Overseas Patients Policy

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					                                 Overseas Patients Policy




Reference Number                               10.14

Version                                        1

Name of responsible (ratifying) committee      Hospital Management Committee (HMC)

Date ratified                                  25.02.2009

Document Manager (job title)                   Private Patient and Overseas Visitors Manager

Date issued                                    23.04.2009

Review date                                    April 2010

Electronic location                            Management Policies

Related Procedural Documents
                                               Overseas Patients Policy
                                               Overseas patient
                                               Overseas visitor
Key Words (to aid with searching)              Overseas
                                               Baseline questions
                                               Charging for NHS treatment
                                               Immediately necessary treatment




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                   Page 1 of 54
Contents
Section           Description                                                          Page
1                 Introduction                                                            3
2                 Purpose                                                                 4
3                 Scope                                                                   4
4                 Definitions                                                             4
5                 Duties and Responsibilities                                             4
6                 Process for Establishing a Patient‟s Eligibility for NHS Treatment      8
7                 Process to be followed for All Interviews                              14
8                 Process to Invoke Stabilisation and Discharge                          16
9                 Charging                                                               17
10                Training Requirements                                                  18
11                References and Associated Documentation                                18
12                Monitoring Compliance and Effectiveness                                18
13                Consultation                                                           19
14                Equality Impact Assessment                                             19
15                Ratification                                                           19
Appendix 1        The Law in England and Wales                                           20
Appendix 2        Baseline Questions                                                     28
Appendix 3        Stage Two Interview Process                                            29
Appendix 4        Out of Hours Contact form                                              32
Appendix 5        Patient Registration Form                                              33
Appendix 6        Standard Enquiry letter to Patient                                     35
Appendix 7        EEA and Non-EEA Bilateral Healthcare Agreement Countries &
                  Territories                                                            36
Appendix 8        IGA form                                                               37
Appendix 9        Advice from Doctor and Medical Practitioner form                       38
Appendix 10       Stabilise and Discharge Request form                                   39
Appendix 11       Stage Two Interview Record                                             40
Appendix 12       Credit/Debit Card Declaration                                          41
Appendix 13       Quote for Care                                                         42
Appendix 14       Overseas Visitor Patient Contract form                                 43
Appendix 15       Overseas Patients Policy: Full list of definitions                     46




Overseas Patients Policy. Issue 1 23.04.2009
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1      INTRODUCTION

1.1    The National Health Service (NHS) provides healthcare free of charge to people, who are

       resident in the United Kingdom (UK). People who do not usually live in the UK are not

       automatically entitled to use the NHS free of charge. Residency is therefore the main

       qualifying criterion, applicable regardless of nationality or whether the person holds a British

       passport, or has lived and paid taxes or National Insurance contributions in the UK in the

       past.



1.2    This policy is concerned with the management of individuals who do not normally live in the

       UK (overseas visitors), when they seek treatment from Portsmouth Hospitals NHS Trust

       (PHT).



1.3    The charging regulations as directed by the Department of Health (Implementing the

       Overseas Visitors Hospital Charging Regulations- April 1989, amended 2004) (Appendix 1)

       place a legal obligation on NHS Trusts in England to establish if people to whom they are

       providing NHS hospital services are not normally resident in the UK. If they are not then

       charges may be applicable for the NHS services provided. When that is the case the Trust

       must charge the person liable (usually the patient) for the cost of NHS services.



1.4    Enquiries regarding overseas visitors should be made to the Private Patient and Overseas

       Visitors Manager on 023 9228 2093. If the issue is still unclear advice will be sought from the

       Department of Health (DoH).



1.5    An individual department cannot intervene in individual cases. The decision about whether an

       individual patient is liable for charges rests with the Private Patient and Overseas Manager.




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2      PURPOSE

2.1    The purpose of this policy is to:

       2.1.1   introduce a standardised Trust wide policy for the management of Overseas Visitors in

               line with current legal requirements; and

       2.1.2   provide guidance and support to all PHT front line staff.



3      SCOPE

3.1    This policy applies to all staff (including voluntary workers, students, locums and agency)

       within the Trust and MDHU (Portsmouth), whilst acknowledging for staff other than those of

       the Trust the appropriate line management or chain of command will be followed.




3.2    In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that

       it may not be possible to adhere to all aspects of this document. In such circumstances, staff

       should take advice from their line manager and all possible action must be taken to maintain

       ongoing patient and staff safety.



4       DEFINITIONS

4.1    A full list of definitions can be found at Appendix 15.



5      DUTIES AND RESPONSIBILITIES

       Chief Executive

       The Chief Executive has ultimate responsibility for Corporate Governance; including ensuring

       processes are in place to support the management of Overseas Visitors in line with current

       legal requirements.

       Trust Board

       The Trust Board has overall responsibility for ensuring that, through good policy

       management, the organisation complies with all legal, statutory and good practice

       requirements.


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       Hospital Management Committee

       The Hospital Management Committee is responsible for the coordination and oversight of the

       operational delivery of the Trust. To fulfil this responsibility the Committee will ratify the

       Overseas Patients Policy and receive annual reports from the Private Patient and Overseas

       Visitors Manager.



       Managers

       Managers for each service area are responsible for ensuring that all relevant staff (see Duties

       and Responsibilities of a Stage One Interviewer (page 6) have undertaken the minimum level

       of training in order to confidently undertake stage one interviews (baseline questioning

       process).    Managers are also responsible for ensuring that the overseas visitors training

       forms part of each staff member‟s Personal Development Plan (PDP) and that staff are aware

       of the Trusts Complaints and Plaudits Management Policy and the Patient Advice and Liaison

       (PALS) service.



       Medical Practitioner

       The Medical Practitioner responsible for the treatment of the patient is responsible for

       ensuring that a patient, who has been classified as an overseas visitor and is liable for

       charges and is unable or unwilling to pay, only receives immediately necessary treatment

       (defined by the Regulations as „treatment that is required to save a patient‟s life and not what

       is clinically appropriate for the treatment of a certain condition‟).   The Medical Practitioner is

       also responsible for ensuring that all decisions are recorded in the patient‟s notes and for

       completing the Advice from Doctor and Medical Practitioner form. In the case of a patient,

       who has been identified as an overseas visitor and who has been in receipt of said

       immediately necessary treatment, 2 (two) Consultants will then be responsible for assessing

       that the patient is stable and can be discharged. The 2 Consultants who assess the patient

       as being stable and able to be discharged are also responsible for completing the Stabilise

       and Discharge Request form, keeping a copy in the patient‟s notes and forwarding a second

       copy to the Finance Department.

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        Private Patient and Overseas Visitors Manager

       The Private Patient and Overseas Visitors Manager is responsible for ensuring that

       appropriate processes are in place to support the management of Overseas Visitors in line

       with current legal requirements and for providing assurance to the Hospital Management

       Committee through the provision of an annual report, to include any necessary

       recommendations to address identified deficits. The Private Patient and Overseas Visitor

       Manager will also provide advice, training and support to Stage One Interviewers and Stage

       Two Officers and will refer any issues to the Director of Finance and Investment or the

       Department of Health, as required.



       Stage One Interviewer

       The Stage One Interviewer is all staff (medical, nursing and admin staff) who form part of an

       admin team for each service that is responsible for admitting patients, e.g. admissions clerk,

       receptionists etc., to PHT. The stage one interviewer is responsible for applying the baseline

       question process to every patient entering the Trust and referring those patients whose

       status is unable to be determined to a Stage Two Officers and/or Private Patient and

       Overseas Visitor Manager. The stage one interviewer is also responsible for completing the

       stage one questionnaire entitled „Patient Registration Form‟, filing it in the patient notes,

       placing an overseas visitor sticker to the front of the patient notes and for ensuring that the

       information is correctly entered onto the Patient Administration System (PAS).



       Stage Two Officer

       The Stage Two Officer (which includes the Private Patient and Overseas Visitor Manager) is

       responsible for assessing the eligibility status of a patient that has been referred via the stage

       one interview process. The Stage Two Officer is also responsible for conducting a stage two

       interview, deciding if a patient is liable for charges for the cost of NHS services, completing

       the Stage Two Interview Record, ensuring that the patient details are appropriately recorded

       and that either a deposit or full cost of the treatment is requested. The Stage Two Officer




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       must also be aware of the Trusts Complaints and Plaudits Management Policy and the

       Patient Advice and Liaison (PALS) service.



       The Stage Two Officer will refer any issues to the Private Patient and Overseas Visitor

       Manager for advice/resolution.




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6       PROCESS FOR            ESTABLISHING         A    PATIENT‟S       ELIGIBILITY       FOR    NHS
        TREATMENT

6.1     Stage One Interview

        The Stage One Interviewer (see Section 5 Duties and Responsibilities) is responsible for

        ensuring that overseas visitors are correctly identified. To do this the baseline question (BLQ)

        process (Appendix 2) must be applied to every patient entering the Trust.



6.1.1   At the time of making-up the notes, the stage one questionnaire entitled Patient Registration

        Form (Appendix 5) must be completed, dated and filed, and if appropriate then a stage two

        interview with a Stage Two Officer and/or Private Patient and Overseas Visitor Manager will

        need to be arranged (see para 6.1.4) as soon as possible.



6.1.2   It is the responsibility of the Stage Two Officer and/or Private Patient and Overseas Visitor

        Manager to conduct a stage two interview in order to determine the current status of the

        patient following referral via the stage one interview process (Appendix 3).



6.1.3   All staff must refrain from giving advice on eligibility for free treatment unless the Private

        Patient and Overseas Visitors Manager has advised them.



6.1.4   The Private Patient and Overseas Visitor Manager is located in the Finance Department,

        Building 3, Fort Southwick, and can be contacted on 023 9228 2093 or 0775508547 during

        the hours of 08.30 to 17.30. There is no out of hours service provided, however, if there is

        doubt about a patients eligibility for free NHS care then they should be initially treated as an

        overseas visitor and an answer phone message left on 023 9228 2093, and an Out of Hours

        Contact form (Appendix 4) duly completed and returned to the Private Patient and Overseas

        Visitor Manager.




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6.2     Admission via Accident and Emergency (A&E)

        There is no exemption from charge for „emergency‟ treatment (other than that given in an

        accident and emergency department or an observation ward attached to an A&E department).

        PHT will always provide immediately necessary treatment if it is to save the patient‟s life. It

        must not be delayed whilst the patient‟s chargeable status is determined. Failure to do so is

        in direct breach of the Human Rights Act 1998.



6.2.1   If a patient has indicated that they are a visitor to the UK or that they are on holiday, the

        overseas address must be entered onto the PAS system as the permanent address and the

        UK address as the temporary address.



