Healthcare & Hospitals in the UK

Published in The Expatriate's Guide to Living in the UK

NHS & Private Healthcare

Wherever you are, whatever you are doing, your health will be one of your main concerns. Quite simply, you want to be healthy and happy. It can be less simple to unravel exactly what healthcare will be available to you when you are living abroad.

This article will help you understand the healthcare system in the UK and tell you what to look out for if you need or choose to have private medical treatment when you are living here.

The UK has a two tier healthcare system. Publicly funded healthcare is provided by the National Health Service (NHS). Private healthcare (where the patient pays for treatment) is also available.

The National Health Service (NHS)

The NHS was set up in 1948 and is recognised by the World Health Organisation as one of the best health services in the world. It is made up of NHS England (in England), NHS Scotland (in Scotland), NHS Wales (in Wales) and Care NI (Northern Ireland). The information in this article relates to the NHS in England. For more information on Scotland, Wales and Northern Ireland, please visit the websites given at the bottom of this page.

The NHS, managed by the Department of Health (a UK government department), provides the majority of healthcare services that most people will need, including general practitioners, accident and emergency departments, long-term healthcare and dentistry and supplementary services such as the NHS Direct – a 24-hour telephone and e-health information service. These services are funded by taxes so are generally provided free of charge to eligible users. There are some exceptions, such as prescriptions and dental treatment, which are chargeable services.

For health advice and information 24 hours a day, 365 days a year, just dial 111 from any landline or mobile phone free of charge. Some areas of the country are still covered by the 0845 4647 service.

Who is eligible for free NHS treatment?

You are eligible for free NHS treatment in England if:

• You are “ordinarily resident” in the UK. This is defined as “someone who is living lawfully in the UK voluntarily and for settled purposes as part of the regular order of their life for the time being, with an identifiable purpose for their residence here which has a sufficient degree of continuity to be properly described as settled”

• You are exempt from charges under the National Health Service (Charges to Overseas Visitors) Regulations 1989, as amended.

A guide to the circumstances in which overseas visitors are not liable to pay for NHS hospital treatment can be downloaded from the publications section of the Department of Health website. If you are not eligible for free treatment, you may be liable for charges.

NHS charges and exceptions

Under the National Health Service (Charges to Overseas Visitors) Regulations 1989, the NHS hospital that is treating you is responsible for deciding whether you are eligible for free treatment. Full details can be found on the Department of Health website. However, it is worth knowing that the following are always free of charge:

Treatment given in an accident and emergency (A & E) department

Treatment given in a walk-in centre providing similar services to those of an accident and emergency department of a hospital

Treatment for certain communicable diseases.

You can get free NHS prescriptions if, at the time the prescription is dispensed, you:

are 60 or over

are under 16

are 16-18 and in full-time education

are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx)

have a specified medical condition and have a valid medical exemption certificate (MedEx)

have a continuing physical disability that prevents you from going out without help from another person and have a valid MedEx

hold a valid war pension exemption certificate and the prescription is for your accepted disability

are an NHS inpatient

Some countries have reciprocal healthcare arrangements with the UK, giving their citizens access to free NHS treatment. See the Department of Health website for more information.

Private healthcare provision in the UK

As outlined above, not everyone is eligible for free, public healthcare in the UK. In these cases, the Department of Health recommends that you take out appropriate private medical insurance (PMI).

Some people choose to go private rather than use the NHS because they believe they will get better quality treatment more quickly and they will be able to choose the treatment centres and sometimes the professionals that they use. Treatment for acute conditions (conditions that can be cured) can have long waiting lists on the NHS, but this kind of treatment is available privately and is covered by PMI plans.

Private healthcare services run alongside those provided by the NHS, and sometimes offer complementary or alternative treatments. The cost of treatment means that people going private will usually have a PMI plan to pay for their medical treatment. Your employer may have a group scheme that you can join. If not, you can buy your own PMI plan.

The international private medical insurance market

There are over 20 international PMI providers operating in the UK and abroad, each offering a number of plans with medical treatment ranging from in-patient only through to cover for most in- and out-patient treatment.

Many providers can cover individuals, families and corporate or affinity groups, and providers will differ in the way that they underwrite plans.

Plans tend to run on a yearly basis, so if you are in the UK for a relatively short period of time you may want to investigate the cover available from travel insurance plans, rather than private medical insurance plans.

