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An immigration health surcharge for long stays in the UK

Lisa Expat Assure — Tue, 16 Feb 2021 09:30:00 +0000

Post edited on 16/02/2021: with Brexit, Europeans planning a temporary stay of more than six months in the UK must now also pay the immigration health surcharge.

If you are planning a temporary stay in the UK of more than six months, you now have to pay a health tax, the immigration health surcharge, in order to access the UK’s National Health Service (NHS). Subscribing to a private medical insurance won’t exempt you from paying the health surcharge that costs £624 per person and per year (£470 for children and students). Find out in this article if you too may have to pay the immigration health surcharge, in order to be granted the right to enter the UK.

First of all, what is the Immigration Health Surcharge?

In recent years, the British Government has put into place a series of measures aiming to discourage ‘medical tourism’. The most notable one was to create a financial contribution, as part of the visa requirements, to access the NHS, called the immigration health surcharge (IHS), in 2015.

This health tax was originally intended for temporary residents from countries outside the European Economic Area (EEA) who stay in the UK for more than six months. But with Brexit, EU citizens are now also expected to pay the IHS, with the exception of a few categories of people.

The IHS gives visitors the same access to the UK healthcare system as for UK residents.

The fee is £624 per year and per person. It is reduced to £470 per year for children, students and people applying for the Youth Mobility Scheme visa.

The health surcharge must be paid for at the same time as when applying for your visa, and before entering the UK.

Visitors who are already in the UK and who are applying for a visa extension will also have to add the health surcharge on top of their visa fees.

The UK is one of the countries in the world with highest visa costs. The immigration health surcharge therefore pushes the visa bill even more. For instance, a family of two parents with a child staying in the UK two years, will have to pay £3436 in health surcharge fees alone, not including the visa fees.

The Immigration Health Surcharge is calculated based on the length of your stay in the UK. Here is an online tool to help you accurately calculate the amount of your medical surcharge.

Am I exempt from paying the immigration health surcharge if I choose to sign up for private medical insurance?

If you decide to take out international health insurance, and even if you are planning on not using the National Health Service, you are not exempt from paying the surcharge, as it is mandatory. However, for several reasons, it can still remain a good choice to take out an international health insurance for the UK.

Who needs to pay the Immigration Health Surcharge?

The British government’s website explains that “you usually need to pay the healthcare surcharge if you’re applying for a visa or immigration application”:

for more than 6 months, if you’re applying outside the UK
for any length of time, if you’re applying inside the UK

Who doesn’t need to pay the Immigration Health Surcharge?

You do not need to pay the health surcharge if you’re visiting the UK, applying for a visitor visa or if you are remaining in the UK permanently.

If you are coming to the UK as a visitor for a short stay, you will still be able to use your European Health Insurance Card (or equivalent) to access public healthcare in the UK. However, the EHIC is only valid for medically necessary and unplanned healthcare. It is not a replacement for full access to public healthcare or for private health insurance.

Australians and New Zealanders are also exempt from paying the health surcharge as their countries have special agreements with the UK.

Other categories of people are exempt from paying the IHS, such as members of armed forces, eligible healthcare workers, people applying for indefinite leave to enter or remain, asylum seekers, victims of slavery or human trafficking etc. See the full list of people who do not need to pay the IHS.

A brief history of the Immigration Health Surcharge

This financial contribution to access the NHS came into effect on 6th April 2015. It was originally intended for people coming from countries outside the European Economic Area (EEA), who plan on staying in the UK for more than 6 months: employees, students, or visitors.

Previously, some NHS care was offered to non-EEA nationals for free, whilst other treatments were payable. But it seems that the NHS was having difficulty being paid retrospectively for the services provided. This represented an administrative cost for the NHS. “The new charge will raise around £200 million a year and help offset the estimated £2 billion cost of providing free healthcare to overseas visitors, temporary non-EU workers and foreign students, the Home Office said at that time.

