National Health Service, England PART 1 Introduction Citation and commencement 1 These Regulations may be cited as the National Health Service (Charges to Overseas Visitors) Regulations 2015 and come into force on 6th April 2015. Interpretation 2 In these Regulations— “ the 1971 Act ” means the Immigration Act 1971 ; “ the 2006 Act ” means the National Health Service Act 2006; “ the 2014 Act ” means the Immigration Act 2014 ; “actual charge” has the meaning given in regulation 3(7); “advance payment sum” has the meaning given in regulation 3(7); “ authorised child ” means a child who— has been granted leave to enter the United Kingdom with a parent for the purpose of the parent receiving a course of treatment in respect of which no charge may be made or recovered under regulation 17; or is a child of an authorised companion; “ authorised companion ” means a person who has been granted leave to enter the United Kingdom to accompany a person who is obtaining a course of treatment— in respect of which no charge may be made or recovered under regulation 17; or ordinarily resident in Ukraine and is obtaining a course of treatment; “ child ” means a person who is under the age of eighteen; “competent institution” has the same meaning as in Regulation (EC) No 883/2004 or Regulation (EEC) No 1408/71 , as the case may be; “ domestic abuse ” has the meaning given in Part 1 of the Domestic Abuse Act 2021; “ entry clearance ” has the meaning given in section 33(1) (interpretation) of the 1971 Act ; “equivalent document” means a document which, for the purposes of a listed healthcare arrangement, as defined in regulation 1(3) of the Healthcare (European Economic Area and Switzerland Arrangements) (EU Exit) Regulations 2019, is treated as equivalent to an S1 healthcare certificate ; “ healthcare ” means all forms of healthcare provided for individuals, whether relating to mental or physical health, and includes related ancillary care; “ healthcare agreement ” means an agreement or other commitment between the United Kingdom and either a country or territory outside the United Kingdom or an international organisation, concerning healthcare provided anywhere in the world; “ immigration health charge ” means a charge payable under an order made under section 38 (immigration health charge) of the 2014 Act; “ immigration rules ” means the rules laid before Parliament under section 3(2) (general provisions for regulation and control) of the 1971 Act; “ international organisation ” means an organisation of which— two or more sovereign powers are members; or the governments of two or more sovereign powers are members; “ overseas visitor ” means a person not ordinarily resident in the United Kingdom ; “ parental responsibility ” has the meaning given in section 3 (meaning of “parental responsibility”) of the Children Act 1989 ; ... “ registered dentist ” has the meaning given in section 53(1) (interpretation) of the Dentists Act 1984 ; “Regulation (EC) No 883/2004 ” means Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems, as it had effect immediately before IP completion day; “Regulation (EEC) No 1408/71 ” means Council Regulation (EEC) No 1408/71 of 14 June 1971 on the application of social security schemes to employed persons, to self-employed persons and to members of their families moving within the Community, as it had effect immediately before IP completion day; “relevant body” means— an NHS foundation trust; an NHS trust; a local authority within the meaning of section 2B of the 2006 Act (functions of local authorities and Secretary of State as to improvement of public health) exercising public health functions (within the meaning of that Act); or any other person providing relevant services, except in respect of regulation 6A, for which purposes a person mentioned in paragraph (d) is not a “relevant body”; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “ relevant services ” means accommodation, services or facilities which are provided, or whose provision is arranged, under the 2006 Act other than— primary medical services provided under Part 4 (medical services); primary dental services provided under Part 5 (dental services); primary ophthalmic services provided under Part 6 (ophthalmic services); or equivalent services which are provided, or whose provision is arranged, under the 2006 Act; “ ship ” includes fishing vessels and hovercraft; “ treatment the need for which arose during the visit ” means— diagnosis of symptoms or signs occurring for the first time after the overseas visitor's arrival in the United Kingdom; or treatment, provided that the overseas visitor has not travelled to the United Kingdom for the purpose of seeking that treatment, which in the opinion of a registered medical practitioner or registered dentist employed by or providing services to the relevant body is required promptly for a condition which arose, or became acutely exacerbated, after the overseas visitor's arrival, or which, but for the treatment, would be likely to become acutely exacerbated, which cannot wait until the overseas visitor can reasonably be expected to return to the overseas visitor's country of ordinary residence. PART 2 Provision for making and recovery of charges Obligation to make and recover charges 3 1 Where the condition specified in paragraph (2) is met, a relevant body must make and recover charges for any relevant services it provides to an overseas visitor from the person liable under regulation 4 (liability for payment of charges). 