Tag Archives: NHS

EEA PR & Comprehensive Sickness Insurance

March 2017
EEA PR – the Comprehensive Sickness Insurance Requirement – the Retrospective Effect!

With the Article 50 due to be trigger before the end of the month, many EEA nationals will be keen to file for a document proving their right to reside in the UK permanently as soon as possible.

The longstanding myth that permanent residence is acquired automatically by residing in the UK for a period of 5 years has rendered many EEA nationals oblivious to the true nature of their immigration status.

For many, the requirements to be met, the amount of documentation and information to be submitted in support of their EEA PR application, has come as a complete surprise.

With the Brexit in sight, they are now facing qualifying requirements that they have never been aware of, which are being applied to them retrospectively.

The most controversial of these requirements by far is the need to have held ‘comprehensive sickness insurance’ (CSI) when relying on periods of self-sufficiency or study.

As EEA nationals residing in the UK have access to NHS care, many will be under the impression that this access amounts to having CSI. Unfortunately this is not the case at present.

Realising that access to the NHS will not suffice, applicants will hope to be able to rely on a European Health Insurance Card (EHIC) issued by another state member as an alternative to the CSI. The Home Office policy document appears to suggest that in certain circumstances an EHIC (or E111) card would be acceptable as an alternative to having a private CSI when used to obtain a permanent residence document.

The CSI requirement is likely to impact most of the people who have spent all or part of their qualifying time in the UK in a self-sufficient capacity either studying or simply being inactive.

Many scenarios come to mind when considering the devastating effects the lack of CSI could have on applicants and their families.

These include EEA elderly parents who came to the UK to be near their EEA children. Most of them will not have ever worked in the UK and will not have been dependent on their children. Without CSI, the time spent in the UK is unlikely to count toward their permanent residence’s qualifying period. There will also be EEA nationals who took time off work to have a family or care for a loved one or to go on a retreat.
Unfortunately under the current rules, in most cases, the lack of CSI will prove to be an insurmountable obstacle.

Those who do not currently have comprehensive sickness insurance have the following options:

– purchase a Comprehensive Sickness Insurance now so that to start the clock again towards the 5 year qualifying period. This, of course, depending on the outcome of the Brexit negotiations, could turn out to be a complete waste of money;
– become a self-employed person or a worker, again resetting the clock towards permanent residence ;
-stand your ground and wait to see what the Brexit negotations bring. This is by far the bravest option. Although it is likely that something will be put in place to protect EEA nationals who have resided in the UK without having the right of residence either temporarily or permanently, there is no guarantee that this will be the case.

If you need Immigration legal assistance with your EEA PR application, please do not hesitate to contact us.

April 2015 – NHS surcharge for applicants both inside and outside the UK

The government is set to recoup up to £1.7 billion over the next ten years to help pay for the cost of NHS treatment given to temporary migrants.

The Legislation that came into effect on 6 April means that going forward nationals from outside the European Economic Area (EEA) coming to the UK for longer than six months will be required to pay a ‘health surcharge’ when they make their immigration application.  This surcharge must also be paid by non-EEA nationals already in the UK, who are applying to extend their stay. The surcharge does not apply to Tier 2 Intra-company transferees, Nationals of Australian and New Zealand – below is a detailed list of all exemptions .

The health surcharge is £150 per year for students and £200 per year for all other migrants to whom the surcharge applies. It is payable upfront and for the total period of time for which migrants are given permission to stay in the UK.

So who is to pay the NHS surcharge?

Considering that a migrant worker coming to the UK for 5 years with 2 dependants, is liable for a charge of £3000, which comes on top of the actual visa fees of £3384, the surcharge will act as a very strong deterrent on most migrants. Sponsors are very likely to have to have to pick up the bill which in most occasions will double their HR immigration budget. As the NHS surcharge is non refundable, sponsors may consider including a claw back clause in the migrant’s contract.

Many of our clients have already commented that Tier 2 migrants contribute to the UK economy through taxation. Bearing in mind that they are subject to NI contributions, with this surcharge they will end up paying for the service twice. The Home Office’s response to this is: ‘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. 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.’

Who is exempt from paying the surcharge?

A summary of exemptions is listed below.

Visitors, and where the grant of entry clearance (permission to stay in the UK) is for 6 months or less.

Intra company transfers (Tier 2 skilled workers).

Children under 18 years taken into care or in the care of a local authority.

