UK NHS Health Surcharge

[ThaiVisaExpress]

The introduction of an NHS Health Surcharge is included in the latest Immigration Act. It doesn’t seem to have got much publicity, but it does look like it will be introduced in April this year.

The Surcharge will affect every applicant for a visa of more than 6 months, except for Tier 2 intra company transfer migrants. That means that applicants for spouse/partner visas, or child applicants to join parents in the UK , will have to pay the surcharge. The charge will be 200 GBP a year, but students will pay 150 GBP a year. The fee will be payable in advance at the visa application stage. So a spouse, getting a visa for 2.5 years, will have to pay a charge of 500 GBP, in addition to the normal visa fee.

Prospective visa applicants and sponsors should bear in mind that, from April this year, they may be paying 50% more for a visa at the application stage, and again at the FLR stage in the UK.

I don’t think there has been an official start date announced yet, but information on the internet strongly suggests that it will be in two months time.

Tony M

[theoldgit]

Tony

Are you saying they are intending to impose this surcharge on visit visas, settlement visas or both?

Mention of FLR would suggest this would include settlement. So a person who settles in the UK, and can legally work, might be paying this surcharge, even though they may be making NI contributions. I wonder how they determine the cost of the surcharge, one year, two, five?

If it's for a visit visa, say for two years, coincidently, I wonder if the applicant would have to pay the surcharge for the full two years even though they could only stay a maximum of 180 days per year, and would almost certainly have travel insurance.

I do remember reading about this a while ago, I thought then it was poorly thought out.

Have I misread this?

[steve187]

I would think it applies to all people that the TB test applies to, all people that are granted a visa that allows them to stay over 6 months

What would happen if as in many cases the visa is refused, would the prepaid NHS money be lost as well

what about the euro immigrants!!!!!!!!!!

Edited January 15, 2015 by steve187

[ThaiVisaExpress]

Tony

Are you saying they are intending to impose this surcharge on visit visas, settlement visas or both?

Mention of FLR would suggest this would include settlement. So a person who settles in the UK, and can legally work, might be paying this surcharge, even though they may be making NI contributions. I wonder how they determine the cost of the surcharge, one year, two, five?

If it's for a visit visa, say for two years, coincidently, I wonder if the applicant would have to pay the surcharge for the full two years even though they could only stay a maximum of 180 days per year, and would almost certainly have travel insurance.

I do remember reading about this a while ago, I thought then it was poorly thought out.

Have I misread this?

This is an extract from the UKGOV website, and may throw some light on the subject, and your questions. It seems to apply to visas for more than 6 months, and I agree that some migrants may end up paying twice if they are working in the UK. :

Phase 3: Implementing the surcharge

100. The Immigration Act 2014 changes the meaning of ‘ordinarily resident’ for the

purposes of the NHS Act so that in the future non-EEA nationals will not be deemed

ordinarily resident unless they have been granted Indefinite Leave to Remain (ILR) in

the UK. Building on this, the Act also allows legislation to be introduced that will require

those non-EEA nationals subject to immigration control who are coming to the UK for

more than six months to pay an ‘immigration health surcharge’ (surcharge) with their

visa application fee. This is expected to be £150 per year for students and £200 per

year for others, and will be paid upfront for the duration of the visa. There will be limited

exemptions e.g. for those seeking asylum, refugees and victims of human trafficking.

101. Many of those who can currently access NHS care for free upon moving to the UK will

instead be contributing towards the cost of any NHS care they need during their stay.

Those who pay the surcharge (or are exempt from paying it) will then be able to access

the NHS on the same basis as a resident for as long as their leave to remain is valid.

102. The Department has been and continues to work closely with the Home Office on

relevant aspects of the legislation. A key action for the Department and the NHS to

support implementation of the Act is to support the NHS in responding to the

surcharge. This will need to ensure that the NHS is ready for the impact of the

surcharge as well as supporting a wider communications package to payees of the

surcharge to promote effective information on their care entitlements. This will include

the Department making the necessary changes to the NHS Charging Regulations so

that those who have paid the surcharge will be able to access NHS care in the same

way as a person who is ordinarily resident.

103. The UK has reciprocal agreements with several non-EEA countries. As was signalled in

the consultation response, they are typically in relation to short term visitors in need of

treatment for unexpected accidents and illnesses, rather than comprehensive health

needs that the surcharge will provide access to, so we anticipate that the surcharge will still be applicable to temporary migrants from those countries

This might answer your question about long-term visit visa, but I think that point will need some clarification when the actual charge is implemented :

With the exception of Tier 2 intra company transfer applicants, all other migrants applying for a visa of more than six months’ duration will be required to pay the surcharge with their visa application fee.

