NHS UK eligibility - the truth?

[schoolies]

NHS cover eligibility is this correct? I think it is.

Returning to the UK to settle; official UK.Gov summary of 6.2 below

Citizens who return to the UK on a settled basis will be classed as ordinarily resident,

and will be eligible for free NHS care immediately.

6.2 British citizens, European Economic Area (EEA) nationals and non-EEA nationals with

indefinite leave to remain returning to resume properly settled residence in the UK will meet

the ordinary residence test (assuming their residence is lawful and voluntarily adopted), most

likely from the date of their arrival.

Basically if you have a UK passport holder, without restrictions, and state 'you intend to return to UK on a settled basis' you are entitled to immediate free NHS care in full. The chance that the UK government could prove that the statement 'you intend to return to UK on a settled basis' was not made in good faith is NIL.

If you are happy in Thailand stay there (like me). If you develop a serious illness, go back to UK and settle with a relative "in good faith". Your health cover with NHS is then 100%. You can also use 'the final years exemption'.

If you are just going on holiday, take out cover if you can get it but remember EMC is still available for everyone in UK as is GP access. You may be charged but on a 'reasonable ability to pay basis'. That you can query.

Lastly an observation. Tory politicians say they 'want to protect the NHS for taxpayers' . I am a full UK tax payer but as an ex-pat don't have automatic (see above) access to the NHS anymore? They do say "no taxation without representation!"

I would favour a 94 day NHS rule (if you stay in the UK for more than 93 days you are 'ordinarily resident for tax purposes'). How about if you stay in the UK for 94 days per year you are entitled to tax funded NHS services - just a thought to any budding politicians reading this. After all I do pay tax. I am MORE than willing to give up offshore interest rate returns for NHS access. Are you? Let your MP know.

[thai3]

what is the final years exemption? never heard of that

[NancyL]

Having known a few elderly British expats who have returned, there isn't the automatic assumption that they are returning for good or in their "final years", esp if they make the mistake of talking about "Thai wives" (even if they really mean girlfriends) or Thai children (ie. their girlfriend's children.

They are greeted with suspicion that they have come just temporarily for medical care and will soon return to their Thai wives and children. You have to be very careful to have cut all connection with Thailand. Actually, it helps if you go on overstay and are deported. Then you're welcome with open arms, especially if you're elderly.

[robertthebruce]

I have always kept a London Address....

[schoolies]

I agree there is not an 'automatic assumption' you are returning to settle. My point is if you are stating you are intending to settle in 'good faith' there is no way of proving you aren't? You will be staying at a UK address, can open a UK bank account can, to all intent and purpose, give every impression of settling in UK. Unless you say "I'm not really staying I'm just ill and will 'bog off' after treatment - surely you are OK?

As for 'final years'. If you (God forbid) become seriously ill (terminal even) you can say that you are settling in UK for your 'final years'. In fact these will be your 'final years' you will be settling in UK, voluntarily on a current UK passport, without restrictions, and again you are eligible for full NHS care on the day of arrival.

One musn't forget as a UK citizen you have the RIGHT to stay or settle in UK at any time.

As for the query re 'final years' it has been stated by the health secretary and by MP's in house of commons and is mentioned in UK.gov. docs. Basically if you want to settle in UK for your final years, no one can stop you (see above) and you will be entitled to NHS care on arrival. After all it is your country don't forget.

Refugees and migrants (EEA's too) have the right to settle in the UK and free/full NHS care on arrival. If you state your intent to settle (like a refugee or migrant may state) you too are entitled to the same care.

It's all about intent to settle and the actual settling in that country. I would only leave Thailand and settle in UK if I became seriously ill but that doesn't mean I can't chose to settle in UK because I am ill.

[schoolies]

Lastly there is no compunction to "cut all ties/ connections with Thailand" to state a desire to settle in UK in good faith. You can settle in the UK and continue to communicate with friends and relatives and provide monetary support for them. The point is the intent and desire in good faith shown by action and behaviour to gain a settled basis in UK.