6.2.2   At the time of making-up the notes, the stage one questionnaire entitled Patient Registration

        Form (Appendix 5) must be completed, dated and filed, and if appropriate then a stage two

        interview with a Stage Two Officer and/or Private Patient and Overseas Visitor Manager will

        need to be arranged (see para 6.1.4) as soon as possible before patient admission.



6.2.3   The patient‟s representative should be asked the stage one questions if the patient is unable

        to answer them, an interpreter may be used from either Language Line or the Trust‟s

        preferred Interpreting Service if required.



6.2.4   If any patient upon questioning at stage one indicates that they are a visitor to the UK or are

        on holiday then they must be referred to the Private Patient and Overseas Visitor Manager as

        soon as possible, as it is likely that they are liable for NHS charges.



6.3     Inpatient Admissions

        If the patient is admitted a stage two interview should take place as soon as is conveniently

        possible. All patients admitted for a new episode of treatment must complete the stage one

        questionnaire entitled Patient Registration Form (Appendix 5), or have the form completed by

        the Outpatients Department.

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         Once Status has been determined this MUST be entered correctly on to the PAS hospital
         system.


         Follow all the normal procedures for entering a patient except when you come to the
         status and a category should be chosen. Please choose the correct category.
         See Figure 1.




           Figure 1




         The next step is to choose the correct valid code rather than just using the natural default
         code No 8. This will need to match the status, e.g. if OVE status then No 1 relates to this, if
         OVP then No 4 is the correct code to use. See Figure 2.




           Figure 2




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6.4     Outpatient Appointment

        The Outpatients Department has a poster displaying the information requirements for patients

        to prove exemption status and the appointment letter contains a paragraph explaining to the

        patient that they will be required to prove eligibility to receive free NHS treatment.



6.4.1   On the day of the appointment, the admissions clerk must ensure that the baseline questions

        (Appendix 2) are asked as part of the admissions procedure. Where the baseline questions

        do not confirm eligibility for free NHS care the case must be referred to the Private Patient

        and Overseas Visitor Manager (see para 6.1.4).



6.4.2   The patient should be informed that they will be interviewed to establish their eligibility for free

        NHS treatment. At this stage the patient should NOT be booked in until eligibility is

        established.



6.4.3   This process should be followed regardless of whether the patient has a new or old set of

        notes.



6.4.4   In cases where the GP referral letter indicates that the patient has recently arrived in the UK

        then a copy of the letter must be given to the Private Patient and Overseas Visitor Manager. If

        in the opinion of the medical staff the appointment is not classed as immediately necessary

        treatment eligibility must be established before any treatment is given.

         Once Status has been determined this MUST be entered correctly on to the PAS hospital
         system.


         Follow all the normal procedures for entering a patient except when you come to the status
         and a category should be chosen, please chose the correct category. See Figure 3.




Overseas Patients Policy. Issue 1 23.04.2009
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           Figure 3




        The next step is to choose the correct valid code rather than just using the natural default
        code No 8. This will need to match the status, e.g. if OVE status then No 1 relates to this, if
        OVP then No 4 is the correct code to use. See Figure 4.




        Figure 4




6.4.5   When a patient is referred to the Private Patient and Overseas Visitor Manager on the basis

        of a GP referral letter, before the appointment date a letter must be sent to the patient

        (Appendix 6) by the Private Patient and Overseas Visitor Manager. If no response is received

        within two weeks then a follow-up telephone call will be made to the patient, in order to

        establish eligibility using the stage two process. A stage two interview can be conducted over

        the telephone.


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6.5     Elective Admissions

        Where the patient is chargeable, PHT should NOT initiate any treatment process, e.g. by

        putting the patient on a waiting list, until a deposit equivalent to the estimated full cost of

        treatment is obtained. If no deposit is obtained then PHT should NOT perform the procedure.



6.5.1   A patient from a European Economic Area (EEA) member state (Appendix 7) can be added to

        a waiting list in the same way as an NHS patient can be, however if the diagnosis is on the

        Payment by Results (PbR) Tariff then this is transmitted to the Department of Health in the

        same way as PBR. If the diagnosis is not on the PBR tariff then an IGA Form is completed by

        the Finance Department (Appendix 8) and sent to:

         Leeds North East Primary Care Trust
         Overseas Visitors Section (Finance)
         Sycamore Lodge
         7a Woodhouse Cliff
         LEEDS
         LS6 2HF



6.6     Tertiary Referrals

        When a Consultant accepts a tertiary referral the patient‟s status should be established prior

        to admission unless the patient has a life threatening condition or is in need of immediately

        necessary treatment. If this is not possible due to the patient‟s condition then the patient‟s

        status should be identified as soon as the patient is stable (in the clinician‟s view) (see

        Section 8) and informed of their eligibility for free of charge NHS treatment.




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7       PROCESS TO BE FOLLOWED FOR ALL INTERVIEWS

7.1     Timely Decision and Action

        It is imperative that the process to establish overseas status and the collection of any

        payments due is concluded as quickly as possible.



7.2     The Stage One Interview (baseline question (BLQ)) process

        The Stage One Interviewer has a duty to follow the Trust policy on interviewing patients, using

        registered interpretation services, where appropriate, and maintaining the privacy and dignity

        of the patient at all times.



7.2.1   The interview is effectively the asking of the baseline questions (Appendix 2), witnessing the

        supporting residency evidence and completing the stage one questionnaire entitled Patient

        Registration Form (Appendix 5). This process should not take longer than a few minutes.



7.2.2   The baseline questions must be asked of every patient entering the Trust. Once the

        baseline question process has been completed and the stage one interviewer has any doubt

        about the patient‟s status from the answers given, then they must refer them to the Private

        Patient and Overseas Visitor Manager for further investigation (see para 6.1.4).



7.2.3   It is not the responsibility of the stage one interviewer to establish eligibility (Appendix 3).



7.2.4   The majority of patients will not be liable for charges. The purpose in asking the baseline

        questions at this stage is to avoid discrimination and to ensure those patients who are liable

        for charges are identified at the earliest opportunity.




Overseas Patients Policy. Issue 1 23.04.2009
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7.3     Overseas Visitor Sticker

        An overseas visitor sticker should be added to the FRONT of the medical notes once a

        patient is identified as being chargeable (see Figure 5).


             Figure 5

                          OVERSEAS PATIENT
                   Please contact:: Overseas Visitors Manager
                             for Overseas Patients
                                 023 9228 2093

                   LIABLE               EEA          NOT LIABLE


7.4     Complaints

        Where a patient is unhappy with the care they have received then they (or someone acting on

        their behalf with their consent) should be advised on how to make a complaint through the

        Trust‟s complaints procedure.



7.4.1   All Stage One Interviewers and Stage Two Officers must be aware of the Trusts Complaints

        and Plaudits Management Policy and the Patient Advice and Liaison (PALS) service.




Overseas Patients Policy. Issue 1 23.04.2009
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8       PROCESS TO BE FOLLOWED TO INVOKE STABILISATION AND SUBSEQUENT
        DISCHARGE OF AN IDENTIFIED OVERSEAS PATIENT


8.1     Medical Practitioner‟s responsibilities to invoke stabilise and discharge

        Once the patient becomes stable and out of immediate danger then the Medical Practitioner

        will discharge the patient from their care (see para 8.1.3 below).



8.1.1   Immediately necessary treatment is defined as treatment that is required to save the

        patients life, not what is clinically appropriate for the treatment of a certain condition.



8.1.2   It is important that the Trust minimises financial loss by ensuring that discharge is facilitated

        as soon as the patient is deemed by a Clinician to be stable. All decisions must be recorded

        in the patient‟s clinical notes. If the patient states that they have no funds then the Medical

        Practitioner is asked to complete an Advice from Doctor & Medical Practitioner form

        (Appendix 9).



8.1.3   As agreed by the Medical Staffing Committee, a patient is to be discharged in a stable

        condition as determined by the treating consultant and two other consultants. A Stabilise

        and Discharge Request Form (Appendix 10) must be completed keeping a copy in the

        patient‟s notes and forwarding a second copy to the Finance Department.



8.1.4   The patient is able, if they so wish, to re-enter the Trust via the Accident & Emergency

        Department and be re-assessed in the normal way. The Regulations make no provision for

        how many times a patient can attend A&E.




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9       CHARGING

9.1     If the Trust is satisfied that the patient is an overseas visitor then the Trust must charge the

        patient for the NHS services provided.



9.1.2   If there are any doubts over the validity of exemption for a patient the patient should also be

        charged for their treatment.



9.1.3   If the patient refuses to pay or states that they have no funds available to pay (this is treated

        as a refusal to pay) then a payment plan can be negotiated in order to settle the debt however

        this is at the discretion of the Trust.



9.1.4   It is not acceptable for an invoice not to be raised for treatment because it is believed or

        claimed that there is an inability to pay.



9.2     Pharmacy

        Overseas visitors are not entitled to receive an NHS subsidised prescription therefore they

        must pay the charge of a private prescription (details from Pharmacy & Private Patient‟s

        Tariff).



9.3     Deceased Patients

        Where a patient dies without making or completing a payment to the Trust the debt then

        becomes recoverable from the deceased‟s estate. An offer from relatives or another person

        to meet the debt can be accepted but this must not be actively pursued, unless it was they

        who had signed the undertaking to pay form.




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10     TRAINING REQUIREMENTS

       Appropriate training is essential to enable staff to confidently undertake stage one interviews

       (baseline question process). Managers in each service area must ensure that all relevant

       staff has undertaken the minimum level of training in order to complete the interview.

       Managers should ensure that overseas visitors‟ training forms part of each staff member‟s

       Personal Development Plan (PDP).



       The Private Patient and Overseas Visitor Manager will provide advice, training and support to

       Stage One Interviewers. This can be arranged by contacting 023 9228 2093 (see para 6.1.4).



11     REFERENCES AND ASSOCIATED DOCUMENTATION

       Human Rights Act 1998

       National Health Service Act 1977 (s.121) (as amended by sections 7(12) and (14) of the
       Health and Medicines Act 1998)

       National Health Service (Charges to Overseas Visitors Regulations 1989 (SI No.306))

       National Health Service (Charges to Overseas Visitors) (Amendment Regulations 2004 (SI
       No.614)

       Implementing the Overseas Visitors Hospital Charging Regulations, Department of Health,
       April 1989 (Amended April 2004)

       Implementing the Overseas Visitors Hospital Charging Regulations: A Guidance for NHS
       Trust Hospitals in England, Department of Health, Revised January 2007, DH_0811516[2].
       www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH
       _4080313

       Race Relations (Amendment) Act 2000



12     MONITORING COMPLIANCE AND EFFECTIVENESS OF THIS POLICY


       The Private Patient and Overseas Visitors Manager is responsible for ensuring that

       appropriate processes are in place to support the management of the Overseas Visitors

       Policy in line with current legal requirements and for providing assurance to the Hospital

       Management Committee through the provision of an annual report, to include any necessary

       recommendations to address identified deficits.
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       The Private Patient and Overseas Visitor Manager is also responsible for providing advice,

       training and support to Stage One Interviewers and Stage Two Officers and will refer any

       issues to the Director of Finance and Investment or the Department of Health, as required.



