Are you visiting the United Kingdom?

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1 Feedback We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS): Freephone: From a mobile or abroad: ext or [email protected] Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR Are you visiting the United Kingdom? Did you know you may have to pay for hospital treatment while you are here? The Trust endeavours to ensure that the information given here is accurate and impartial. This document can be provided in different languages and formats. For more information please contact the Overseas Visitors Team Telephone: ext [email protected] Helen Wilkinson June All rights reserved. Nottingham University Hospitals NHS Trust. Review June Ref: 0424/v5/0615/AS. NUH01925N Public information

2 NHS Treatment NHS hospital treatment is free to people who are Ordinarily Resident in the United Kingdom. If you do not normally live here and you do not meet one of the exemptions from charges then you will have to pay for any treatment you might need. This is regardless of whether you are a British citizen, have lived or worked here in the past or have paid UK taxes/national Insurance in the past. Overseas Visitor Overseas Visitor means any person of any nationality not Ordinarily Resident in the UK. Further information This leaflet is a general guide and not a full statement of the current regulations. All information contained within it was correct at the time of going to print, but may change. For further information see the NHS England website NHS England Information for Visitors to England at: accessing-nhs-services. Alternatively, ask a member of staff to contact the Overseas Visitors Team How do I find out if I have to pay? The law says that the hospital providing treatment must decide if each patient is entitled to free NHS hospital treatment. We will ask you to provide evidence to confirm your eligibility. If we conclude that you are not entitled to free NHS hospital treatment, we are legally obliged to charge you for your treatment. 2 11

3 Obtaining free health care by deception Access to free medical treatment is subject to strict qualifying conditions. Providing false information or failing to disclose information in order to access free treatment which would otherwise be chargeable may constitute a criminal offence resulting in a criminal conviction being imposed by the Courts. Anyone suspected to have provided false information or to have withheld information in order to access free medical care will be referred to East Midlands NHS Counter Fraud Service for full investigation and referral of the matter to prosecuting solicitors if evidence of fraud is found. Charges for treatment falsely claimed will be made by the Trust. East Midlands NHS Counter Fraud Service may also share information with the UK Border Agency (UKBA) for the prevention or detection of criminal offences. What do I have to pay for? You will have to pay the full cost of all treatment you receive, including emergency treatment, with the following exceptions which are free to everyone (except where the overseas visitor has travelled to the UK for the purpose of seeking that treatment): Treatment given in the Emergency Department. But emergency treatment given elsewhere in the hospital is chargeable (e.g. Intensive Care). Diagnosis and treatment of certain infectious diseases Diagnosis and treatment of sexually transmitted infections including HIV Compulsory psychiatric treatment Family planning services Treatment required for a physical or mental condition caused by torture, female genital mutilation (FGM), domestic violence or sexual violence. 10 3

4 What happens if I can t pay for my treatment? Please be reassured that in the event than an overseas visitor is unable to pay, Nottingham University Hospitals (NUH) would never withhold or withdraw any treatment that a doctor considers to be immediately necessary to save life or to prevent serious deterioration in an acute condition. This includes all antenatal and obstetric care. However, an invoice will still be raised for the treatment given and we will pursue the debt in the normal way. No non-urgent treatment will be provided to a chargeable overseas visitor without payment in advance. Where an overseas visitor fails to pay for their treatment we may pass the debt to our debt collection agency who may share information regarding the unpaid invoice with other agencies (e.g. embassies, the UK Borders Agency) as part of their debt collection procedures. A person with an outstanding debt to the NHS of 1,000 or more can be refused a visa or an extension of their stay until that debt is paid. If you are visiting the UK and do not meet any of the exemption criteria listed on the next page, we strongly recommend that you take out travel/medical insurance which covers the duration of your visit. If you are visiting or are a student from a European Economic Area (EEA) country, you should ensure that you have a valid European Health Insurance Card (EHIC) and present this prior to treatment. Key: 1. Immediate medical treatment only. 2. Only treatment required promptly for a condition that arose after arrival in the UK or became significantly worse (or would have become significantly worse without treatment). 3. All treatment on the same basis as for a person insured in the other country, including services such as routine monitoring of pre-existing conditions, but not including circumstances where a person has travelled to the other country for the purpose of obtaining healthcare. 4. All treatment free on the same terms as for an eligible UK resident (an ordinary resident), including elective treatment. For all levels of coverage, it will be for a doctor or dentist employed by the relevant NHS body to provide clinical input into whether required treatment meets a specific level of coverage. * For these countries, the agreement will also apply to those persons requiring treatment if they are a member of the crew, or a passenger, on any ship, vessel or aircraft travelling to, leaving from or diverted to the UK and the need for urgent treatment has arisen during the voyage or flight. 4 9