Then, with Brexit, the UK officially left the EU on 1st January 2021. The immigration rules applying to EU citizens aligned with the UK’s immigration rules for non-Europeans. Now, Europeans planning to stay temporarily in the UK for more than 6 months, must also pay the immigration health surcharge.

The payment of the immigration health surcharge initially amounted to £200 per year for temporary migrants and £150 per year for students and those on the Youth Mobility Scheme. This payment was doubled in January 2019, passing to £400/£300 a year. In October 2020, the fee rose again to £624/£470.

If you are a tourist from a non-European country, you will be subject to another rule

If you come from a country outside of the European Economic Area (EEA), and you visit the UK on a tourist visa, you are not affected by the mandatory NHS health surcharge, but a different rule applies to you: since April 2015, non-EEA tourists will be charged 150% of the cost of the health care they receive, 50% more than what it was previously. “This reflects the additional cost burden that the NHS carries when managing the administration for visitors to the UK”, explains the British government on its website, while stressing that “for this group, possession of adequate travel and health insurance is highly recommended”.

“The intended effect of the surcharge is that a person’s access to healthcare should be in line with their immigration status in the UK”, states the UK’s Home Office. “Temporary migrants have not built up the long-term contribution to the UK that a British Citizen will have built up and will build up over the course of their lifetime.”

As a reminder, European residents travelling to the UK for a short stay are not subject to this “right to access” surcharge and can benefit from the NHS using their European Health Insurance Card (or equivalent), thanks to the EU–UK Trade and Cooperation Agreement, that states reciprocal healthcare provision between the EU and the UK continues after Brexit.

However, British expatriates who have been outside of the European Economic Area for more than six months relinquish their residential right of access to the NHS and will also be asked to pay the 150% tariff if they are travelling in a touristic capacity.

People settling in the UK permanently are neither affected by the immigration health surcharge nor by the 150% contribution to their potential health treatments in the UK, as access to the NHS is, by definition, granted to all residents of the UK, regardless of their nationality.

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Is there a “right way” to treat people suffering with depression?

Lisa Expat Assure — Fri, 07 Apr 2017 11:10:03 +0000

Mental health doesn’t only affect the sufferer. We gain expert advice on how family and friends should help support a loved one, while taking care of themselves too.

Depression is the single largest contributor to ill health and disability globally. Over 300 million people are estimated to be suffering from depression, which is equivalent to 4.4% of the world’s population. The estimates have been released by the World Health Organization (WHO) in the lead up to World Health Day on 7^th April. The aim of the day, which this year is centred on the theme of depression, is to promote a better public understanding of the ‘invisible’ condition and push more people to seek help.