       The Hospital Management Committee is responsible for the coordination and oversight of the

       operational delivery of the Trust. To fulfil this responsibility the Committee will ratify the

       Overseas Visitors Policy and receive annual reports from the Private Patient and Overseas

       Visitors Manager to ensure a robust process is in place.



13     CONSULTATION


       The Clinical Directors‟ Forum (8.10.08) and the Governance and Quality Committee

       (19.11.08) have been consulted in the development of this policy.



14     QUALITY IMPACT ASSESSMENT

       This policy has been assessed against the PHT Equality Impact Assessment process.


15     RATIFICATION


       The Hospital Management Committee has ratified the Overseas Visitors Policy.




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APPENDIX 1

The Law in England and Wales

1.1    All NHS Trusts have a statutory obligation to establish whether people using their services are

       normally resident in the UK. The Trust‟s statutory duty extends to charging those who are

       found not to be eligible for free treatment, and who are not otherwise exempt or covered by a

       Reciprocal Healthcare Agreement or European Economic Area (EEA) arrangements. If the

       Trust is satisfied that the patient is liable to pay, the law requires the Trust to calculate and

       recover the charges for any treatment given.

1.2    Only the Secretary of State can, in special cases agree to waive charges.

1.3    The Trust is required to inform the Department of Health if it provides services to a patient

       from one of the countries with which the UK holds a Reciprocal Healthcare Agreement or from

       one of our EEA partner States. This information is needed at a national level to maintain

       those agreements and to ensure that they remain fair to the UK and other partners.

1.4    The statutory provisions which enable overseas visitors to be charged for NHS treatment are

       found in section 121 of the National Health Service Act 1977 (as amended by sections 7(12)

       and (14) of the Health and Medicines Act 1988). These give authority to the Secretary of

       State for Health to make regulations concerning charging anyone who is not ordinarily

       resident in Great Britain for any NHS services provided. They also give him powers to

       calculate such charges on any appropriate commercial basis. These powers are devolved to

       Health Authorities, Foundation Trusts and NHS Trusts in England.

       Using the powers in section 121 Parliament has approved regulations exempting some

       people and some services from charges. These exemptions are detailed in the Regulations

       contained within these appendices.

1.5    Amendments to The National Health Service (Charges to Overseas Visitors) Regulations

          The National Health Service (Charges to Overseas Visitors) Regulations 1989 (Statutory

           Instrument (SI No. 306) – the current baseline Regulations;

          The National Health Service (Charges to Overseas Visitors) Amendment Regulations

           1991 (SI No.438) – amended the baseline to reflect the introduction of NHS Trusts;



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           introduced exemption for family planning services and made changes to the list of bilateral

           healthcare agreement countries;

          The National Health Service (Charges to Overseas Visitors) Amendment Regulations

           1994 (SI No.1535) – introduced amendments necessary on the creation of the European

           Economic Area (EEA); removed the dental and optical emergency departments from the

           services exempt from charges; made amendments concerned with the European Social

           Charter and amended the list of diseases for which no charge shall be made and the list

           of countries with which we hold bilateral healthcare agreements;

          The National Health Service (Charges to Overseas Visitors) Amendment Regulations

           2000 (SI No.602) – amended the baseline Regulations to include Primary Care Trusts

           (PCT’s);

          The National Health Service (Charges to Overseas Visitors) (Amendment) (No.2)

           Regulations 2000 (SI No.909) – corrected an error in SI No.2000/602 which omitted a

           coming into force date;

          The NHS (Functions of Strategic Health Authorities and Primary Care Trusts and

           Administration Arrangement (England) Regulations 2002 (SI No.2375) – placed

           responsibilities on Strategic Health Authorities to performance manage the operation of

           arrangements made under s121 of the NHS Act 1977; and

          The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations

           2004 (SI No.614) – amended the baseline Regulations to include the changes to

           Regulations designed to tighten loopholes open to abuse and modernise the charging

           regime.

The Regulations Explained

There are ten main regulations governing the management of overseas visitors seeking treatment in

the UK.

1) Regulation 1

This regulation provides some definitions of the words and terms used in the other Regulations (see

glossary included in the A-Z of overseas patients Appendix 15).



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Calculating the Period of Residence – The Regulation provides that when calculating a period of

residence a person can be out of the UK for up to three months before it is taken into consideration.

For example, if a person has lived in the UK for 12 months immediately preceding their treatment but

has spent three months of that time on holidays abroad they can still be considered to have spent the

last 12 months in the UK.

Child – for the purpose of the Regulations a child is someone under the age of 16, or 16-19 but in full

time education.

Member of the Family – this applies only to people from EEA countries.

Overseas Visitors – means any person of any nationality not ordinarily resident in the UK.

Treatment the need for which arose during the visit – this applies to treatment needed where the

diagnosis of a condition is made when first symptoms arise during a visit to the UK. It does not

include routine monitoring of an existing condition, e.g. diabetes.

2) Regulation 2

This Regulation states when and how a Trust should make a charge for treatment and how it should

recover the money.

The Regulation places a legal obligation on the Trust to establish if a person is not ordinarily

resident in the UK. The Trust must make reasonable enquiries into the circumstances of that person

to determine if they are liable for charges.

If, in the light of enquiries, the Trust decides that the patient is not eligible for free treatment then this

Regulation requires the Trust to levy a charge and recover it from the patient. The Trust must

give the patient or the person paying the charge a receipt for the amount paid.

3) Regulation 3

Some NHS services provided by a Trust are free to everyone regardless of their status as a patient.

These services are detailed below:

 A&E – Treatment given in an accident and emergency department, a walk-in centre, a minor

 injuries area, an A&E clinic or an Observation Ward attached to an A&E department. This

 exemption from charges ceases when the patient leaves the area and is admitted to a ward or

 given an outpatient appointment. To clarify a common misconception, emergency treatment is

 not exempt; the area in which the treatment is administered is exempt.

Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                         Page 22 of 54
 The same emergency treatment given in ITU is chargeable or CCU is chargeable.

 Community – Some services provided in the community will be chargeable only where the staff

 are employed by a Trust, e.g. District Nurses by the local PCT. However a Practice Nurse

 employed by a GP providing a service is NOT chargeable.

 Public Health Protection – There are certain diseases where treatment is necessary to protect the
 wider public health. They are as follows:
                 Acute encephalitis                                   Plague
                 Acute poliomyelitis                                  Rabies
                Amoebic Dysentery                                Relapsing Fever
                       Anthrax                                        Rubella
                Bacillary Dysentery                            Salmonella infection
                       Cholera                      SARS (Severe Acute Respiratory Syndrome
                      Diphtheria                                   Scarlet Fever
                   Food Poisoning                                    Smallpox
                       Leprosy                              Staphylococcal infections
                    Leptospirosis                                     Tetanus
                       Malaria                                     Tuberculosis
                       Measles                                    Typhoid Fever
                      Meningitis                                      Typhus
             Meningococcal septicaemia                      Viral haemorrhagic fevers
                (without meningitis)
                       Mumps                                       Viral hepatitis
               Opthalmia neonatorum                             Whooping Cough
                 Paratyphoid fever                                 Yellow Fever


 Treatment given in, or as the result of a referral from a Sexually Transmitted Diseases (STD)

 Clinic – This does not apply to treatment for HIV Positive patients who must pay for any treatment

 beyond an initial diagnostic test and any counselling associated with the test or its result. An

 overseas visitor with HIV/AIDS referred to a hospital from such a clinic will be liable for charges

 unless otherwise exempt.

 For example, a Patient with TB & HIV, the treatment for TB will be exempt from charges; however

 the patient will still incur charges for the treatment of HIV.

 Detained under Mental Health Act – All treatment given to people detained under the Mental

 Health Act 1983 or a court probation order is exempt.




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                  Page 23 of 54
Regulation 4

This Regulation specifies the circumstances where an overseas visitor may be exempt from charges:

      Where married couples are concerned, if either the husband or the wife is exempt then their

       spouse and any children under the age of 16 or under 19 if they are still in full time education

       will also be exempt if they are either in the UK with the exempt person for the duration of their

       visit.

      The exemption only applies to spouse and children where the exempt person is in the UK with

       them at the time of treatment. If they are travelling independently of the exempt person, then

       the exemption does not extend to them.

      Anyone who at the time of receiving treatment has been resident in the UK for the previous 12

       months. This is the fundamental qualifier to recognise ‘ordinarily resident status.’ (See

       Baseline Questions Appendix 2)

                                                Ordinarily Resident

          A person lawfully living in the UK voluntarily and for settled purposes as part of the regular

                order their life for the time being. They should have an identifiable purpose for their

          residence here and that purpose should have sufficient degree of continuity to be properly

                                                described as „settled‟.



      Anyone who has come to the UK to take up permanent residence.

      Anyone who has come to the UK for employment (self employed or employed by others) it is

       not sufficient to have the right to work here; they must actually be in work.

      Students pursuing a full time course of study – minimum six months (at the time of treatment

       are still attending their course) the spouse and children of an exempt overseas student will

       also be exempt provided that they are living with the student on a permanent basis for the

       duration of the course.

      Someone who has entered the UK on a temporary basis, for example on a visitor‟s visa, but

       makes an application to remain in the UK permanently will remain liable for charges until

       application has been granted.



Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                        Page 24 of 54
      Anyone who is living lawfully in the UK for 12 months prior to treatment, except where the

       patient originally came to the UK for the purpose of obtaining private medical

       treatment.

      Where a Refugee or an Asylum seeker (A refugee is someone who has been granted asylum

       in this country) has been living in the UK more than 12 months and is receiving a course of

       treatment free of charge and is subsequently established that the application has finally failed

       and exhausted all appeals, they cannot be charged for the present treatment but any new

       treatment must, however be charged – Exemption only lasts until their claim is determined

       and the Trust will check that the application is still on-going regular intervals if treatment is

       being provided over a long period. If the claim is finally rejected then any new claim is

       chargeable. Once they have completed 12 months residence they do not become exempt

       from charges.

