UK NHS Care for Expats

[chiang mai]

Last year I wrote a letter to Ministers Questions to try and determine whether or not I would still be covered by the NHS in the event I moved back to the UK, five months later I recieved a response. The scaenario I presented to them (and really I was merely fishing here) was a returning expat aged under 65 who was returning on a permanent basis.

The reply was a typical politicians letter that restated the obvious about paying NI contributions plus lots of other legal boiler plate, eventually the letter stated that my elligibility would be determined by the individual health care trust in the area I moved to and that I would be best advised to contact them directly. The letter then closed with the writer saying that he believed I was likely to be elligible for care and treatment based on the sceanario I had set out.

Things I already knew beforehand: emergency care is free and available to everyone, only follow up and existing conditions become questionable as to whether the treatment is free or not.

Aged over 65 and in reciept of State Pension means that the recipient is fully elligible once again.

Individual health care trusts make their own decisions on whether to treat a patient free of charge or not, there is little by way of central guidelines on this.

Any UK citizen who says they are returning to the UK to live permanently is thought to be elligble once again however, health care trusts can ask for proof that the expat has truly abandoned their overseas residence, exactly how they do this is unclear but I suspect having only a one way plane ticket might help!

To prove it you need to have all the usual things like utility bills etc and also to show that you have been resident in the UK for 182 days or more.

I don't think so, you're confusing liability to UK tax with eligibility for NHS services, the 182 day rule only applies to HMRC and not to the NHS.

I believe that what the governement has in mind when proving that you've given up your overseas residence is proof of overseas property sale, termination of overseas lease, proof of property purchase in the UK, proof of lease for property rental in the UK, sale of goods overseas etc.

[bifftastic]

I can't see where you get the 182 days from, it says here http://www.nhs.uk/chq/Pages/1087.aspx?CategoryID=68&SubCategoryID=162

NHS hospital treatment in England

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.

[Muhendis]

Thanks for clarification chiang mai.

"I believe that what the government has in mind when proving that you've given up your overseas residence is proof of overseas property sale, termination of overseas lease, proof of property purchase in the UK, proof of lease for property rental in the UK, sale of goods overseas etc." Are you still talking about HMRC?

[chiang mai]

Thanks for clarification chiang mai.

"I believe that what the government has in mind when proving that you've given up your overseas residence is proof of overseas property sale, termination of overseas lease, proof of property purchase in the UK, proof of lease for property rental in the UK, sale of goods overseas etc." Are you still talking about HMRC?

No, I'm refering to the NHS requirement to prove permanent return of an expat, the HMRC rules for taxation are crystal clear and unambiguous and include, as you say, the 182 day rule.

[Rumpole]

If you show up on British soil, sick, with a British passport, what are they going to do? Deport you?

No they could treat you then sue you for damages if you refused to pay. If you leave the country then they may issue an international warrant of arrest through Interpol. That would look great for re-applying for your Thai visa.

Not paying your bills is a civil offence. You can't be 'arrested' for it.

Indeed. You could not be sued for "damages" either, though they may be able to pursue you for the debt.

[truckerjoe]

After many years away I flew back to the UK when I was sick, went to the nearest hospital, told them I felt ill, filled out a form gave my NI number and was admitted, spent one week in hospital and left fully recovered, I had heard so many stories of run down British hospitals with super bugs waiting to leap onto you as soon as you step foot in the place, but I found the level of cleanliness top notch as was the level of care, when I was admitted to a Thai hospital with a burst appendix a while ago i wasn't so impressed,

an orderly who delivered my inedible meals had a pet squirrel on his shoulder, now I have no beef with Squirrels but in a hospital?

And when I went to get my wound sewn up the pain killing injection the nurse had given me had all but worn off before I was finally wheeled to the doctor,the clamping and sewing of the wound really hurt, i complained and asked for another injection, the doctors reply was "no time, endure" <deleted>!

Go home to get treated, if you have an nhs/ni number they will treat you,

Of course better if you can afford to get medical insurance cover here, Then you can get treatment at good Thai hospitals that have squirrel free zones!

