Many parts of this post-Brexit world are confusing.

And it only gets trickier if you’re one of nearly 1.4 million British expats living in Europe, trying to understand your new relationship with your former home country.

You may have to pay for NHS services you’ve previously received for free, at 150% of their price – even if you still pay taxes to the UK government.

Fortunately, we’re here to clear up what you can and can’t ask the NHS for if you require medical attention – and the documentation you’ll need to have.

NHS patient and doctors

Like this woman, you may be able to still use the NHS for free but it depends  

Who is entitled to free NHS treatment?

Primary care

Everyone is entitled to free primary care.

If you’re visiting the UK, you can register as a temporary patient with a local GP at any point after you’ve been in the area for more than 24 hours, but less than three months, according to the NHS.

After you’ve registered, you can access all primary services, including consultations with a GP or nurse, prescriptions, and check-ups with a dentist or optometrist.

You – and everyone else who finds themselves in the UK when they require medical treatment – can also receive the following services for free:

  • Accident and emergency services, including at a minor injuries or urgent care centre
  • Diagnosis and treatment of 33 communicable diseases including HIV, measles, and cholera
  • COVID-19 testing, treatment, and vaccinations
  • Diagnosis and treatment of sexually transmitted infections
  • Family planning services, excluding abortions and fertility treatments
  • Treatment of any physical or mental condition caused by domestic violence, female genital mutilation, sexual violence, or torture
  • End of life care

Secondary care

To receive secondary care for free on the NHS, you must live in the UK on what the government calls “a properly settled basis.”

This is judged on a case-by-case basis, but largely includes people who plan to live in the UK for at least the next six months.

If you’re a British expat visiting the UK for a short time, this won’t include you – and whether or not you’re still a British taxpayer makes no difference.

You’ll either have to buy health insurance for your trip to the UK, or pay 150% of the price of NHS services if you end up using them.

So for instance, a series of treatments worth £1,000 would cost you £1,500.

Other exemptions

The following groups of people don’t have to pay to use NHS services, even if they live abroad:

  • UK government employees
  • War pensioners
  • Vulnerable people such as refugees, asylum seekers, and unaccompanied children
  • Detainees or prisoners
  • NATO personnel
NHS patient and doctor

It’s better to know where you stand before you talk to your GP

Can I access treatments for free on the NHS?

Everyone can access primary care for free, and there are ways to access certain free secondary services – but it depends on where in Europe you’ve moved to.

The rules for residents in the EU (European Union) are different to the regulations for people whose new countries are in the EEA (European Economic Area), but not the EU.

Coming from the EU

If you have a European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC), you can access services for free in the following scenarios:

  • Illness
  • Medical emergency
  • Treatment of pre-existing medical conditions
  • Routine maternity care, as long as you didn’t specifically visit the UK to give birth or receive related treatments

If you’ve mislaid your EHIC or GHIC, or never had one in the first place, you can request a Provisional Replacement Certificate (PRC) from the relevant authority in your new country.

Make sure to do this well in advance of your visit to the UK, and if you’re experiencing issues, contact the NHS’s Overseas Healthcare Services for help.

You can’t get any pre-planned treatments for free on the NHS, unless you’ve arranged it in advance, using an S2 form.

This form allows EEA residents to receive state-funded treatment in the UK (or vice-versa), but the application can take months, so start the process as quickly as possible.

If you don’t provide an EHIC/GHIC, PRC, or S2, you’ll be charged 150% of the NHS rate for any secondary care services you receive.

Coming from Iceland, Liechtenstein, Norway, or Switzerland

If you moved to one of these countries – which are in the EEA but not the EU – before 31 December 2020, you can still use an EHIC, GHIC, or PRC in the UK.

This will allow you to access the same free services as EU residents (listed above), according to the NHS.

If you moved abroad after 31 December 2020, you’ll need to pay for all secondary care services that aren’t offered for free to everyone, at 150% of the NHS rate.

That is, unless you’re one of 21,036 British expats who live in Norway, in which case you can receive medically necessary healthcare – as long as you have a Norwegian passport.

Next steps

If you’re coming to the UK, make sure you have an EHIC, GHIC, PRC, or S2.

For every other medical eventuality, you should take out health insurance so you can access all the secondary care services you need, without breaking the bank.