      Members of HM Forces and other Crown servants and British Council or Commonwealth War

       Graves Commission staff serving overseas and others working overseas under arrangements

       sponsored by HM Government.

      People working abroad for not more than five years, as long as they have lived in the UK

       lawfully for ten continuous years, will receive immediate necessary treatment during their

       short visits, but if working more than five years they will no longer be exempt.

      Seamen working on UK registered ships.

      Those receiving UK war pensions

      Diplomatic staff at embassies and commonwealth high commissions in London.

      EEA nationals working in another EEA member state but paying compulsory UK Class I or

       Class II National Insurance contributions.

      Referred to the UK for specific treatment from EEA countries or Switzerland must have E112

       issued by the State Health Authority in their home country.

5) Regulation 4a

This Regulation concerns people who are in receipt of a UK state pension.

      Pensioners residing in both the UK and another EEA member state – as long as they spend

       at least six months living in the UK and are not registered as a resident in another EEA

Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                     Page 25 of 54
       member state, they remain exempt. This exemption does not apply of they are living in a non-

       EEA member country during the period they are away.

6) Regulation 5

This Regulation lists categories of overseas visitors who are exempt from charges. In this case

however, the exemption is limited to treatment needed for conditions arising during the visit. Under

this Regulation pre-existing conditions are excluded. The Regulations exemption applies to:

      UK State pensioners who are living in a non-EEA country, who have lived in the UK for ten

       continuous years at some point or have been employed by the UK government for ten

       continuous years.

      Nationals from Turkey who are genuinely without resources to pay for their treatment.

      Visitors from non-EEA countries with which we hold bilateral healthcare agreements (see

       Appendix 7)

7) Regulation 6

This Regulation provides for free treatment to be given to a person who is serving with an armed

force which is part of NATO, but only where that treatment cannot be readily provided by either his or

her own medical force or the UK Armed Forces Medical Services.

8) Regulation 6a

This Regulation allows the Secretary of State for Health to designate an individual as exempt from

charges on exceptional humanitarian grounds, as long as certain specified criteria are met. The

Secretary of State can only make this designation and the Trust would need to establish whether

such determination has been made.

The patient is allowed to be accompanied by an authorised companion, who will be exempt from

charges for treatment should the need arise whilst they are in the UK, but not for other treatment.

The Trust will be advised that the appropriate determination has been made and that supporting

documentation will be provided (although in an emergency this may arrive after the patient).

9) Regulation 7

This Regulation specifies who is liable to pay the NHS charges. In the vast majority of cases this will

be the patient. There are only two exceptions:

          Seamen or women – liability is with the owner of the ship; and

Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                     Page 26 of 54
          Aircrew – liability is with the Airline or employer.

10) Regulation 8

This Regulation concerns the repayment of NHS charges. These can be repaid only where the

person who paid them can provide evidence that, at the time they received the services, they

were not liable for the charges. The person has to provide the Trust with the receipt for the money

already paid; a signed declaration in support of his or her claim and whatever reasonable evidences

the Trust requires. Where these conditions are met, any charges recovered should be repaid. The

final decision is with the Director of Finance and Investment.

 Treatment provided in A&E, Minor Injuries units and Observation Wards attached to A&E

 departments is exempt. The exemption from charge ceases when the patient leaves the

 department, i.e. is admitted to a ward within the hospital or is referred to an outpatient clinic. The

 common misconception is that „emergency‟ treatment is free, it is not, it is the location that is

 exempt not the treatment. Trusts have an obligation to treat patients who have life threatening

 conditions and to provide immediately necessary treatment, irrespective of ability to pay.




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                    Page 27 of 54
APPENDIX 2
The Baseline Question (BLQ) Process




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                        Page 28 of 54
APPENDIX 3

2.1    Stage Two Interview Process

       It is the responsibility of the Stage Two Officer (this includes the Overseas Visitors Manager

       for Overseas Patients) to undertake a stage two interview to assess the current status of a

       patient who has been referred via the stage one interview process. The Trust has five

       appointed stage Two Officers‟. The Private Patient and Overseas Visitors Manager will

       provide advice and leadership to the team of Stage Two Officers‟ and will ensure that the

       team are up-to-date with current legislation and are fully supported and trained in order to

       carry out the interviews.

       The process for the Stage Two Officer:

          Research all information with regard to the patient before the interview commences (use

           PAS, GP Referral letter, CSA);

          Always ask nursing staff if the patient is well enough to be interviewed;

          Ensure that infection control procedures are adhered to without exception;

          Arrange an interpreter if required (using the Official Trust Interpreting Service);

          Always respect the patient‟s dignity and confidentiality – ensure that the interview is

           conducted in a private way as possible, if the patient is bed bound the curtains MUST be

           drawn. If the patient is mobile conduct the interview in a side office on the ward;

          It will become clear as the interview progresses if the patient is not ordinarily resident,

           but some patients may dispute this assessment. It is up to the patient to prove that

           they are exempt from charge, not the Trust to prove that they are not. If the Stage Two

           Officer is not satisfied with any or all of the responses then the patient should be charged;

          The patient can be reimbursed at a later date if they successfully prove they were entitled

           to exempt treatment at the time of the charge; and

          The Stage Two Officer will complete the stage two interview record (Appendix 11).




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                      Page 29 of 54
2.2    Upon deciding that the patient is liable for charges as an Overseas Visitor the Stage Two

       Officer must also carry out the following duties:

          Ensure that the patient details are appropriately recorded;
          Request the full cost of the treatment in advance (or in the case of an in-patient before
           discharge) this can be taken by credit, debit card, cheque, cash, and bankers‟ draft (see
           Appendix 12);
          An initial deposit of £500.00 or one bed day whichever is greater should be charged to the
           patient, which should cover one bed day and any initial tests. (If the patient is in CCU or
           ITU then this charge should increase to £750.00);
          Request an immediate invoice be raised; and
          Provide advice on overseas patients issues, where appropriate or liasing with the Private
           Patient and Overseas Visitors Manager in more complex cases, call 023 9228 2093 (see
           para 6.1.4)


2.3    Patients found to be liable for charges

       If the patient is found to be liable for charges, explain the procedure to them and to the next of

       kin, or an advocate acting on the patient‟s behalf. The liability to pay rests with the patient;

       however an undertaking to pay can be taken from anyone the patient nominates to act on his

       or her behalf. In some cases a guarantor may be requested. The £500.00 initial deposit or

       50% whichever is greater should be requested or an estimate for the full cost of treatment

       (Appendix 13), followed by an invoice for the full cost of treatment should be raised. This

       should be handed to the patient and payment sought immediately, using a credit/debit card or

       any other acceptable means. If the patient has left the hospital then this should be posted in

       the normal way to the patient‟s home address and standard business terms used including

       national and international debt recovery.

2.4    Personal Liability

       The Regulations state that a deposit for an estimate for the full cost of treatment should be

       obtained from the patient prior to any treatment being given. The Trust will require the patient

       to sign an Overseas Visitor Patient Contract (Appendix 14). However, the patient is liable

       for charges irrespective of signing an agreement or not.




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                     Page 30 of 54
2.5    Patients who are insured

       Charges for patients who are insured are calculated on the same basis as the patient who

       has personal liability. It is not best practice to, nor it is advised by the Department of Health to

       deal with third parties, therefore any charge should be made to the patient and it is up to them

       to make their own claim to the insurance company. The Trust will not deal with overseas

       insurance companies unless in exceptional circumstances and it has been cleared in advance

       by the insurance company involved. The final decision is made by the Director of Finance

       Investment.



2.6    Complaints

       All Stage Two Officers must be aware of the Trusts Complaints and Plaudits Management

       Policy and the Patient Advice and Liaison (PALS) service.




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                      Page 31 of 54
APPENDIX 4
Out of Hours Contact Form


Overseas Patients Record Form (Out of Hours only)
Form Completed by


Job Title


Bleep Number


Signed


Do not leave the above area blank – an audit trail needs to be established for each patient.

Patient Name


Date of Birth                                                Postcode


Home Address:




UK Address:




Ward/Area:                                                   Admission Date:


Credit Card details recorded                                  YES/NO
Reason for NO:



Please do not use this form if it is Monday to Friday 9am to 5pm. (Unless you have been notified that
the Private Patient and Overseas Visitors Manager is not on site.


Please call 023 9228 2093 for the Private Patient and Overseas Visitors Manager.




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                                        Page 32 of 54
  APPENDIX 5 – Patient Registration Form



                (Attach patient ID here)          Overseas Patient Department
                                                                                                                                      
                                                  Portsmouth Hospitals NHS Trust
                                                  Queen Alexandra Hospital Cosham Portsmouth PO6 3LY
                                                  Tel DDI: 023 9228 2093, Fax: 023 92282095
                                                  Email: deborah.stemp@porthosp.nhs.uk
Confidential Patient Registration Form
As a new registration to this Trust, we are legally obliged by Government Regulations to assess your eligibility
to receive free NHS treatment. Entitlement is based on residency, irrespective of nationality, citizenship or any
previous payment of NICs or taxes.

Please complete this form to the best of your ability, and return it in the enclosed addressed envelope with a
copy of your passport and accompanying supporting documentation relating to your exemption
claim. Please note that until your status has been determined, you will remain liable for charges for all
NHS treatment (no charges apply to any treatment received within the Accident & Emergency Dept only).
Personal Details:
Surname: .……………………………………........................         Forename: ……………...………….…………………………….

Permanent Home Address:…………………………………….                   DOB: ………………………………………………………………….

……………………………………………………………………………                            Tel Number: Home: ………………………………………….

Postcode: ……………………………………………………………                        Mobile:………………………………………………………………

Nationality: ...……………………………………………………..                   Work:………………………………………………………………..

Part 1 Residency:

Where have you been living for the past 12 months? ……………………………………………………………………………..
                                                                              Give full postal address if difference from the above
What date did you arrive in the UK? ………………………………………………………………………………………………………

Which country did you come from? ……………………………………………………………………………………………………….

What is your overseas address? …………………………………………………………………………………………………………….
                                                                                                                    (if applicable)


Approx how many months have you spent OUTSIDE the UK in the last year? …………………………………..…….

Part 2

What is the purpose of your stay in the UK? (Please give details i.e. Names and addresses)

Work: …………………………………………………………………………………………………………………………………………………
State Name and Address of Employer                                                             Copy of Work permit/visa /payslips


Study: ………………………………………………………………………………………………………………………………………………..
State Name & Address of Educational Facility                               Copy of Student visa and letter from college/university


Visiting: ………………………………………………………………………………………………………………………………………………
State UK Address                                                   Copy of UK entry Clearance Visa if you are from outside the EEA


                                                                                 Please continue over the page



Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                                  Page 33 of 54
Taking up permanent residency: ……………………………………………………………………........................................
State Reason:                                               Copy of rental/tenancy agreement, utility bills, bank statement, council tax etc


As a refugee or asylum seeker: ……………………………………………………………………………………………………………..
                                                                                                    Copy of IND/ARC/Home Officer papers


Other: (Please give details)……………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………………..