1A Where the condition specified in paragraph (2) is met, before providing a relevant service in respect of an overseas visitor, a relevant body must secure payment for the estimated amount of charges to be made under paragraph (1) for that relevant service unless doing so would prevent or delay the provision of— a an immediately necessary service; or b an urgent service. 1B The person from whom payment is to be secured under paragraph (1A) in respect of a relevant service is the person who it appears to the relevant body, at the time that the request for that payment is made, will be the person to whom a charge will be made under paragraph (1) in respect of that relevant service at the time that it is provided. 2 The condition is that the relevant body , having made such enquiries as it is satisfied are reasonable in all the circumstances, including in relation to the state of health of that overseas visitor, determines that the case is not one in which these Regulations provide for no charge to be made. 3 Where more than one relevant body is to provide relevant services to an overseas visitor, each relevant body must secure the advance payment sum in respect of each relevant service that it is to provide. 3A Where more than one relevant body provides relevant services to an overseas visitor, each relevant body must make and recover the actual charge in respect of each relevant service that it provides. 4 A relevant body that makes and recovers a charge in accordance with paragraph (1) or secures payment in accordance with paragraph (1A) must give or send to the person making the payment a receipt for the amount paid. 4A In making and recovering an actual charge from a person in respect of a relevant service, a relevant body must— a deduct any advance payment sum secured by the relevant body from that person in respect of that relevant service; and b refund any amount by which an advance payment sum secured by the relevant body from that person in respect of that relevant service exceeds the amount of the actual charge that person is liable to pay. 5 Subject to paragraph (6), where— a a relevant body has determined that an overseas visitor is exempt from being charged for relevant services under these Regulations, except where the overseas visitor is exempt from being charged by virtue of— i regulation 10 (immigration health charge); ii regulation 11 (overseas visitors who have made applications for entry clearance or leave to remain prior to the commencement of the immigration health charge); ... iii regulation 25(3) (family members of overseas visitors – children born to a parent exempt under regulation 10 or 11); or iv regulation 14 (reciprocal health care agreements); b the overseas visitor has received relevant services from a relevant body as part of a course of treatment; and c prior to the course of treatment being completed, a relevant body has determined that the overseas visitor is no longer exempt from being charged for relevant services under these Regulations, a relevant body may not make and recover charges under paragraph (1) in respect of relevant services provided as part of that course of treatment during a period where the overseas visitor has remained in the United Kingdom without absence. 6 Paragraph (5) does not apply where a relevant body has determined that a person is exempt from being charged for relevant services as a result of that body receiving fraudulent or misleading information. 7 In this regulation— “actual charge” means a charge to be made under paragraph (1); “advance payment sum” means a sum to be secured under paragraph (1A); “immediately necessary service” means— antenatal services provided in respect of a person who is pregnant; intrapartum and postnatal services provided in respect of— a person who is pregnant; a person who has recently given birth; or a baby; and any other relevant service that the treating clinician determines the recipient needs promptly— to save the recipient’s life; to prevent a condition becoming immediately life-threatening; or to prevent permanent serious damage to the recipient from occurring; “urgent service” means a service that the treating clinician determines is not an immediately necessary service but which should not wait until the recipient can be reasonably expected to leave the United Kingdom. Obligation to record information against an overseas visitor’s consistent identifier 3A 1 An NHS foundation trust or an NHS trust that, in meeting its obligations under regulation 3, determines that a person is an overseas visitor must, as soon as it is practicable to do so, record against the overseas visitor’s consistent identifier— a the fact that the person has been determined to be an overseas visitor; b the date on which that determination was made; and c whether Part 4 (overseas visitors exempt from charges) provides for no charge to be made. 2 In this regulation, “consistent identifier” means a consistent identifier specified in regulation 2 of the Health and Social Care Act 2012 (Consistent Identifier) Regulations 2015. Liability for payment of charges 4 1 The person liable to pay charges under these Regulations is, unless paragraph (2), (3) or (4) applies, the overseas visitor in respect of whom the relevant services are provided. 