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The National Health Service (Charges to Overseas Visitors) Regulations 2015

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Statutory Instruments

2015 No. 238

National Health Service, England

The National Health Service (Charges to Overseas Visitors) Regulations 2015

Made

5th February 2015

Laid before Parliament

16th February 2015

Coming into force

6th April 2015

The Secretary of State for Health, in exercise of the powers conferred by sections 175 and 272(7) and (8) of the National Health Service Act 2006 M1, makes the following Regulations.

Marginal Citations

M12006 c.41. By virtue of section 271(1) of the National Health Service Act 2006 (“the 2006 Act”) the powers of the Secretary of State exercised in making these Regulations are exercisable only in relation to England.

PART 1E+WIntroduction

Citation and commencementE+W

1.  These Regulations may be cited as the National Health Service (Charges to Overseas Visitors) Regulations 2015 and come into force on 6th April 2015.

InterpretationE+W

2.  In these Regulations—

“the 1971 Act” means the Immigration Act 1971M2;

“the 2006 Act” means the National Health Service Act 2006;

“the 2014 Act” means the Immigration Act 2014M3;

[F1“actual charge” has the meaning given in regulation 3(7);]

[F1“advance payment sum” has the meaning given in regulation 3(7);]

“authorised child” means a child who—

(a)

has been granted leave to enter the United Kingdom with a parent for the purpose of the parent receiving a course of treatment in respect of which no charge may be made or recovered under regulation 17; or

(b)

is a child of an authorised companion;

“authorised companion” means a person who has been granted leave to enter the United Kingdom to accompany a person who is obtaining a course of treatment—

(a)

[F2 in respect of which no charge may be made or recovered under regulation 17;] [F3or

(b)

ordinarily resident in Ukraine and is obtaining a course of treatment;]

“child” means a person who is under the age of eighteen;

[F4“competent institution” has the same meaning as in Regulation (EC) No 883/2004 or Regulation (EEC) No 1408/71, as the case may be;]

“entry clearance” has the meaning given in section 33(1) (interpretation) of the 1971 ActM4;

[F5“equivalent document” means a document which, for the purposes of a listed healthcare arrangement, as defined in regulation 1(3) of the Healthcare (European Economic Area and Switzerland Arrangements) (EU Exit) Regulations 2019, is treated as equivalent to an S1 healthcare certificate ;]

“immigration health charge” means a charge payable under an order made under section 38 (immigration health charge) of the 2014 Act;

“immigration rules” means the rules laid before Parliament under section 3(2) (general provisions for regulation and control) of the 1971 Act;

“overseas visitor” means a person not ordinarily resident in the United KingdomM5;

“parental responsibility” has the meaning given in section 3 (meaning of “parental responsibility”) of the Children Act 1989M6;

“reciprocal agreement” means arrangements agreed mutually between the Government of the United Kingdom and the Government of a country or territory outside the United Kingdom for the provision of health care;

“registered dentist” has the meaning given in section 53(1) (interpretation) of the Dentists Act 1984M7;

[F6“Regulation (EC) No 883/2004” means Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems, as it had effect immediately before IP completion day;

“Regulation (EEC) No 1408/71” means Council Regulation (EEC) No 1408/71 of 14 June 1971 on the application of social security schemes to employed persons, to self-employed persons and to members of their families moving within the Community, as it had effect immediately before IP completion day;]

[F1“relevant body” means—

(a)

an NHS foundation trust;

(b)

an NHS trust;

(c)

a local authority within the meaning of section 2B of the 2006 Act (functions of local authorities and Secretary of State as to improvement of public health) exercising public health functions (within the meaning of that Act); or

(d)

any other person providing relevant services,

except in respect of regulation 6A, for which purposes a person mentioned in paragraph (d) is not a “relevant body”;]

F7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“relevant services” means accommodation, services or facilitiesM8 which are provided, or whose provision is arranged, under the 2006 Act other than—

(a)

primary medical services provided under Part 4 (medical services);

(b)

primary dental services provided under Part 5 (dental services);

(c)

primary ophthalmic services provided under Part 6 (ophthalmic services); or

(d)

equivalent services which are provided, or whose provision is arranged, under the 2006 Act;

“ship” includes fishing vessels and hovercraft;

“treatment the need for which arose during the visit” means—

(a)

diagnosis of symptoms or signs occurring for the first time after the overseas visitor's arrival in the United Kingdom; or

(b)

treatment, provided that the overseas visitor has not travelled to the United Kingdom for the purpose of seeking that treatment, which in the opinion of a registered medical practitioner or registered dentist employed by or providing services to the [F8relevant body] is required promptly for a condition which arose, or became acutely exacerbated, after the overseas visitor's arrival, or which, but for the treatment, would be likely to become acutely exacerbated,

which cannot wait until the overseas visitor can reasonably be expected to return to the overseas visitor's country of ordinary residence.

Textual Amendments

Marginal Citations

M4The definition of “entry clearance” in section 33(1) was amended by the British Nationality Act 1981 (c. 61), Schedule 4, paragraph 2, and the Immigration Act 1988 (c. 14), Schedule, paragraph 5.

M5The meaning of ordinary residence in section 175 of the 2006 Act was amended by section 39 (related provision: charges for health services) of the Immigration Act 2014 (c. 22) which has not yet come into force.

M71984 c. 24; to which there are amendments not relevant to these Regulations.

M8“Facilities” is defined in s275(1) of the 2006 Act.

PART 2E+WProvision for making and recovery of charges

Obligation to make and recover chargesE+W

3.—(1) Where the condition specified in paragraph (2) is met, a [F9relevant body] must make and recover charges for any relevant services it provides to an overseas visitor from the person liable under regulation 4 (liability for payment of charges).

[F10(1A) Where the condition specified in paragraph (2) is met, before providing a relevant service in respect of an overseas visitor, a relevant body must secure payment for the estimated amount of charges to be made under paragraph (1) for that relevant service unless doing so would prevent or delay the provision of—

(a)an immediately necessary service; or

(b)an urgent service.

(1B) The person from whom payment is to be secured under paragraph (1A) in respect of a relevant service is the person who it appears to the relevant body, at the time that the request for that payment is made, will be the person to whom a charge will be made under paragraph (1) in respect of that relevant service at the time that it is provided.]

(2) The condition is that the [F9relevant body], having made such enquiries as it is satisfied are reasonable in all the circumstances, including in relation to the state of health of that overseas visitor, determines that the case is not one in which these Regulations provide for no charge to be made.

[F11(3) Where more than one relevant body is to provide relevant services to an overseas visitor, each relevant body must secure the advance payment sum in respect of each relevant service that it is to provide.

(3A) Where more than one relevant body provides relevant services to an overseas visitor, each relevant body must make and recover the actual charge in respect of each relevant service that it provides.

(4) A relevant body that makes and recovers a charge in accordance with paragraph (1) or secures payment in accordance with paragraph (1A) must give or send to the person making the payment a receipt for the amount paid.

(4A) In making and recovering an actual charge from a person in respect of a relevant service, a relevant body must—

(a)deduct any advance payment sum secured by the relevant body from that person in respect of that relevant service; and

(b)refund any amount by which an advance payment sum secured by the relevant body from that person in respect of that relevant service exceeds the amount of the actual charge that person is liable to pay.]

(5) Subject to paragraph (6), where—

(a)a [F9relevant body] has determined that an overseas visitor is exempt from being charged for relevant services under these Regulations, except where the overseas visitor is exempt from being charged by virtue of—

(i)regulation 10 (immigration health charge);

(ii)regulation 11 (overseas visitors who have made applications for entry clearance or leave to remain prior to the commencement of the immigration health charge); F12...

(iii)regulation 25(3) (family members of overseas visitors – children born to a parent exempt under regulation 10 or 11); [F13or]

[F14(iv)regulation 14 (reciprocal health care agreements);]

(b)the overseas visitor has received relevant services from a [F9relevant body] as part of a course of treatment; and

(c)prior to the course of treatment being completed, a [F9relevant body] has determined that the overseas visitor is no longer exempt from being charged for relevant services under these Regulations,

a [F9relevant body] may not make and recover charges under paragraph (1) in respect of relevant services provided as part of that course of treatment during a period where the overseas visitor has remained in the United Kingdom without absence.

(6) Paragraph (5) does not apply where a [F9relevant body] has determined that a person is exempt from being charged for relevant services as a result of that body receiving fraudulent or misleading information.