On what date will you be leaving the UK? ………………………………………………………………………………………………
(If applicable)

Documentation relating to legal Right of Entry to the UK:

Please indicate which of the following you are currently in possession of:

       A current UK or European Union Passport
       Current Non EU Passport with valid UK entry Clearance Visa
       ARC – Asylum Registration Card
       United Kingdom Home Office Papers
       IND – Immigration National Directorate Card
       Work Permit
       Worker Registration Scheme Certificate
       Student Visa
       Working/Holiday Visa
       Other – (state type of documentation)


Please ensure that you enclose a copy when returning this form
GP Details:

Name of GP: ……………………………………………………….                          Telephone No: …………………………………………………….

Address: …………………………………………………………….                           Your NHS No: ……………………………………………………..
                                                            (If known)

…………………………………………………………………………..

Declaration:
I have read and understand the reasons I have been asked to complete this form and agree that the relevant official
bodies may be contacted to verify any statement I have made. The information given is correct and I understand that if I
have knowingly given false information, then action will be taken against me: this may result in referring the matter to
the Trust’s Local Counter Fraud Specialist, Police or Home Office. Any costs incurred will be passed to a Debit Collecting
Agency for the recovery of monies due to the NHS. The Trust may use this information to validate with the above named
parties.


Signed by: ……………………………………………………………………… Date: ………………………………………………………….

or on behalf of: ……………………………………………………………….
(child under the age of 16 years)



NOTE:
FAILURE TO COMPLETE AND RETURN THIS FORM WITH A COPY OF YOUR PASSPORT/ID CARD AND
ACCOMPANYING DOCUMENTATION RELATING TO YOUR EXEMPTION CLAIM MAY RESULT IN
APPOINTMENT ALLOCATION DELAYS AND DISCHARGE FROM ANY WAITING LISTS. YOU MAY ALSO
BE SENT AN INVOICE FOR ANY TREATMENT ALREADY RECEIVED.

IF YOU REQUIRE FURTHER INFORMATION ON HOSPITAL CHARGING REGULATIONS, PLEASE PICK
UP A LEAFLET AT THE MAIN HOSPITAL ENTRANCE - “ARE YOU VISITING THE UNITED KINGDOM” OR
VISIT THE DEPARTMENT OF HEALTH WEBSITE AT www.dh.gov.uk/overseasvisitors




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                                           Page 34 of 54
APPENDIX 6
Standard Enquiry Letter to Patient


Name of Patient
Address 1
Address 2
Address 3


Hospital Number:


Date:


Dear


You have been referred to this department to validate your claim for free NHS treatment.


It is your responsibility to prove to Portsmouth Hospitals NHS Trust your claim for exemption from
charge. If you do not provide satisfactory evidence of your claim you will be deemed liable for
charges and we will issue an invoice for any treatment given and seek a deposit for the full cost of
any future treatment.


In order to determine your eligibility for free treatment it is necessary to verify your residential status.
We will require you to produce any relevant residency papers, a work permit and entry visa to the
UK.


Please make sure you contact us before you attend any further hospital appointments.
We will be happy to make an appointment to process your claim at your earliest convenience. Please
telephone 023 9228 2093 to arrange this.


We must stress that we cannot guarantee non-emergency NHS treatment to you until we have
processed your claim for exemption.


Yours sincerely


Overseas Visitors Office



Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                       Page 35 of 54
APPENDIX 7

EEA & Non-EEA Bilateral Healthcare Agreement Countries and Territories

Anguilla                                          Kazakhstan *
Armenia *                                         Kirgizstan *
Australia                                         Macedonia *
Azerbaijan *                                      Malta *
Barbados                                          Moldova *
Bosnia *                                          Montserrat
British Virgin Islands                            New Zealand *
Bulgaria                                          Poland
Channel Islands                                   Romania
Croatia *                                         Russia *
Czech Republic *                                  Slovak Republic *
Falkland Islands                                  Slovenia *
Georgia *                                         St Helena
Gibraltar *                                       Tajikistan *
Hungary *                                         Turkmenistan *
Iceland                                           Turks and Caicos Islands
Isle of Man                                       Ukraine *
Yugoslavia, * i.e. Serbia & Montenegro            Uzbekistan *

Countries with an (*) asterisk have agreements covering their nationals and UK nationals only. The
others cover all residents, irrespective of nationality. It is for non-nationals residents in an “all
residents” country to produce evidence of their residential status. N.B. The Czech Republic, Hungary,
Malta, Poland and Slovenia joined the EU on 1st May 2004 and Bulgaria & Romania joined the EU on
1st Jan 2007 and the bilateral healthcare arrangements are replaced by EC regulations. Iceland is an
EEA member state but the bilateral healthcare arrangements also cover non-EEA nationals resident
in Iceland. The agreements covering nationals only applies to nationals living in their own country,
not if they are living in another country with which the UK holds a bilateral healthcare agreement.


Persons who can present a passport, residence permit, identity card or social security card showing
that they are either nationals or residents as appropriate of any of these countries should be treated
as exempt from charges in respect of treatment the need for which arose during a temporary visit to
the UK.




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                    Page 36 of 54
APPENDIX 8
IGA Form

IGA (Previously IGA 19)                                                                                                          DEPARTMENT OF HEALTH
                                                                                         Financial Monitoring of Overseas Visitors Episodes of Care for Recovery of UK Costs
                                                                                                             ALL SECTIONS OF THIS FORM MUST BE FULLY COMPLETED




NHS TRUST
                    ……………………………………………………………………………………………………… PGO No …………………….

LEAD COMMISSIONER ………………………………………………………………
                                                                                                                         ……………………………………………….…………. ORGANISATION CODE ……

                                                                                                                                                                                                                                             Total cost:
                                                                                                                                                                                                                                                                …..………………………
                                                                                                                                        PATIENT DETAILS


Local Patient Identifier: ......................................................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………...
Patient's Name (Surname/Forenames): .............................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………
Date of Birth: DD/MM/YYYY
                                                .....…../....….../....
Patient's Usual Address:                 ..................................................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………...
...........................................................................................................................................................................................................................................................................................................
                                                                                                                                                                                                                                                                                                              ………...
                                                            
Date of arrival in UK             DD/MM/YYYY
                                                                   …/…./…
Postcode of Usual Address                                    (use NHS User Postcode Directory - 5th & 6th                                                                                                                                                                             ……            ……
                                                                                                                                                                                                                                                                                             ..               ..
                                                                                                   (characters only. NOTE the codes may
Patient's Nationality                                        (not be the same in both sections)                                                                                                                                                                                       ……            ……
                                                                                                                                                                                                                                                                                             ..               ..

INPATIENTS and DAYCASES:

                                                                          Start Date: DD/MM/YYYY                      
                                                                                                                             …/…/
                                              End Date: DD/MM/YYYY                                   /          /
                                                                                                 …             …

Diagnosis: Primary (ICD 10 Code):                                   Operative Procedure: Primary

                                                               Operation (OPCS4 Code): 

Specialty Code: 

Health Care Resource Group Code                           ……………….


OUTPATIENTS:


Attendance Date: DD/MM/YYYY                           ....… /....… /....
                                                              ..         ..
Source of Referral:                                              Reason for Referral: 


Outcome:                                                        Specialty Code: 




OTHER CONTRACT DETAILS


Was the patient referred by an overseas authority?                                                                                                                                                                                                                                                YES/NO
If YES and the patient is from EEA: a copy of the E112 must be attached


State Quota number if appropriate: 


Patient's Guide category under which treatment was given                                     …………….




CONTACT FOR ENQUIRIES .......................................................................................................................................... ………………………………………………………
(staff member who completed the form)


TELEPHONE NUMBER/EXT .................................................................................................................................................................................................................
                                                                                                                                                                                                                                                              ……………………..
PLEASE SEND THIS FORM TO: Overseas Visitor Section
                                  (Finance Dept), Leeds North East PCT, Sycamore Lodge,
7a Woodhouse Cliff, Leeds LS6 2HF. Tel 0113 3059790 or 3059795 Fax 0113 3059870




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                                                                                                                                                                                                  Page 37 of 54
APPENDIX 9
Advice from Doctor & Medical Practitioner form

Dear Doctor


NAME OF PATIENT


Date of Birth:                                  Hospital Number:



This patient is an overseas visitor as defined in the National Health Services (Charges to Overseas
Visitors) Regulations 1989 as amended. Having interviewed the patient we have found him/her to be
liable for charges as an overseas visitor.

Government advice to safeguard NHS resources is to obtain payment where possible before
treatment is given. In this case the patient also declared that he/she will not be able to pay for the
treatment to be provided prior to receipt of the treatment. Would you therefore tick one of the
declarations below?



          I intend to give treatment, which is immediately necessary to save the patient‟s life.



          I intend to give urgent treatment, which is not immediately necessary to save the patient‟s
           life, but cannot wait until the patient‟s returns home.



          No treatment will be given unless payment can be made.


Where treatment is given (or has been given already), the Trust is obliged to raise an invoice for the
cost of any such treatment, and to pursue debt recovery procedures if necessary.


Date:                                          Signed:                      (Doctor)



Print Name:


Date:                                          Signed:                      (Overseas Visitors Manager)



Print Name:




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                     Page 38 of 54
APPENDIX 10
Stabilise and Discharge Request form


Failure or refusal to pay NHS charges as an overseas visitor is in contravention of section 121 of the
NHS Act 1977 in respect of NHS treatment.

It is policy of Portsmouth Hospitals NHS Trust to minimise the financial loss to the Trust for any
patients who refuse to pay for their medical treatment. The Overseas Visitors Charging NHS
Charging Regulations make no provision for unable or unwilling to pay. Payment for Overseas
Visitors charges in the NHS is not optional and is non-negotiable. It is not within anyone‟s power
except for the Secretay of State for Health to waive a charge for medcial treatment. However in all
instances payment must be made to the treating hospital before any claim for exemption can be
assessed.

In order to minimise the financial loss to the Trust, the Medical Staffing Committee (MSC) agreed that
a forum or two Consultants would consider all requests made by the Income Generation Manager
(IGM) to invoke the clause in the Overseas Visitors Policy of „Stabilise and Discharge‟. Whereby a
patient who is out of the crisis stage of their illness or disease must be discharged from the care of
the Trust. Even if it is not consistent with the usual clinical pathway.