There is only a need to prove a link with UK not to cut ties with Thailand (I have found no legal precedent to do so). Remember to try and evade/avoid UK tax there is a long convoluted Q and A to disprove you have cut all ties with UK. I've tried it - it's impossible. School there, friends there, culture, teams, work (your previous life) PROVES you have links with UK to force you to pay UK tax. They can't then turn around and say your intention to gain a 'settled basis' in UK is not in 'good faith'. As it is your home country. You are a citizen with full rights. You are, already, 'ordinarily resident for tax purposes' now you can exercise your right to a settled basis in UK for NHS care.

Citizens who return to the UK on a settled basis will be classed as ordinarily resident,

and will be eligible for free NHS care immediately.

[johnatong]

Here is evidence of at least one lady not being eligible for NHS care/treatment in spite of the fact that she worked as an NHS nurse for many years ...................

http://www.express.co.uk/news/uk/627709/NHS-Kathleen-Batten-hospital-bill

Edited May 28, 2016 by johnatong

[ThaiKneeTim]

Keep a UK address (friend or family) and bank account and have any mail fowarded to Thailand. That should be enough to fool the government into thinking you're still in residence.

[Henryford]

Correct you have to state that you are returning to stay in the UK permanently (whether true or not). But maybe be careful how you answer any questions like do you have a return ticket to Thailand, a Thai wife/children etc. Just say you have come back to stay in the UK till your death. They can't prove otherwise.

[i claudius]

Keep a UK address (friend or family) and bank account and have any mail fowarded to Thailand. That should be enough to fool the government into thinking you're still in residence.

Also be registered with a doctor ,have a British driving licence and renew your passport when you are over there ,

[stevenl]

Here is evidence of at least one lady not being eligible for NHS care/treatment in spite of the fact that she worked as an NHS nurse for many years ...................

http://www.express.co.uk/news/uk/627709/NHS-Kathleen-Batten-hospital-bill

She's living abroad and was in the UK on a short visit. So correct, not covered by NHS, she should have gotten travel insurance.

[evadgib]

https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations

HTH

Edited June 3, 2016 by evadgib

[NancyL]

I agree there is not an 'automatic assumption' you are returning to settle. My point is if you are stating you are intending to settle in 'good faith' there is no way of proving you aren't? You will be staying at a UK address, can open a UK bank account can, to all intent and purpose, give every impression of settling in UK. Unless you say "I'm not really staying I'm just ill and will 'bog off' after treatment - surely you are OK?

As for 'final years'. If you (God forbid) become seriously ill (terminal even) you can say that you are settling in UK for your 'final years'. In fact these will be your 'final years' you will be settling in UK, voluntarily on a current UK passport, without restrictions, and again you are eligible for full NHS care on the day of arrival.

One musn't forget as a UK citizen you have the RIGHT to stay or settle in UK at any time.

As for the query re 'final years' it has been stated by the health secretary and by MP's in house of commons and is mentioned in UK.gov. docs. Basically if you want to settle in UK for your final years, no one can stop you (see above) and you will be entitled to NHS care on arrival. After all it is your country don't forget.

Refugees and migrants (EEA's too) have the right to settle in the UK and free/full NHS care on arrival. If you state your intent to settle (like a refugee or migrant may state) you too are entitled to the same care.

It's all about intent to settle and the actual settling in that country. I would only leave Thailand and settle in UK if I became seriously ill but that doesn't mean I can't chose to settle in UK because I am ill.