[F15(7) In this regulation—

“actual charge” means a charge to be made under paragraph (1);

“advance payment sum” means a sum to be secured under paragraph (1A);

“immediately necessary service” means—

(a)

antenatal services provided in respect of a person who is pregnant;

(b)

intrapartum and postnatal services provided in respect of—

(i)

a person who is pregnant;

(ii)

a person who has recently given birth; or

(iii)

a baby; and

(c)

any other relevant service that the treating clinician determines the recipient needs promptly—

(i)

to save the recipient’s life;

(ii)

to prevent a condition becoming immediately life-threatening; or

(iii)

to prevent permanent serious damage to the recipient from occurring;

“urgent service” means a service that the treating clinician determines is not an immediately necessary service but which should not wait until the recipient can be reasonably expected to leave the United Kingdom.]

Textual Amendments

[F16Obligation to record information against an overseas visitor’s consistent identifierE+W

3A.—(1) An NHS foundation trust or an NHS trust that, in meeting its obligations under regulation 3, determines that a person is an overseas visitor must, as soon as it is practicable to do so, record against the overseas visitor’s consistent identifier—

(a)the fact that the person has been determined to be an overseas visitor;

(b)the date on which that determination was made; and

(c)whether Part 4 (overseas visitors exempt from charges) provides for no charge to be made.

(2) In this regulation, “consistent identifier” means a consistent identifier specified in regulation 2 of the Health and Social Care Act 2012 (Consistent Identifier) Regulations 2015.]

Textual Amendments

Liability for payment of chargesE+W

4.—(1) The person liable to pay charges under these Regulations is, unless paragraph (2), (3) or (4) applies, the overseas visitor in respect of whom the relevant services are provided.

(2) Where—

(a)an overseas visitor is employed or engaged or works in any capacity on board a ship and whose normal place of work is on board a ship; and

(b)that overseas visitor is present in the United Kingdom in the course of that employment, engagement or work,

the person liable to pay charges under these Regulations is the shipowner of the ship on which the overseas visitor is employed, engaged or works.

(3) Where an overseas visitor is an air crew member and is present in the United Kingdom in the course of that employment, the person liable to pay charges under these Regulations is the employer of that overseas visitor.

(4) Where an overseas visitor is a child, the person liable to pay charges under these Regulations is the person with parental responsibility for that child.

[F17(4A) Where, due to a change in circumstances occurring during the period in which a relevant service is provided, more than one person is liable under paragraphs (1) to (4) to pay charges under these Regulations in respect of that relevant service, each such person is liable to pay charges only in respect of relevant services provided during the period during which those paragraphs apply to that person.]

(5) In this regulation—

“air crew member” means any person employed or engaged in an aircraft in flight on the business of the aircraft;

“shipowner” has the meaning given in regulation 2(1) (interpretation) of the Merchant Shipping (Maritime Labour Convention) (Minimum Requirements for Seafarers etc) Regulations 2014 M9.

Textual Amendments

Marginal Citations

[F18Repayment of a sum recovered or secured by a relevant bodyE+W

5.—(1) A claim to a relevant body for repayment of a sum—

(a)recovered in respect of charges made; or

(b)secured in respect of an estimated amount of charges to be made,

under these Regulations may be made by the person who paid the sum to the relevant body (“the claimant”).

(2) When making a claim under paragraph (1), the claimant must provide to the relevant body—

(a)the receipt for payment of the sum or other evidence of the claimant’s having paid the sum;

(b)a declaration in support of the claim signed by or on behalf of the claimant; and

(c)such other evidence in support of the declaration as the relevant body may require.

(3) Where a claimant makes a claim under paragraph (1) and the relevant body is satisfied that any sum was paid to it by the claimant in respect of—

(a)a charge that should not have been made and recovered under these Regulations;

(b)a relevant service that was not, or will not in the reasonably foreseeable future be, provided by the relevant body;

(c)an advance payment sum, which was paid by or on behalf of a person who is not liable to pay an actual charge in respect of the relevant service to which the advance payment sum relates; or

(d)a charge that should not have been recovered as a consequence of regulation 6A(2)(b) (provision relating to victims of female genital mutilation and supported individuals),

the relevant body must repay that sum to the claimant.]

Textual Amendments

Provision relating to recovery of charges in respect of refugees and victims of [F19modern slavery] E+W

6.—(1) This paragraph applies to an overseas visitor who—

(a)received relevant services from a [F20relevant body];

(b)subsequent to receiving the relevant services, has become an overseas visitor who is exempt from charges under—

(i)regulation 15(a) (refugees, asylum seekers, supported individuals and looked after children); or

(ii)regulation 16 (victims of [F21modern slavery]); and

(c)at the time that the overseas visitor received the relevant services—

(i)where paragraph (1)(b)(i) applies, was in the United Kingdom for the purpose of making an application to be granted temporary protection, asylum or humanitarian protection under the immigration rules, but had not made that application; or

(ii)where paragraph (1)(b)(ii) applies, was a person to whom regulation 16 applies but had not yet been identified as such.

(2) An overseas visitor to whom paragraph (1) applies is to be treated for the purposes of these Regulations as if, at the time that the relevant services were provided, the overseas visitor was an overseas visitor in respect of whom no charge may be made or recovered for the relevant services.

(3) A [F20relevant body] which, in respect of an overseas visitor to whom paragraph (1) applies, has—

(a)yet to make charges under regulation 3 (obligation to make and recover charges), must not make the charges;

(b)made charges under regulation 3 but has yet to recover the charges, must not recover the charges; or

(c)made charges under regulation 3 and received payment in respect of the charges, must repay any sum paid in respect of the charges in accordance with regulation 5 [F22(repayment of a sum recovered or secured by a relevant body)].

Textual Amendments

[F23Provision relating to victims of female genital mutilation and supported individualsE+W

6A.—(1) This paragraph applies to an overseas visitor who received relevant services from a [F24relevant body] during the period beginning on 6th April 2015 and ending on 31st January 2016, where—

(a)those services were provided for the treatment of a condition, which was caused by female genital mutilation in the circumstances described in paragraph (d) of the definition of “female genital mutilation” in regulation 8(1) (interpretation of this part); or

(b)at the time the relevant services were provided—

(i)the overseas visitor was a person in respect of whom an application to be granted temporary protection, asylum or humanitarian protection under the immigration rules had been rejected; and

(ii)the overseas visitor was supported under Part 1 (care and support) of the Care Act 2014 by the provision of accommodation.

(2) A [F24relevant body] which, in respect of an overseas visitor to whom paragraph (1) applies, has—

(a)yet to make a charge under regulation 3 (obligation to make and recover charges), must not make the charges; or

(b)made charges under regulation 3 but has yet to recover the charges, must not recover the charges.]

Textual Amendments

Charges imposed on overseas visitorsE+W

7.—(1) The [F25relevant body] must calculate charges made under these Regulations[F26, including where charges are estimated for the purposes of determining an advance payment sum,] in accordance with this regulation.

F27(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(3) [F28Unless paragraph (3A) applies], the charge payable in respect of each relevant service provided to an overseas visitor shall be equal to the tariff for that relevant service multiplied by 150 per cent.

[F29(3A) Where an overseas visitor who is ordinarily resident in an EEA state or Switzerland has—

(a)before IP completion day received relevant services from a relevant body, or

(b)on or after IP completion day received relevant services from a relevant body as part of a course of treatment which commenced before IP completion day,

the charges payable in respect of those services must be calculated in the same way as provided for by regulation 13(1) of the National Health Service (Cross-Border Healthcare) Regulations 2013.]

(4) In this regulation “the tariff” has the meaning set out in paragraphs (5) to (8), subject to paragraphs (9) to (12).

(5) [F30Where] a relevant service is specified in the national tariff under section 116(1)(a) (national tariff) of the 2012 Act, the tariff for the provision of that service to an overseas visitor is such price as is determined in accordance with the national tariff on the basis of the national price specified in the national tariff for that service F31... including any applicable modification referred to in paragraph (10).

(6) Where—

(a)a [F25relevant body] provides a relevant service to an overseas visitor that is included in a bundle of services to which a pathway payment applies in accordance with the national tariff;

(b)that relevant service constitutes part, but not all, of the bundle of services; and

(c)the [F25relevant body] is unable to determine the price of that relevant service as an individual service within the bundle of services to which the pathway payment relates,

the tariff is such reasonable price for the provision of the relevant service that [F32the relevant body] determines having had regard to the matters set out in paragraph (7).

(7) The matters to which the [F25relevant body] must have regard for the purposes of determining the tariff for a relevant service under paragraph (6) are—

(a)the amount of the pathway payment which would be payable to the [F25relevant body] in accordance with the national tariff, by the commissioner with responsibility for commissioning services in respect of the overseas visitor to whom the relevant service was provided, if that overseas visitor were ordinarily resident in the United Kingdom;

(b)the relevant service that the overseas visitor received as a proportion of the bundle of services to which the pathway payment applies; and

(c)the complexity of the relevant service provided to the overseas visitor.