Consultant 1:


Consultant 2:


Income Generation Manager:


Patients Hospital Number:                      Patients Name:


Charges Outstanding:



Reason for request:


Area of Activity:


Admission Date:                                Discharge Date:

X1 copy to be filed in the patient‟s notes
X1 copy to be held in Finance Department




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                   Page 39 of 54
APPENDIX 11
Stage Two Interview Record

I have been interviewed for a Stage 2 interview by ………………………………….. at Portsmouth

Hospitals NHS Trust has interviewed me for a stage 2 interview and it has been found that I am

liable for the charges for NHS treatment as an Overseas Visitor (Implementing Overseas Visitors

Charging Regulations April 2004).

Referred by                 Under the Care of         Bleep   Comments



Diagnosis




Affix patient label here:




                  LIABLE                                            NOT LIABLE
I am liable/not-liable for treatment as an NHS CHARGED PATIENT (overseas visitor) and I am
unwilling/willing to pay for the cost of the treatment.

I understand that Portsmouth Hospitals NHS Trust is unable to offer this treatment without making a
charge. I understand that if I go to another NHS Trust then I will be liable for the cost of treatment
with them too. I consent for my details to be passed on to other NHS Trust‟s in order to safeguard
NHS resources.

I am aware that it is my choice to decline the treatment today and if I require treatment I will make
other arrangements.

Patient Name                      Patient Signature               Date




Overseas Patients Manager         Signature                       Date




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                    Page 40 of 54
APPENDIX 12 Credit/debit Card Declaration


I have signed a declaration to pay Portsmouth Hospitals NHS Trust for the cost of NHS treatment for
the patient named underneath.


I understand that I will pay all charges attributed to this episode of care and it will be taken from my
credit/debit card.


The amount owed will increase as the length of stay increases and further tests are carried out.


I have received a quote for care and I accept the charges listed on this as a fair and accurate
estimation of the cost.


I authorise Portsmouth Hospitals NHS Trust to charge my credit/debit card (in my absence) for the
full cost of treatment.
 Patients name:                                                 Ward/Area:


 Hospital Number:                                               Consultant:

My details are as follows:

 Name on Card

       Card Issuer

         Start Date                                                    Expiry Date

          Signature

                          (Long number through the centre of the card)
    Card Number

             Amount £

                          (Last three digits on the signature strip)
   Security Code

 Signed on behalf of Portsmouth
 Hospitals NHS Trust
                                 Designation

                                             Date




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                              Page 41 of 54
APPENDIX 13
Quote for Care


Quote for Care:

Prepared on ……………………. by (or put Name, designation, contact details here) Deborah Stemp
– Overseas Visitors Manager – 023 9228 2093

 Patient Name

 Date of Birth                                 Postcode

 Home Address:




 Ward/Area:                                    Admission Date:

                                               Discharge Date:

 INPATIENT STAY                                  TO
 COST:                            £              TRANSFERRED TO:
 INPATIENT STAY
 COST:                            £
 DRUGS                            £

 MINIMUM REQUIRED                                £

The above quote is based upon projections of care; if there are any complications with the patient or
after delivery, your child requires further treatment, I understand that will be an additional charge.

I shall pay Portsmouth Hospitals NHS Trust for the full amount of the cost of care using the most
appropriate method to the Trust (credit/debit card, cash, cheque + guarantee card to the limit,
bankers draft).

I understand that if I leave the UK without paying, that Portsmouth Hospitals NHS Trust shall make
reasonable efforts to recover the debt using an International debt collection agency.

Any non-payment of the debt may have further implications on any future entry requirements into the
UK.

I have read the quote and the statement and I understand and agree the terms quoted.

Signed (patient)                                                  Date:


Signed (on behalf of PHT)                                         Date:




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                   Page 42 of 54
 APPENDIX 14

 Overseas Visitor Patient Contract Form
    Contract No:




 OVERSEAS PAYING PATIENT – CONTRACT AND UNDERTAKING TO PAY
 FORM


                                                                                 Date
Consultant: ........................................................................... of appointment/admission: .....................................


                                                                                   Date
Specialty: .............................................................................. of Discharge: ..........................................................


                                                                                 G.P.
Ward/Clinic: .......................................................................... Name: .....................................................................




 SECTION A – PERSONAL DETAILS (please print)

 Mr/Mrs/Miss/Other: ........................ Surname………………………………..Maiden name: ……………………

 Forenames:………………………………………………………………………Date of birth: …………………….

 Temporary Address (Where staying in the UK):……………………………………………………………………

 …………………………………………………………………………………………………………………………..

 Post Code: .................................... Telephone Nos.: ……………………………………………………………

 Permanent Address:
 ………………………………………………………………………………………………………………………..

 Post/Zip Code: ………………………Telephone Nos:………………………………………………………………

 Email address: ………………………………………………………………………………………………………


                 DO YOU HAVE TRAVEL INSURANCE that covers your medical expenses?

 YES/NO (Delete where applicable)

  If YES complete Section B & C If No complete Section C




 Overseas Patients Policy. Issue 1 23.04.2009
 Review Date: April 2010                                                                                                            Page 43 of 54
                                   SECTION B – INSURANCE DETAILS
I hereby authorise the Trust, or its authorised agents, to make enquiries with my insurers to confirm the extent of, and the

limits to, my health insurance policy. My insurance details are:

Insurers Name: ……………………………………………………………………………………………………..


Address: ………………………………………………………………………………………………………………


………………………………………………………………………………………………………………………….


Post Code: .................................... Telephone No: …………………………………………………………….



Policy Number: ................................................................... Authorisation No: ……………………………..



Benefits administrator: …………………………………………………………………………………………..

Notwithstanding the provisions of my personal undertaking, I agree to assign to the Trust any of my rights to be paid
hospital or other related charges by my insurers in respect of the current episode of treatment provided. Should there be
any shortfall in payment by the insurer I understand that and agree to accept full liability. I also unreservedly
authorise disclosure of any medical notes including the provision of copies thereof to my insurer as part of their
claim and payment processing requirements.
                                                                                                                   Initial
SECTION C – PATIENT DECLARATION
I understand that being insured does not mitigate my legal responsibility to settle the account rendered in full and within the
terms stipulated in this form, in the Terms of Business for Overseas Paying patients, and on the Portsmouth Hospitals NHS
Trust invoice. I understand that the account will be referred to the Trust‟s recovery agents if unpaid immediately thereafter
and that ALL the above details will be made available to the said Recovery Agents. This authority is unconditional and
irrevocable.
Note: for the purposes of security, the Trust reserves the right to instruct an appropriate agency to verify the patient‟s
address. Such an enquiry will be recorded on the agency‟s file and may be shared with other users. I also understand that if
I am not a British passport holder and/or am not ordinarily resident in the UK, the Trust and/or the Recovery Agents reserve
the right to contact British Government missions abroad for the purposes of confirming and/or verifying the information
provided by me regarding myself, next of kin, guarantor, and/or sponsor for visa purposes.
I agree not to bring jewellery and other valuables into the hospital. I understand that responsibility for any losses
rests solely with myself.

Signed .…………………………………………………………………                                               Date……………………...



NOTES

1.   This form is to be completed by the patient or his/her representative who is willing to accept FULL responsibility on the

     patient’s behalf. This undertaking must not be signed by a TRUST, CHARITY, LIMITED COMPANY, PARTNERSHIP,

     LIMITED LIABILITY PARTNERSHIP, or any other corporate body.

2.   Minors must NOT sign this agreement.

3.   All charges are subject to the provisions of section 121 of the National Health Service Act 1977 as or may be

     subsequently amended.

4.   This document is an agreement to pay for any and all hospital charges and is legally binding.

Please return this form to: Portsmouth Hospitals NHS Trust, Finance Department, Building 003, Fort Southwick,
James Callaghan Drive, Fareham, Hampshire. PO17 6AR
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                                             Page 44 of 54
                                                     For Office Use Only


Consultant …………………………………………….                                     Ward or Clinic……………………………………………………….


Speciality………………………………..                                          Date of appointment or admission ……./……./………

Insured Patients:                                                 Pre-Authorised by:
                                                   Date
Pre-Authorisation Number………………………                …./…./…..        ………………………………………………………………………….

Procedure/Investigations……………………                                  Budget Codes:………………………………………………….

……………………………………………….                                               ……………………………………………………………………

Self Pay Patients:                                                Credit/Debit Card:
                                                   Date
Payment Received £ ……………………………..                                  Card Number………………………………………………………...
Cheque/Cash/Credit Card (Delete as applicable)   …../…../….
                                                                  Name on Card……………………………………………………….
Cheque
Number…………………………………………….                                          Start Date…………………………Expiry Date ……………………

                                                                  3 Figure Security Code No ………………………………………..
                                                                  (on back of card)




       Overseas Patients Policy. Issue 1 23.04.2009
       Review Date: April 2010                                                            Page 45 of 54
APPENDIX 15
Overseas Patients Policy: Full list of definitions

 Abortion               See Termination of Pregnancy (ToP)

 AIDS                   See HIV

 Ambulance              The Regulations do not apply to ambulance services. These should be
 Services               provided free of charge where they are part of the patients clinical need.

 Artificial Limbs       See Prosthetic services

 Asylum Seeker          A person who has made a formal application to the Home Office for
                        recognition as a Refugee under the 1951 UN Convention and its 1967
                        Protocol Relating to the Status of Refugees.
                            A person who has made a formal application for asylum in the UK
                               will be issued with an Immigration & Nationality Directorate (IND)
                               Application Registration Card (ARC). This card contains a
                               photograph of the asylum seeker, details such as their name and
                               an electronic chip containing biometric information.
                            Where an asylum seeker has had an initial application for refuge
                               refused he or she has rights of appeal. They will continue to be
                               entitled to hospital treatment without charge until the asylum
                               appeal has been exhausted.
                            If an asylum seeker‟s claim is finally rejected (including appeals)
                               they cannot be charged for a course of treatment they were
                               receiving at the time their status was determined. That remains
                               free of charge until completed. The must however, be charged for
                               a new course of treatment. If that is routine elective treatment
                               then payment should be handled in the same way as everyone
                               else seeking non-urgent treatment, i.e. payment should be
                               obtained before treatment begins.