2 Where— a an overseas visitor is employed or engaged or works in any capacity on board a ship and whose normal place of work is on board a ship; and b that overseas visitor is present in the United Kingdom in the course of that employment, engagement or work, the person liable to pay charges under these Regulations is the shipowner of the ship on which the overseas visitor is employed, engaged or works. 3 Where an overseas visitor is an air crew member and is present in the United Kingdom in the course of that employment, the person liable to pay charges under these Regulations is the employer of that overseas visitor. 4 Where an overseas visitor is a child, the person liable to pay charges under these Regulations is the person with parental responsibility for that child. 4A Where, due to a change in circumstances occurring during the period in which a relevant service is provided, more than one person is liable under paragraphs (1) to (4) to pay charges under these Regulations in respect of that relevant service, each such person is liable to pay charges only in respect of relevant services provided during the period during which those paragraphs apply to that person. 5 In this regulation— “ air crew member ” means any person employed or engaged in an aircraft in flight on the business of the aircraft; “ shipowner ” has the meaning given in regulation 2(1) (interpretation) of the Merchant Shipping (Maritime Labour Convention) (Minimum Requirements for Seafarers etc) Regulations 2014 . Repayment of a sum recovered or secured by a relevant body 5 1 A claim to a relevant body for repayment of a sum— a recovered in respect of charges made; or b secured in respect of an estimated amount of charges to be made, under these Regulations may be made by the person who paid the sum to the relevant body (“the claimant”). 2 When making a claim under paragraph (1), the claimant must provide to the relevant body— a the receipt for payment of the sum or other evidence of the claimant’s having paid the sum; b a declaration in support of the claim signed by or on behalf of the claimant; and c such other evidence in support of the declaration as the relevant body may require. 3 Where a claimant makes a claim under paragraph (1) and the relevant body is satisfied that any sum was paid to it by the claimant in respect of— a a charge that should not have been made and recovered under these Regulations; b a relevant service that was not, or will not in the reasonably foreseeable future be, provided by the relevant body; c an advance payment sum, which was paid by or on behalf of a person who is not liable to pay an actual charge in respect of the relevant service to which the advance payment sum relates; or d a charge that should not have been recovered as a consequence of regulation 6A(2)(b) (provision relating to victims of female genital mutilation and supported individuals), the relevant body must repay that sum to the claimant. Provision relating to recovery of charges in respect of refugees and victims of modern slavery 6 1 This paragraph applies to an overseas visitor who— a received relevant services from a relevant body ; b subsequent to receiving the relevant services, has become an overseas visitor who is exempt from charges under— i regulation 15(a) (refugees ...); or ii regulation 16 (victims of modern slavery ); and c at the time that the overseas visitor received the relevant services— i where paragraph (1)(b)(i) applies, was in the United Kingdom for the purpose of making an application to be granted temporary protection, asylum or humanitarian protection under the immigration rules, but had not made that application; or ii where paragraph (1)(b)(ii) applies, was a person to whom regulation 16 applies but had not yet been identified as such. 1A This paragraph applies to an overseas visitor who— a received relevant services from a relevant body; b subsequent to receiving the relevant services, has become an overseas visitor who is exempt from charges under— i regulation 15(aa) (dependants of refugees); or ii regulation 25(1A) (family members of victims of modern slavery); and c at the time that the overseas visitor received the relevant services— i where paragraph (1A)(b)(i) applies— aa that visitor was a dependant of another overseas visitor (“the principal overseas visitor”); and bb the principal overseas visitor was in the United Kingdom for the purpose of making an application to be granted temporary protection, asylum or humanitarian protection under the immigration rules, but had not made that application; or ii where paragraph (1A)(b)(ii) applies— aa that visitor was a family member of another overseas visitor (“the principal overseas visitor”); and bb the principal overseas visitor was a person to whom regulation 16 (victims of modern slavery) applies but had not yet been identified as such. 2 An overseas visitor to whom paragraph (1) or (1A) applies is to be treated for the purposes of these Regulations as if, at the time that the relevant services were provided, the overseas visitor was an overseas visitor in respect of whom no charge may be made or recovered for the relevant services. 