OVERSEAS VISITORS' LIABILITY TO PAY CHARGES FOR NHS CARE AND SERVICES
Health Rights Information Scotland has produced a number of factsheets explaining the NHS services which overseas visitors can expect to receive when in Scotland.
Overseas Visitors to Scotland, who have a legitimate reason to be here, will always be welcomed by the Scottish Government as they contribute to our economy as well as to our vibrancy and diversity as a nation.
This guidance, which is not legally binding and should not be regarded as a complete and authoritative statement of law, is aimed at explaining, and providing a balanced interpretation of, the Regulations for healthcare providers who deal with overseas visitors on a regular basis. It also covers other matters relevant to overseas visitors' use of NHS care and services while in Scotland.
It is for healthcare providers to determine an overseas visitor's need for NHS healthcare or services and if charges should be applied. (Regulation 2(1) of the National Health Service (Charges to Overseas Visitors) (Scotland) Regulations 1989, as amended). It should be noted that possession of a Community Health Index (CHI) number does not necessarily preclude an overseas visitor from paying NHS charges.
The overseas visitors regulations do not permit charging for NHS primary care services other than certain dental and optical services. It is for GP practices to exercise their discretion as to whether to register an overseas visitor or to treat them privately (including the provision of private prescriptions), taking into account the terms of the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004, as amended. Reference to the general principles set out in this guidance may, however, be helpful in reaching a decision on registration.
"Overseas visitor" is defined as a person not ordinarily resident in the UK and, accordingly, only those who are not ordinarily resident may be charged for NHS services. The concept of ordinary residence can be described as living lawfully in the UK for settled purposes, as part of your regular order of life. A person's identifiable purpose and whether that purpose has a sufficient degree of continuity to be properly described as settled are the determining factors, regardless of whether a UK passport is held, the person owns property in the UK or pays UK taxes. Ordinary residence is essentially a question of fact and the definitive interpretation of ordinary or temporary residence would be for a court to decide in the specific circumstances of an individual case. As a rule, 6 months is seen as a reasonable period of time for a person to remain lawfully in Scotland before they can be classed as ordinarily resident, although individual circumstances may vary. All people who are adjudged to be ordinarily resident in Scotland are not overseas visitors and are only charged for NHS services on the same basis as a UK national ordinarily resident in Scotland.
Overseas visitors may be liable to charges as a result of the NHS (Charges to Overseas Visitors) (Scotland) Regulations 1989, as amended) and have to pay for some forms of NHS treatment or services that they receive. Where an overseas visitor is liable to charging this should be explained to them from the outset and they should be asked to sign an undertaking that they agree to this ideally before treatment commences. There will, however, be instances when this is not feasible in the interests of the patient's immediate health or wellbeing.
If a person is found to be "exempt from NHS charges", they are entitled to healthcare and services on the same basis as a person who is ordinarily resident in Scotland. This exemption also applies to their spouse / registered civil partner and children under the age of 16 (or under the age of 19 if still in full-time education). However, young people under the age of 18 do not have to be in education to qualify for free NHS general dental treatment.
Anyone who meets the exemption criteria under the Overseas Visitors Regulations will, in normal circumstances, still have to pay statutory NHS charges for certain NHS healthcare provision, such as NHS dental or optical treatment, prescriptions, wigs and fabric supports. They may, however, qualify for exemption from such charges on the same basis as a UK national who is ordinarily resident in Scotland, depending on their status.
Overseas visitors may be charged for NHS eye/dental examinations unless they come under one of the specific exemption categories set out in the Regulations. Optical vouchers are only available to those people who meet one of the eligibility criteria in the Optical Charges Regulations, and who are adjudged to be ordinarily resident in Scotland.
Emergency NHS treatment at an A&E or casualty department, including treatment in an observation ward, is free to all, regardless of their residency status. Following this treatment, it is for NHS healthcare providers to determine whether an overseas visitor requires further in-patient treatment or registration as an outpatient, and whether or not they should be charged for that treatment.
Healthcare providers are strongly advised to check the residency status of all patients seeking treatment. Referral by a GP is not in itself proof that an individual is exempt from NHS hospital charges.
The Scottish Government expects NHS Boards to take all reasonable steps to recover the cost of NHS treatment from those overseas visitors who are liable to charges under the Regulations. Boards may, if necessary, wish to discuss debt recovery procedures with the Central Legal Office which has a contract with an international debt recovery company. Boards must also pass full details of the non-payer to NHS Scotland Counter Fraud Services who will liaise with the UK Border Agency.