Sorry, but I beg to differ based on some indigent British people that we've helped to return from here in Chiang Mai. Usually they start out in homeless shelters or perhaps with relatives, hoping to get subsidized housing, so they don't have a permanent "UK address" nor extra funds to open a UK bank account. They're put thru endless interviews by social workers about why they left Thailand and how they lived in Thailand if they were indeed indigent. Who supported them, how did they live? Usually they had money at one time, but it disappeared due to "circumstances" here. This is when the stories of Thai "wives" come out and/or maybe how they lost their fortunes building a home for their Thai wife. Some are truly committed to their wives and want to continue to send support and even are stupid enough to talk about wanting to return "once they get healthy". Such talk results in them having to wait to obtain the NHS benefits.

Somehow they're greeted much more kindly in the U.K. if they go on overstay and are deported and "blacklisted" from Thailand. That's a clear sign they aren't returning any time soon. Just as the U.K. welcomes incoming refugees, they seem to welcome incoming criminal U.K. nationals much better than those who stayed within the law here.

[moobie]

Strictly speaking if you are moving out of the UK on a permanent basis you are supposed to inform your GP so that you and any family members following you are removed from the GP's books.

http://www.nhs.uk/NHSEngland/Healthcareabroad/movingabroad/Pages/Introduction.aspx

As for treatment in any hospital, it is not just the Manager in charge of determining if you are actually "Normal Resident in the UK" but Nurses, Cleaners, etc.which you must be wary of. Any unwarranted slip of the tongue may lead to further investigation and potential charges. And yes many staff will have been told to report anything which may incriminate. (A further note, there are varying degrees of treatment which can be applied to the sick and poorly. Stabilisation/Emergency-only treatment may be given as a base level rather than the more normal full treatment depending on your residential status.)

[orientalist]

Unfortunately, as I found out long ago, when you move out and return your NHS card they destroy all your vaccination records. So, as for coming back, never say never...

[HauptmannUK]

My mother spent part of her life outside the UK. She was diagnosed with breast cancer a few years ago and returned to live with my sister. She was immediately treated by the NHS plus follow-up radiotherapy. At her first appointment she was asked to take her passport with her. That was looked at and then that was the end of the matter - immediate free treatment and no further questions asked.

If someone is returning to the UK and claiming to be destitute (i.e. requesting social housing) then I would expect and hope that Social Services would be very rigorous in checking the claim is genuine and the claimant is not sitting on assets abroad. The last thing I want to hear about is some old boy getting council accommodation whilst his wife is sitting in a smart house in Thailand - then when he feels like it he hops on a plane out of the UK again...

[chiang mai]

The OP's statement included the following para.:

" Basically if you have a UK passport holder, without restrictions, and state 'you intend to return to UK on a settled basis' you are entitled to immediate free NHS care in full. The chance that the UK government could prove that the statement 'you intend to return to UK on a settled basis' was not made in good faith is NIL".

I believe the above was written by a poster who is well known to post nonsense in order to disrupt a particular thread and/or to incite angry debate.

The above notwithstanding, the rules about NHS usage by expats have changed in recent years, my current understanding is that expats will be charged or threatened with charges until six months in country can be confirmed. In many cases there will be no need to have residency examined, in other cases it will be scrutinised very very closely, what happens also varies based on area it seems. There are NHS check lists of questions available on this site and on the web detailing the questions various Trusts are required/suggested to ask.

The above view is gained from my niece who is a UK hospital administrator.

[partington]

The OP's statement included the following para.:

" Basically if you have a UK passport holder, without restrictions, and state 'you intend to return to UK on a settled basis' you are entitled to immediate free NHS care in full. The chance that the UK government could prove that the statement 'you intend to return to UK on a settled basis' was not made in good faith is NIL".

I believe the above was written by a poster who is well known to post nonsense in order to disrupt a particular thread and/or to incite angry debate.

The above notwithstanding, the rules about NHS usage by expats have changed in recent years, my current understanding is that expats will be charged or threatened with charges until six months in country can be confirmed. In many cases there will be no need to have residency examined, in other cases it will be scrutinised very very closely, what happens also varies based on area it seems. There are NHS check lists of questions available on this site and on the web detailing the questions various Trusts are required/suggested to ask.