[evadgib]

Insurance would be affordable here if treatment was based on nature of injury rather than ethnicity of patient.

[sustento]

After many years away I flew back to the UK when I was sick, went to the nearest hospital, told them I felt ill, filled out a form gave my NI number and was admitted, spent one week in hospital and left fully recovered, I had heard so many stories of run down British hospitals with super bugs waiting to leap onto you as soon as you step foot in the place, but I found the level of cleanliness top notch as was the level of care,

If you read the papers (especially the Daily Fail) you'd think that the NHS is going to sink next week. If you actually use it regularly as I do you see just how good it really is.

Edited October 31, 2013 by sustento

[uptheos]

If you show up on British soil, sick, with a British passport, what are they going to do? Deport you?

No they could treat you then sue you for damages if you refused to pay. If you leave the country then they may issue an international warrant of arrest through Interpol. That would look great for re-applying for your Thai visa.

Give me a break!!

If you turn up on British soil with a British passport, you will get treated, I know I've done it after being away for years!

Issuing an international warrant through interpol You couldn't make this stuff up.

Actually, the passport didn't come into it, just went and got a referral from my GP who really doesn't give a toss whether I'm resident or not.....great chap, one of the best.

Scaremongering seems to be a common pastime on here.

Edited October 31, 2013 by uptheos

[uptheos]

After many years away I flew back to the UK when I was sick, went to the nearest hospital, told them I felt ill, filled out a form gave my NI number and was admitted, spent one week in hospital and left fully recovered, I had heard so many stories of run down British hospitals with super bugs waiting to leap onto you as soon as you step foot in the place, but I found the level of cleanliness top notch as was the level of care, when I was admitted to a Thai hospital with a burst appendix a while ago i wasn't so impressed,

an orderly who delivered my inedible meals had a pet squirrel on his shoulder, now I have no beef with Squirrels but in a hospital?

And when I went to get my wound sewn up the pain killing injection the nurse had given me had all but worn off before I was finally wheeled to the doctor,the clamping and sewing of the wound really hurt, i complained and asked for another injection, the doctors reply was "no time, endure" <deleted>!

Go home to get treated, if you have an nhs/ni number they will treat you,

Of course better if you can afford to get medical insurance cover here, Then you can get treatment at good Thai hospitals that have squirrel free zones!

Exactly if you just walk into emergency, give your name an address and NI number, no-one's going to grill you whether you've been living abroad, they'll just get on with the job.

[Chivas]

if you leave the uk.perminant you are required to return your nhs.medical card with your name and ni.no on it so they can remove you from the system.if you dont you will be still registered.

What Medical Card !! Never seen or had one in my life and that certainly goes for all my kids ?

[uptheos]

I have every confidence that if I had a serious illness or required immediate surgery, I would get it if I returned to the UK......even if I had to lay in a sleeping bag outside the Hospital's Emergency Entrance (after notifying many from the press of course). If this doesn't work just tell someone from one of the MH organisations that your'e going to commit suicide if not treated and describe your plan to them. You'll be inside before you know it.

Except that the airlines won't take you as their insurance would be void.

You could always grab an air ambulance back for about twenty thousand quid...

Yes an air ambulance might be necessary in a dire emergency.

Of course it depends on how 'outwardly' physically sick you are whether they refuse or not. If you can manage to make the regular 13 hour flight, you could then collapse at Heathrow or wherever and all the care you need will be free.

[JoeLing]

if you leave the uk.perminant you are required to return your nhs.medical card with your name and ni.no on it so they can remove you from the system.if you dont you will be still registered.

What Medical Card !! Never seen or had one in my life and that certainly goes for all my kids ?

I don't know about Medical Card. Do you mean NI Card?

I got one, my son got one although I never had to show it to my GP or any Hospital I have been referred too.

Maybe if one just walks in to a hospital, they might ask for your NI number. I have been lucky so far that I didn't

have too, so don't know.

Don't know if they still issue NI Cards today.