[F33(8) Where a relevant service is not specified in the national tariff under section 116(1)(a) of the 2012 Act and—

(a)the rules specified in the national tariff under section 116(4)(b) of that Act make provision for a unit price to be used as the basis for determining the price payable for that service (even if only in certain circumstances specified in the rules), the tariff is such price as would be determined for that service in accordance with those rules on the basis of that unit price;

(b)where paragraph (6) and sub-paragraph (a) of this paragraph do not apply, the tariff for the provision of that service is such price as is determined in accordance with the rules specified in the national tariff under section 116(4)(b) of the 2012 Act.]

(9) The following variations to the national price of a relevant service made under the 2012 Act shall not apply to the determination of the national price for that relevant service for the purpose of paragraph (5)—

(a)a variation agreed to by the commissioner of the service and the [F25relevant body] that is providing that service in accordance with rules made under section 116(2);

(b)a variation specified in the national tariff under section 116(4)(a), except for a variation—

(i)to reflect regional cost difference; or

(ii)to reflect patient complexity.

(10) An applicable modification is any modification to the price, as determined in accordance with the national tariff, of the relevant service where that modification is—

(a)made in accordance with an agreement made under section 124(1) of the 2012 Act; or

(b)determined by Monitor under section 125(1) of the 2012 Act.

(11) For the purposes of determining the tariff for a relevant service provided to an overseas visitor—

(a)under paragraph (5) F34..., a modification of the kind specified in paragraph (10) will apply to the relevant service only when the modification applies to the price payable to the [F25relevant body] by the commissioner with responsibility for commissioning services in respect of that overseas visitor; and

(b)under paragraph (8), an agreement between a commissioner and the [F25relevant body] made in accordance with the rules [F35specified in the national tariff under section 116(4)(b) of the 2012 Act] will be relevant for the determination of the tariff only when the commissioner which is party to the agreement is the commissioner with responsibility for commissioning services in respect of that overseas visitor.

(12) Where rules made under section 116(6) provide for which specification of a relevant service is to apply in a particular case or cases of any particular description, the [F25relevant body] must comply with those rules when calculating charges under this regulation for that relevant service.

(13) For the purposes of this regulation—

“the 2012 Act” means the Health and Social Care Act 2012 M10;

“national price” has the meaning given in section 115(1) (price payable by commissioners for NHS services) of the 2012 Act;

“national tariff” is the document known as the national tariff published by Monitor under section 116(1) of the 2012 Act M11;

F36...

F37(14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

Marginal Citations

M11The 2014/15 national tariff is published on the following website: https://www.gov.uk/government/publications/national-tariff-payment-system-2014-to-2015 or available from the Pricing Team, Monitor, 3rd Floor Wellington House, 133-155 Waterloo Road, London SE1 8UG.

PART 3E+WRelevant services exempt from charges

Interpretation of this PartE+W

8.—(1) In this Part—

“female genital mutilation” means the excision, infibulation or other mutilation (collectively referred to as mutilation) of the whole or any part of a female's labia majora, labia minora or clitoris where—

(a)

that mutilation constituted an offence under the Female Genital Mutilation Act 2003M12 (“the 2003 Act”);

(b)

if the mutilation was performed prior to the coming into force of the 2003 Act, that mutilation would have constituted an offence under the 2003 Act if the Act had been in force at the time the mutilation was performed; F38...

(c)

if the mutilation was performed outside the United Kingdom but did not constitute an offence under the 2003 Act, that mutilation would have constituted an offence under the 2003 Act had it been performed in the United Kingdom; [F39or]

(d)

[F40if the mutilation was performed outside the United Kingdom prior to the coming into force of the 2003 Act, that mutilation would have constituted an offence under the 2003 Act if—

(i)

the mutilation had been performed in the United Kingdom; and

(ii)

the 2003 Act had been in force at the time the mutilation was performed;]

F41. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“torture” has the meaning given in Article 1(1) of the United Nations Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (agreed in New York on 4th February 1985)M13.

(2) The reference to treatment in regulation 9(f) includes—

(a)any subsequent or on-going treatment provided to an overseas visitor for any condition, including a chronic condition, that is directly attributable to the torture, female genital mutilation, domestic violence or sexual violence; and

(b)in the case of female genital mutilation, any antenatal, perinatal and postpartum treatment provided to an overseas visitor the need for which is directly attributable to the mutilation.

Textual Amendments

Marginal Citations

M13Cm 1775. The Convention entered into force in respect of the United Kingdom on 7th January 1989.

Relevant services exempt from chargesE+W

9.  No charge may be made or recovered in respect of any of the following relevant services provided to an overseas visitor—

(a)accident and emergency services, but not including any services provided—

(i)after the overseas visitor has been accepted as an in-patient at a hospital M14; or

(ii)at an outpatient appointment;

[F42(aa)services provided as part of the telephone advice line commissioned by a clinical commissioning group or the National Health Service Commissioning Board;]

F43(b). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(c)family planning services;

(d)services provided for the diagnosis and treatment of a condition listed in Schedule 1;

(e)services provided for the diagnosis and treatment of sexually transmitted infections;

(f)services provided for the treatment of a condition caused by—

(i)torture;

(ii)female genital mutilation;

(iii)domestic violence; or

(iv)sexual violence,

provided that the overseas visitor has not travelled to the United Kingdom for the purpose of seeking that treatment.

[F44(g)palliative care services provided by—

(i)a company referred to in section 26 of the Companies (Audit, Investigations and Community Enterprise) Act 2004 (community interest companies); or

(ii)a palliative care charity within the meaning given in section 33D of the Value Added Tax Act 1994 (charities to which section 33C applies);]

Textual Amendments

Marginal Citations

M14“Hospital” is defined in section 275(1) of the 2006 Act.

PART 4E+WOverseas visitors exempt from charges

[F45Interpretation of this PartE+W

9A.  In this Part—

“chargeable assisted conception services” means any medical, surgical or obstetric services provided for the purpose of assisting a person to carry a child, other than—

(a)

a service that the National Health Service Commissioning Board must arrange under the following regulations of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibility and Standing Rules) Regulations 2012—

(i)

regulation 7 (services for serving members of the armed forces and their families);

(ii)

regulation 8 (infertility treatment: seriously injured serving members and veterans); or

(iii)

regulation 9 (infertility treatment: further provision); or

(b)

a service provided as part of a course of treatment, where that course of treatment began before 21st August 2017.]

Textual Amendments

Immigration health chargeE+W

10.—(1) In this regulation “relevant period” means—

(a)where—

(i)an immigration health charge is payable M15;

(ii)an exemption from paying an immigration health charge applies as a consequence of any exemption provided for in an order made under section 38 (immigration health charge) of the 2014 Act;

(iii)the Secretary of State has exercised discretion to reduce or waive all or part of an immigration health charge in accordance with such an order; F46...

(iv)the Secretary of State has exercised discretion to refund part F47... of an immigration health charge paid under such an [F48order; or]

[F49(v)in a case to which paragraph (5) applies, the Secretary of State has exercised discretion to refund all of an immigration health charge paid under such an order,]

the period of leave to enter or remain in the United Kingdom which is granted to the overseas visitor, or has effect on their arrival in the United Kingdom, in respect of the application for entry clearance or leave to remain to which the immigration health charge, exemption, reduction [F50, refund] or waiver relates; and

(b)in a case where the overseas visitor's leave to enter or remain in the United Kingdom is extended by virtue of—

(i)section 3C (continuation of leave pending variation decision) M16; or

(ii)section 3D (continuation of leave following revocation) M17,

of the 1971 Act, the period in respect of which leave is extended under those sections.

(2) [F51Subject to paragraph (2A),] no charge may be made or recovered under these Regulations in respect of any relevant services provided during the relevant period to an overseas visitor in respect of whom—

(a)an immigration health charge has been paid;

(b)an exemption from paying such an immigration health charge applies, unless paragraph (3) applies;

(c)[F52subject to paragraph (6),] a reduction or waiver from paying such an immigration health charge applies; or

(d)a refund for part, [F53or in a case to which paragraph (5) applies (but only in that case)] all, of an immigration health charge has been made,

in accordance with an order made under section 38 of the 2014 Act.

[F54(2A) Paragraph (2) does not apply in respect of chargeable assisted conception services.]

