Not everyone is entitled to free NHS hospital treatment in England. If you require treatment from St Helens and Knowsley Teaching Hospitals NHS Trust, you may have to pay for your treatment.
This page gives you more details about treatment for overseas visitors.
If you are not ordinarily resident in the UK at the time of your treatment, you will be classed as an 'Overseas Visitor'. This means that you may be asked to pay for the treatment you receive at St Helens and Knowsley Teaching Hospitals NHS Trust.
NHS Trusts have a legal obligation to establish whether a person is an overseas visitor to whom changes apply, or whether they are exempt from charges. Where there is no exemption, NHS Trusts must make and recover charges from the person liable to pay for the NHS services provided to the overseas visitor.
Overseas visitors seeking healthcare while in England may be interviewed by our overseas visitors team, who will ask for various documentation in order to demonstrate lawful and current residence in the UK, which entitles you to the use of the NHS free of charge.
It is the responsibility of the patient to provide evidence, when requested, to demonstrate that they are entitled to free NHS treatment. When evidence is not provided, treatment will be charged for.
Some NHS services are free to everyone. This includes accident and emergency services but not including services provided after an overseas visitor is accepted as an inpatient or at a follow-up outpatient appointment, family planning services, diagnosis and treatment of sexually transmitted infections and treatment of certain infectious diseases.
- > Patients living in European Economic Area (EEA) countries
If you are travelling from a European country to the UK you will need to show a valid European Health Insurance Card (EHIC) otherwise you will have to pay for your care directly. You will also be asked to provide a copy of your passport and your full address abroad.
The EHIC must be produced (or a provisional replacement certificate (PRC)) prior to discharge from the hospital or prior to an outpatient appointment, or you will be liable to pay all fees associated with your care and claim your care back through your home country.
The EU Regulations apply to all countries within the European Economic Area, which is made up of the member states of the EU:
Austria, Belgium, Bulgaria, Croatia, Cyprus (Southern), Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, plus Iceland, Liechtenstein, Norway and Switzerland.
Please note that your EHIC does not apply if you are having elective planned treatment. You will need to obtain an E112/S2 from your local Health Authority in your country of origin prior to an appointment being given in the UK. In the event, elective planned treatment is provided prior to receipt of an E112/S2, you will be charged for your treatment.
- > Patients from countries with reciprocal or bilateral arrangements with the UK for healthcare
The UK has reciprocal healthcare agreements with the following non-European economic area countries (EEA):
Anguilla, Australia, Barbados, Bosnia & Herzegovina, British Virgin Islands, Falkland Islands, Gibraltar, Isle of Man, Jersey, Kosovo, Macedonia, Montenegro, Montserrat, New Zealand, Serbia, St Helena, Turks and Caicos Islands.
Overseas visitors who can present evidence that they are nationals, citizens or lawful residents of one of these countries may be treated as exempt from charges in respect of treatment that the relevant agreement entitles them to. Generally, only immediate medical treatment is to be provided free of charge, to allow the overseas visitor to return home for other needs. Also, the agreements do not usually apply when the person has travelled to the UK for the purpose of obtaining healthcare.
Assessment of eligibility under reciprocal or bilateral arrangements can be complex so please contact the Overseas Visitor Coordinator for advice.
Please note that reciprocal and bilateral agreements do not apply if you are having elective planned treatment or treatment that can be carried out in your country of origin.
- > Patients with insurance
Patients who are not exempt from charges may choose to use travel insurance or health insurance to fund their treatment. If you have insurance cover, it is your responsibility to contact the company to gain a 'letter of guarantee' and authorisation numbers from your insurers authorising your treatment.
- > Patients who have come from abroad to take up employment of studies in the UK
If you have come from abroad to take up employment or studies in the UK, you might be entitled to free hospital treatment. However, it will not be enough to show your 'right to work'. You need to be able to show evidence that you are actually working for a UK-based employer. If you are in full-time study, you need to be able to show that you are attending a full-time course of not less than six months duration.
- > Patients who are a refugee or asylum seeker
If you are a refugee or an asylum seeker whose formal application to the UK Border Agency is still being considered, you will not have to pay hospital charges. A refugee is someone who has been granted asylum in this country. If you are a refugee or an asylum seeker you will still have to pay for all prescribed medications.
Frequently Asked Questions (FAQs):
> How can I prove that I am entitled to free NHS hospital treatment in England?
Entitlement to healthcare in the UK is based on living lawfully in the UK. All patients admitted to our Trust, whatever nationality and living status, may be required to provide accurate information when registering their details.
The following documents can be used as proof of identity:
- Current signed passport
- Biometric Residence Permit issued by the Home Office
- Valid UK photo-card driving licence
- EU or Swiss national identity photo-card
- Application Registration Card (ARC)
- Valid armed forces or police photographic identity card
The following documents can be used as proof of address:
- Recent original utility bill (gas, electricity, water, land line phone bill) (mobile not accepted)
- Local Authority council tax bill for the current year
- Bank, building society or credit union statement of passbook
- Original mortgage statement from recognised lender issued within the last year
- Current council/housing association rent book/card or tenancy agreement
- HMRC self-assessment letter or tax demand dated within the current financial year
- Recent payslip / P45 / P60
- Notification letter from Department for Work and Pensions confirming your right to benefit or state pension
- Solicitor letter within the last three months confirming recent house purchase/land registry confirmation of address
- Recent letter from School/University/Place of employment
> What happens if I cannot pay?
Chargeable treatment which is considered by clinicians to be immediately necessary and/or clinically urgent must be never be withheld from an overseas visitor or delayed, even when that overseas visitor has indicated that they cannot pay. This does not mean that treatment is provided free of charge. Charges will still apply, and, if not yet recovered, will be pursued after the treatment is provided.
If a patient states that they cannot afford to pay for their treatment, the Finance Department may be able to offer arrangements for the patient to pay in instalments, depending on the circumstances.
If you fail to pay for NHS treatment for which charges are appropriate, your future application to enter, or remain in the UK may be denied. Necessary (non-medical) personal information may be passed via the Department of Health to the Home Office for this purpose.
If you are unsure of your entitlement or status, please contact the Overseas Visitors Coordinator on 0151 430 1901 or email
You can find more information on
the Department of Health and Social Care website