Domestic versus international private medical insurance

As an expatriate in the UK, you can choose between taking out a UK domestic PMI plan or an international PMI plan. As an expatriate, there are features of an international plan which may be of benefit to you. Our checklist on the right outlines some of these:

Your Checklist For International Private Medical Insurance (PMI)

Here are a few things to consider when you are looking for international private medical insurance:

Pre-existing medical conditions: some providers underwrite their plans on a moratorium basis. This means that any pre-existing medical conditions that you have will not be covered by the plan until a specified time period has elapsed. The benefit of a moratorium is that it allows a provider to keep their premiums down, that the application process is easier and quicker as you don’t have to fill in a medical questionnaire and there is no permanent exclusion of pre-existing medical conditions. An alternative is to look for a provider that medically underwrites their plans. This means that you will need to fill in a medical questionnaire when you apply for a plan and the provider will then tell you what conditions they will cover and what it will cost. If you have pre-existing conditions make sure you know exactly what will and won’t be covered on a plan

In-patient treatment claims: look for a provider that will pay the hospital or clinic direct for your in-patient treatment. If so, you will not be out of pocket while you wait for your claims to be settled. Make sure you choose a provider that offers you access to a 24 hour, multi-lingual helpline so you can get emergency assistance and approval for treatment at all times

Out-patient claims: where claims are settled through reimbursement, find out how quickly the provider pays out. Make sure there are no bank charges deducted from your reimbursement

Emergency evacuation and repatriation: in some parts of the world, high quality medical treatment is not readily available, so you may need to be evacuated by air ambulance. The most comprehensive emergency evacuation benefit will cover the patient’s evacuation, medical treatment and repatriation back to the country of residence and, in addition, will cover both travel and accommodation costs of the patient’s dependants. Some providers will evacuate you if there is no adequate treatment in your location, as well as in an emergency

Out-patient treatment: most plans will cover in-patient and emergency medical treatment, but not all of them cover out-patient treatment. Treatment that should be covered under the out-patient section of a PMI plan includes post-hospitalisation treatment, visits to your GP, diagnostic tests, consultants’ and specialists’ fees, psychiatric treatment, physiotherapy, complementary therapies, scans and treatment for allergies

Chronic and terminal conditions and HIV/ AIDS: if you develop a new chronic condition, a plan with high monetary limits for maintenance (for example routine check-ups and prescribed medicines) will give you peace of mind. If the worst happens and a condition is diagnosed as terminal, a plan that covers palliative treatment will ease the financial burden. HIV and AIDS are covered on some plans, often in a separate benefit

Wellness: with preventative medicine becoming increasingly important to your wellbeing, some providers will cover the costs of preventative tests such as cervical smear and prostrate cancer tests and vaccinations. Look out for other benefits that you can use when you are well, rather than in a medical emergency, for example hormone replacement therapy, treatment for allergies, complementary therapies, dental and maternity benefits

Dental: dental treatment can be expensive so only the top end plans tend to cover this. However, it can be invaluable if you want to access the highest quality, private dental treatment available

Maternity: when you are planning a baby, cover for private maternity treatment will make the process a lot easier for you. Some plans include maternity benefits as standard while others offer it as an optional add-on plan, meaning you only need to pay for the benefit when you need it

Add-on plans: some providers offer optional add-on plans that complement your main healthcare plan. For example, worldwide annual travel insurance, personal accident insurance and cover for maternity treatment

Non-medical benefits: some plans cover legal expenses if you suffer an injury as the result of a third party, a visit to a critically ill relative or for your body to be returned home should you die abroad

Area of cover: you will have a choice of geographic area that your plan will cover. If you want cover in your home country, make sure you pick a provider and area of cover that allows this. Also look at whether the plan covers emergency medical treatment outside of your chosen geographic area of cover

War and terrorism: some PMI plans will cover you if you need treatment as a result of an act of war or terrorism. Make sure you read the benefit conditions and exclusions to find out if this will be covered

Reducing your premium: some providers offer a no claims discount (make sure this is not affected by claims for “wellness” treatments), special rates for families or the option to select a voluntary excess.

Useful Healthcare Websites:

www.dh.gov.uk - The Department of Health website, includes information on eligibility for free NHS treatment

www.nhs.uk - Information on the NHS in England

www.show.scot.nhs.uk - Information on the NHS in Scotland

www.wales.nhs.uk - Information on the NHS in Wales

www.healthandcareni.co.uk - Information on the NHS in Northern Ireland

www.nhsdirect.nhs.uk - 24 hour e-health information service

www.amii.org.uk - The Association Of Medical Insurance Intermediaries website, allows you to search for an AMII member in your area.

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Content

Healthcare & Hospitals in the UK

NHS & Private Healthcare

The National Health Service (NHS)

Who is eligible for free NHS treatment?

Your Checklist For International Private Medical Insurance (PMI)