WHO’s decision to shine a spotlight on the issue is a relief for the one in five of us who will experience depression at some point in our lives, as well as the many people with loved ones suffering from depression and anxiety disorders. Campaigners, charities, mental healthcare specialists and researchers have long been calling for more prominence in the treatment and understanding of mental health. WHO, along with many other charities and organisations, hopes to inform and educate as many people as possible about mental health disorders, as well as the ways people can seek support or help those suffering. Mental health is determined by a range of socioeconomic, biological and environmental factors. Depressive and anxiety disorders are the two main categories for common mental disorder diagnoses, with the severity, symptoms and duration varying from person to person. These disorders are typically characterised by persistent sadness, loss of interest or pleasure, feelings of low self-worth and disturbed sleep or appetite, with severe symptoms including suicidal thoughts and self-harm. As diagnosable health conditions, the feelings that mental illness sufferers experience are far removed from the passing negative emotions of sadness or stress that most people may experience in life. Mental illness can have implications on a person’s relationships, lifestyle and ability to cope with their usual daily life, meaning friends and family of those suffering are often left unsure of what actions to take or how to emotionally support their loved ones. Depression can strike at any time and affects people of all ages and from all walks of life, and the number of people suffering from mental health disorders is increasing. Depression is the major contributor to suicide deaths, and someone dies by suicide every 40 seconds somewhere in the world. Lack of support for people with mental disorders, coupled with stigma, prevent many from accessing the treatment they need to live healthy, productive lives. But there are effective treatments for depression whether through medication, talking therapy, or a combination of the two. Despite the existence of various treatments as a proven way to alleviating symptoms, WHO estimates that nearly 50% of people with depression do not get treatment, even in high-income countries. A major barrier to accessing care is the social stigma associated with mental disorders. Tackling stigma through education is a vital target of UK-based mental health charity SANE. Along with the scientific and psycho-social research the charity conducts into mental illness and its consequences, SANE implements community and school-based programmes and promotes access to help through the Black Dog Campaign: named after a bygone metaphor for depression referred to by Winston Churchill and ancient Roman poets. However, their fresh and forward-thinking approach to mental health is anything but old-fashioned. The ongoing campaign aims to increase visibility and reverse prejudice as well as encourage people to seek help rather than suffer in silence. SANE provides confidential, specialist emotional support and expert information to anyone affected by mental illness, including the family, friends and carers of those suffering. For many people, coping with symptoms of a loved one’s mental illness can be challenging, and may leave them feeling helpless or frustrated. “Mental illness can make relationships difficult,” says Adrian Garcia, leader of the Black Dog Campaign. “The person who is suffering might push away those closest to them. This can be particularly tough for loved ones, as they just want to help. It sometimes takes perseverance, as recovery can take time, but have patience, and keep trying.” Depression and anxiety can manifest in many different ways, and it is helpful to learn as much as possible about a diagnosis to better understand what an individual is going through, as well as how treatments and medications can help. If you are concerned about someone’s mental health but they are feeling unwilling or anxious about seeing their GP, encouraging them to go and offering to accompany them might be the push they need to seek help. Reassure your loved one that talking about what they are feeling, whether to you or to a professional, can help on the journey to treatment and recovery. Adrian advises finding an appropriate time and place to talk to the person you are worried about. “Make it clear that you want to help and you will listen to them without judgement,” he says. “Everyone’s experience is so unique, but for a lot of people, if they don’t talk about their mental illness their negative feelings can become internalised, and they can magnify. If they don’t talk about it, they aren’t going to get help. Making yourself available as someone they can trust is an invaluable way of showing support.” Advancing the public understanding of the realities of mental health disorders is a key focus for the Black Dog Campaign. “The most important thing is for a person not to be denied their suffering. That can take a lot of different forms, but shrugging it off as ‘just needing to cheer up’ is damaging. Acceptance of mental illness as a serious condition is vital,” Adrian says. “The stigma that mental illness is associated with scary Victorian asylums: that’s changing. More people are aware that it comes in many different forms, and it can develop from something physical, biological or psychological.” “There can be hesitation about how to act around someone suffering with depression, and a lot of people’s worries stem from not knowing what to say,” Adrian says, “But actually, saying something is a lot better than saying nothing. Any form of mental illness can be incredibly isolating, so staying in touch, checking how the person is doing, and showing you care can be of great comfort.” Whether the support you are offering is emotional encouragement or helping with everyday practical tasks, it’s crucial that you take care of yourself too. “Providing this support can be emotionally overwhelming,” says Adrian, “So try to find ways to relax and continue doing things you enjoy. You need to consider your own support needs, especially if you are caring for someone full-time who is suffering from a mental illness.” Many people find it helpful to attend support groups for those affected by a loved one’s mental illness. It gives the opportunity to meet others in similar positions and help you realise you are not alone in your situation. It can be helpful to share experiences with those who may be going through similar feelings that you are, as well as gaining ideas of what other people have found helpful to them. SANE helps 750,000 people per year, all without government funding. Adrian and the rest of the team have high hopes that soon, mental conditions will be perceived in the same way as physical conditions, and will hold the same importance in terms of priority, range of treatments, research, funding and public attitude. Adrian says: “Physical health has been researched and funded for hundreds of years, whereas mental health is a very recent interest in terms of research. So we think mental health should be given a boost in funding to have at least the same as physical health, so it can catch up!” Only 3% of government budgets, on average, is invested in mental health (WHO estimate). Economically, investment in mental health makes sense. A WHO-led study on future health outcomes showed that in 36 low, middle and high income countries, the current low levels of both access to mental healthcare and recognition of mental illnesses would be predicted to result in a global economic loss of a trillion US dollars per year. This amount would be incurred due to people out of work through mental illness, employers suffering financially through absenteeism and low productivity, and governments’ welfare expenditures. A strain is also put on healthcare systems, as depression increases the risk of substance use disorders and diseases such as diabetes and heart disease. With better access to mental healthcare and, therefore, a vastly increased number of people in employment, every US dollar invested in improving mental healthcare has a return of four dollars. SANE offers confidential emotional support services from professional staff and trained volunteers. Specialist knowledge, emotional support and information is available to anyone affected by mental illness, including family, friends and carers. If you think a person is in immediate danger, seek professional help from the emergency services, a crisis line, or a healthcare professional. Contact SANE:

Helpline: 0300 304 7000 from 4:30pm – 10:30pm every evening
Textcare: Allows you to arrange for messages of support at times that are right for you
Support Forum: Available 24 hours a day to share or read experiences with other members and give and receive mutual support
Social media: Facebook and Twitter communities are a good source of support and sharing
Write to SANE at: SANE Services, St. Mark’s Studios, 14 Chillingworth Road, Islington, London, N7 8QJ

Contact Samaritans:

Call Samaritans on 116 123 any time of day or night. The service provides confidential emotional support for people who are experiencing feelings of distress, despair or suicidal thoughts.
Visit Samaritans website
Social media: Facebook and Twitter

Follow Adrian Garcia on Twitter: @cicbdc Opinions expressed are those of the individual and do not necessarily reflect those of SANE.

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The NHS treatments blacklist

Lisa Expat Assure — Thu, 25 Feb 2016 09:55:13 +0000

The NHS (the UK’s public healthcare system), is currently undergoing numerous budget cuts. In 2015, the blacklist of medication not covered was made longer. Sixteen types of medication used to treat 23 different types of cancer, including pancreatic cancer, breast cancer and blood cancer are no longer covered by the NHS. They were rejected due to the decision that they were not cost effective. The charity The Rarer Cancers Foundation estimates that 5,500 patients will be affected by this cost-cutting measure.

Medicines not covered by the NHS are grouped under an ‘NHS Blacklist’. These medicines are those considered by the NHS to be ineffective, or a more expensive version of a cheaper/generic version available to the NHS. The complete list can be found here.

Homeopathy is equally at risk of being rejected by the NHS

The Department of Health has scheduled a consultation for 2016 in order to come to a decision as to whether the NHS will continue to cover homeopathy or not. The NHS has indicated that it believes that ‘there is no good quality evidence that homeopathy is an effective treatment for these or any other health conditions.’

Homeopathy is currently only available in two public hospitals in the UK, and only a minority of GPs will refer patients for homeopathic treatment. Homeopathy is therefore a treatment that is usually accessed through the private sector.

Other than the medicines blacklisted by the NHS, there are other types of treatment not publically available in the UK. As well as homeopathy, other complementary medicines such as osteopathy and chiropractic treatment are only available with a GP referral, and as long as the patient lives in a catchment area which offers these therapies. Dental and optical care as well as all prescription medication are also payable, with some exceptions (for more information please see our NHS information page).

If you would like to have a more complete medical cover in the UK you could consider subscribing either to a local health insurance or to an international health insurance policy. As an independent broker, Expat Assure can advise you regarding what would best suit your needs. Feel free to contact us so that we can discuss your options.