Tony M

Edited January 15, 2015 by ThaiVisaExpress

[moobie]

What I am about to Post is not Thailand specific :-

Surely this surcharge should be subject to a medical "clean bill of health?"

If not then the NHS may actually find itself as the Global Health service, as mooted by some, because this will give a right to treatment which would previously been under the remit of medical insurance companies.

(Let me give an example. Anyone who arrives or is currently in the UK, regardless of legal status, has to be treated if they have HIV/AIDs. The current cost of treatment/care runs in excess of £18,000 per annum. This rises as new antivirals are found and applied. Ergo, £200 for many conditions is actually a bargain price for many treatments.)

[ThaiVisaExpress]

What I am about to Post is not Thailand specific :-

Surely this surcharge should be subject to a medical "clean bill of health?"

If not then the NHS may actually find itself as the Global Health service, as mooted by some, because this will give a right to treatment which would previously been under the remit of medical insurance companies.

(Let me give an example. Anyone who arrives or is currently in the UK, regardless of legal status, has to be treated if they have HIV/AIDs. The current cost of treatment/care runs in excess of £18,000 per annum. This rises as new antivirals are found and applied. Ergo, £200 for many conditions is actually a bargain price for many treatments.)

I think you may well be right, and the point was brought up during the consultation period. It will be a cheap price to pay for expensive, possibly long term, medical treatment, unless there are some caveats in the final proposals which haven't been made public yet. I guess it depends on what is in the small print in the insurance policy ? As I understand it, applicants will not have a choice of providers. It will one UKVI nominated company that issues the insurance.

Tony M

[technologybytes]

I would not complain, that's a small price to pay in order to get immediate and full cover of NHS services.

[bkk_mike]

Should I point out that the NHS, from 2012, already treats HIV+ people for free if they're in the UK, regardless of their visa status.

(That was on the basis that, like a disease like TB, treating anyone that's ill is better than letting them infect others because they're not being treated.)

[Patanawet]

I would not complain, that's a small price to pay in order to get immediate and full cover of NHS services.

But I,as an expat out of the U.K. for more than 6 months, have to pay full foreigner NHS fees even though I've paid years of National Insurance.

Edited January 16, 2015 by Patanawet

[Tony M]

I would not complain, that's a small price to pay in order to get immediate and full cover of NHS services.

But I,as an expat out of the U.K. for more than 6 months, have to pay full foreigner NHS fees even though I've paid years of National Insurance.

There is also a proposal that Brits who have paid NI for years will be entitled to NHS treatment without having to prove that they are ordinarily resident in the UK. We are still waiting to hear if the proposal will go through.

[uptheos]

Every time I go home, which is usually once or twice a year I go to see my doctor.

He knows I'm in Thailand even answered an email from me when I needed advice.

Never been charged, never been queried.

Last summer he referred met to a NHS ear specialist in hospital and got me in quick knowing I was coming back here.

The ear specialist wanted to see me again in two months but I told him I was returning to Thailand. He asked if I could get it followed up there, but in any case gave me a one year open appointment.

I'm amazed how some British Citizens who have worked and paid taxes, insurance etc all their lives are quite prepared to take it up the rear, without thinking about how to find a way around these things IF they crop up, which mostly they don't, only on forums where people love to scare monger!

[Suradit69]

What I am about to Post is not Thailand specific :-

Surely this surcharge should be subject to a medical "clean bill of health?"

If not then the NHS may actually find itself as the Global Health service, as mooted by some, because this will give a right to treatment which would previously been under the remit of medical insurance companies.

(Let me give an example. Anyone who arrives or is currently in the UK, regardless of legal status, has to be treated if they have HIV/AIDs. The current cost of treatment/care runs in excess of £18,000 per annum. This rises as new antivirals are found and applied. Ergo, £200 for many conditions is actually a bargain price for many treatments.)

A similar problem arose in the UAE. When I first started working there subsidized medical care was provided for all residents and their dependents as well as free care for nationals

Some foreign workers started taking in "relatives" who just happened to have major, very expensive medical issues. By the time I left the UAE our medical expenses were covered only by private medical insurance, in my case part of my employment package, with insurance premiums for "relatives" deducted from salary or up to the individuals to find on their own.

Just as is the case in Thailand, loopholes, whether in immigrations rules & regs or government medical programs, will quickly be exploited to the point where the intent of the law is abused and everyone gets hit by the inevitable subsequent "crackdown."