5 Country Level of cover provided (see key) Anguila 1* Further information patients to the UK for free NHS hospital treatment. Armenia 1 Applies only to citizens resident in that country. Australia 1* Applies to all residents of that country. Azerbaijan 1 Applies only to citizens resident in that country. Barbados 1* Applies to all residents of that country. Belarus 1 Applies only to citizens resident in that country. Bosnia and Herzegovina 3 Applies to all insured persons of that country. British Virgin Islands 1* Falkland Islands 4 patients to the UK for free NHS hospital treatment. Applies to all residents of that country. Can also refer an unlimited number of patients to the UK for free treatment Georgia 1 Applies only to citizens resident in that country. Gibraltar 3 Isle of Man 2 Jersey 2 Applies only to citizens resident in that country when that citizen is not expected to stay in the UK for more than 30 days. Can also refer an unlimited number of patients to the UK for free elective treatment. Applies to all residents of the Isle of Man for a period of stay in the UK that has not exceeded, nor is expected to exceed, three months. Applies to all residents of Jersey for a period of stay in the UK that has not exceeded, nor is expected to exceed, three months. Kazakhstan 1 Applies only to citizens resident in that country. Kosovo 3 Applies to all insured persons of that country. Kyrgyzstan 1 Applies only to citizens resident in that country. Macedonia 3 Applies to all insured persons of that country. Moldova 1 Applies only to citizens resident in that country. Montenegro 3 Applies to all insured persons of that country. Montserrat 1* patients to the UK for free NHS hospital treatment. New Zealand 2 Applies only to citizens resident in that country. Russia 1 Applies only to citizens resident in that country. Serbia 3 Applies to all insured persons of that country. St Helena 1* Applies to all residents of that country. Does not include Acension Island or Tristan da Cunha. Can also refer four patients per year for free NHS hospital treatment. Tajikistan 1 Applies only to citizens resident in that country. Turkmenistan 1 Applies only to citizens resident in that country. Turks and Cacos Islands 1* patients per year for free NHS hospital treatment. Ukraine 1 Applies only to citizens resident in that country. Uzbekistan 1 Applies only to citizens resident in that country. 8 Who does not have to pay? Some Overseas Visitors are entitled to NHS treatment: Visitors from EEA member states see list later in this booklet. Visitors with an EHIC are entitled to all necessary treatment during their visit. Those with an EHIC who are resident and working in the UK are entitled to full NHS care on the same basis as a British passport holder living here. In either case, the EHIC card should be presented every time that NHS care is sought. Anyone covered by a reciprocal healthcare agreement with the UK (see the table later in this booklet for level of entitlement). Serving NATO personnel. Anyone who receives a UK war pension, war widows pension or armed forces compensation scheme payment. Members of the regular and reserve forces. Employees on ships. Anyone who has paid, or who is exempt from paying, the immigration health charge or for whom the charge is waived, reduced or partially refunded, while their leave to remain is continuing, including for any children born to that person for a period of 3 months. Migrants who apply for leave to enter or remain for over 6 months prior to the surcharge being introduced but who cannot pay the surcharge until their next application for leave. Anyone granted asylum or temporary or humanitarian protection in the UK (e.g. refugees). Anyone who has applied for asylum or temporary or humanitarian protection, until their application, including appeals, is decided (e.g. asylum seekers). 5

6 Anyone receiving S4 or S95 Home Office support (Immigration and Asylum Act 1999). This includes all failed asylum seekers who receive S21 support from a Local Authority (National Assistance Act 1948). Children in Local Authority care. UK state pensioners living in EEA member states or Switzerland. Government workers (Crown servants, UK Government financed employment, British Council and Commonwealth War Graves Commission staff) who are required to work abroad as long as they were Ordinarily Resident in the UK prior to taking up the post. Anyone who is detained in prison or by Immigration Authorities in the UK. An employee on a ship registered in the UK. A resident of the Falkland Islands, under Bilateral Agreement. Bilateral Healthcare Agreement countries EUROPEAN ECONOMIC AREA (EEA) MEMBER STATES: Austria, Belgium, Bulgaria, Croatia, Cyprus (Southern), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Republic of Ireland, Romania, Slovakia, Slovenia Spain, Sweden, United Kingdom plus Iceland, Liechtenstein and Norway. Switzerland by special arrangement. For all Patients, Visitors, Family and friends, if you live in the UK, apply for an EHIC (European Health Insurance Card) in the UK. This can be done on the Internet. If you live in the EEA apply for an EHIC in the Country you currently live in. Non-EEA Countries: Some people are entitled to receive specific treatment the need for which arises during the visit. This applies where the diagnosis of a condition is made when first symptoms arise during a visit to the UK. It also applies where treatment is needed quickly to prevent an existing condition from getting worse: Anyone lawfully in the UK and covered under the European Social Charter or European Convention on Social and Medical Assistance with insufficient resources to pay ( needs arising treatment only). Victims of violence (relating to domestic violence, sexual violence, torture and female genital mutilation (FGM)). Only the treatment needed to treat conditions caused by the violence is exempt from charge. The UK has reciprocal healthcare agreements with some non- European Economic Area (EEA) countries. Overseas visitors who can present evidence that they are nationals, citizens or lawful residents of one of these countries should be treated as exempt from charges in respect of treatment that the relevant agreement entitles them to. See the table on the next page and the key on the opposite page for entitlements. Proof that the person is a national/citizen/resident (as appropriate) of the country and that they are resident in that country, e.g. passport, residence permit, identity card, social security card, utility bill etc. For referrals for elective treatment (see next page), confirmation from the relevant country/the Department for Work and Pensions (DWP) that the referral has been agreed. 6 7