The UK government introduced the ‘Visitor and Migrant NHS Cost Recovery Programme’ in April 2014, the Department of Health’s objective was to ensure that non-UK residents (visitors, migrants and previous residents) make a fair contribution to the NHS for the costs of healthcare provided to them.

The National Health Service (Charges to Overseas Visitors) Regulations (2015)  allow the NHS to charge overseas visitors up to 150% of the standard NHS rate for all medical treatments in secondary care (which do not fall under the exemption list). In 2017, the regulations were expanded so as to require:

  • Providers of NHS-funded care (although not a part of the NHS) and other secondary care givers outside a hospital setting, to charge for the treatment provided by them to non-UK residents at the above said rate.
  • Advance payment for non-urgent planned care.
  • NHS trusts and foundation trusts to flag a patient’s record to indicate a chargeable status.

The above ‘expansions’ to the NHS (Charges to Overseas Visitors) Regulations were introduce to not only increase the funds available to the NHS but also to create an unfavourable environment for those who do not have a right to reside in the UK.  This means that ‘owing a debt to the NHS’ would be considered grounds for refusal of your leave to enter or remain applications.

Under the Immigration Rules for visitors (Appendix V), if a relevant NHS body has notified the Secretary of State (which they are required to do under the above said regulations), that an applicant owes the NHS at least £500 or above, their application would normally be refused (applicable to NHS charges incurred after 6th April 2016). If you owe the NHS for charges incurred between 1st November 2011 and 5th April 2016, the amount which would qualify for refusal would be at least £1,000.

Who can and cannot incur a debt to the NHS?

Any non-EEA national migrant or visitor who has not paid the Immigration Health Surcharge (IHS) towards their visa applications would fall under the ‘not ordinarily resident’ category. EEA nationals arriving in the UK after 31st December 2020 would be considered as overseas visitors for the purposes of incurring this debt.

The following overseas visitors are exempt from incurring this NHS charge or debt:

  • Those in the UK with valid visas of more than six months
  • Asylum seekers and refugees
  • Children looked after by a local authority
  • Victims and suspected victims of modern slavery
  • Prisoners and immigration detainees
  • Most EEA nationals and their family members
  • Residents of 17 countries with whom the UK has reciprocal health agreements, listed at pages 85 and 86 of the guidance (India is not one of them)

What type of medical treatment gives rise to an NHS debt?

Usually, urgent medical treatments received at a hospital would be more likely to incur an NHS debt. The following treatments are exempt from incurring the above said charges:

  • Accident & Emergency services, “not including services provided after the overseas visitor has been accepted as an inpatient or at a follow-up outpatient appointment”
  • Diagnosis and treatment for specified infectious diseases such as corona virus
  • Diagnosis and treatment for sexually transmitted infections, most commonly HIV
  • Family planning services (e.g. contraceptive products but not termination of pregnancy)
  • Palliative care services provided by a registered palliative care charity or a community interest company
  • Treatment required for a physical or mental condition caused by:
    • torture;
    • female genital mutilation;
    • domestic violence; or
    • sexual violence;

Unless the ‘overseas visitor’ traveled to the UK specifically for such treatments

Read How to extend UK Visit Visa due to Covid-19?

Can I enter the UK even with an outstanding debt to the NHS?

It is not a mandate that the Home Office refuse all applications where the applicant owes the NHS £500 or upwards, there is some amount of discretion given to the assessing officers, if “there are compelling or compassionate circumstances or human rights considerations that would make refusal inappropriate because discretion should be exercised in the person’s favour.”

Could you be refused even if you were not aware that you had an outstanding debt with the NHS?

Yes, if you owe the NHS £500 or upwards, your UK visa application may be refused even if you were not aware of the debt!
The only way to find out if you have incurred an NHS debt might be to contact the UK hospital where you received medical treatment and inquire regarding any pending charges in your name and then proceed with making your UK visa application, after the payment of any outstanding NHS charges or setting up a mutually agreed payment plan.

Read What to do if the UK visit visa is refused?

SmartMove2UK provides seamless immigration advice, ensuring that the applicant meets all the requirements set out under the Immigration Rules. Should you require help with your UK visa applications, you can ‘Book an online consultation‘ or contact our immigration expert based in London, Mumbai, Delhi, Bangalore and Chandigarh.


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