[FiestyFarang]

Seems fair enough to me, why should people get free healthcare from taxpayers. Also the system is abused as many just "visit" the UK for the treatment. It should be mandatory to show an approved form of photo ID too on arrival (except emergencies) where a liability for payment contract should be signed. Too often I have been with people to hospital being the only 2 people speaking English!

[Jay Sata]

I agree with you Feisty.

The NHS is already overloaded thanks to Blair and his open door policies.

The sum of £200 seems reasonable.

[Basil B]

I would say then returning expatriates returning to the UK and not having paid NI for more than 2 years should also be paying a one of fee of £400.

[theoldgit]

I agree with you Feisty.

The NHS is already overloaded thanks to Blair and his open door policies.

The sum of £200 seems reasonable.

But it's more than £200 isn't it, it's £200 for every year the applicant expects to remain in the UK until the FLR stage, so at least £500.

I suspect most applicants will seek employment in the UK and thus be making their own contributions to the National Insurance scheme from their salary, so effectively will be paying twice, does that seem reasonable?

[theoldgit]

I would say then returning expatriates returning to the UK and not having paid NI for more than 2 years should also be paying a one of fee of £400.

But it's not that simple is it, a UK National returning to the UK to work will already be liable for NI contributions.

Pensioners are already exempt from NI contributions, be they already in the UK or returning, those pensioners returning are more than likely to already being paying UK tax and will probably have been doing so for years, some of the income being taxed at 40%.

Are you really suggesting that returning expats should be liable for this charge.

I believe this proposed charge is ill thought out, will not address the issue and is designed to appease the average Daily Mail reader.

[theoldgit]

Seems fair enough to me, why should people get free healthcare from taxpayers. Also the system is abused as many just "visit" the UK for the treatment. It should be mandatory to show an approved form of photo ID too on arrival (except emergencies) where a liability for payment contract should be signed. Too often I have been with people to hospital being the only 2 people speaking English!

A certainly agree that visitors shouldn't get free healthcare, but this ill thought out proposal isn't designed for visitors, it's designed to hit future UK residents who will probably be UK National Insurance contributors and tax payers in their own right, so this charge would mean they are paying twice.

Visitors should certainly be liable to meet the costs of their none life threatening treatment, and insurance cover should be compulsory.

I suspect this proposal is going to be introduced because health care staff don't have the time or recourses to ascertain if those seeking treatment are actually qualified to receive it under the NI scheme.

[Jay Sata]

I agree with you Feisty.

The NHS is already overloaded thanks to Blair and his open door policies.

The sum of £200 seems reasonable.

But it's more than £200 isn't it, it's £200 for every year the applicant expects to remain in the UK until the FLR stage, so at least £500.

I suspect most applicants will seek employment in the UK and thus be making their own contributions to the National Insurance scheme from their salary, so effectively will be paying twice, does that seem reasonable?

If you look at the charge as being £4.00 a week to access the raft of NHS services it is a bargain.

About the price of a very basic fast food meal.

You won't get far by train on £4.00.

[theoldgit]

If you look at the charge as being £4.00 a week to access the raft of NHS services it is a bargain.

About the price of a very basic fast food meal.

You won't get far by train on £4.00.

But you've completely missed my point.

You said it's £200 for access to healthcare, when it's two and a half times that, though the actual price is rather irrelevant.

I will concede that £500 for access to world class healthcare is very cheap, though others have already pointed the dangers of that policy.

My point is that if your or my wife decided to settle in the UK and got a job to contribute to the economy, they would pay NI contributions in their own right and still have to pay this surcharge, so in effect would be paying twice for access to the NHS, that just cannot be right.

[Jay Sata]

I appreciate what you say OG but not every partner will work from the day they arrive.

It is worth pointing out the change in rules means all EU migrants and visitors will be required to show a European Health Insurance Card in order to avoid being charged.

[theoldgit]

I appreciate what you say OG but not every partner will work from the day they arrive.

You're probably right I suspect not all spouses joining their UK National husband or wife will feel the need to work from day one, for a myriad of reasons, the same way as people that UK Nationals born and bred in the UK and married to a UK National don't always feel the need to work, they would be covered by their partners contributions and taxes, it would seem that because some UK Nationals have partners from outside the EU, they will be treated differently.

On a side, but related point, I suffered a major heart attack a couple of months ago on a jaunt to Singapore, whilst I was being resuscitated the hospital staff were riffling through my partners handbag looking for a credit card, OK maybe a slight exaggeration, but they were certainly looking for a decent deposit from her on the spot. She had to pay a deposit of SGN$5,000 before they would continue treatment, though I doubt very much if they would have allowed me to die. Throughout my stay in hospital, not a private one, they were giving me further invoices, the final bill was in the region of SGN$30,000, plus follow on treatment costs, which I was expected to pay before I flew back to Thailand.