The above view is gained from my niece who is a UK hospital administrator.

This is not correct.

There is no minimum period of residence either stated in the NHS guidelines or officially legally implemented for eligibility for free NHS services . To be eligible you merely need to be settled in the UK, and you can be settled in the UK on the first day that you arrive, providing your intention is to live permanently. You may be asked to show this, but you do not need to be resident for any minimum period before becoming eligible. This is why EU migrant workers moving to the UK are eligible for NHS care from day 1.

The six months seems to be a confusion, probably about the application of an NHS surcharge which may be applied to NON-EU citizens (but never to UK returning expats who have unlimited leave to remain in the country by definition) who have applied for a visa to enter the UK for more than six months.

This is all dealt with in the guidelines published April 2016 online here:

https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations/summary-of-changes-made-to-the-way-the-nhs-charges-overseas-visitors-for-nhs-hospital-care

The most relevant quotes:

"Returning to the UK to settle

Citizens who return to the UK on a settled basis will be classed as ordinarily resident, and will be eligible for free NHS care immediately."

"Within England, free NHS hospital treatment is provided on the basis of someone being ‘ordinarily resident’. It is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK. The changes which came into effect from April [2015] affect visitors and former UK residents differently, depending on where they now live..."

"An immigration health charge (or ‘surcharge’) is now payable by non-EEA nationals who apply for a visa to enter or remain in the UK for more than 6 months. People with indefinite leave to remain in the UK [...] are not liable to pay the surcharge, but may be ordinarily resident here and entitled to free NHS healthcare on that basis."

Edited June 16, 2016 by partington

[chiang mai]

The OP's statement included the following para.:

" Basically if you have a UK passport holder, without restrictions, and state 'you intend to return to UK on a settled basis' you are entitled to immediate free NHS care in full. The chance that the UK government could prove that the statement 'you intend to return to UK on a settled basis' was not made in good faith is NIL".

I believe the above was written by a poster who is well known to post nonsense in order to disrupt a particular thread and/or to incite angry debate.

The above notwithstanding, the rules about NHS usage by expats have changed in recent years, my current understanding is that expats will be charged or threatened with charges until six months in country can be confirmed. In many cases there will be no need to have residency examined, in other cases it will be scrutinised very very closely, what happens also varies based on area it seems. There are NHS check lists of questions available on this site and on the web detailing the questions various Trusts are required/suggested to ask.

The above view is gained from my niece who is a UK hospital administrator.

This is not correct.

There is no minimum period of residence either stated in the NHS guidelines or officially legally implemented for eligibility for free NHS services . To be eligible you merely need to be settled in the UK, and you can be settled in the UK on the first day that you arrive, providing your intention is to live permanently. You may be asked to show this, but you do not need to be resident for any minimum period before becoming eligible. This is why EU migrant workers moving to the UK are eligible for NHS care from day 1.

The six months seems to be a confusion, probably about the application of an NHS surcharge which may be applied to NON-EU citizens (but never to UK returning expats who have unlimited leave to remain in the country by definition) who have applied for a visa to enter the UK for more than six months.

This is all dealt with in the guidelines published April 2016 online here:

https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations/summary-of-changes-made-to-the-way-the-nhs-charges-overseas-visitors-for-nhs-hospital-care

The most relevant quotes:

"Returning to the UK to settle

Citizens who return to the UK on a settled basis will be classed as ordinarily resident, and will be eligible for free NHS care immediately."

"Within England, free NHS hospital treatment is provided on the basis of someone being ‘ordinarily resident’. It is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK. The changes which came into effect from April [2015] affect visitors and former UK residents differently, depending on where they now live..."

"An immigration health charge (or ‘surcharge’) is now payable by non-EEA nationals who apply for a visa to enter or remain in the UK for more than 6 months. People with indefinite leave to remain in the UK [...] are not liable to pay the surcharge, but may be ordinarily resident here and entitled to free NHS healthcare on that basis."