(3) [F55Subject to paragraph (4), this] paragraph applies where a person is exempt from payment of an immigration health charge under an order made under section 38 of the 2014 Act by virtue of having made an application—

(a)for entry clearance where, if granted in accordance with the immigration rules, the entry clearance would have effect on arrival in the United Kingdom as leave to enter for 6 months or less, or where the leave to enter which may be granted pursuant to that entry clearance would be for 6 months or less if granted in accordance with the immigration rules; or

[F56(b)for entry clearance—

(i)before 6th April 2016, under Part 2 of the immigration rules (visitors to the UK); or

(ii)on or after 6th April 2016, under Appendix V to the immigration rules (immigration rules for visitors).]

[F57(4) Paragraph (3) does not apply where a person is exempt from the payment of an immigration health charge by virtue of Schedule 2, paragraph 1(o) of the Immigration (Health Charge) Order 2015.

(5) No charge may be made to or recovered from a person under these Regulations—

(a)in respect of any relevant services provided to that person on or after 27th October 2020 and during the relevant period, and

(b)where a full refund of an immigration health charge has been made to, or in respect of, that person on the ground that they are a—

(i)person who is working in the field of health or social care; or

(ii)dependant of a person who is working in the field of health or social care.]

[F58(6) Paragraph (2) does not apply in respect of relevant services that are provided to an overseas visitor —

(a)who is granted leave to remain in the United Kingdom under Appendix S2 Healthcare Visitor to the immigration rules, and

(b)in respect of whom a waiver to the immigration health charge applies,

where those relevant services are not part of the planned healthcare treatment authorised by that person’s S2 healthcare certificate.]

Textual Amendments

Marginal Citations

M15It is anticipated that an order will be made under section 38 of the Immigration Act 2014 to be in force on the 6th April 2015, but if that is not the case then regulations 10, 11 and 25(3) have no practical effect until such time as an order is made.

M161971 c. 77; section 3C was amended by the Nationality, Immigration and Asylum Act 2002 (c. 41), section 118; the Immigration, Asylum and Nationality Act 2006 (c. 13), section 11(1) to (4); and the Immigration Act 2014 (c. 22) (the 2014 Act), Schedule 9, paragraphs 20 and 21.

M17Section 3D was amended by the Immigration, Asylum and Nationality Act 2006, section 11(5) and the 2014 Act, Schedule 9, paragraphs 20 and 22.

Overseas visitors who have made applications for entry clearance or leave to remain prior to the commencement of the immigration health chargeE+W

11.—(1) In this regulation “relevant period” means—

(a)the period of leave to enter or remain in the United Kingdom granted to the overseas visitor in respect of the application for entry clearance or leave to remain to which paragraph (3)(a) refers; and

(b)in a case where the overseas visitor's leave to enter or remain in the United Kingdom is extended by virtue of—

(i)section 3C (continuation of leave pending variation decision); or

(ii)section 3D (continuation of leave following revocation),

of the 1971 Act, the period in respect of which leave is extended under those sections.

(2) In this regulation “relevant date” means the date of coming into force of the first order made under section 38 of the 2014 Act.

(3) [F59Subject to paragraph (3A),] no charge may be made or recovered under these Regulations in respect of any relevant services provided to an overseas visitor during the relevant period who—

(a)made an application for entry clearance or leave to remain in the United Kingdom before the relevant date and was granted leave to enter or remain in the United Kingdom or entry clearance which has effect on the overseas visitor's arrival in the United Kingdom as leave to enter or remain in the United Kingdom in respect of that application;

(b)has entered, or remained in, the United Kingdom by virtue of that leave to enter or remain; and

(c)had that application for entry clearance or leave to remain been made on or after the relevant date, would be—

(i)liable to pay an immigration health charge; or

(ii)exempt from paying an immigration health charge as a consequence of an exemption provision under an order made under section 38 of the 2014 Act, unless paragraph (4) applies.

[F60(3A) Paragraph (3) does not apply in respect of chargeable assisted conception services.]

(4) This paragraph applies where an overseas visitor—

(a)would be exempt from an immigration health charge under an order made under section 38 of the 2014 Act by virtue of having made an application of a kind described in regulation 10(3)(a) or (b) (immigration health charge); or

(b)has been granted leave to enter or remain in the United Kingdom outside the immigration rules for 6 months or less.

Textual Amendments

[F61Overseas visitors with citizens’ rightsE+W

12.—(1) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who has an entitlement to the provision of those services without charge by virtue of a right arising from—

(a)Title III of Part 2 of the withdrawal agreement,

(b)Title III of Part 2 of the EEA EFTA separation agreement, or

(c)the social security co-ordination provisions of the Swiss citizens’ rights agreement.

(2) In paragraph (1), “withdrawal agreement”, “EEA EFTA separation agreement” and “Swiss citizens’ rights agreement” have the same meanings as in section 39(1) of the European Union (Withdrawal Agreement) Act 2020.]

Textual Amendments

[F62Overseas visitors with Trade and Cooperation Agreement rightsE+W

12A.—(1) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who has an entitlement to the provision of those services without charge by virtue of a right arising from the SSC Protocol provisions of the Trade and Cooperation Agreement.

(2) In paragraph (1), “the SSC Protocol” has the same meaning as in section 26(5) of the European Union (Future Relationship) Act 2020 (“the 2020 Act”) and “the Trade and Cooperation Agreement” has the same meaning as in section 37(1) of the 2020 Act.]

Textual Amendments

[F63Overseas visitors with a United Kingdom issued S1 healthcare certificate or equivalent documentE+W

13.  No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who—

(a)was ordinarily resident in an EEA state or Switzerland immediately before IP completion day,

(b)continues to be ordinarily resident in an EEA state or Switzerland on and after IP completion day,

(c)receives a state pension paid by the United Kingdom Government, and

(d)holds an S1 healthcare certificate, or an equivalent document, issued to or in respect of that person by a competent institution of the United Kingdom.

Textual Amendments

Persons who make late applications under Appendix EU to the immigration rulesE+W

13A.—(1) Subject to paragraph (4), no charge may be made or recovered in respect of relevant services provided to an overseas visitor to whom paragraph (2) or (3) applies during the period which begins with the date on which the application mentioned in paragraph (2)(b) or (3)(b), as the case may be, is made and which ends with the date on which that application is finally determined under Appendix EU to the immigration rules.

(2) This paragraph applies to a person who is an overseas visitor by virtue of section 39 of the 2014 Act who—

(a)is eligible to apply for leave to enter or remain in the United Kingdom under Appendix EU to the immigration rules, and

(b)makes a valid application for leave to enter or remain in the United Kingdom under that Appendix to those rules after the application deadline.

(3) This paragraph applies to a person who is an overseas visitor by virtue of section 39 of the 2014 Act who—

(a)was granted limited leave to enter or remain in the United Kingdom under Appendix EU to the immigration rules, and

(b)after the expiry of that limited leave to enter or remain, makes a valid application for indefinite leave to enter or remain in the United Kingdom under Appendix EU to the immigration rules.

(4) Where it is determined under Appendix EU to the immigration rules not to grant leave to enter or remain in the United Kingdom to a person pursuant to an application mentioned in paragraph (2)(b) or (3)(b), as the case may be, a relevant body must make and recover charges for any relevant services provided to that person during the period specified in paragraph (1).

(5) Where a person is granted leave to enter or remain in the United Kingdom pursuant to an application mentioned in paragraph (2)(b) or (3)(b)—

(a)if the relevant body has made charges for relevant services provided during the period specified in paragraph (1), it must not recover those charges;

(b)if the relevant body has made and recovered charges for relevant services provided during the period specified in paragraph (1), it must repay any sum paid in respect of those charges in accordance with regulation 5.

(6) In paragraph (2), “application deadline” has the meaning given in regulation 2 of the Citizens’ Rights (Application Deadline and Temporary Protection) (EU Exit) Regulations 2020.]

Textual Amendments

Reciprocal health care agreementsE+W

14.  No charge may be made or recovered in respect of any relevant services provided to an overseas visitor where those services are provided in circumstances covered by a reciprocal agreement with a country or territory specified in Schedule 2.

[F64Family members of British citizens of Northern IrelandE+W

14C.—(1) No charge may be made or recovered in respect of relevant services provided to an overseas visitor who—

(a)is ordinarily resident in the United Kingdom (disregarding section 39 of the Immigration Act 2014 (immigration health charge related provision: charges for health services));

(b)has leave to enter or remain under Appendix EU to the immigration rules granted on the basis of a relationship with a relevant person of Northern Ireland; and

(c)would, at the date of assessment of whether a charge under these Regulations falls to be made, have a right to reside in accordance with the Immigration (European Economic Area) Regulations 2016, disregarding that the relevant person of Northern Ireland is not included in the definition of “EEA national” in regulation 2 (general interpretation).

