Guidance

Providing healthcare for overseas visitors from the EU, Iceland, Liechtenstein, Norway and Switzerland: information for primary care staff

Updated 1 November 2021

How you can help get money back into the NHS

Whether a visitor from the EU, Iceland, Liechtenstein, Norway and Switzerland is here on holiday, studying or moving here to retire, the cost of any NHS treatment they receive can sometimes be reimbursed to the UK from their home country or, if they have moved here to retire, the country responsible for their continuing healthcare costs.

This guidance applies in England only. Accessing healthcare in Scotland, Wales and Northern Ireland could be different from England. Check the websites for health services in each country:

• Northern Ireland
• Scotland
• Wales

Moving to England from the EU, Iceland, Norway, Liechtenstein or Switzerland on or before 31 December 2020

Citizens of an EU country, Iceland, Norway, Liechtenstein and Switzerland and their family members who were lawfully residing in the UK by 31 December 2020 will keep their right to healthcare, as long as they meet the ordinary residence test.

From 1 July 2021, they must have been granted settled or pre-settled status under the EU Settlement Scheme. These rights will be subject to any future domestic policy changes which apply to UK nationals.

Irish citizens’ rights are unaffected by these new arrangements. They can continue to come to the UK to live and work as now. Irish or British citizens who are residing in Ireland will not be charged for needs-arising treatment in England when temporarily visiting the UK.

Anyone not ordinarily resident in the UK will be considered to be an overseas visitor and may be charged for NHS services.

Moving to England from the EU, Iceland, Norway, Liechtenstein or Switzerland from 1 January 2021

From 1 January 2021, people moving to England from an EU country, Iceland, Norway, Liechtenstein or Switzerland must pay the immigration health surcharge when applying for a visa to enter and remain in the UK for more than 6 months.

Payment of the immigration health surcharge entitles the payer to NHS-funded healthcare on the same basis as someone who is ordinarily resident, from the date their visa is granted and for as long as it remains valid.

They are entitled to free NHS services, including NHS hospital care, except for services for which a UK ordinary resident must also pay, such as dentistry and prescriptions in England, and assisted conception services.

Temporary visitors from the EU, Iceland, Norway, Liechtenstein or Switzerland on or before 31 December 2020

Residents from an EU country, Iceland, Liechtenstein, Norway or Switzerland whose visit to the UK began on or before 31 December 2020 are exempt from charges for treatment that is medically necessary during their stay. This includes treatment for chronic conditions, including routine monitoring. They must show a valid European Health Insurance Card (EHIC), or a Provisional Replacement Certificate (PRC) to receive free care.

Pre-planned treatment is not included free of charge without special, prior arrangement. Where authorisation for planned treatment in the UK was sought on or before 31 December 2020, residents of an EU country, Iceland, Liechtenstein, Norway or Switzerland can complete that treatment in the UK using an S2 form.

Temporary visitors from the EU, Iceland, Liechtenstein, Norway or Switzerland from 1 January 2021

From 1 January 2021, visitors to the UK who fall ill or have a medical emergency during a temporary stay in England may have to pay for NHS healthcare at 150% of the cost of the treatment, unless an exemption applies.

From 1 January 2021, eligible visitors from the EU will have access to NHS care, using these 4 main documents, to avoid being charged directly when they access the NHS:

• European Health Insurance Card (EHIC)
• Provisional Replacement Certificate (PRC) – in the absence of an EHIC
• S1 form
• S2 form

From 1 November 2021, eligible visitors from Switzerland will also have access to NHS care using these 4 main documents to avoid being charged directly.

These documents currently confirm that another country will reimburse the UK for providing healthcare to that individual, which is then used to fund more frontline NHS services.

Irish and Norwegian visitors may use alternative forms of evidence when accessing medically necessary healthcare, for example a valid passport.

If a visitor from the EU or Switzerland is not eligible for any of these 4 documents, they should be charged for accessing NHS care unless it is a service that would be free of charge for all, or an exemption category applies.

This document details what you should do if a patient has one of these documents.

Registering visitors from the EU, Iceland, Liechtenstein, Norway or Switzerland

A patient does not need to be ordinarily resident in the UK to be eligible for NHS primary medical care. Anybody in England, including overseas visitors, can register as an NHS patient or temporary resident if they’re going to be in the country for between 24 hours and 3 months. They can consult with a GP without charge.

If an EEA/Swiss visitor applies to register with your practice, you should encourage them to complete the optional supplementary questions in the GMS1 form to give details of their valid non-UK EHIC or S1 form (if applicable) or whether they consider themselves to be exempt from charge or chargeable for NHS secondary care services.

When patients declare that they hold a valid non-UK EHIC or S1 form, you must record this manually in the patient’s medical record and to send the GMS1 form and supplementary questions to the appropriate organisation.

Non-UK EHICs are processed by NHS Digital and S1 forms by the Overseas Healthcare Team. Send the forms by email or post using the contact details below on this page.

Accessing free NHS hospital treatment

The NHS in England provides free hospital treatment to people who are ‘ordinarily resident’ in the UK. This means people living lawfully in the UK, voluntarily and for settled purposes as part of the regular order of their life. Citizens who are subject to immigration control are also required to have the immigration status of indefinite leave to remain. Such people who are paying (or are exempt from paying) the immigration health surcharge are exempt from charges.

Citizens from an EU country, Iceland, Liechtenstein, Norway or Switzerland who were living in the UK on or before 31 December 2020 must obtain settled or pre-settled status under the EU Settlement Scheme to access NHS free hospital treatment. The deadline for applications is 30 June 2021.

