The NHS in England is a residence-based system, unlike many other countries, which have insurance-based healthcare systems. This means that all visitors to England may have to pay for NHS healthcare, depending on their circumstances.
Unplanned treatment on a temporary visit to England
If you're a visitor from an EU country and you fall ill or have a medical emergency during your temporary stay in England, you can continue to use your European Health Insurance Card (EHIC).
Your EHIC will cover you for treatment that becomes medically necessary during a visit to England, until you return to your country. It also covers you for the treatment of pre-existing medical conditions and for routine maternity care, providing the reason for your visit is not specifically to give birth or receive treatment.
Bear in mind that the healthcare system in England may be different from that in your home country. The EHIC might not cover everything you would expect to get for free back home.
The EHIC is not an alternative to travel insurance. It will not cover any private medical healthcare, being flown back home, or lost or stolen property. Therefore, it is important to have both an EHIC and a valid private travel insurance policy.
If your EHIC has been lost or stolen during your visit in England and you need a replacement, then you'll have to contact the relevant organisation in your home country to request a Provisional Replacement Certificate (PRC).
If you do not have an EHIC and cannot obtain a PRC, you may have to pay for treatment.
Visitors from Norway can access medically necessary healthcare using a valid Norwegian passport.
Visitors from Iceland, Norway, Liechtenstein and Switzerland
If you're a resident of Iceland, Norway, Liechtenstein or Switzerland and your visit began before but ends after 31 December 2020, you can continue to use your EHIC to access healthcare until the end of your visit to the UK.
From 1 January 2021, most visitors from Iceland, Liechtenstein and Switzerland may need to pay for NHS healthcare. Any treatment that you have to pay for will be charged at 150% of the national NHS rate.
If you're a UK national who moved to Norway, Iceland, Liechtenstein or Switzerland before 31 December 2020, you can continue to use your EHIC or a PRC in the UK.
Seeking planned treatment in England
From 1 January 2021, planned treatment under the S2 route is only available to visitors from EU countries.
You'll need to make all the necessary arrangements yourself in advance. Planned treatment is not covered by the EHIC. If you do not have valid documentation, you'll be charged for treatment. You'll need to arrange an S2 form from the relevant organisation in your home country before you travel to England.
The S2 only relates to state-provided treatment and you will not be required to pay anything yourself, except any mandatory patient contributions that patients in England would have to pay, such as prescription costs.
If you're a resident of Iceland, Norway, Liechtenstein and Switzerland and you requested authorisation from the relevant health authority in your home country for planned treatment in the UK on or before 31 December 2020, you may complete that treatment, even if takes place at a later date.
The EU Directive route
The EU Directive route ceased to apply in the UK on 31 December 2020.
UK nationals and others whose healthcare in the EU is paid for by the UK
If you're a UK national living outside the UK, you should not expect to be able to use NHS services for free when visiting the UK. You should take out appropriate travel insurance when visiting the UK, as you would when visiting any other country.
If you were living in an EU country, Norway, Iceland, Liechtenstein or Switzerland on or before 31 December 2020 and the UK government pays for your healthcare through S1 arrangements, you'll be able to use NHS services in England without charge when visiting the UK. People who have their healthcare paid for by the UK include those who get a UK State Pension or some other UK benefits, and posted workers, who are people working abroad for UK companies or organisations.
If you're a UK national and you move to an EU country, you can only use NHS services for free if you have an EHIC, PRC or S2 to show your healthcare costs are funded by the EU country where you now live, or another exemption applies.
If you move to Iceland, Liechtenstein or Switzerland, you may have to pay for any treatment that you need when visiting the UK. Any treatment that you have to pay for will be charged at 150% of the national NHS rate.
You should check before visiting the UK whether your family members are also eligible for free healthcare in England. If you're a family member of a frontier worker you can receive NHS treatment for free if it becomes medically necessary during a temporary visit to England. However, you need to be able to present a copy of your S1 form.
If you return to the UK permanently and you're ordinarily resident, you'll be able to access NHS care without charge.
If you need to access NHS treatment while you're visiting England, you'll need to follow the same processes as people living in England. For example, most hospitals require a GP referral, issued by a GP in England, before you can have hospital treatment.
You may also need to show a copy of your S1 or A1 certificate or ask the healthcare provider to contact Overseas Healthcare Services to verify the status of your S1 or A1 certificate. You may also be able to apply for an S2 certificate for the treatment from the relevant organisation in your country of residence. This can then be accepted for the treatment instead of proof of a registered S1 certificate. For more information on this process, contact the NHS provider directly to check what their referral requirements are.
You can also make an appointment with a GP as you would if you were living in England. GPs can agree to register you as a temporary patient as long as you are in the area for more than 24 hours but less than 3 months.
You'll need to pay for some types of NHS care in the same way as people who live in England, for example, paying for prescriptions or dental treatment.