I am aware of how this issue is worded but it is not the wording that's a problem, it's the interpretation of them and the process through which they are applied practically that creates secondary checks and balances, rightly so in my view:

Yes it is possible to be settled in the UK from the first day of arrival. But increasingly hospitals will want to see proof of that and in the absence of that proof there will be a wait period before the status is confirmed, in the case of the one NHS Trust I know well that period is six months.

There is a series of forms that were produced by DOH and issued to all Trusts, which set out the questions that should be asked by hospital staff to determine free eligibility and residency status, I'll try and dig them out and post them again. The forms ask a series of questions which, if all answered correctly, will help confirm settled status. The questions ask for evidence to prove things such as:

Overseas property/assets have been sold;

Time in country before needing medical care;

Patient travelled on a one way ticket;

UK bank account shows current activity consistent with a settled lifestyle AND that a history of the same exists;

Overseas funds have been transferred back to the UK;

The reasons given by the patient are consistent with wanting a change in lifestyle and not consistent with medical tourism;

And on and on.

So in a hypothetical scenario where a pensioner for example had been diagnosed with a major illness and was seeking free NHS treatment, his arrival in the UK one week after diagnosis, claiming settled status but without any of the above, would likely result in a six month wait before that status was confirmed.

In a second example, that same person who had been in the UK for a couple of months before being diagnosed and was able to meet all the criteria above, almost certainly wouldn't have a problem and would be considered settled.

[i claudius]

My mother spent part of her life outside the UK. She was diagnosed with breast cancer a few years ago and returned to live with my sister. She was immediately treated by the NHS plus follow-up radiotherapy. At her first appointment she was asked to take her passport with her. That was looked at and then that was the end of the matter - immediate free treatment and no further questions asked.

If someone is returning to the UK and claiming to be destitute (i.e. requesting social housing) then I would expect and hope that Social Services would be very rigorous in checking the claim is genuine and the claimant is not sitting on assets abroad. The last thing I want to hear about is some old boy getting council accommodation whilst his wife is sitting in a smart house in Thailand - then when he feels like it he hops on a plane out of the UK again...

What ,like the Romanians do?

[dick dasterdly]

An appalling situation when overseas residents (who have spent their entire working lives in the UK and are still paying UK tax) have to worry about 'jumping through hoops' to receive free NHS care.

[chiang mai]

An appalling situation when overseas residents (who have spent their entire working lives in the UK and are still paying UK tax) have to worry about 'jumping through hoops' to receive free NHS care.

AND, if they do have to pay, those same expat UK residents have to pay 50% more than any other nationality, they must pay 150% of NHS charges, it's scandalous.

[Bunnychow]

Keep a UK address (friend or family) and bank account and have any mail fowarded to Thailand. That should be enough to fool the government into thinking you're still in residence.

Also be registered with a doctor ,have a British driving licence and renew your passport when you are over there ,

Which also convinces the UK tax man you may also be resident for tax purposes as well and they may not declare you non resident for tax purposes...going this route does not suit all people, certainly if they do spend time in the UK in any given tax year

[bluesofa]

Keep a UK address (friend or family) and bank account and have any mail fowarded to Thailand. That should be enough to fool the government into thinking you're still in residence.

I've read in the UK press over the last couple of years that UK immigration are planning to stamp (or monitor anyway) UK nationals entering and leaving the UK, something they haven't done in the past.

Then there's the intergrated IT system that's so far cost millions and was still not working the last I heard about it. The idea is that when it does work, many government agencies can track passport holders movements in and out of the country, making it more difficult to use a UK address if you're living abroad.

[Ricardo]

New rules on eligibility are now due to come into effect  ...  even UK-citizens who pay UK Income-Tax, may in-future need to pay up-front for some non-essential treatment, unless they can prove UK-residency at the hospital, according to a story on the BBC-website this morning  ...