Maybe the UK should adopt this approach.

[Jay Sata]

I hope you had travel insurance to cover that OG?

It is easy to slate the UK and it's NHS but in other parts of the world lack of funds can mean death.

I hope the new fees will be spent on hospital staff.

[theoldgit]

Yes I did, I took it out the day before we travelled.

The only snag with most Thai insurers is that they don't settle with the hospital, you have to pay up front and claim when you get home, in my case they did settle most of the claim.

[Bernard Flint]

I would not complain, that's a small price to pay in order to get immediate and full cover of NHS services.

But I,as an expat out of the U.K. for more than 6 months, have to pay full foreigner NHS fees even though I've paid years of National Insurance.

There is also a proposal that Brits who have paid NI for years will be entitled to NHS treatment without having to prove that they are ordinarily resident in the UK. We are still waiting to hear if the proposal will go through.

from age 65 brits care, even if living in thailand

[7by7]

National Insurance contributions fund contribution based benefits, the main one being, of course, the state pension. Only 2.05% of an individual's NICs goes to the NHS (source).

This is not, of course, anywhere near enough. The NHS is not funded from NI contributions; it is funded mainly from the exchequer; i.e all taxation. (See NHS funding and expenditure)

This, of course, does not just mean income tax but VAT, fuel duty etc.

Anyone using the immigration rules to settle in the UK via the family route must have a British or UK resident sponsor who is earning above £18,600 p.a. or has savings above £62,500 or a combination of income and savings.

Therefore it is probable that the sponsor is paying tax on their earned income or unearned income such as the interest on their savings.

If the family member is going to be working in the UK then they, too, will be paying income tax.

But even if neither of them are paying income tax, they will be paying indirect taxes, VAT etc., on nearly everything they buy.

So they will be contributing.

Now the government want them to contribute another £1000 (£500 at the initial visa stage, another £500 when applying for FLR).

The argument from someone who used his Irish nationality to obtain a free EEA family permit for his wife to live in the UK that this is less than £4 per week is missing the point.

Applicant's/sponsor's wont be able to pay it on a weekly basis; they will have to pay £500 up front with each application.

That's £500 on top of an application fee which, using the governments own figures, is already well over the actual cost of processing the visa.

If children are involved, then that's an additional £500 each!

If the government is really concerned about the cost to the NHS of non EEA immigrants then a fairer method would be to either

• insist that migrants have adequate health insurance until they have ILR, or, better still,
• allow them to contribute weekly or monthly until they have ILR via their or their sponsor's tax code.

[steve187]

surely British born nationals are entitled to NHS services due to that fact, they were born in the UK. that is the right of a citizen, NI contribution do not come into it.

yes if a UK national brings a wife to the UK, she could work and pay NI but how many do not, look how many wives from India are arriving in the UK, how many of them will work - not many and of those that do how many will not be on the 'books' so to speak.

So if a small proportion of the arriving wives work and pay NI, does that small amount cover what they are able to receive in terms of NHS services, i believe that the £200 is a start in the process of buying that first start in the NHS system, to try and allow the payment to be made weekly/monthly would be an extra cost to the system. NI contributions cover a whole array of services, a big chunk of which would be a pension, which many arriving wives would be entitled to after 10 years in the UK.

So I am in favour of the charge, my concern is what happens if the visa is refused, I also believe the visa costs are too extreme. and above all i believe that all persons arriving in the UK, from anywhere should pay the same charge, and if no family ties to the UK the cost should be more.

Lets think about this logically the NHS is struggling, a lot to do with The EU, not so much to do with arriving wives, but is £4.00 a week too much to pay for the services that the NHS provide, would we pay 200 Bhat a week to provide the same level of care, to arriving western husbands, or in fact would we pay this amount to cover our Thai wives in Thailand for the same service. £ 4.00 a week is not even a fish/chip dinner

Bringing the wife to live in the UK should be part of the marriage, not the only reason for the marriage.

[7by7]

Like others, Steve187, you are forgetting that it is not NICs which fund the NHS; it is taxation; direct and indirect.

Which means that, even if not working, everyone in the UK pays tax; VAT on almost everything they buy.

You also forget that it is not £200; it is £200 per year for the life of the visa applied for; a total of £500 for a family settlement visa. Then the same again for FLR.

It is also not £4 per week; this extra £500 will have to be paid up front in a lump sum at the time of the application.

