Healthcare in the UK

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

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

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

The National Health Service (NHS)

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

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

Who is eligible for free NHS treatment?

You are eligible for free NHS treatment in England if:

You are “ordinarily resident” in the UK. This is defined as “someone who is living lawfully in the UK voluntarily and for settled purposes as part of the regular order of their life for the time being, with an identifiable purpose for their residence here which has a sufficient degree of continuity to be properly described as settled.”
You are exempt from charges under the National Health Service (Charges to Overseas Visitors) Regulations 1989, as amended. A guide to the circumstances in which overseas visitors are not liable to pay for NHS hospital treatment can be downloaded from the publications section of the Department of Health website.

If you are not eligible for free treatment, you may be liable for charges.

NHS charges and exceptions

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

Treatment given in an accident and emergency (A & E) department
Treatment given in a walk-in centre providing similar services to those of an accident and emergency department of a hospital
Treatment for certain communicable diseases

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

Private healthcare provision in the UK

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

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

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

Domestic versus international private medical insurance

As an expatriate in the UK, you can choose between taking out a UK domestic PMI plan or an international PMI plan. While a domestic plan may be cheaper, as an expatriate, there are features of an international plan which may be of benefit to you. For example:

Portability – international plans often provide cover in large geographical areas, or worldwide, so if you move about a lot you can keep the same plan. Some international plans will also give you private healthcare cover in your home country.
Compassionate emergency visits – some plans will cover your airfare if you need to visit a critically ill relative outside of your country of residence
Emergency evacuation when there is no medical treatment available in your location – this is less important in the UK, but if you do move around a lot it is good to know that this lifeline is available to you.
Cover for primary consultations – many domestic PMI plans will not cover visits to your GP, but if you are not eligible for free NHS treatment you may have to pay for services. Some international PMI plans will cover these initial consultations and GP visits, which could well make up the bulk of your medical costs.
Repatriation of mortal remains – should the worst happen and you die abroad an international plan may pay for your burial or for your body to be returned home.
Cover for treatment needed as a result of terrorism – an increasing threat for everyone.

The international private medical insurance market

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

Many providers can cover individuals, families and corporate or affinity groups. Providers will differ in the way that they underwrite plans (usually either through full medical underwriting or moratorium – see below for more information on this) and in the small print of their benefits, conditions and exclusions.

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

So, if you decide that an international PMI plan is the right way for you to cover your healthcare, what should you look out for?

Your checklist for international private medical insurance

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

Pre-existing conditions – some providers underwrite their plans on a moratorium basis. This means that any pre-existing medical conditions that you have will not be covered by the plan until a specified time period has elapsed. The benefit of a moratorium is that it allows a provider to keep their premiums down and means that the application process is easier and quicker as you don’t have to fill in a medical questionnaire. If you have pre-existing conditions, you should speak to the provider to find out exactly what will and won’t be covered. An alternative is to look for a provider that medically underwrites their plans. This means that you will need to fill in a medical questionnaire when you apply for a plan and the provider will then tell you what conditions they will cover and what it will cost.

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

Out-patient claims: where claims are settled through reimbursement, find out how quickly the provider pays out. Are there deductions for bank charges or will you be fully reimbursed?

Emergency evacuation and repatriation: look at the small print of the benefit. Some providers will pay for the patient to be evacuated but will not pay for their return airfare back to their country of residence after treatment; some providers cover the cost of a return flight and accommodation for someone to accompany the patient; the most comprehensive emergency evacuation benefit will cover the patient’s evacuation, medical treatment and repatriation back to the country of residence and, in addition, will cover both travel and accommodation costs of the patient’s dependants.

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

Wellness – with preventative medicine becoming increasingly important to your wellbeing, some providers will cover the costs of preventative tests such as cervical smear and prostrate cancer tests and vaccinations.

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

Maternity – are you planning to have a baby? If so, cover for private maternity treatment will make the process a lot easier for you. Some plans include maternity benefits as standard while others offer it as an optional add-on plan. This can be beneficial as it means you only need to pay for the benefit when you need it.

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

Chronic conditions: some plans exclude chronic conditions completely; some pay for treatment for stabilisation of acute episodes of the condition; others also pay towards maintenance of the condition so will cover things like routine check-ups and prescribed drugs.

Non-medical benefits: some plans cover legal expenses if you suffer an injury as the result of a third party, a visit to a critically ill relative - look carefully at the small print with this benefit as some providers only pay for a visit back to your home country, while others pay for a visit anywhere in the world - or for your body to be returned home should you die abroad.

Area of cover: do you want cover in your home country? Not all plans offer this. Also look at whether the plan covers emergency medical treatment outside of your chosen geographic area of cover.

War and terrorism: some, but not all, PMI plans will cover you if you need treatment as a result of an act of war or terrorism. Make sure you read the benefit conditions and exclusions to find out if this will be covered.

Reducing your premium: some providers offer a no claims discount, special rates for families or the option to select a voluntary excess.

Working with a broker

If you are not sure what to look for or are baffled by the variety of healthcare plans on offer, you can speak to an independent broker or financial adviser. They will analyse your needs and research the market for you to help you find the best plan.

If you are working with a UK-based broker or adviser, make sure they are authorised and regulated by the Financial Services Authority (FSA). The FSA is an independent body that regulates the financial services industry in the UK. Their aim is “to promote efficient, orderly and fair markets and to help retail consumers achieve a fair deal.”

All UK-based providers of domestic or international PMI should also be authorised or regulated by the FSA.

Your health is one of your most valuable assets. By understanding what’s available to you and making provision for your healthcare needs you can enjoy your time in the UK a whole lot more.

Useful websites

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

www.nhs.uk – information on the NHS in England

www.show.scot.nhs.uk – information on the NHS in Scotland

www.wales.nhs.uk – information on the NHS in Wales

www.healthandcareni.co.uk – information on the NHS in Northern Ireland

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

www.moneymadeclear.fsa.gov.uk – impartial information on insurance and money matters from the Financial Services Authority

Andrew Sandilands

Compliance Officer

InterGlobal