 

http://www.bbc.com/news/health-41692815

 

"Providers of NHS treatment are required from Monday to make sure patients in England are eligible for free care - and to charge them up front if not.  The measures apply to planned, non-urgent care - A&E, maternity, general practice and infectious disease treatment remain free to all.

 

The government hopes it will contribute to £22bn of savings needed in the NHS."

[Eff1n2ret]

1 hour ago, Ricardo said:

New rules on eligibility are now due to come into effect 

The rules have been in place since April 2015, but it looks as if hospitals are now required to be more robust in enforcing them - and it's not just for "non-essential  treatment", any in-patient treatment will be charged for. I suppose if you're actually having a heart attack or are a woman in labour they are unlikely to keep you hanging about in reception while they frisk you for your credit card or a utility bill, but of course those of us expats with a bank account or property in the UK, or whose pensions are paid from the UK are an easy target compared with foreign visitors who have no assets which can be easily seized.

I don't visit the UK now without travel insurance, but that would only be effective for accidental injuries, as there are no travel policies available in Thailand to septuagenarians which include pre-existing conditions. There will come a point in future years as my health deteriorates when I can not afford the risk of being ill when visiting my home country, so I will no longer be able to go and see my grandchildren and family. The thought makes me quite angry, considering I'm still paying my full whack of income tax.

[steve187]

1 hour ago, Ricardo said:

New rules on eligibility are now due to come into effect  ...  even UK-citizens who pay UK Income-Tax, may in-future need to pay up-front for some non-essential treatment, unless they can prove UK-residency at the hospital, according to a story on the BBC-website this morning  ...

 

http://www.bbc.com/news/health-41692815

 

"Providers of NHS treatment are required from Monday to make sure patients in England are eligible for free care - and to charge them up front if not.  The measures apply to planned, non-urgent care - A&E, maternity, general practice and infectious disease treatment remain free to all.

 

The government hopes it will contribute to £22bn of savings needed in the NHS."

not really aimed at uk born and passports, but may catch some out if they are not careful, it looks to me to be aimed at EU, medical tourists.

 

quote here - Health Minister Lord O'Shaughnessy said: "We have no problem with overseas visitors using our NHS as long as they make a fair financial contribution, just as the British taxpayer does.

[Ricardo]

On the other hand, it's perfectly possible to be British-born, have paid NICs for decades, still pay income-tax in the UK, and yet now be non-resident & thus not eligible for free non-urgent care.

 

As indeed many Brits living in Thailand are.

 

I think the requirement to get the money off you, before they start treating you, is the key change.

[partington]

4 hours ago, Eff1n2ret said:

. I suppose if you're actually having a heart attack or are a woman in labour they are unlikely to keep you hanging about in reception while they frisk you for your credit card or a utility bill,

You should read the actual conditions before trying to be ironic.  

 

The charges refer to non-emergency pre-planned care only:

5 hours ago, Ricardo said:

The measures apply to planned, non-urgent care - A&E, maternity, general practice and infectious disease treatment remain free to all.

A& E means accident and emergency, and is specifically defined as being free to all, so you not daring to visit the UK in case you have an accident or emergency during a visit might be considered a bit inappropriate.

[dick dasterdly]

12 minutes ago, partington said:

You should read the actual conditions before trying to be ironic.  

 

The charges refer to non-emergency pre-planned care only:

A& E means accident and emergency, and is specifically defined as being free to all, so you not daring to visit the UK in case you have an accident or emergency during a visit might be considered a bit inappropriate.

But still annoys the hell out of those of us who spent our entire working lives paying UK tax and, now retired (living abroad but still paying tax on those pensions) - will be charged 150% of the NHS cost .

 

Edit - to look on the 'bright' side.... only a few will be affected as 'expats' are only likely to go back for NHS treatment - unless they are unfortunate enough to suffer a life-threatening (but possibly curable) problem.

Edited October 23, 2017 by dick dasterdly