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Sixteen types of medication used to treat 23 different types of cancer, including pancreatic cancer, breast cancer and blood cancer are no longer covered by the NHS.

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European Health Insurance Card: the pros and cons

Lisa Expat Assure — Mon, 20 Jul 2015 09:48:38 +0000

Article updated on 11.01.2021 with information about the new UK Global Health Insurance Card

The European Health Insurance Card (EHIC) is very useful in that it provides Europeans with medical coverage during a temporary stay in another European country. However, the coverage offered by the EHIC is limited: it’s only valid for medically necessary and unplanned treatment. It doesn’t cover private healthcare. Subsequently there are many instances where the EHIC may not be sufficient or even completely invalid. This article outlines the main ‘need to know’ facts related to the European Health Insurance Card.

What exactly is the EHIC and what benefits does it provide?

The European Health Insurance Card allows you to benefit for healthcare which is medically necessary and unplanned/unforeseen, during your temporary stay in one of the 27 countries of the European Union, as well as Switzerland, Norway, Iceland, and Liechtenstein.

This includes things like:

emergency treatment and visits to A&E
treatment for a long-term or pre-existing medical condition
routine medical care for pre-existing conditions that need monitoring
routine maternity care, as long as you’re not going abroad to give birth
oxygen and kidney dialysis

All care that is planned in advance is excluded. If you are going abroad to receive treatment for something that has been diagnosed in your country of residence the EHIC will not cover you.

To obtain an EHIC you must apply in your country of residence. The EHIC is issued free of charge. The validity period of the new EHIC depends on where it was issued, for example if it is issued in France it is valid for two years. Please note that the long term validity of the EHIC does not mean that you can use it during an expatriation. If you become a resident of another European country, you will need to sign-up to the social security system of your host country. Your previous EHIC becomes invalid and you will need to reapply for an EHIC with the authorities of your new country of residence.

The EHIC is individual: each family member must have their own card, including children.

Good to know: information on the EHIC is now accessible via an official application for smartphones. The application is called European Health Insurance Card. Available in 24 languages, it allows you to obtain information on how the card works in each participating country, the treatment covered, reimbursement procedures and emergency medical numbers for each country.

The EHIC in the UK after Brexit

Under the terms of the EU–UK Trade and Cooperation Agreement, the UK and the EU agreed that reciprocal healthcare provision would continue. This means that UK residents will still be able to access healthcare in European countries and European residents will still be able to access healthcare in the UK, within the same conditions as the EHIC.

EHICs issued before the 1st January 2021 will continue to be valid until their expiry date.

People who don’t have an EHIC will be able to use a provisory replacement certificate instead (which needs to be requested from their local health authority before travelling).

In the long run, the EHIC will be replaced by another document:

For UK residents, the EHIC will be replaced by a UK Global Health Insurance Card (GHIC).
For EU citizens, it is not yet known which document will replace their EHIC when travelling to the UK for a short stay.

Regarding the GHIC, there is one important difference with the EHIC. It is not valid in as many countries as the EHIC. British residents won’t be able to use their GHIC in Norway, Iceland, Liechtenstein or Switzerland, as was possible with the EHIC.

Will my healthcare be free?

The EHIC only gives access to the public health care system of your host country. If you are treated privately the EHIC will not reimburse you.

With regards to care in the public sector, the EHIC gives you access to the same level of care as nationals of the country you’re visiting. Thus, if a national enjoys free treatment, you will have nothing to pay. However, as each country has its own rules and regulations on pricing of healthcare, it may be that care is free in your country of residence, but not necessarily in the country that you are visiting. In that case, the EHIC does not allow reimbursement above what the nationals of the host country receive; e.g. in France you are covered for up 80% of the costs, but the remaining 20% must be paid by you, not by the EHIC.
Regarding treatments that are fully covered, two scenarios are possible depending on the regulations of the country to which you are travelling:

Either you do not have to advance any medical expenses;
Or you have to advance your medical expenses and you will be reimbursed through the social security system of your host country, or on your return, via the system of your country of residence. It is often simpler to be reimbursed when you return, as you are dealing with a familiar system in a familiar language, rather than a foreign system in a foreign language. In the UK, the claims centre will also verify that you have been correctly charged. The disadvantage of this is that reimbursements can sometime take several weeks.