3 A relevant body which, in respect of an overseas visitor to whom paragraph (1) or (1A) applies, has— a yet to make charges under regulation 3 (obligation to make and recover charges), must not make the charges; b made charges under regulation 3 but has yet to recover the charges, must not recover the charges; or c made charges under regulation 3 and received payment in respect of the charges, must repay any sum paid in respect of the charges in accordance with regulation 5 (repayment of a sum recovered or secured by a relevant body) . Provision relating to victims of female genital mutilation and supported individuals 6A 1 This paragraph applies to an overseas visitor who received relevant services from a relevant body during the period beginning on 6th April 2015 and ending on 31st January 2016, where— a those services were provided for the treatment of a condition, which was caused by female genital mutilation in the circumstances described in paragraph (d) of the definition of “female genital mutilation” in regulation 8(1) (interpretation of this part); or b at the time the relevant services were provided— i the overseas visitor was a person in respect of whom an application to be granted temporary protection, asylum or humanitarian protection under the immigration rules had been rejected; and ii the overseas visitor was supported under Part 1 (care and support) of the Care Act 2014 by the provision of accommodation. 2 A relevant body which, in respect of an overseas visitor to whom paragraph (1) applies, has— a yet to make a charge under regulation 3 (obligation to make and recover charges), must not make the charges; or b made charges under regulation 3 but has yet to recover the charges, must not recover the charges. Charges imposed on overseas visitors 7 1 The relevant body must calculate charges made under these Regulations , including where charges are estimated for the purposes of determining an advance payment sum, in accordance with this regulation. 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Unless paragraph (3A) applies , the charge payable in respect of each relevant service provided to an overseas visitor shall be equal to the amount payable for that relevant service multiplied by 150 per cent. 3A Where an overseas visitor who is ordinarily resident in an EEA state or Switzerland has— a before IP completion day received relevant services from a relevant body, or b on or after IP completion day received relevant services from a relevant body as part of a course of treatment which commenced before IP completion day, the charges payable in respect of those services must be calculated in the same way as provided for by regulation 13(1) of the National Health Service (Cross-Border Healthcare) Regulations 2013. 3B In this regulation “ amount payable ” has the meaning set out in paragraphs (3C) to (3H). 3C Where the rules contained in the NHS payment scheme specify a price for a relevant service, that is the amount payable for that service. 3D Where the rules contained in the NHS payment scheme specify amounts, agreements, formulae or other matters on the basis of which the price for a relevant service is to be determined, the amount payable for that service is the price that would apply as specified in those rules if the service were provided to a person ordinarily resident in the United Kingdom. 3E Where the rules contained in the NHS payment scheme provide for prices to be determined for, or by reference to, components of a relevant service, the amount payable for that service is the price that would apply for the whole service, if the service were provided to a person ordinarily resident in the United Kingdom, as calculated using the price for each component. 3F Where the rules contained in the NHS payment scheme provide for prices to be determined for, or by reference to, a group of services of which the relevant service is a part, the amount payable for that service is the price that would apply for the proportion of the group of services that the relevant service represents, if the services were provided to a person ordinarily resident in the United Kingdom. 3G Where the NHS payment scheme does not contain rules for determining the price for a relevant service as described by paragraphs (3C) to (3F), the amount payable for that service is such reasonable charge that the relevant body determines having had regard to the matters set out in paragraph (3H). 3H The matters to which the relevant body must have regard for the purposes of determining the amount payable for a relevant service under paragraph (3G) are— a the actual cost that would be payable to the relevant body by the commissioner, in accordance with the rules contained in the NHS payment scheme, in respect of the relevant service, if the service were provided to a person ordinarily resident in the United Kingdom; and b where the relevant service would normally be commissioned as part of a group of services, the proportion of the group of services that the service provided to the overseas visitor represents. 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 For the purposes of this regulation, “ NHS payment scheme ” means the document published under section 114A(1) of the Health and Social Care Act 2012. 