What is the change? The Department of Health released a consultation on ways to recoup £500 million per year by expanding the charging of foreign visitors and migrants for health care services in the U.K.

What does the change mean? The department is seeking comments on the proposals until March 7, 2016 from employers and other interested parties. The current proposals would affect foreign visitors and non-EEA nationals as well as EEA or Swiss nationals residing in England.

  • Implementation time frame: Ongoing. The Department of Health is aiming to publish an Implementation Plan for 2016-18.
  • Visas/permits affected: EEA nationals, Tier 2 (ICTs) and others outside the current immigration health surcharge regime, and visitors.      
  • Who is affected: Employers and migrants paying the Immigration Health Surcharge will not be affected – that regime remains in place. The proposals essentially affect EEA residents without a European Health Insurance Card, non-EEA nationals who are currently exempt from the healthcare surcharge, i.e., Tier 2 Intra Company Transferees, and visitors (including business visitors).
  • Business impact: The proposed expansion of health care fees may increase living costs for some EEA and Swiss nationals and non-EEA nationals visiting or taking residence in the U.K., but will not affect direct business costs.

Background: The current Immigration Health Surcharge regime, which applies to many foreign workers (but not to EEA nationals working in the UK, or to intra-company transferees on assignment), may be viewed here.

The intention of the proposed changes is to tackle perceived abuse of the U.K.’s National Health Services from within the European Union and to shore up the European Health Insurance Card system to allow costs to be recovered from European member states. The consultation proposes to both expand charges for health services and recoup costs from the home country of EEA nationals with permanent resident status in the U.K. who currently receive free healthcare alongside British residents. The proposal would redefine “ordinary resident” for purposes of receiving free health care to exclude EEA nationals whose home country is responsible for their healthcare costs. It also seeks to prevent “health tourism” by other measures.

Key proposals include:

  • Primary care: EEA residents who do not have a European Health Insurance Card (or provisional certificate) and non-EEA nationals who do not pay the health surcharge would be charged for primary medical care. Consultations by a nurse or general practitioner would remain free of charge.
  • Drugs: Foreign visitors would be required to pay a charge for prescription medications. Currently, several exemptions apply for adults over 60, children under 16, pregnant women and individuals with certain medical conditions. The exemptions would continue to apply to U.K. and EEA residents, but most non-EEA residents who are not subject to the health surcharge would have to pay a prescription charge.
  • Dental care: Most non-EEA residents who are not subject to the health surcharge would pay a banded dental charge depending on the treatment provided. Currently National Health Services sets three price bands that cover varying levels of treatment. Exemptions for youths, students, pregnant women and others would continue to apply for EEA and U.K. residents.
  • Eye care: Free sight tests and vouchers for eyeglasses would no longer be available to most non-EEA residents who do not pay the healthcare surcharge.
  • Emergency care: Foreign visitors would be charged for all types of accident and emergency care, including treatment at walk-in centers, urgent care centers and minor-injuries units. Exemptions would apply to those who pay the health surcharge or are exempt from it, and for EEA residents who are able to produce a European Health Insurance Card (or provisional certificate).
  • Ambulance services: All treatment by ambulance services, such as on-site accident care and paramedic services, would be charged to the patient. EEA residents who are able to show their European Health Insurance Card or Provisional Replacement Certificate would be exempt as would non-EEA residents who pay the health surcharge or are exempt from it. The department is also looking into the feasibility of charging patients for air ambulance services.
  • Other services. Fertility services would only be available if both partners demonstrate they are ordinarily resident at the time of treatment; for non-EEA nationals, both partners must have indefinite leave to remain. Those who have paid the healthcare surcharge would no longer have the right to NHS-funded fertility services. Foreign visitors seeking any out-of-hospital care or NHS-funded care by a non-NHS provider would be charged for those services. Individuals who are not ordinarily resident and receive continuing healthcare (such as a visitor with a multi-entry visa who is too ill to return home) may be brought under the charging regulations.

The full contents of the Department of Health’s consultation and soliciting of public comments may be read here.

BAL Analysis: Employers and other stakeholders interested in participating in the consultation or submitting comments may respond directly to the questionnaire contained in the consultation or contact their BAL professional.

This alert has been provided by the BAL Global Practice group in the United Kingdom. For additional information, please contact

Copyright © 2016 Berry Appleman & Leiden LLP. All rights reserved. Reprinting or digital redistribution to the public is permitted only with the express written permission of Berry Appleman & Leiden LLP. For inquiries please contact