The costs that the EHIC will not reimburse

Sometimes, the EHIC is not sufficient to cover all costs related to the medical problems that you may encounter abroad. For example, once your condition has stabilised, the EHIC does not cover repatriation to your home country. So if you are too sick to go home and do not have means to pay the medical transportation, you will be forced to stay.
To cover the costs that the EHIC does not support, it is advised that you take out travel insurance. Travel insurance can cover:

The patient co-payment charge in the public sector
Repatriation or rescues
The costs if you have been referred to a private hospital

An EHIC is not a substitute for international medical insurance

In light of what has been stated above, it is important not to regard the European Health Insurance Card as free expatriate insurance in Europe. To summarise, here are the main limitations of the EHIC:

The card only covers you if you fall ill abroad. However, if the purpose of your trip is to seek treatment, this would count a planned treatment and the card would not be valid
The EHIC does not guarantee free services, you are only guaranteed the same treatment as the nationals of your host country
The use of private healthcare is not supported
The EHIC is only valid in European countries
If you become a resident in your host country, your EHIC loses its validity

Overall, an EHIC is very useful when you travel occasionally – holidays and business trips for example. However, it is best to take out additional travel insurance to ensure that all expenses related to your medical issues are covered. If you are expatriated, you will join the health system of your host country and depending on your situation and requirements, you may need an international medical insurance.

Expat Assure can help you to find the international medical cover best suited to your needs. Feel free to contact us directly or fill in a form online to request your insurance comparison.

You may also be interested in these articles:

What is the best international health insurance?

8 reasons why you need expat insurance

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NHS and private maternity in London

Lisa Expat Assure — Sun, 10 Mar 2013 14:43:15 +0000

Approximately 95% of births in London take place within the National Health Service. Although the NHS does a good job, each year a large number of women rely wholly or partly on the private medical sector for one of the most important acts of their lives.

This trend can be explained by four main reasons:

1 . There are an increasing number of expatriates in London and they sometimes have expatriate health insurance covering all or part of a private maternity (the classic British medical insurance doesn’t cover private maternity costs).

2 . The absence of wealth taxes, an attractive tax environment and a relaxed social climate in the UK encourages more ‘High Net Worth Individuals’ and entrepreneurs to this country who can afford a private maternity.

3 . The fact that women are tending to give birth at an older age has significantly increased the risk of complications during childbirth: 37% of births are either induced or by caesarean section.

4 . For those moments that can be magical but unfortunately sometimes traumatic, some women prefer to choose their own midwife / obstetrician and to give birth in more comfort than the NHS can offer.

For many the ultimate place to choose for a private delivery is in the Portland Hospital. And yet … why is it that the Duchess of Cambridge (Kate Middleton) chose to give birth to Prince George, future heir to the throne, in the private wing of an NHS hospital (St. Mary’s Hospital) in July?

A key reason is that NHS hospitals are well equipped for emergencies, which is not the case for private hospitals such as Portland. Another reason, perhaps equally important, is that like other NHS hospitals, St Mary’s Hospital has a “Private Maternity Wing” which allows for all the benefits of private care. This formula allows women to combine comfort with the security that only the NHS can give.

Other NHS hospitals in London with a “Private Maternity Wing” include:

– Guy’s & St Thomas’ NHS Hospital

– Chelsea & Westminster NHS Hospital

– University College London NHS Hospital

The advantage of choosing one of the latter options, which is significant, is the fact that these hospitals are less expensive than private ones such as the Portland.

NHS hospitals listed above actually offer many packages with different services and different rates.

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