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PART 3 Relevant services exempt from charges Interpretation of this Part 8 1 In this Part— “ female genital mutilation ” means the excision, infibulation or other mutilation (collectively referred to as mutilation) of the whole or any part of a female's labia majora, labia minora or clitoris where— that mutilation constituted an offence under the Female Genital Mutilation Act 2003 (“ the 2003 Act ”); if the mutilation was performed prior to the coming into force of the 2003 Act, that mutilation would have constituted an offence under the 2003 Act if the Act had been in force at the time the mutilation was performed; ... if the mutilation was performed outside the United Kingdom but did not constitute an offence under the 2003 Act, that mutilation would have constituted an offence under the 2003 Act had it been performed in the United Kingdom; or if the mutilation was performed outside the United Kingdom prior to the coming into force of the 2003 Act , that mutilation would have constituted an offence under the 2003 Act if— the mutilation had been performed in the United Kingdom; and the 2003 Act had been in force at the time the mutilation was performed; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “ torture ” has the meaning given in Article 1(1) of the United Nations Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (agreed in New York on 4th February 1985) . 2 The reference to treatment in regulation 9(f) includes— a any subsequent or on-going treatment provided to an overseas visitor for any condition, including a chronic condition, that is directly attributable to the torture, female genital mutilation, domestic abuse or sexual violence; and b in the case of female genital mutilation, any antenatal, perinatal and postpartum treatment provided to an overseas visitor the need for which is directly attributable to the mutilation. Relevant services exempt from charges 9 No charge may be made or recovered in respect of any of the following relevant services provided to an overseas visitor— 1 No charge may be made or recovered in respect of any of the following relevant services provided to an overseas visitor— a accident and emergency services, but not including any services provided— i after the overseas visitor has been accepted as an in-patient at a hospital ; or ii at an outpatient appointment; aa services provided as part of the telephone advice line commissioned by an integrated care board or NHS England ; b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c family planning services; d services provided for the diagnosis and treatment of a condition listed in Schedule 1; e services provided for the diagnosis and treatment of sexually transmitted infections; f services provided for the treatment of a condition caused by— i torture; ii female genital mutilation; iii domestic abuse ; or iv sexual violence, provided that the overseas visitor has not travelled to the United Kingdom for the purpose of seeking that treatment. g palliative care services provided by— i a company referred to in section 26 of the Companies (Audit, Investigations and Community Enterprise) Act 2004 (community interest companies); or ii a palliative care charity within the meaning given in section 33D of the Value Added Tax Act 1994 (charities to which section 33C applies); 2 In a case to which this paragraph applies, a relevant body— a yet to make charges under regulation 3 (obligation to make and recover charges), must not make the charges; b that made charges under regulation 3 but has yet to recover the charges, must not recover the charges; or c that made charges under regulation 3 and received payment in respect of the charges, must repay any sum paid in respect of the charges in accordance with regulation 5 (repayment of a sum recovered or secured by a relevant body). 3 Paragraph (2) applies in the case of an overseas visitor who, on or after 1st May 2022 but before that paragraph came into force, was provided with services for the diagnosis or treatment of monkeypox. PART 4 Overseas visitors exempt from charges Interpretation of this Part 9A In this Part— “chargeable assisted conception services” means any medical, surgical or obstetric services provided for the purpose of assisting a person to carry a child, other than— a service that NHS England must arrange under the following regulations of the NHS England and integrated care boards (Responsibility and Standing Rules) Regulations 2012— regulation 7 (services for serving members of the armed forces and their families); regulation 8 (infertility treatment: seriously injured serving members and veterans); or regulation 9 (infertility treatment: further provision); or a service provided as part of a course of treatment, where that course of treatment began before 21st August 2017. Immigration health charge 10 1 In this regulation “ relevant period ” means— a where— i an immigration health charge is payable ; ii an exemption from paying an immigration health charge applies as a consequence of any exemption provided for in an order made under section 38 (immigration health charge) of the 2014 Act; iii the Secretary of State has exercised discretion to reduce or waive all or part of an immigration health charge in accordance with such an order; ... iv the Secretary of State has exercised discretion to refund part ... of an immigration health charge paid under such