[Chivas]

if you leave the uk.perminant you are required to return your nhs.medical card with your name and ni.no on it so they can remove you from the system.if you dont you will be still registered.

What Medical Card !! Never seen or had one in my life and that certainly goes for all my kids ?

I don't know about Medical Card. Do you mean NI Card?

I got one, my son got one although I never had to show it to my GP or any Hospital I have been referred too.

Maybe if one just walks in to a hospital, they might ask for your NI number. I have been lucky so far that I didn't

have too, so don't know.

Don't know if they still issue NI Cards today.

nic.jpg

Ah ok. Ex Wife has one issued when she got her National Insurance number 13 years ago but I or my boys have never had one

[sustento]

I had a medical card but it was when the dinosaurs were young.

[bkk_mike]

if you leave the uk.perminant you are required to return your nhs.medical card with your name and ni.no on it so they can remove you from the system.if you dont you will be still registered.

That was the theory anyway.

I sent back all our medical cards when we emigrated (back in 2001), but the family's moved back (I move back this weekend), and the only one that wasn't still registered at the GP was my youngest (because she was born in Thailand in 2002.)

They don't issue cards any more nowadays. It's just an NHS number. (which is NOT the same as your NI number).

As for NI numbers. They're now a lot harder to get. Found out as we weren't claiming child benefit for our eldest that she's therefore not on the "system", and had to attend an interview. But they still refused her an NI number as her passport had expired. (what the expiry date of her passport has to do with her ILR status - which she's had since she was 4 - I don't know... I think it's more likely the people in the Job Centre doing the interviewing aren't used to people that got ILR in the days before the issue of the biometric ID cards).

Personally, I have no issue with ID cards, except they were going to charge silly money for them. And if they made them mandatory, it's effectively a new poll tax.

Edited October 31, 2013 by bkk_mike

[JoeLing]

They don't issue cards any more nowadays. It's just an NHS number. (which is NOT the same as your NI number).

I have a NHS pension number. Could that be the same number you mention?

[dunque]

This is a copy of part of the UK Govt. white paper for expats that are over retirement age:

• 12. Expatriate UK citizens who move to reside abroad currently lose their entitlement to free
• NHS treatment. They regain this if they return to live in the UK permanently but usually not
• when returning to visit. In line with the principle that everybody makes a fair contribution, we
• propose to confirm the entitlement of any person who has previously paid at least seven
• years of National Insurance contributions.

This clearly implies that you don't get it today except by lying. The rules will be changing in in line with the white paper in 2014.

Edited October 31, 2013 by dunque

[meatboy]

They don't issue cards any more nowadays. It's just an NHS number. (which is NOT the same as your NI number).

I have a NHS pension number. Could that be the same number you mention?

for those of you that came from another planet to live in the uk.google NHS MEDICAL CARD then click on the nhs no.

the old med card i mentioned which had a mixture of letters and no's has been replaced by a 10 digit unique personel no.in the format of 3-3-4 which you will get when you register with a doctor.it has nothing to do with your ni.no.

the medical no.helps if you have an emergancy then they can find out your history.

[cbluck58]

Seems to me that if you have paid up your NI contributions, they have no case with which to refuse treatment.

[Muhendis]

Seems to me that if you have paid up your NI contributions, they have no case with which to refuse treatment.

Whilst I, and I'm sure many others, agree wholeheartedly with your sentiment the UK Govt. does what it pleases (especially to non-voters).

[salapau]

At the moment those expats older than retirement age are entitled to return and use NHS services.

After 2016 all expats who have paid 10 years NI payments will be entitled to return and use NHS services.

Hardly an explosion, when the government has already decided to treat nearly everyone.

Sorry this is not right. I paid NI contributions for 45 years and am now unable to get free NHS treatment or the free prescriptions for the over 60's, when I visit England.

[FiftyTwo]

At the moment those expats older than retirement age are entitled to return and use NHS services.

After 2016 all expats who have paid 10 years NI payments will be entitled to return and use NHS services.

