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 , makes the following Regulations.

PART 1 — Introduction

Citation and commencement

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

Interpretation

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In these Regulations—

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

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

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

• “actual charge” has the meaning given in regulation 3(7);

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

• “authorised child” means a child who—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; oris 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— in respect of which no charge may be made or recovered under regulation 17; orordinarily resident in Ukraine and is obtaining a course of treatment;

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

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

• “domestic abuse” has the meaning given in Part 1 of the Domestic Abuse Act 2021;

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

• “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 ;

• “healthcare” means all forms of healthcare provided for individuals, whether relating to mental or physical health, and includes related ancillary care;

• “healthcare agreement” means an agreement or other commitment between the United Kingdom and either a country or territory outside the United Kingdom or an international organisation, concerning healthcare provided anywhere in the world;

• “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;

• “international organisation” means an organisation of which—two or more sovereign powers are members; orthe governments of two or more sovereign powers are members;

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

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

• ...

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

• “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;

• “relevant body” means—an NHS foundation trust;an NHS trust;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); orany 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”;

• . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

• “relevant services” means accommodation, services or facilities which are provided, or whose provision is arranged, under the 2006 Act other than—primary medical services provided under Part 4 (medical services);primary dental services provided under Part 5 (dental services);primary ophthalmic services provided under Part 6 (ophthalmic services); orequivalent 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—diagnosis of symptoms or signs occurring for the first time after the overseas visitor's arrival in the United Kingdom; ortreatment, 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 relevant 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.

PART 2 — Provision for making and recovery of charges

Obligation to make and recover charges

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• (1) Where the condition specified in paragraph (2) is met, a relevant 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).

• (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 relevant 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.

• (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 relevant 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); ...

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

• (iv) regulation 14 (reciprocal health care agreements);

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

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

a relevant 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 relevant 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.

• (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—antenatal services provided in respect of a person who is pregnant;intrapartum and postnatal services provided in respect of—a person who is pregnant;a person who has recently given birth; ora baby; andany other relevant service that the treating clinician determines the recipient needs promptly—to save the recipient’s life;to prevent a condition becoming immediately life-threatening; orto 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.

Liability for payment of charges

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• (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.

• (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 .

Repayment of charges made and recovered by relevant NHS bodies

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• (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.

Provision relating to recovery of charges in respect of refugees and victims of modern slavery

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

• (a) received relevant services from a relevant body;

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

• (i) regulation 15(a) (refugees ...); or

• (ii) regulation 16 (victims of modern 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.

• (1A) This paragraph applies to an overseas visitor who—

• (a) received relevant services from a relevant body;

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

• (i) regulation 15(aa) (dependants of refugees); or

• (ii) regulation 25(1A) (family members of victims of modern slavery); and

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

• (i) where paragraph (1A)(b)(i) applies—

• (aa) that visitor was a dependant of another overseas visitor (“the principal overseas visitor”); and

• (bb) the principal overseas visitor 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 (1A)(b)(ii) applies—

• (aa) that visitor was a family member of another overseas visitor (“the principal overseas visitor”); and

• (bb) the principal overseas visitor was a person to whom regulation 16 (victims of modern slavery) applies but had not yet been identified as such.

• (2) An overseas visitor to whom paragraph (1) or (1A) 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 relevant body which, in respect of an overseas visitor to whom paragraph (1) or (1A) 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).

Charges imposed on overseas visitors

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

• (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

• (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