an order; or v in a case to which paragraph (5) applies, the Secretary of State has exercised discretion to refund all of an immigration health charge paid under such an order, the period of leave to enter or remain in the United Kingdom which is granted to the overseas visitor, or has effect on their arrival in the United Kingdom, in respect of the application for entry clearance or leave to remain to which the immigration health charge, exemption, reduction , refund or waiver relates; and b in a case where the overseas visitor's leave to enter or remain in the United Kingdom is extended by virtue of— i section 3C (continuation of leave pending variation decision) ; or ii section 3D (continuation of leave following revocation) , of the 1971 Act, the period in respect of which leave is extended under those sections. 2 Subject to paragraph (2A), no charge may be made or recovered under these Regulations in respect of any relevant services provided during the relevant period to an overseas visitor in respect of whom— a an immigration health charge has been paid; b an exemption from paying such an immigration health charge applies, unless paragraph (3) applies; c subject to paragraph (6), a reduction or waiver from paying such an immigration health charge applies; or d a refund for part, or in a case to which paragraph (5) applies (but only in that case) all, of an immigration health charge has been made, in accordance with an order made under section 38 of the 2014 Act. 2A Paragraph (2) does not apply in respect of chargeable assisted conception services. 3 Subject to paragraph (4), this paragraph applies where a person is exempt from payment of an immigration health charge under an order made under section 38 of the 2014 Act by virtue of having made an application— a for entry clearance where, if granted in accordance with the immigration rules, the entry clearance would have effect on arrival in the United Kingdom as leave to enter for 6 months or less, or where the leave to enter which may be granted pursuant to that entry clearance would be for 6 months or less if granted in accordance with the immigration rules; or b for entry clearance— i before 6th April 2016, under Part 2 of the immigration rules (visitors to the UK ); or ii on or after 6th April 2016, under Appendix V to the immigration rules (immigration rules for visitors). 4 Paragraph (3) does not apply where a person is exempt from the payment of an immigration health charge by virtue of Schedule 2, paragraph 1(o) of the Immigration (Health Charge) Order 2015. 5 No charge may be made to or recovered from a person under these Regulations— a in respect of any relevant services provided to that person on or after 27th October 2020 and during the relevant period, and b where a full refund of an immigration health charge has been made to, or in respect of, that person on the ground that they are a— i person who is working in the field of health or social care; or ii dependant of a person who is working in the field of health or social care. 6 Paragraph (2) does not apply in respect of relevant services that are provided to an overseas visitor — a who is granted leave to remain in the United Kingdom under Appendix S2 Healthcare Visitor to the immigration rules, and b in respect of whom a waiver to the immigration health charge applies, where those relevant services are not part of the planned healthcare treatment authorised by that person’s S2 healthcare certificate. Overseas visitors who have made applications for entry clearance or leave to remain prior to the commencement of the immigration health charge 11 1 In this regulation “ relevant period ” means— a the period of leave to enter or remain in the United Kingdom granted to the overseas visitor in respect of the application for entry clearance or leave to remain to which paragraph (3)(a) refers; and b in a case where the overseas visitor's leave to enter or remain in the United Kingdom is extended by virtue of— i section 3C (continuation of leave pending variation decision); or ii section 3D (continuation of leave following revocation), of the 1971 Act, the period in respect of which leave is extended under those sections. 2 In this regulation “ relevant date ” means the date of coming into force of the first order made under section 38 of the 2014 Act. 3 Subject to paragraph (3A), no charge may be made or recovered under these Regulations in respect of any relevant services provided to an overseas visitor during the relevant period who— a made an application for entry clearance or leave to remain in the United Kingdom before the relevant date and was granted leave to enter or remain in the United Kingdom or entry clearance which has effect on the overseas visitor's arrival in the United Kingdom as leave to enter or remain in the United Kingdom in respect of that application; b has entered, or remained in, the United Kingdom by virtue of that leave to enter or remain; and c had that application for entry clearance or leave to remain been made on or after the relevant date, would be— i liable to pay an immigration health charge; or ii exempt from paying an immigration health charge as a consequence of an exemption provision under an order made under section 38 of the 2014 Act, unless paragraph (4) applies. 