 Au Pairs               Au Pairs are not employed as such and therefore are not automatically
                        eligible for free treatment. Au Pair is a technical term applied by the
                        Home Office when granting entry to the UK, usually for a minimum of two
                        years, and it can apply only to people from certain countries. Many of
                        these countries have bilateral healthcare agreements with the UK or are
                        EEA member states or Switzerland, so the au pair would be eligible for
                        any treatment, which arises during the visit.
                        Alternatively the Au Pair coming to the UK can be settled and living for a
                        period of time may be considered „ordinarily resident‟.
                        The Trust must decide on each individual case and it be judged on its
                        own merits.

 Authorised Child       A child of a person who has been given leave to enter the UK with a
                        parent who has come to the UK for specified treatment under provision of
                        Regulation 6A; or a child of an authorised companion of such person
                        given leave to enter the UK. There may be several authorised children
                        travelling with the exempt person or their authorised companion. An
                        authorised child is eligible for free treatment the need of which arises
                        whilst they are here.

 Authorised             A person who has been given leave to enter the UK with a parent who
 Companion              has come to the UK for specified treatment under the provision of
                        Regulation 6A. There will normally only be one authorised companion,
                        and they will be eligible for free treatment which arises during their stay
                        here.
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                    Page 46 of 54
 Baseline               All Trusts should have systems in place to ask all patients beginning a
 Questions (BLQ)        new course of treatment at the Hospital the Baseline Questions. (There is
                        a page in every set of notes that asks these questions and a copy of the
                        flowchart for distribution is contained in Appendix 2).

                        Where a person‟s answers to the Baseline Questions indicate they may
                        be chargeable, they must be referred for a second interview with a
                        trained member of staff to establish eligibility. (Directorate Income
                        Generation Manager or Other Stage Two Officer.)

 Community              Some services delivered in the community will be subject to charge as
 Services               services delivered by PHT on behalf of the community. Where staff not
                        supplied by PHT supplies services then the charging regulations do not
                        apply.

 Confidentiality        PHT staff becoming aware that a patient may be here without the proper
                        authorisation must make a decision in the full light of the patient‟s
                        circumstances as to the reporting of their immigration status. It is
                        important each case is judged on its own merits. There is a public interest
                        argument in the reporting of such patients but this should be weighed
                        with the medical confidentiality rules and the medical needs of the
                        patient. It must be discussed with PHT Caldicott Guardian (Graeme Zaki
                        – Medical Director). With a possible view to discuss with PHT legal
                        advisors also.

 Dependant              Where are child who normally lives abroad is visiting a parent who is
 children visiting      ordinarily resident in the UK, that child can take on the status of the
 an ordinarily          parent if they have dual access or joint custody.
 resident parent
 Dependants             For all patients, except those from EEA member states, dependants are
                        limited to marriage partner and children under the age of 16, or under 19
                        if still in fulltime education or receiving child benefit. For EEA member
                        States the accepted dependants of a person will be named on the
                        relevant E form issued or other identity documents.

 Dialysis               The Regulations, and therefore the charges, apply where visitors to the
                        UK require haemodialysis or peritoneal dialysis for the treatment of
                        kidney failure.
                             Temporary visitors from the EEA countries and Switzerland (other
                               than for medical purposes) i.e. on holiday or on business, or for
                               short-term work, do not need an E112 to obtain dialysis treatment.
                               This should be provided under the bilateral healthcare
                               arrangements for immediately necessary treatment. This is
                               subject to the patient making an advance booking and facilities
                               being available at the time of treatment.
                             For non-EEA countries with which the UK holds bilateral
                               healthcare agreements with, only Australia has made provision for
                               dialysis treatment to be provided as immediately necessary
                               treatment.
                             For Visitors from countries outside the EEA, Australia and
                               Switzerland (including Channel Islands) the provision of dialysis
                               treatment is not the responsibility of the NHS and patients are
                               liable for charges.
                             UK residents who enquire about the provision of dialysis whilst
                               abroad should be directed to the NHS unit where they normally
                               dialyse for advice. For EEA countries an E111 (European Health
                               Insurance Card - EHIC post Dec 2005) which will cover the cost of
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                    Page 47 of 54
                                their treatment. In Spain it is a P10 form issued before their visit.)

 Domiciliary            See Community Services
 Nursing
 Dual Residence         A person with homes in more than one country may be considered
                        ordinarily resident in the UK if the are likely to spend at least 9 months of
                        the year living in the UK. However, if they are a person in receipt of a
                        British State Pension who spends not more than 6 months living in
                        another EEA member state and not less than six months living in the UK
                        then they will be exempt under Regulation 4A even though they spend
                        more than 3 months in another EEA member state.

 Employment             The Regulations do not define employment other than to make clear self-
                        employment is included, and that it must be with an employer based in
                        the UK or at a registered UK branch of an overseas employer.
                        Self-employed workers must show that their principle place of business is
                        the UK.
                        Generally where there is any doubt that a person is employed it can be
                        satisfied by asking to see (up to date) documentary evidence from the
                        employer, or in the case of a self-employed person, a letter from a
                        reputable bank or solicitor.
                        Part time work will also count but PHT must satisfy the reason for being
                        in the UK is primarily to work. Where a person has entered the UK as a
                        visitor and has applied to switch to employed status then this will not
                        count.

 Establishing           Full Guidance can be found at
 Responsible            http://www.dh.gov.uk/assetRoot/04/06/97/97/04069797.pdf
 Commissioner
 General                The Hospital Charging Regulations do not apply to General Practice.
 Practitioners          GP’s are able to offer treatment to overseas visitors on a private basis
                        but can also accept them as NHS patients, i.e. exempt this is in
                        accordance with the Human Rights Act 1998. Such patients may
                        receive an NHS card and number. This does NOT automatically entitle
                        them to treatment without charge at PHT, nor does the fact that they may
                        be have been referred to WMUH by a GP.
                        PHT remains responsible for checking that all patients – including those
                        with NHS cards or numbers – are ordinarily resident in the UK or
                        otherwise exempt before treating them without charge, unless care is
                        required before liability status can be established, e.g. major medical
                        emergency..
 Health Visitors        See Community Services

 HIV                    There is no charge for a diagnostic test and any associated counselling
                        to establish if a patient is HIV positive. Any further treatment needed,
                        including the full cost of drugs, for HIV or AIDS is liable to charges. If a
                        liable patient is in possession of a HC2 certificate this does not exempt
                        them from charges for drugs for HIV/AIDS treatment.

 Hospital at Home       See Community Services

 Illegal Immigrants     It may happen that during investigations to establish a patient‟s residence
                        it transpires that the person is in the UK without proper permission. This
                        may be that they entered the country on a visitor‟s visa that has since
                        expired or they may have an application for asylum rejected but have not
                        yet been removed from the country. In these cases charges may apply
                        depending on the circumstances, particularly if they have been in the UK
                        for more than 12 months. (See confidentiality)
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                       Page 48 of 54
                        If the Trust can prove that another government department has failed in
                        their statutory duty to remove persons from this country PHT will not
                        accept the financial responsibility for these person(s) and will move to
                        transfer the outstanding balance to the relevant department that has
                        failed PHT.

 Immediately            PHT needs to treat patients in need of immediately necessary care
 Necessary              regardless of their ability to pay. This may be because their condition is
 Treatment              life threatening, or because if treatment is not given immediately it will
                        become life threatening, or because permanent serious damage will be
                        caused by any delay.
                        It is a matter of clinical judgement that should not be second-guessed by
                        administrative staff.
                        However, in the interest of good audit management, the responsible
                        health professional‟s reasons should be recorded in the patient‟s clinical
                        notes and the request for advice from a doctor (Appendix 9) should be
                        completed.
                        Where immediately necessary treatment occurs and PHT knows that
                        payment is unlikely, treatment should be limited to that which is
                        clinically necessary to enable the patient to return to his or her own
                        country.
                        This should not normally include routine treatment unless it is necessary
                        to prevent a life-threatening situation. Any charge payable for such
                        treatment will still stand, but if it proves to be irrecoverable, then it should
                        be written off.

 Israel                 There is no general bilateral healthcare agreement with Israel but a
                        person entitled to industrial injuries benefit in Israel is fully exempt from
                        NHS charges for treatment arising from their industrial injury or
                        occupational illness.

 Maternity              Maternity services are not exempt from charges. However because of the
 Services               severe health risks associated with such conditions such as eclampsia
                        and pre-eclampsia, maternity services should not be withheld if the
                        woman is unable to pay in advance. The patient remains liable for
                        charges and the debt should be pursued in the normal way.
                        Women from EEA countries and Switzerland are covered for all maternity
                        care i.e. antenatal and postnatal care for up to 15 weeks after the birth of
                        the child.
                        Women from non-EEA countries with which we have bilateral healthcare
                        agreements are eligible to receive immediately necessary treatment in
                        connection with their pregnancy, if an unexpected emergency arises
                        during their visit. This applies irrespective of whether the pregnancy was
                        confirmed in the UK or elsewhere.
                        However if they come to the UK or remain in the UK to obtain routine
                        antenatal care or deliver their baby then charges will apply, unless they
                        are specifically referred to the UK under agreement because of
                        complications.

 Midwifery              See Community Services

 Newborns               Where a baby is born in hospital mother and child are charged as a
                        single patient. If one of them is transferred to another department, e.g.
                        SCBU, the charge will continue to accumulate to recover the full costs of
                        treating them both.
                        If one is discharged and the other remains the charge will continue to
                        accumulate to recover the cost of treating the one remaining. If either is
                        transferred to a different hospital then that hospital will be responsible for
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                        Page 49 of 54
                        recovering the costs for the treatment that they provide.

 NHS    Card       or Having an NHS card or number does not give automatic entitlement to
 Number               free NHS hospital treatment. Every patient’s eligibility should be checked.

 NHS      Charged Overseas Visitors who are liable for charges are NHS charged patients.
 Patients         They should not be confused with private patients. They must receive the
                  same priority as NHS patients.
                  Unlike private patients NHS charged patients are liable to pay for
                  their treatment even where an undertaking to pay has not been
                  obtained.

 No Recourse to A stamp on some visitor‟s passports. It does not apply to NHS treatment
 Public Funds   but prevents people from accessing UK social security funds.

 Non-urgent             Routine elective treatment that could in fact wait until the patient returned
 treatment              home.
                        The patient‟s chargeable status should be established as soon as
                        possible after the 1st referral to PHT. Where the patient is chargeable
                        PHT will not initiate treatment processes, including assigning a waiting
                        list entry, until a deposit equivalent to the estimated full cost of treatment
                        (Quote for care Appendix 13).
                        Any surplus, which is paid, can be returned to the patient on completion
                        of treatment. This is not refusing to provide treatment, it is requiring
                        payment conditions to be met in accordance with the charging
                        regulations before treatment can commence.