Migrants making an application for asylum, humanitarian protection, or a claim that their removal from the United Kingdom would be contrary to article 3 of the European Convention on Human Rights.

Victims of human trafficking.

A migrant who applies under the Home Office concession known as the ‘destitute domestic violence concession’.

Dependents of a member of Her Majesty’s Forces.

As a dependant of a member of another country’s Forces who is exempt from Immigration Control.

Those making an immigration application related to an EU obligation, such as an application under the Turkish European Communities Association Agreement, are exempt.

Nationals of Australia or New Zealand.

A British Overseas Territory citizen who is the resident of the Falkland Islands.

What about the tourists, do they have to pay the health surcharge too?

No, Tourists travelling on a visitor visa [or EEA nationals] are not be liable for the surcharge. In fact from April 2015 those entering the UK on a visitor visa will be charged 150% of the cost of any medical treatment they receive from the NHS.

Please do not hesitate to contact us if you have any questions on any of the above.

December 2013 – Changes to the Entry Clearance form – NHS debts recovery

The National Health Service (Charges to Overseas Visitors) Regulations (as amended) states that the NHS will charge and recover payment for treatment provided to visitors, or non-residents (someone who is not considered as settled in the UK).

Hospitals can also use their discretion whether or not to withhold treatment if payment is not made in advance.

GPs must offer treatment to anyone who asks for it, but if a doctor deems further treatment as necessary they can use their discretion to refuse to register people as permanent or temporary patients.

If someone is not entitled to free hospital treatment, then a referral from a GP for treatment does not allow exemption from charges, unless the treatment falls under an exempt category (see below).


Regulation 3, Schedule 1 of the NHS regulations 1989 sets out:
– the overseas patients that are exempt from the charges; or
– circumstances when overseas patients are exempt.

Whilst the list below is not exhaustive, ‘circumstantial’exemptions include:
• Treatment at A&E, casualty or ‘walk-in’ centres
• Treatment for incapacitating illnesses, such as food poisoning, diarrhoea, salmonella infections, whooping cough etc (see Schedule 1 of the Regulations for a full list)
• Treatment for a sexually transmitted disease (see HIV below)
• Family planning services
• Services provided for those under the Mental Health Act 1983
• Psychiatric treatment required by a court.

Overseas patients exempted from paying the NHS charges are:
• Permanent residents (those holding indefinite leave to remain / permanent residency)
• Those based in the UK for employment, including self-employment (Tier 2, Tier 5, Tier 1..etc)
• Those that can obtain services due to reciprocal agreements with certain countries
• Those who are part of HM Forces and NATO armed forces
• Long term students (over 6 months leave) or students whose course is substantially funded by the UK government
• Refugees, including applicants for refugee status; but not refugees who have been refused asylum – more information is available on the Department of Health website: asylum seekers and refugees
• Those who have previously had 10 years continuous lawful residence in the UK and who have worked overseas for less than 5 years
• Those who work in another EEA state
• EEA nationals, including refugees of EEA states and their dependants


Since the 1st November 2011 any unpaid debt to one or more relevant NHS Bodies, with a total value of at least £1,000, is grounds to refuse an application for entry clearance.


Entry clearance will normally be refused if the applicant has unpaid NHS charges of £1,000 or more taking into consideration any compelling compassionate circumstances and/or human rights considerations.

Where a refusal application is also linked to a dependant application, any dependent will also fall to be refused.

However if the dependent is responsible for refusal, due to unpaid NHS debts, there is no requirement that the main applicant is also refused.

Where the debt relates to a dependent minor the parents/guardian will be responsible for the debt.

The rule only apply to debts acquired on or after 1 November 2011.

Refusal will be under the Immigration Rules paragraph 320(22) stating the charges owed to the NHS.

There are no additional appeal rights.

Application forms have recently been revised to show these changes.

If in the application form an applicant (not covered by the exemption listed above) states that they have received chargeable NHS treatment and there is no evidence that payment has been made, after taking into consideration any compassionate and human rights considerations, and if the applicant’s statement indicates that the NHS debt is for £1,000 or more, which is confirmed by the appropriate checks, then the Entry Clearance Officer will consider refusing the application under the Immigration Rules para 320(22).

If the debt is for less than £1,000, the application should not be refused under paragraph 320(22).

When an applicant has stated they have received chargeable NHS treatment in their application form, the visa officer will check their system or carry out further check with the help of the UKBA NSH SUPPORT TEAM who will contact the relevant hospital/trust and will feedback any information to post.

For further information, please contact us.