Hardly an explosion, when the government has already decided to treat nearly everyone.

Sorry this is not right. I paid NI contributions for 45 years and am now unable to get free NHS treatment or the free prescriptions for the over 60's, when I visit England.

retirement age is 65 in the UK.

Edited November 1, 2013 by FiftyTwo

[uptheos]

At the moment those expats older than retirement age are entitled to return and use NHS services.

After 2016 all expats who have paid 10 years NI payments will be entitled to return and use NHS services.

Hardly an explosion, when the government has already decided to treat nearly everyone.

Sorry this is not right. I paid NI contributions for 45 years and am now unable to get free NHS treatment or the free prescriptions for the over 60's, when I visit England.

If you still have a doctor you can get both with no problem.

[sustento]

At the moment those expats older than retirement age are entitled to return and use NHS services.

After 2016 all expats who have paid 10 years NI payments will be entitled to return and use NHS services.

Hardly an explosion, when the government has already decided to treat nearly everyone.

Sorry this is not right. I paid NI contributions for 45 years and am now unable to get free NHS treatment or the free prescriptions for the over 60's, when I visit England.

retirement age is 65 in the UK.

Free prescriptions are available to those 60 years of age and older. They're also available free to those with some specific chronic diseases such as diabetes no matter how old they are.

[truckerjoe]

At the moment those expats older than retirement age are entitled to return and use NHS services.

After 2016 all expats who have paid 10 years NI payments will be entitled to return and use NHS services.

Hardly an explosion, when the government has already decided to treat nearly everyone.

Sorry this is not right. I paid NI contributions for 45 years and am now unable to get free NHS treatment or the free prescriptions for the over 60's, when I visit England.

If you still have a doctor you can get both with no problem.

I am back in the UK for a while, arrived 3 weeks ago, staying with family in a different town to my last registered address, signed up with a new doctor

with no problems, just gave him my last doctors details and my N.I. number.

Over the last 10 days I have been referred to hospital for a knee x-ray and a chest x-ray, I have also received an invitation to have a full health check

(think it is every five years for over 60s).and as I mentioned in an earlier post I returned two years ago to the UK for hospital treatment without any problem.

I am 64 and have paid NI contributions for less than 30 years as I have lived outside the country on several occasions.

[Muhendis]

This is a copy of part of the UK Govt. white paper for expats that are over retirement age:

• 12. Expatriate UK citizens who move to reside abroad currently lose their entitlement to free
• NHS treatment. They regain this if they return to live in the UK permanently but usually not
• when returning to visit. In line with the principle that everybody makes a fair contribution, we
• propose to confirm the entitlement of any person who has previously paid at least seven
• years of National Insurance contributions.

This clearly implies that you don't get it today except by lying. The rules will be changing in in line with the white paper in 2014.

At the moment NOBODY (pensioner, student and any other criteria you care to think of) who is domiciled outside of the UK is entitled to NHS treatment in the UK except as an emergency admission.

In other words;

If you are visiting the UK and are involved in an accident or perhaps have a heart attack then you will be treated because that is an unforeseen emergency.

If, on the other hand, you visit the UK and go to a doctor requesting treatment for a hearing problem that is clearly not an accident and you must pay.

That is the way the law stands at the moment. As others have said there are ways of circumventing the law but that is between you and your conscience.

Please read the copy of my earlier post and try to understand that this will change but not until next year and then only for those that have paid more than seven years NIC. This means it will not be related to your age but instead it will be related to how much you have contributed over the years to the National Insurance Scheme in the UK.

This is good news for those with long standing ailments that would normally be treated by a doctor and/or in a hospital. It may be less costly to pay for the flight and accommodation to the UK and get your free treatment rather than pay for treatment in your country of residence.

[chiang mai]

This is a copy of part of the UK Govt. white paper for expats that are over retirement age:

• 12. Expatriate UK citizens who move to reside abroad currently lose their entitlement to free
• NHS treatment. They regain this if they return to live in the UK permanently but usually not
• when returning to visit. In line with the principle that everybody makes a fair contribution, we
• propose to confirm the entitlement of any person who has previously paid at least seven
• years of National Insurance contributions.