(2) In paragraph (1), “relevant person of Northern Ireland” has the meaning given in Appendix EU to the immigration rules.]

Textual Amendments

Modifications etc. (not altering text)

Refugees, asylum seekers, supported individuals and looked after childrenE+W

15.  No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who—

(a)has been granted temporary protection, asylum or humanitarian protection under the immigration rules;

[F65(aa)has leave to enter or remain in the United Kingdom as the dependant of a person granted temporary protection, asylum or humanitarian protection under the immigration rules;]

(b)has made an application, which has not yet been determined, to be granted temporary protection, asylum or humanitarian protection under [F66the immigration rules];

[F67(ba)is treated as a dependant of a person described in paragraph (b) for the purposes of an application described in that paragraph;]

(c)is currently supported under section 95 (persons for whom support may be provided) of the Immigration and Asylum Act 1999 M18 (“the 1999 Act”);

(d)has made an application to be granted temporary protection, asylum or humanitarian protection under the immigration rules which was rejected and who is supported under—

(i)section 4(2) (facilities for the accommodation of a person) of the 1999 Act M19; F68...

F69(ii). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; or

[F70(iii)Part 1 (care and support) of the Care Act 2014 [F71or section 35 or 36 of the Social Services and Well-being (Wales) Act 2014,] by the provision of accommodation; F72...]

[F73(da)is treated as the dependant of a person described in paragraph (d) for the purposes of the provision of support under that paragraph; or]

(e)is a child who is looked after by a local authority within the meaning of section 22(1) (general duty of local authority in relation to children looked after by them) of the Children Act 1989 M20 [F74or, as the case may be, section 74(1) of the Social Services and Well-being (Wales) Act 2014 (child or young person looked after by a local authority)].

Textual Amendments

Marginal Citations

M181999 c. 33; section 95 was amended by the Nationality, Immigration and Asylum Act 2002 (c. 41), section 44(1) and (6) and 50(1).

M201989 c. 41; section 22(1) was amended by the Local Government Act 2000 (c. 22), Schedule 5, paragraph 19; the Children (Leaving Care) Act 2000 (c. 35), section 2(1) and (2), and the Adoption and Children Act 2002 (c. 38), section 116(2).

[F75Victims of modern slaveryE+W

16.—(1) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor, where a competent authority—

(a)has identified the overseas visitor as a victim of modern slavery; or

(b)considers that there are reasonable grounds to believe that the overseas visitor is a victim of modern slavery, and—

(i)a competent authority is required to make a conclusive determination; and

(ii)there has not been a conclusive determination by a competent authority that the overseas visitor is not a victim of modern slavery.

(2) In this regulation—

“competent authority” means a designated competent authority of the United Kingdom for the purposes of the Trafficking Convention;

“Trafficking Convention” means the Council of Europe Convention on Action against Trafficking in Human Beings (agreed at Warsaw on 16th May 2005);

“victim of modern slavery” means a victim of—

(a)

trafficking in human beings, which has the same meaning as in the Trafficking Convention, as set out in article 4 of that Convention; or

(b)

slavery, servitude, or forced or compulsory labour, which have the same meaning as they have for the purposes of article 4 of the Convention for the Protection of Human Rights and Fundamental Freedoms (agreed at Rome on 4th November 1950).]

Textual Amendments

Exceptional humanitarian reasonsE+W

17.—(1) Where an overseas visitor who has been granted leave to enter the United Kingdom outside the immigration rules—

(a)applies (or someone applies on the overseas visitor's behalf) for exemption from charges in respect of relevant services for a course of treatment; and

(b)the Secretary of State determines that exceptional humanitarian reasons justify it,

no charge may be made or recovered in respect of relevant services provided to that overseas visitor for that course of treatment.

(2) A determination under paragraph (1)(b) may only be made by the Secretary of State if the Secretary of State is satisfied, in the case of that overseas visitor, that—

(a)the treatment specified is not available in that person's home country;

(b)the necessary arrangements have been made for temporary accommodation for that person, any authorised companion and authorised child for the duration of the course of treatment; and

(c)the necessary arrangements have been made for the return of that person, any authorised companion and any authorised child to their home country when the course of treatment is completed.

Overseas visitors detained in hospital or subject to court ordered treatmentE+W

18.  No charge may be made or recovered in respect of relevant services provided to an overseas visitor—

(a)who is liable to be detained in a hospital, received into guardianship or subject to a community treatment order under the Mental Health Act 1983 M21;

(b)who is detained in a hospital in circumstances which amount to deprivation of the overseas visitor's liberty and that deprivation of liberty is authorised under any of the following provisions of the Mental Capacity Act 2005 M22—

(i)section 4A (restriction on deprivation of liberty) M23;

(ii)section 4B (deprivation of liberty necessary for life-sustaining treatment etc) M24;

(iii)section 16 (powers to make decisions and appoint deputies: general); or

(iv)Schedule A1 (hospital and care home residents: deprivation of liberty) M25;

(c)whose detention in hospital is authorised by any other enactment authorising detention in a hospital; or

(d)who is required to submit to a specified form of treatment that is imposed by, or included in, an order of a court and paragraph (a), (b) or (c) does not apply.

Marginal Citations

M211983 c. 20. Section 17A(3) of the Mental Health Act 1983, which was inserted by section 32(1) and (2) of the Mental Health Act 2007 (c. 12) (“the 2007 Act”), defines “community treatment order” for the purposes of that Act.

M23Section 4A was inserted by the 2007 Act, section 50(1) and (2).

M24Section 4B was inserted by the 2007 Act, section 50(1) and (2).

M25Schedule A1 was inserted by the 2007 Act, Schedule 7.

Prisoners or detaineesE+W

19.—(1) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor—

(a)who is detained in prison or in a place in which a person may be detained that is provided by the Secretary of State under section 43(1) (remand centres and young offender institutions) of the Prison Act 1952 M26; or

(b)who is detained under any of the following provisions—

(i)Schedule 2 (administrative provisions as to control on entry etc) M27 or Schedule 3 (supplementary provisions as to deportation) M28 to the 1971 Act;

(ii)section 62 (detention by Secretary of State) of the Nationality, Immigration and Asylum Act 2002 M29;

(iii)section 40(7)(c) (searches: contracting out) of the Immigration, Asylum and Nationality Act 2006 M30; or

(iv)section 2 (detention) or 36 (detention) of the UK Borders Act 2007 M31.

(2) In this regulation, “prison” has the meaning given in section 53(1) of the Prison Act 1952 M32.

Marginal Citations

M261952 c. 52; section 43(1) was amended by the Criminal Justice Act 1988 (c. 33), Schedule 8, paragraph 1, Schedule 15, paragraph 11, Schedules 16 and 18; the Criminal Justice and Public Order Act 1994 (c. 33), section 5(2), 18(3) and Schedule 11; the Crime and Disorder Act 1998 (c. 37), Schedule 8, paragraph 6; the Powers of Criminal Courts (Sentencing) Act 2000 (c. 6), Schedule 9, paragraph 5(1) and (2); the Criminal Justice and Immigration Act 2008 (c. 4), Schedule 26, paragraph 3, and the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (c. 10), Schedule 12, paragraph 4.

M271971 c. 77; Schedule 2 was amended by the Criminal Justice Act 1972 (c. 71), Schedule 6, Part II; the British Nationality Act 1981 (c. 61), Schedule 4, paragraphs 2 and 3(1); the Immigration Act 1988 (c. 14), Schedule, paragraphs 6 to 9 and 10(1); the Asylum and Immigration Act 1996 (c. 49), Schedule 2, paragraphs 5 to 12 and Schedule 4; the Access to Justice Act 1999 (c. 22), Schedule 13, paragraph 70; the Immigration and Asylum Act 1999 (c. 33), section 18, 19, 132(2), 134(2), 135(2), 136(2), 139(2), 140, Schedule 14, paragraphs 43, 56 to 65, 67 and Schedule 16; the Nationality, Immigration and Asylum Act 2002 (c. 41), sections 63, 64, 73(1) and (5), 119 and Schedule 7, paragraphs 2, 4 and 6; the Courts Act 2003 (c. 39), Schedule 8, paragraph 149; the Health Protection Agency Act 2004 (c. 17), Schedule 3, paragraph 3; the Asylum and Immigration (Treatment of Claimants, etc) Act 2004 (c. 19), section 16, 18 and Schedules 2 and 4, paragraph 1; the Immigration, Asylum and Nationality Act 2006 (c. 13), sections 27, 31 and 42 and Schedule 3; the Immigration Act 2014 (c. 22), section 5, 7, 9, 13, Schedule 1, paragraphs 1, 2(1) and 3, Schedule 2, paragraph 1, Schedule 8, Schedule 9, paragraphs 1, 20, 23 and 72; S.I. 1990/2227, 1993/1813, 2010/21 and 2014/1704.

