The National Health Service recovers the costs of treatments provided to overseas visitors through a range of routes, including Immigration Health Surcharge, direct cost recovery from chargeable patients, and reciprocal healthcare arrangements.

Under the European Health Insurance Card (EHIC) scheme, visitors, students, and certain workers from the European Economic Area (EEA) and Switzerland are entitled to necessary healthcare during their temporary stay in the United Kingdom. The Global Health Insurance Card is issued by the UK to cover costs incurred abroad, so is not used to recover NHS costs.

NHS providers request an EHIC from the patient and record details of the care provided. These costs are then submitted to the NHS Business Services Authority (NHSBSA) who coordinate recovery of costs from the EEA and Switzerland in line with the rules set out in international agreements. Under these agreements, participating countries are obliged to reimburse eligible costs where a valid EHIC card has been presented for state funded medically necessary healthcare.

The vast majority of costs submitted under the EHIC scheme are successfully recovered from patients’ country of residence. However, a small number of rejections can occur for a range of reasons, including incomplete or inaccurate details being submitted by the NHS facilities. Digitisation of systems for reporting EHIC claims has helped reduced the incidence of these types of clerical errors. The NHSBSA monitors rejected claims and works closely with NHS providers to improve data quality and maximise recovery.

The Department continues to work with NHS to ensure that the NHS recovers all costs it is entitled to under our international agreements.

The National Health Service recovers the costs of treatments provided to overseas visitors through a range of routes, including Immigration Health Surcharge, direct cost recovery from chargeable patients, and reciprocal healthcare arrangements.

Under the European Health Insurance Card (EHIC) scheme, visitors, students, and certain workers from the European Economic Area (EEA) and Switzerland are entitled to necessary healthcare during their temporary stay in the United Kingdom. The Global Health Insurance Card is issued by the UK to cover costs incurred abroad, so is not used to recover NHS costs.

NHS providers request an EHIC from the patient and record details of the care provided. These costs are then submitted to the NHS Business Services Authority (NHSBSA) who coordinate recovery of costs from the EEA and Switzerland in line with the rules set out in international agreements. Under these agreements, participating countries are obliged to reimburse eligible costs where a valid EHIC card has been presented for state funded medically necessary healthcare.

The vast majority of costs submitted under the EHIC scheme are successfully recovered from patients’ country of residence. However, a small number of rejections can occur for a range of reasons, including incomplete or inaccurate details being submitted by the NHS facilities. Digitisation of systems for reporting EHIC claims has helped reduced the incidence of these types of clerical errors. The NHSBSA monitors rejected claims and works closely with NHS providers to improve data quality and maximise recovery.

The Department continues to work with NHS to ensure that the NHS recovers all costs it is entitled to under our international agreements.

The mean processing time for Global Health Insurance Cards over the last six months was 2.2 days and the median was zero days. The mean processing time for new United Kingdom-issued European Health Insurance Cards over the last six months was 18.9 days and the median was one day. Both of these times are measured from the point at which the application was submitted until the card was issued.

Where applicants are asked to provide evidence to support their applications, the response time following provision of those documents is currently three working days.

The service is currently meeting these key performance indicators and there are no delays with card production or mailing. Consequently, applicants are not being informed that there are delays.

The Department monitors the process for applying for the UK Global Health Insurance Card (GHICs) and works with the NHS Business Services Authority to plan and manage high levels of demand. Under its service level agreement, once approved, the NHS Business Services Authority aims to issue GHIC applications within 10 working days. From 1 to 26 May 2022, 99.9% of cards were fully processed within 10 working days of the decision and 95.8% of cards were processed on the same day.

As of 14 June 2022, the NHS Business Services Authority received 3,572 GHIC and European Health Insurance Cards (EHIC) applications where the automatic residency check had not been met and a manual process was required. Once satisfactory evidence is provided to the NHS Business Services Authority, all cards are issued within five days. For those on a temporary visit to the European Union or Switzerland who require necessary healthcare treatment and do not have a GHIC, these travellers can apply to the NHS Business Services Authority for a Provisional Replacement Certificate. This Certificate provides the same coverage as a GHIC.

Applications for United Kingdom Global Health Insurance Cards (GHIC) are processed by the NHS Business Services Authority under the Healthcare (European Economic Area and Switzerland Arrangements) (EU Exit) Regulations 2019. Applicants may be eligible for a GHIC if they are ordinarily resident in the UK and they do not have healthcare cover provided by a European Union country or Switzerland. UK residency was also an eligibility requirement under the previous European Health Insurance Card system.

To verify applications, the NHS Business Service Authority shares information with Indesser to establish a UK residential address. If an applicant’s residential address cannot be verified, the NHS Business Service Authority will request further evidence from the applicant. There is a wide range of documents which may be used to provide this evidence. This supports all eligible applicants in demonstrating their entitlement and no-one is disadvantaged. Applicants are asked to provide two of the following documents:

- one or more different utility service bills dated within the last three months;

- a local authority council tax bill dated for the current financial year;

- a valid housing association, council tenancy letter or rent agreement;

- a benefit award notice dated within the last three months;

- a letter from HM Revenue and Customs dated within the last three months;

- a bank, building society or credit union statement or passbook dated within the last three months;

- an electoral register entry dated for the current financial year;

- a letter from hospital or general practitioner on headed paper dated within the last three months;

- a mortgage statement from a recognised lender dated within the last three months;

- an HM Revenue and Customs self-assessment letter or tax demand dated for the current financial year; and

- a solicitor’s letter dated within the last three months that shows a recent house purchase or land registry including the address.

Applicants may also send alternative evidence showing their full name and address. The residency check was introduced to ensure that taxpayers’ money is spent on those who are eligible under the reciprocal healthcare agreements. There are no Ministerial Directions which relate to GHIC evidential requirements.

There are approximately 35 to 45 staff deployed to work on Global Health Insurance Card (GHIC) applications. Staffing levels at the NHS Business Services Authority are kept under review to meet demand during peak periods. However, we encourage customers to apply for their GHIC as far in advance of planned travel as possible.

As of 15 November 2021, there were 176,533 Global Health Insurance Card (GHIC) applications which the NHS Business Services Authority would categorise as currently ‘in progress’ and where more information is required from the applicant. As of 15 November 2021, 11,191 applications are classed by the NHS Business Services Authority as ‘awaiting processing’ where the applicant is awaiting a response.

The following table shows the total number of applications received in each month of 2021.

Note:

From June 2021, the new GHIC portal included additional residency checks aimed at preventing fraud.

An applicant cannot apply for the UK Global Health Insurance Card (GHIC) in Welsh. The NHS Business Services Authority (NHSBSA), who are responsible for issuing the cards, are only able to accept applications in English. If a Welsh speaking customer wishes to contact the NHSBSA in relation to an EHIC or GHIC application a translation service is available.