People who don’t normally live in this country (including UK citizens who now live overseas) are not automatically entitled to access NHS services for free, even if they are registered with a GP practice or have an NHS number. All patients, including those born in the UK, need to provide satisfactory documentary or other evidence of entitlement, in order to receive free hospital care. Otherwise they will be directly charged for their treatment.

Referring the patient

No-one can be charged directly for NHS primary medical care but charges may apply to the patient if they are referred for secondary care. It is important that patients are made aware of this. Where a patient has consented to the sending of their personal data to secondary care providers for the purpose of assessing chargeability, it is helpful if you let the hospital know that the patient may be an overseas visitor. Where appropriate, the hospital’s overseas visitor manager will use this information to recover the costs of care provided in hospital.

EHIC (formerly known as E111)

European Health Insurance Cards (EHICs) are used by visitors and students from EU countries and Switzerland. EHICs allow the UK to recover costs of NHS healthcare provided during their stay, from their home country.

An EHIC covers treatment that can’t wait until the patient’s return to their home country. This includes pre-existing medical conditions and routine maternity care, providing the reason for a visit to the UK is not specifically to give birth.

Many EU nationals live in the UK on a settled basis and are ‘ordinarily resident’– they are entitled to free NHS care and do not need to have an EHIC. However, if they do hold an EHIC, because they remain insured for healthcare by their home EU state, and they retain their principal long-term residence in that country, then these costs can still be recovered from their home country through the EHIC.

From 1 January 2021

From 1 January 2021, EU visitors can continue to use their EHIC to access medically necessary NHS healthcare in England.

From 1 November 2021, visitors from Switzerland who hold an EHIC can use it to access medically necessary NHS healthcare in England.

There will also be some visitors from Norway, Iceland and Liechtenstein who can continue to use their EHIC to access medically necessary NHS healthcare in England beyond 1 January 2021. This includes:

• UK nationals living and working in one of these countries on or before 31 December 2020
• students from one of these countries who began their course in the UK on or before 31 December 2020. They must have also applied to the EU Settlement Scheme
• tourists or temporary visitors who began their stay in the UK on or before 31 December 2020

These visitors may need to provide a Provisional Replacement Certificate (PRC) issued by their country of residence.

Provisional Replacement Certificate (PRC) – patients without an EHIC

If a patient is entitled to an EHIC but doesn’t have one, they can apply for a Provisional Replacement Certificate (PRC), which can be quickly issued and used by the hospital where the patient is receiving treatment.

No-one should be denied NHS primary medical care or refused registration at a GP practice because they cannot provide an EHIC or a PRC.

S1 forms (formerly known as E106, E109, E120, E121)

S1 forms are issued to people who live in one EEA country or Switzerland but have their healthcare costs covered by another EEA country or Switzerland. People entitled to apply for an S1 include state pensioners and those in receipt of certain benefits – for example, survivors’ benefits and certain disability benefits. It also includes people who have been posted to work in another country (once they have lived there for 2 years) and frontier workers (people who commute across a border to get to work). Family members are also covered by the S1 form.

From 1 January 2021

People living in the EU, Iceland, Liechtenstein, Norway or Switzerland on or before 31 December 2020 whose healthcare costs are funded by the UK (such as those with a UK-issued S1 that has been registered in another member state) will be entitled to free NHS hospital treatment in England, should they return temporarily to the UK.

UK nationals living in the EU, Iceland, Liechtenstein, Norway or Switzerland on or before 31 December 2020 can also apply for an S1 upon reaching State Pension age and drawing their State Pension.

Family members of frontier workers (someone who lives in the EU, Iceland, Liechtenstein, Norway or Switzerland and was working in the UK in that capacity on or before 31 December 2020), can receive NHS treatment using an S1 form for free if it becomes medically necessary during a temporary visit to England.

S1 forms must be registered in order for the money to be recovered. This is done by sending them to the Overseas Healthcare Services Team at the NHS Business Services Authority for it to be processed. They can be contacted at:

Overseas Healthcare Services
NHS Business Services Authority
Bridge House
152 Pilgrim Street
Newcastle upon Tyne NE1 6SN

Email nhsbsa.faregistrationsohs@nhs.net

Most people submit their S1 form issued by their home country when they register with a GP. It is the patient’s responsibility to make sure the form is registered with the Overseas Healthcare Team, but GP practices can offer to post it off for them. There is no deadline for processing S1 forms. You should ask if you think a registered patient might hold an S1 form or be eligible to claim one.

By registering the form once it automatically means that £4,500 is recovered every year – you do not have to re-register it each year. Any money claimed goes back into the NHS.

No-one should be denied NHS primary medical care or refused registration at a GP practice because they cannot provide an S1 form.

S2 forms (formerly known as E112)

S2 forms are issued to people covered by a reciprocal healthcare arrangement who choose to have their healthcare, usually hospital treatment, in a different EU country to the one in which they live. These forms are processed by the hospital where the individual is receiving treatment.

From 1 January 2021

From 1 January 2021, visitors from the EU can continue to use planned treatment using an S2 form.

From 1 November 2021, eligible visitors from Switzerland can get planned treatment in the UK using an S2 form.

Visitors from Norway, Iceland and Liechtenstein can access planned treatment using an S2 form only if their treatment was requested on or before 31 December 2020. They should arrange an S2 form from the relevant organisation in their home country before travelling to England.

Contact details and further information

Overseas Healthcare Services
NHS Business Services Authority
Bridge House
152 Pilgrim Street
Newcastle upon Tyne
NE1 6SN

Email nhsbsa.ovmqueries@nhs.net

More guidance on overseas-visitors hospital charging regulations is available, as well as information for patients.