M28Schedule 3 was amended by the Criminal Justice Act 1982 (c. 48), Schedule 10; the Immigration Act 1988 (c. 14), Schedule, paragraph 10(2); the Asylum and Immigration Act 1996 (c. 49), Schedule 2, paragraph 13; the Immigration and Asylum Act 1999 (c. 33), section 54 and Schedule 14, paragraphs 43 and 68; the Nationality, Immigration and Asylum Act 2002 (c. 41), Schedule 7, paragraph 7 and 8; the Courts Act 2003 (c. 39), Schedule 8, paragraph 150 and Schedule 10; the Asylum and Immigration (Treatment of Claimants, etc) Act 2004 (c. 19), section 34; the Immigration, Asylum and Nationality Act 2006 (c. 13), section 53, and the Immigration Act 2014 (c. 22), Schedule 1, paragraph 2(2) and Schedule 9, paragraphs 9, 20 and 24.

M292002 c. 41; section 62 was amended by the Prevention of Terrorism Act 2005 (c. 2), section 16(2)(c) and the Immigration Act 2014 (c. 22), Schedule 9, paragraphs 3(1), (2) and 13.

M312007 c. 30; section 2 was amended by the Borders, Citizenship and Immigration Act 2009 (c. 11), section 52(1).

M321952 c. 52. There are amendments to section 53(1) but none are relevant.

Members of the regular and reserve forces, Crown servants and othersE+W

20.—(1) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is—

(a)a member of the regular or reserve forces within the meaning of the Armed Forces Act 2006 M33;

(b)a qualifying employee who is visiting the United Kingdom in the course of the qualifying employment; or

(c)where paragraph (b) does not apply, a qualifying employee who—

(i)was ordinarily resident in the United Kingdom immediately prior to becoming a qualifying employee; or

(ii)where the qualifying employee has been employed in more than one position of qualifying employment, the qualifying employee was ordinarily resident in the United Kingdom immediately prior to taking up one of the positions of qualifying employment.

(2) An overseas visitor will be a “qualifying employee” if the overseas visitor was recruited in the United Kingdom and is—

(a)a Crown servant (other than a person falling within paragraph (1)(a)) employed by, or in the service of, the Government of the United Kingdom;

(b)an employee of the British Council or the Commonwealth War Graves Commission; or

(c)working in employment, whether or not the overseas visitor derives a salary or wage from that employment, that is financed in part by the Government of the United Kingdom in accordance with arrangements with the Government of some other country or territory or a public body in such other country or territory.

(3) In this regulation “qualifying employment” means any period of employment during which the overseas visitor was a qualifying employee.

Marginal Citations

M332006 c. 52; “the regular forces” and “the reserve forces” are defined in section 374 of the Armed Forces Act 2006 as amended by the Defence Reform Act 2014 (2014 c. 20), section 44(3)(a), (b) and (4).

NATO forcesE+W

21.—(1) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a person to whom Article IX(5) of the Agreement regarding the Status of Forces of Parties to the North Atlantic Treaty (agreed in London on 19th June 1951) M34 applies.

(2) This regulation applies where the services in question cannot readily be provided by the medical services of the armed forces of—

(a)the overseas visitor's own country; or

(b)the United Kingdom.

Marginal Citations

M34Cmd. 9363.

War pensioners and armed forces compensation scheme payment recipientsE+W

22.  No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is in receipt of—

(a)any pension or other benefit under a Personal Injuries Scheme or Service Pensions Instrument, which Scheme and Instrument are defined in regulation 2(1) (interpretation) of the Social Security (Overlapping Benefits) Regulations 1979 M35; or

(b)a payment made under article 15(1)(c) (description of benefits – injury) or article 29(1) (description of benefits – death) of the Armed Forces and Reserve Forces (Compensation Scheme) Order 2011 M36.

Marginal Citations

M35S.I. 1979/597, amended by S.I. 1980/1927; there are other amending instruments but none is relevant.

M36S.I. 2011/517, amended by S.I. 2011/2552; there are other amending instruments but none is relevant.

[F76Overseas visitors from UkraineE+W

22A.—(1) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who—

(a)is lawfully present in the United Kingdom; and

(b)is ordinarily resident in Ukraine.

(2) This paragraph applies to an overseas visitor who, during the relevant period—

(a)received relevant services from a relevant body and who is exempt from charges for those services by virtue of—

(i)paragraph (1);

(ii)regulation 25(2)(d) (family members of overseas visitors); or

(iii)regulation 25(3)(a)(iii) (child aged 3 months or less born to a parent lawfully present in the United Kingdom and ordinarily resident in Ukraine); or

(b)received relevant services consisting of treatment the need for which arose during the visit from a relevant body and who is exempt from charges for those services by virtue of being—

(i)an authorised companion; or

(ii)an authorised child

who has been granted leave to enter the United Kingdom to accompany a person who is exempt from charges under paragraph (1).

(3) An overseas visitor to whom paragraph (2) applies is to be treated for the purposes of these Regulations as if, at the time that the relevant services were provided, the overseas visitor was an overseas visitor in respect of whom no charge may be made or recovered for those relevant services.

(4) A relevant body which, in respect of an overseas visitor to whom paragraph (2) applies, has—

(a)yet to make charges under regulation 3 (obligation to make and recover charges), must not make the charges;

(b)made charges under regulation 3 but has yet to recover the charges, must not recover the charges; or

(c)made charges under regulation 3 and received payment in respect of the charges, must repay any sum paid in respect of the charges in accordance with regulation 5 (repayment of a sum recovered or secured by a relevant body).

(5) Paragraphs (1) to (3) do not apply in respect of chargeable assisted conception services.

(6) In this regulation “the relevant period” means the period from 24th February 2022 to the coming into force of these Regulations.]

Textual Amendments

Employees on shipsE+W

F7723.  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

Treatment the need for which arose during the visitE+W

24.— [F78(1)]  No charge may be made or recovered in respect of any relevant services, consisting of treatment the need for which arose during the visit, provided to an overseas visitor who is any of the following—

(a)a national of a state which is a contracting party to the European Convention on Social and Medical Assistance (agreed in Paris on 11th December 1953) M37 or the European Social Charter (agreed in Turin on 18th October 1961) M38 and is—

(i)lawfully present in the United Kingdom; and

(ii)without sufficient resources to pay the charge;

(b)an authorised child or an authorised companion.

[F79(2) No charge may be made or recovered in respect of any relevant services, consisting of treatment the need for which arose during the relevant period, provided to an overseas visitor who—

(a)is in the United Kingdom during the relevant period;

(b)has been given an accreditation pass by the Organising Committee to allow them to participate in the Games; and

(c)is not part of the Games Workforce.

(3) In this regulation—

the “Games” and the “Organising Committee” have the meaning given in section 1 of the Birmingham Commonwealth Games Act 2020;

“the relevant period” means the period beginning with 14th July 2022 and ending with 17th August 2022;

the “Games Workforce” means—

(a)

a person engaged by the Organising Committee; or

(b)

a person engaged to a supplier, contractor or sub-contractor of the Organising Committee.]

Textual Amendments

Marginal Citations

M37Cmd. 9512. The Convention entered into force in respect of the United Kingdom on 7th September 1954.

M38Cmd. 2643. The Charter entered into force in respect of the United Kingdom on 11th July 1962. Article 13 provides the right to social and medical assistance.

Family members of overseas visitorsE+W

25.—(1) For the purposes of this regulation, unless otherwise provided, “member of the family” means—

(a)the spouse or civil partner of an overseas visitor; or

(b)a child in respect of whom an overseas visitor has parental responsibility.

(2) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a member of the family of another overseas visitor (“the principal overseas visitor”) and is lawfully present if the principal overseas visitor is exempt from charges under any of the following regulations—

[F80(za)regulation 13 (overseas visitors with a United Kingdom issued S1 healthcare certificate or equivalent document);]

(a)regulation 16 (victims of [F81modern slavery]);

(b)regulation 20 (members of the regular and reserve forces, Crown servants and others);

(c)regulation 21 (NATO forces).

[F82(d)subject to paragraph (2A), regulation 22A(1) (overseas visitors from Ukraine).]

[F83(2A) Paragraph (2)(d) does not apply in respect of chargeable assisted conception services.]

(3) No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a child who—

(a)is born in the United Kingdom to a parent who is exempt from charges by virtue of—

(i)regulation 10 (immigration health charge); F84...

