local authorities to decide whether you are ordinary resident or not (in their area), in this case it's up to the hospital to decide. If they don't think you can get free healthcare then you have to prove that you are an ordinary resident by showing

• evidence that you're looking for work
• evidence that you have bought property in the UK or have rented a property
• papers that show you've applied for benefits
• evidence that your children are attending school in the UK

The hospital might also ask you for evidence to prove that you're legally entitled to live in the UK, such as:

• your British passport, or
• permission from the Home Office

If you don't yet have permission from the Home Office to stay permanently then you'll be charged for hospital treatment until:

• your application is granted, or
• you have 12 months' lawful residence in the UK

Answer 2

There's a somewhat more straightforward explanation at http://www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcategoryid=162:

If you move to the UK, you will not be charged for NHS hospital treatment from the date that you arrive as long as:

• you intend to live permanently in the UK, and
• you have the right to live permanently in the UK or have a "route to settlement" that will allow permanent residence in due course

You'll be expected to prove that you meet these requirements.

In short, if you're here on a visa category that will eventually make you eligible for Indefinite Leave to Remain, you are eligible for all free-of-charge NHS services.

There are many private health insurers in the UK. Private medical insurance (PMI) is offered as a benefit by some employers, and some people purchase PMI individually due to perceived shortcomings in NHS service. The big four providers (Aviva, Axa PPP, Bupa and PruHealth) dominate the market, although often you can find better deals from the smaller players. There are also health insurance brokers who specialise in helping people (for a fee) choose from among many insurers. If you choose to engage a broker, look for one that's a member of AMII (the Association of Medical Insurance Intermediaries).