Pushing the cost of a family settlement visa from the already extortionate £885 up to £1385!

The visa fee has to be paid in USD at a rate very favourable to UKVI; will this fee have to be paid in USD as well; making it even more expensive? Knowing UKVI and the government (whatever party) I am certain that it will be.

Of course, although of main concern to us on this forum, it is not just family migrants which will have to pay this additional fee. Take students, for example.

Many universities rely on overseas students and the fees they pay to stay financially afloat. Foreign students contribute annually £7billion to the UK economy.

How many foreign students considering studying in the UK, already put off by the UK's excessive visa fees, will decide to go to another country when they also have to pay an additional £150 per year of their course on top of that fee? As the average university course is 3 years, that's another £450.

So anyone who is thinking of studying in the UK will have to find the visa fee, £310, plus at least £450: a total of £760 on top of the already relatively high, compared to our major competitors, tuition fees. How many will pay that, and how many will decide to go elsewhere instead?

Our universities' competitors in Australia, the USA etc. will be rubbing their hands in glee when they see this news.

See this document for more on UK universities and their competitors.

I wish I could say that if Labour wins the election that this ill thought out, knee jerk measure will be scrapped; but bearing in mind Labour's record; I can't.

Edited January 18, 2015 by 7by7

[Jay Sata]

surely British born nationals are entitled to NHS services due to that fact, they were born in the UK. that is the right of a citizen, NI contribution do not come into it.

yes if a UK national brings a wife to the UK, she could work and pay NI but how many do not, look how many wives from India are arriving in the UK, how many of them will work - not many and of those that do how many will not be on the 'books' so to speak.

So if a small proportion of the arriving wives work and pay NI, does that small amount cover what they are able to receive in terms of NHS services, i believe that the £200 is a start in the process of buying that first start in the NHS system, to try and allow the payment to be made weekly/monthly would be an extra cost to the system. NI contributions cover a whole array of services, a big chunk of which would be a pension, which many arriving wives would be entitled to after 10 years in the UK.

So I am in favour of the charge, my concern is what happens if the visa is refused, I also believe the visa costs are too extreme. and above all i believe that all persons arriving in the UK, from anywhere should pay the same charge, and if no family ties to the UK the cost should be more.

Lets think about this logically the NHS is struggling, a lot to do with The EU, not so much to do with arriving wives, but is £4.00 a week too much to pay for the services that the NHS provide, would we pay 200 Bhat a week to provide the same level of care, to arriving western husbands, or in fact would we pay this amount to cover our Thai wives in Thailand for the same service. £ 4.00 a week is not even a fish/chip dinner

Bringing the wife to live in the UK should be part of the marriage, not the only reason for the marriage.

You make the case well,Steve.

Suggestions that migrants should buy insurance would still involve them paying a charge and in most cases most probably more than £4.00 a week.

Students applying to any major western University face a number of considerable charges. My eldest son owed £37k by the time he finished his MA while my youngest son spent a year at UCLA in Los. Angeles,as part of his degree.

The insurance for that was a lot more than £4.00 a week.

At the end of the day this is a charge on a person who is not a UK citizen,or pays UK taxes.

[steve187]

Yes i understand its a lump sum to find at the beginning, which is hard for all concerned, we all had to find the cash to finance moving our spouse to the UK, but its another plane fare, how many husbands fly to Thailand just to accompany the wife back. If the wife works, once here in the UK, she will easily recoup that money many times over.

If not this, what is the answer, the NHS having to charge everyone at the point of service, we all know stories of how the NHS is abused, over managed, but its there when we need it, some tough choices will have to be made in the future, state pensions have been delayed, some women have had to wait 2 or 3 years longer for their pension.

as i said in my earlier post its £4.00 a week, yes i know it will have to be found in a lump sum, and i also know the NHS is a greater burden on the country than Ni contribution income. I earned the NHS by birthright, newcomers will have to earn the right by a monetary payment, including in my opinion anyone from the EU.

I think its wrong the hoops we have to jump through to get our chosen beloved to the UK, but it is being made harder, and this is another step in that being made harder process.

The newer wedded persons that are now choosing to bring there wives to the UK, know the hoops and should be prepared for them, there are alternative ways, but these come with tough choices as well. ( Surinder Singh).

The ones i feel sorry for are the married a long time with kids type, that are struggling to make ends meet in Thailand and on a pension, that does not allow them to return to the UK with their families. their right to return to the UK should not be subjectto these new rules, but there are lots of things that are not perfect and we have to live with them, frozen pension amoungst them.

Don't get me started on students, i live in a student city........................

Edited January 18, 2015 by steve187