(ii)regulation 11 (overseas visitors who have made applications for entry clearance or leave to remain prior to the commencement of the immigration health charge); [F85or

(iii)regulation 22A(1) (overseas visitors from Ukraine);]

(b)is aged 3 months or less; and

(c)has not left the United Kingdom since birth.

(4) Subject to paragraphs (5) to (7) of this regulation, no charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a member of the family of a principal overseas visitor if—

(a)the overseas visitor is lawfully present in the United Kingdom;

(b)the overseas visitor is visiting the United Kingdom with the principal overseas visitor; and

(c)the principal overseas visitor is exempt from charges under—

[F86(i)regulation 12 (overseas visitors with citizens’ rights); or]

F87(ii). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(iii)regulation 22 (war pensioners and armed forces compensation scheme payment recipients).

[F88(5) Where the overseas visitor is a member of the family of a principal overseas visitor who is exempt from charges under regulation 12 (overseas visitors with citizens’ rights), the exemption in paragraph (4) applies only if the conditions in both paragraph (6) and (7) are satisfied.]

[F89(6) The first condition is that—

(a)the overseas visitor does not have a right arising from a provision mentioned in regulation 12(1)(a) to (c) (overseas visitors with citizens’ rights), and

(b)the reason that the overseas visitor does not have such a right is because the overseas visitor is not recognised as a member of the family (within the meaning of Article 1(i) of Regulation (EC) No 883/2004).]

(7) The second condition is that the relevant services provided to the overseas visitor are services that the overseas visitor would be entitled to receive without charge by virtue of [F90a right arising from a provision mentioned in regulation 12(1)(a) to (c) if the overseas visitor had such a right].

(8) None of the provisions of this regulation affect any entitlement which any member of the family of an overseas visitor may have to an exemption from charges for relevant services by virtue of [F91a right arising from a provision mentioned in regulation 12(1)(a) to (c)] or any other exemption which they may be entitled to in their own right.

Textual Amendments

PART 5E+WConsequential amendments, savings and revocations

Consequential amendmentsE+W

26.  The consequential amendments set out in Schedule 3 have effect.

Savings and revocationsE+W

27.  The instruments set out in column (1) of the table in Schedule 4 are saved in respect of charges made, or to be made, and recovered for courses of treatment (whether continuing or not) commenced before the 6th April 2015, but are otherwise revoked to the extent set out in column (3) of that table.

Signed by authority of the Secretary of State for Health.

Earl Howe

Parliamentary Under-Secretary of State,

Department of Health

Regulation 9

SCHEDULE 1E+WDiseases for which no charge is to be made for treatment

  • Acute encephalitis

  • Acute poliomyelitis

  • Anthrax

  • Botulism

  • Brucellosis

  • Cholera

  • Diphtheria

  • Enteric fever (typhoid and paratyphoid fever)

  • Food poisoning

  • Haemolytic uraemic syndrome (HUS)

  • Human immunodeficiency virus (HIV)

  • Infectious bloody diarrhoea

  • Invasive group A streptococcal disease and scarlet fever

  • Invasive meningococcal disease (meningococcal meningitis, meningococcal septicaemia and other forms of invasive disease)

  • Legionnaires' disease

  • Leprosy

  • Leptospirosis

  • Malaria

  • Measles

  • [F92Middle East Respiratory Syndrome (MERS)]

  • Mumps

  • Pandemic influenza (defined as the “Pandemic Phase”) or influenza that might become pandemic (defined as the “Alert Phase”) as defined by WHO in the World Health Organisation's (“WHO”) Pandemic Influenza Risk Management Interim GuidanceM39

  • Plague

  • Rabies

  • Rubella

  • Severe Acute Respiratory Syndrome (SARS)

  • [F93Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)]

  • Smallpox

  • Tetanus

  • Tuberculosis

  • Typhus

  • Viral haemorrhagic fever

  • Viral hepatitis

  • Whooping cough

  • F94...

  • Yellow fever

Textual Amendments

Marginal Citations

M39The Guidance may be obtained from the World Health Organisation website: http://www.who.int/influenza/preparedness/pandemic/influenza_risk_management/en/ or from the Department of Health, Pandemic Influenza Preparedness Team, Room 101 Richmond House, 79 Whitehall, London SW1A 2NS.

Regulation 14

SCHEDULE 2E+WReciprocal agreements

  • Anguilla

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Australia

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • F96. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • [F97Bosnia and Herzegovina]

  • British Virgin Islands

  • Falkland Islands

  • [F98Faroe Islands]

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Gibraltar

  • [F99Ireland]

  • Isle of Man

  • Israel

  • Jersey

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Kosovo

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • F100. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Montenegro

  • Montserrat

  • New Zealand

  • [F101North Macedonia]

  • [F99Norway]

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Serbia

  • [F102Switzerland]

  • St Helena

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Turks and Caicos Islands

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • F95. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Textual Amendments

F102Word in Sch. 2 inserted (coming into force in accordance with reg. 1(2) of the amending S.I.) by The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2021 (S.I. 2021/1123), reg. 2

Regulation 26

SCHEDULE 3E+WConsequential amendments

Amendment of the Personal Injuries (NHS Charges) (General) and Road Traffic (NHS Charges) (Amendment) Regulations 2006E+W

1.  In the Personal Injuries (NHS Charges) (General) and Road Traffic (NHS Charges) (Amendment) Regulations 2006 M40, in regulation 1 (citation, commencement, application and interpretation), in paragraph (3), in the definition of “overseas visitors' charge” for “or regulation 3 of the National Health Service (Charges to Overseas Visitors) Regulations 2011 (obligation to make and recover charges)” substitute “ , regulation 3 of the National Health Service (Charges to Overseas Visitors) Regulations 2011 (obligation to make and recover charges) or regulation 3 of the National Health Service (Charges to Overseas Visitors) Regulations 2015 (obligation to make and recover charges) ”.

Marginal Citations

Amendment of the Human Tissue Act 2004 (Ethical Approval, Exceptions from Licensing and Supply of Information about Transplants) Regulations 2006E+W

2.  In the Human Tissue Act 2004 (Ethical Approval, Exceptions from Licensing and Supply of Information about Transplants) Regulations 2006 M41, in Schedule 2 (receipt of transplantable material), in paragraph 10(c) after “Schedule 2 to the National Health Service (Charges to Overseas Visitors) Regulations 2011” insert “ , Schedule 2 to the National Health Service (Charges to Overseas Visitors) Regulations 2015 ”.

Marginal Citations

Amendment of the National Health Service (Cross-Border Healthcare) Regulations 2013E+W

3.  In the National Health Service (Cross-Border Healthcare) Regulations 2013 M42, at the end of regulation 14 (exemption from NHS charges for certain persons who reside in another member State) insert—

“(5) None of the provisions of this regulation affect any entitlement which any person may have to the provision of services without charge by virtue of regulations made under section 175 of the NHS Act.”.

Marginal Citations

Regulation 27

SCHEDULE 4E+WRevocations

(1) Instruments revoked(2) References(3) Extent of revocation
The National Health Service (Charges to Overseas Visitors) Regulations 2011SI 2011/1556The whole Regulations
The National Health Service (Charges to Overseas Visitors) Amendment Regulations 2012SI 2012/1586The whole Regulations
The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2014SI 2014/1534The whole Regulations
The National Treatment Agency (Abolition) and the Health and Social Care Act 2012 (Consequential, Transitional and Saving Provisions) Order 2013SI 2013/235Paragraph 164 of Schedule 2

Explanatory Note

(This note is not part of the Regulations)

These Regulations replace the National Health Service (Charges to Overseas Visitors) Regulations 2011 (the 2011 Regulations) and provide for the making and recovery of charges for relevant services provided under the National Health Service Act 2006 (the 2006 Act) to certain persons not ordinarily resident in the United Kingdom (overseas visitors).

Regulation 2 defines “child” to mean a person who is under the age of eighteen. This aligns the definition of child with that set out in the Children Act 1989 (the Children Act). “Parental responsibility” is defined by reference to the meaning in section 3 of the Children Act. “Entry clearance” and “immigration rules” are defined which are relevant for the purposes of regulations 6, 10, 11 and 15.

The definition of “relevant NHS body” includes NHS foundation trusts, NHS trusts and local authorities exercising public health functions. The definition of “relevant services” means all services provided under the 2006 Act, except for primary medical, dental and ophthalmic services.

The definition of “treatment the need for which arose during the visit” includes only that treatment which cannot wait until the overseas visitor can reasonably be expected to return to their country of ordinary residence and only applies where the overseas visitor has not travelled to the United Kingdom for the purpose of seeking treatment.