This clearly implies that you don't get it today except by lying. The rules will be changing in in line with the white paper in 2014.

At the moment NOBODY (pensioner, student and any other criteria you care to think of) who is domiciled outside of the UK is entitled to NHS treatment in the UK except as an emergency admission.

In other words;

If you are visiting the UK and are involved in an accident or perhaps have a heart attack then you will be treated because that is an unforeseen emergency.

If, on the other hand, you visit the UK and go to a doctor requesting treatment for a hearing problem that is clearly not an accident and you must pay.

That is the way the law stands at the moment. As others have said there are ways of circumventing the law but that is between you and your conscience.

Please read the copy of my earlier post and try to understand that this will change but not until next year and then only for those that have paid more than seven years NIC. This means it will not be related to your age but instead it will be related to how much you have contributed over the years to the National Insurance Scheme in the UK.

This is good news for those with long standing ailments that would normally be treated by a doctor and/or in a hospital. It may be less costly to pay for the flight and accommodation to the UK and get your free treatment rather than pay for treatment in your country of residence.

I'm sorry to keep disagreeing with you but what you've written is incorrect.

Domicile and residency are two totally different things, residency can easily be changed whereas domicile is very difficult to change, as Lord Denning, Master of the Rolls put it, "domicile is not a raincoat that can be discarded at will"!

But residency is a different matter, we can choose our residency and can easily change it, if for example a UK citizen who has been resident in Thailand for the past ten years for example, decides to return to the UK to become permanently UK resident once again, they are once again entitled to free NHS care from the day they arrive. Similiarly, anyone over the age 65 is also entitled to complete and free NHS care by virtue of their age.

[Muhendis]

Apology not necessary Chiang Mai.

The word used by the UK govt. is expatriate which broadly speaking means people that do not live and work in their country of origin. It is not stated if this means non-domiciled or non-residence. However the result is still the same. You are not entitled to NHS treatment (except for emergency) until the UK Govt. says so next year.

By the way I had a quick look for the UK Govt. interpretation of expatriate and this came up. Off topic but interesting

Expats: help us test a new service

by John Waterworth on 23/10/2013

We need your help to test one of our services.

One goal of the Individual Electoral Registration project is to allow people to register online at GOV.UK. We hope that the new service will make it easier for overseas voters in particular to register and exercise their voting rights.

We are now looking for expats to try out a prototype of the new service, to see how well it works for them and to see how we can improve it.

[chiang mai]

Apology not necessary Chiang Mai.

The word used by the UK govt. is expatriate which broadly speaking means people that do not live and work in their country of origin. It is not stated if this means non-domiciled or non-residence. However the result is still the same. You are not entitled to NHS treatment (except for emergency) until the UK Govt. says so next year.

By the way I had a quick look for the UK Govt. interpretation of expatriate and this came up. Off topic but interesting

Expats: help us test a new service

by John Waterworth on 23/10/2013

We need your help to test one of our services.

One goal of the Individual Electoral Registration project is to allow people to register online at GOV.UK. We hope that the new service will make it easier for overseas voters in particular to register and exercise their voting rights.

We are now looking for expats to try out a prototype of the new service, to see how well it works for them and to see how we can improve it.

The difference between residency and domicile is that a non-UK domicile means a person is inelligible for Inheritance Tax, residents and non-residents are. There are also other layers of tax law that apply to the two different categories although to discuss those things here is to side track unecessarily. So back to NHS and residency:

Even prior to the current/planned changes on this subject, certain allowances were available to expats., one was the restoration of NHS benefits to a returning expats, the other was a gaurantee of benefits to people over the gae of 65. It seems to me that little has changed with the new order, I had read the green paper but not the white paper and I thought the only substantial change was that people need to have paid a minimum of nine years NI payments in order to have elligibilbty restored, otherewise the rules seem identical.

Finally, emergency treatment remains available to all, at any time.