 Norwegian              A Norwegian national employed on a Norwegian registered vessel is
 Seafarers              exempt if brought to the UK for treatment on or from that vessel.

 Observation            Patients kept in the Observation Wards attached to A&E at PHT should
 Wards                  not be charged unless they are formally admitted to the hospital as an
                        inpatient.

 Offshore Workers       A person working in UK territorial waters or in the UK sector of the
                        Continental Shelf is exempt, as is an offshore worker working elsewhere
                        on the shelf if his employer or contractor has his principal place of
                        business in the UK.

 One Year Rule          There is no „one year rule‟ that‟s says you have to be in the UK to receive
                        free treatment at PHT. This should not be confused with the exemption
                        for people who have been living lawfully in the UK for 12 months
                        immediately preceding the date at which treatment Is given. Someone
                        who is ordinarily resident, or is exempt under one of the other exemptions
                        is entitles to free treatment from the day they arrive in the UK, there is no
                        qualifying residence period.
                        In order to take the House of Lords judgement into account, when
                        assessing the residence status of a person seeking free NHS services,
                        WMUH must consider:
                                 “….living lawfully in the UK voluntarily and for settled
                                 purposes as part of the regular order of their life for the time
                                 being whether they have an identifiable purpose for their
                                 residence here and whether that purpose has sufficient
                                 degree of continuity to be properly described as „settled‟.”

 Overseas Visitor       Any person of any nationality who is not ordinarily resident in the UK.

 Permanent              People taking up permanent residence in the UK are entitled to free
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                      Page 50 of 54
 Residence              hospital treatment. They must however have the legal right to live here
                        permanently and PHT can ask to see evidence of that right before
                        exemption can be granted.
                        People who have a right to live here and claim to be returning here
                        permanently to the UK after living abroad can be asked to provide
                        evidence to support such a move – perhaps the sale of such property
                        abroad, shipping of belongings, transfer of assets, etc

                        People who have made applications for permanent residence will be
                        chargeable up until they are granted leave to remain by the Home Office
                        or they have completed 12 months lawful residence and then charges will
                        cease.
                        Where a person applies to extend their current entry visa, only those
                        claims that are made before the existing visa runs out will be considered
                        as lawful residence.
                        Where a person applies to extend their leave to remain after their current
                        visa has expired the calculation of 12 months lawful residence starts from
                        the date they reapplied.

 Prisoner               Anyone who has to be detained under provision of section 43(1) of the
                        Prison Act 1952 or anyone who has been detained under provision of the
                        Immigration Act 1971.

 Prosthetic             The artificial Limb and Appliance services are not provided under the
 Services               NHS Act 1977, and the overseas visitors charges Regulations made
                        under that Act cannot therefore apply to services provided by them.
                        Patients who are liable for charges under the Regulations and who needs
                        artificial limbs or appliance must therefore obtain them privately.

 Public purse           A term used in some travel documents to signify the holder cannot
                        access UK social security benefits. It does not apply to NHS treatment.
 Refugee                A person who has been granted asylum by the UK government has been
                        recognised as a refugee (a successful asylum seeker) and is exempt
                        from charges.

 Repatriation back When a person goes to live outside of the UK the NHS ceases to have
 to the UK         responsibility for their healthcare. If such a person is taken seriously ill
                   the NHS is not responsible for funding their repatriation back to the UK.
                   However if a patient‟s family make their own arrangements to repatriate
                   the patient who on arrival will be resuming their permanent residence,
                   then they will become entitled to access full NHS treatment from the date
                   of their arrival.
                   If PHT is advised in advance of the patient‟s arrival we must make
                   adequate arrangements to ensure that the patient receives the
                   appropriate healthcare upon their arrival back in the UK.

 Repatriation back      Where a person has received NHS treatment and has not been able to
 to the Visitors        pay for that treatment and expresses a wish to return home, PHT can
 home country           consider funding the cost of the repatriation if the cost of the repatriation
                        outweighs the cost of treating the patient and will therefore produce a
                        cost saving for the Trust and if the patient gives consent to return home.
                        It is not possible to force repatriation of a patient.

 Routine                This includes routine monitoring of conditions like diabetes. Such
 Monitoring             provision will not be covered under existing non-EEA bilateral healthcare
                        agreements and charges will apply.

 Seamen or women A person working on a UK registered ship is exempt from charges. A
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                      Page 51 of 54
                        person who is working on any other registered vessel is exempt if they
                        are ordinarily resident in the UK.
                        If they are from an EEA country or Switzerland, a non-EEA bilateral
                        healthcare country and the need for treatment arose in the UK or on a
                        voyage to the UK; or if they are a former UK resident and the five or ten
                        year exemptions apply.

 Six month Rule         There is no six-month rule that says you have to have been in the UK for
                        six months before you are entitled to free NHS treatment.

 Sponsors               Some people are allowed into the UK only because another person or
                        authority has agreed to sponsor their stay here and guaranteed that they
                        will not become a drain on the public purse. The public purse does not
                        include NHS treatment; therefore sponsored people can use the NHS
                        and must be exempt in their own right.
                        A sponsor is not liable for NHS charges and charges must be sought in
                        the same way as an overseas visitor if the person requires NHS
                        treatment. Even if the sponsor has offered to pay.

 Spouse (and            Where a person is exempt from charges for NHS hospital treatment then
 children)              so is their marriage partner (but not an unmarried co-habitee or
                        „common-law‟ partner) and children when they are either:
                            In the UK with the exempt person for the duration of their visit; or
                            Living permanently with the exempt person if they have come to
                               the UK on a settled basis
                        The exempt person must be in the UK with their spouse and/or children.
                        Where a person is ordinarily resident and their spouse lives abroad, the
                        spouse will not be considered ordinarily resident on a visit to the UK.
                        Unless they meet one of the exemptions from charge in their own right
                        then they are liable for charges.

 State Pensions         The following are UK state pensions to which there is entitlement under
                        the Social Security Act 1975 and which could apply to a person living
                        overseas:
                             Retirement pension
                             Attendance allowance
                             Widow‟s benefit
                             Industrial injuries disablement benefit
                             Incapacity benefit
                             Severe disablement allowance
                             Guardian‟s allowance
                             Disabled living allowance
                             Carers allowance
                        Occupational pensions (including civil service pensions) are not state
                        pensions.

 Students               People who are pursuing a full time course of study of not less than 6
                        months in duration or people who are pursuing a full time course of study
                        of any duration which is funded either wholly or substantially by the UK
                        government. A person here on a visitor‟s visa spending a few hours a
                        week learning English is a visitor not a student and therefore liable for
                        charges.

 Termination of         Where a patient seeks a ToP and is liable for charges but is unable to
 Pregnancy (ToP)        pay in advance the hospital may decline to provide the service and
                        should advise the woman to seek termination in her own country.
                        The only exception to this is where the woman's life is at risk. In these

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Review Date: April 2010                                                      Page 52 of 54
                        circumstances the termination should take place. The patient remains
                        liable for charges and debt should be pursued in the normal way.
                        Women from a bilateral agreement country who come to the UK
                        specifically to seek ToPs will be liable for charges unless they have
                        either, (for EEA nationals, obtained an authorised E112 form from their
                        own health institutions,) or for Non-EEA bilateral agreement countries,
                        have been specifically referred for treatment under the terms of the
                        agreement.

 Treatment the          The limiting of access to treatment without charge to conditions, which
 need for which         occur, only whilst present in the UK or in the Doctors opinion, although
 arose during the       pre-existing, need immediate treatment to prevent deterioration.
 visit
 Twelve Month           See one year rule
 Rule
 UK Government          People claiming exemption under this Regulation should be able to
 Financed Posts         provide satisfactory documentary evidence of their entitlement.
                        Recruitment must have taken place in the UK and will include people
                        working for the Department for International Development and the British
                        Volunteer Programme.

 UK Government     People who are pursuing a full time course of study, of any duration,
 Financed students which is funded either wholly or substantially by the UK Government. The
                   must provide satisfactory evidence of their entitlement.

 Unaccompanied          Children of overseas visitors will rarely be exempt in their own right, but
 Minors                 only via their parent‟s status. Thus where treatment is given to a child
                        under the age of 16 who is in the UK without his or her parents it will be
                        chargeable unless the treatment itself is exempt (e.g. provided solely in
                        the A&E department or the Observation Suite. The liability should be
                        explained to the person in whose charge the child has been left (e.g.
                        teacher, tour leader, host) and the bill handed to that person. Copies
                        should be sent to the child‟s parents.
                        A further exception is that children from EEA member states or
                        Switzerland who will be eligible for free treatment the need for which
                        arose during their visit (E111 or EHIC arrangements) as will children from
                        bilateral agreement countries.
                        A further exception is unaccompanied minors attending boarding school
                        in the UK whose parents both live outside the UK. In this case the child
                        will be classed ordinarily resident while at school because in legal terms
                        the school act in loco parentis.
 Unemployed             There is no exemption for unemployed persons with the exception of
 persons                people here under specific EEA arrangements. This person will have a
                        copy of form E119, without this form they are liable for charge.

 Urgent treatment       Where the treatment is, in a clinical opinion, not immediately necessary,
                        cannot wait until the patient returns home. Patients should be booked in
                        for treatment, but the Trust should use the intervening period to establish
                        the patients‟ chargeable status.
                        Wherever possible, if the patient is chargeable, PHT should seek a
                        deposit for an estimate of the full cost of care. Any surplus could be
                        returned to the patient upon completion of treatment.


 Volunteers             Exemption from charges is limited to those people who are providing
 coming to the UK       services that are similar to health or social services.

 Volunteers from        People who leave the UK to spend time as a volunteer are not
Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                    Page 53 of 54
 the UK                 automatically entitled to return to the UK for free hospital treatment. Each
                        case should be carefully considered. Only people working on a UK
                        government financed project are automatically entitled. Others may be if
                        they are returning to take up permanent residence and they can be
                        exempted under ordinarily residence criteria.

 Waiving charges        No power has been given, in the Regulations or otherwise, for any
                        person, including the Trust Chief Executive, the lead Consultant or a
                        Government minister, to waive charge which are due.

 War pensions           The holder of a UK war disablement pension is fully exempt from charges
                        not just those relating to his or her injury. His or her spouse and children
                        are also fully exempt. The holder of a UK war widow‟s pension is also
                        exempt.

 Write-off debt         Where debt is unrecoverable PHT can write it off. However, the Trust
                        must take all reasonable measures to recover the debt, including
                        consideration of using a debt collection agency if it‟s financially viable.
                        Overseas debt must be written off correctly.




Overseas Patients Policy. Issue 1 23.04.2009
Review Date: April 2010                                                     Page 54 of 54

				
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