Regulation 3 imposes an obligation on a “relevant NHS body” to make and recover charges in respect of relevant services provided to an overseas visitor where the relevant NHS body determines that no exemption provided for in the Regulations applies.

Paragraph (4) provides for the remainder of a course of treatment to continue to be exempt from charges where part way through the course of treatment the overseas visitor ceases to be exempt from charges. The exception is where an overseas visitor is exempt from charges under regulation 10 because they have paid, are exempt from paying, or in respect of whom the Secretary of State has waived, the immigration health charge; under transitional arrangements under regulation 11 for overseas visitors unable to pay the health charge until their next visa application; and under regulation 25(3) as a child born to parent who is exempt from charges under regulation 10 or 11. These exemptions are time limited (based on visa expiry or time spent in the UK) so the overseas visitor (or their parents, as the case may be) will know when their entitlement to the exemption from charges will cease and will have the opportunity to apply for further leave to remain, or to regularise the immigration status of their children.

Regulation 4 makes provision about the persons liable to pay charges in respect of relevant services provided to an overseas visitor. Regulation 5 provides for repayment to be made to a person who has paid charges in respect of relevant services provided to an overseas visitor where a charge has been made and recovered which is not payable under these Regulations.

Regulation 6 provides for an overseas visitor who receives relevant services and, subsequent to those charges being made or recovered, is granted temporary protection, asylum or humanitarian protection under the immigration rules or is identified as a victim of human trafficking, to be treated, in respect of those relevant services, as an overseas visitor in respect of whom the Regulations provide for no charge to be made or recovered.

Regulation 7 makes provision about how relevant NHS bodies must calculate charges for relevant services provided to an overseas visitor.

Regulation 8 defines “female genital mutilation” and “torture” for the purposes of Part 3 of the Regulations which makes provision about relevant services which are exempt from charges. Regulation 9 provides for an exemption from charges for relevant services provided to an overseas visitor to treat a condition caused by torture, genital mutilation, domestic violence or sexual violence. Regulation 8(3) makes clear that treatment that is exempt from charges in those circumstances includes any subsequent and on-going treatment for any condition, including chronic conditions, that is directly attributable to the violence and that treatment, in the case of female genital mutilation, includes any antenatal, perinatal and postpartum treatment the need for which is directly attributable to the mutilation.

Regulation 10 provides for an exemption from charges for an overseas visitor who has paid, is exempt from paying (except when exempt on the basis of visiting the United Kingdom for less than six months), or in respect of whom the Secretary of State has exercised discretion to reduce, partially refund or waive, a charge under an order made under section 38 (immigration health charge) of the Immigration Act 2014. The exemption applies for the “relevant period” which is the period for which leave to enter or remain in the United Kingdom is granted to the overseas visitor.

Regulation 11 provides for an exemption from charges for those overseas visitors who apply for leave to enter or remain before the first order made under section 38 comes into force and who, consequently, will not have an opportunity to pay the immigration health charge until they next apply for leave to enter or remain in the United Kingdom. By virtue of section 39 of the Immigration Act 2014 (related provision: charges for health services), which has yet to come into force, such people, who would previously have been ordinarily resident or, in most cases, exempt from charges under the 2011 Regulations will become chargeable under these Regulations. Regulation 11 is intended to maintain the exemption from charges for those people until they next apply for leave to enter or remain in the UK.

Regulation 12 ensures that the Regulations are consistent with the United Kingdom's obligations in respect of overseas visitors who are entitled to the provision of relevant services without charge by virtue of an enforceable EU right.

Regulation 13 provides for an exemption from charges for overseas visitors who would be entitled to the provision of relevant services without charge under Regulation (EC) No 883/2004 if the United Kingdom was listed in Annex IV to that Regulation.

Regulation 14 provides for an exemption from charges for overseas visitors who are entitled to relevant services without charge under the terms of a reciprocal healthcare agreement with another country. Schedule 2 lists those countries with which the United Kingdom has a reciprocal healthcare agreement.

Regulation 15 provides for an exemption from charges for person who have been granted or have made an application for temporary protection, asylum or humanitarian protection and persons supported by the Home Office under section 95 of the Immigration and Asylum Act 1999 (the 1999 Act). Failed asylum seekers who are supported by the Home Office under section 4(2) of the 1999 Act or by a local authority under section 21 of the National Assistance Act 1948 are also exempt from charges. Paragraph (e) provides for an exemption for children looked after by a local authority within the meaning of section 22(1) of the Children Act 1989.

Regulation 16 provides an exemption from charges for an overseas visitor who is identified by a competent authority as a victim of human trafficking under the Council of Europe Convention on Action against Trafficking in Human Beings, or who a competent authority has reasonable grounds for believing is a victim of human trafficking.

Regulation 17 provides for the Secretary of State to determine that, if exceptional humanitarian reasons justify it, an overseas visitor is exempt from charges, subject to conditions on that determination set out in paragraph (2).

Regulation 18 provides for an exemption from charges for an overseas visitor who is detained in hospital under the Mental Health Act 1983, received in guardianship or subject to a community treatment order under that Act or deprived of their liberty under the Mental Capacity Act 2005. An overseas visitor required to submit to treatment under a court order is also exempt from charges.

Regulation 19 provides for an exemption from charges for an overseas visitor who is detained in a prison; or in a remand centre, young offender institution or secure training centre under section 43(1) of the Prison Act 1952; or who is in immigration detention.

Regulation 20 exempts qualifying employees and members of the regular and reserve forces from charges. A qualifying employee, unless they are in the United Kingdom in the course of their employment, must have been recruited in the United Kingdom and have been ordinarily resident in the United Kingdom prior to taking up that employment. A qualifying employee includes Crown servants, employees of the British Council or the Commonwealth War Graves Commission and overseas visitors in employment financed by the United Kingdom Government.

Regulation 21 exempts NATO forces members to whom Article IX(5) of the Agreement regarding the Status of Forces of Parties to the North Atlantic Treaty applies, where the relevant services in question cannot readily be provided by the medical services of either the armed forces of the overseas visitor's own country or those of the United Kingdom.

Regulations 22 exempts war pensioners and armed forces compensation scheme payment recipients from charges for relevant services. Regulation 23 exempts overseas visitors who are employed, engaged or working on a United Kingdom registered ship from charges for relevant services.

Regulation 24 provides for an exemption from charges for treatment the need for which arose during the overseas visitor's visit, for an overseas visitor who is entitled to services under the European Convention on Social and Medical Assistance or the European Social Charter, where the overseas visitor is in the United Kingdom lawfully and without sufficient resources to pay the charges. An authorised child or companion to a person exempt from charges under regulation 17 (exceptional humanitarian reasons) is also exempt from charges for treatment the need for which arose during the overseas visitor's visit.

Regulation 25 provides an exemption from charges for an overseas visitor who is the member of the family of a principal overseas visitor who is exempt from charges under various other regulations.

Paragraph (2) provides an exemption from charges for an overseas visitor who is a member of the family of a principal overseas visitor who is exempt under regulation 16 (victims of human trafficking), regulation 20 (members of the regular and reserve forces, Crown servants and others) or regulation 21 (NATO forces).

Paragraph (3) provides an exemption for a child who is born to a parent who is exempt from charges under regulation 10 (immigration health charge). The exemption applies while the child is less than three months of age provided they have not left the United Kingdom since birth. The exemption ensures that a child born in these circumstances does not attract charges before the child's parents have had an opportunity to regularise the child's immigration status and apply for leave for their child to remain in the United Kingdom and pay the immigration health charge, if applicable.

Paragraph (4) provides an exemption from charges for an overseas visitor who is a member of the family of a principal overseas visitor who has an enforceable EU right to the provision of relevant services without charge under regulation 12 (EU rights) or 13 (overseas visitors who are treated as if entitled under the social security coordination regulation), or is exempt under regulation 22 (war pensioners and armed forces compensation scheme payment recipients). The exemption in respect of family members of overseas visitors with EU rights captures family members who do not have an EU right in their own right or as a family member under EU law because their relationship to the principal overseas visitor is not recognised as a family relationship under EU law. This would include an overseas visitor whose same sex marriage to, or civil partnership with, the principal overseas visitor is not recognised in the law of the member state in which the principal overseas visitor is insured.

Regulation 26 provides for the consequential amendments in Schedule 3 to have effect.

Regulation 27 saves the instruments listed in Schedule 4 in respect of charges made, or to be made, and recovered for courses of treatment commenced before the coming to force of the Regulations, and otherwise revokes the instruments to the extent specified in Schedule 4.

M43An impact assessment for the Visitor and Migrants Cost Recovery Programme was published in July 2014 . A further impact assessment has not been produced for this instrument as no impact on the private or voluntary sectors is foreseen.

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