3A Paragraph (3) does not apply in respect of chargeable assisted conception services. 4 This paragraph applies where an overseas visitor— a would be exempt from an immigration health charge under an order made under section 38 of the 2014 Act by virtue of having made an application of a kind described in regulation 10(3)(a) or (b) (immigration health charge); or b has been granted leave to enter or remain in the United Kingdom outside the immigration rules for 6 months or less. Overseas visitors with citizens’ rights 12 1 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who has an entitlement to the provision of those services without charge by virtue of a right arising from— a Title III of Part 2 of the withdrawal agreement, b Title III of Part 2 of the EEA EFTA separation agreement, or c the social security co-ordination provisions of the Swiss citizens’ rights agreement. 2 In paragraph (1), “withdrawal agreement”, “EEA EFTA separation agreement” and “Swiss citizens’ rights agreement” have the same meanings as in section 39(1) of the European Union (Withdrawal Agreement) Act 2020. Overseas visitors with Trade and Cooperation Agreement rights 12A 1 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who has an entitlement to the provision of those services without charge by virtue of a right arising from the SSC Protocol provisions of the Trade and Cooperation Agreement. 2 In paragraph (1), “the SSC Protocol” has the same meaning as in section 26(5) of the European Union (Future Relationship) Act 2020 (“the 2020 Act”) and “the Trade and Cooperation Agreement” has the same meaning as in section 37(1) of the 2020 Act. Overseas visitors with a United Kingdom issued S1 healthcare certificate or equivalent document 13 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who— a was ordinarily resident in an EEA state or Switzerland immediately before IP completion day, b continues to be ordinarily resident in an EEA state or Switzerland on and after IP completion day, c receives a state pension paid by the United Kingdom Government, and d holds an S1 healthcare certificate, or an equivalent document, issued to or in respect of that person by a competent institution of the United Kingdom. Persons who make late applications under Appendix EU to the immigration rules 13A 1 No charge may be made or recovered in respect of relevant services provided to an overseas visitor to whom paragraph (2) or (3) applies during the period which begins with the date on which the application mentioned in paragraph (2)(b) or (3)(b), as the case may be, is made and which ends with the date on which that application is finally determined under Appendix EU to the immigration rules. 2 This paragraph applies to a person who is an overseas visitor by virtue of section 39 of the 2014 Act who— a is eligible to apply for leave to enter or remain in the United Kingdom under Appendix EU to the immigration rules, and b makes a valid application for leave to enter or remain in the United Kingdom under that Appendix to those rules after the application deadline. 3 This paragraph applies to a person who is an overseas visitor by virtue of section 39 of the 2014 Act who— a was granted limited leave to enter or remain in the United Kingdom under Appendix EU to the immigration rules, and b after the expiry of that limited leave to enter or remain, makes a valid application for indefinite leave to enter or remain in the United Kingdom under Appendix EU to the immigration rules. 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Where a person has made an application mentioned in paragraph (2)(b) or (3)(b) and has received relevant services during the period specified in paragraph (1), if the relevant body— a has made charges for relevant services received during that period, but has not yet recovered them, it must not recover those charges; b has made and recovered charges for relevant services received during that period, it must repay any sum paid in respect of those charges. 6 In paragraph (2), “application deadline” has the meaning given in regulation 2 of the Citizens’ Rights (Application Deadline and Temporary Protection) (EU Exit) Regulations 2020. Healthcare agreements 14 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor under a healthcare agreement with a country, territory or international organisation specified in Schedule 2. Family members of British citizens of Northern Ireland 14C 1 No charge may be made or recovered in respect of relevant services provided to an overseas visitor who— a is ordinarily resident in the United Kingdom (disregarding section 39 of the Immigration Act 2014 (immigration health charge related provision: charges for health services)); b has leave to enter or remain under Appendix EU to the immigration rules granted on the basis of a relationship with a relevant person of Northern Ireland; and c would, at the date of assessment of whether a charge under these Regulations falls to be made, have a right to reside in accordance with the Immigration (European Economic Area) Regulations 2016, disregarding that the relevant person of Northern Ireland is not included in the definition of “EEA national” in regulation 2 (general interpretation). 2 In paragraph (1), “relevant person of Northern Ireland” has the meaning given in Appendix EU to the immigration rules. Refugees, asylum seekers, supported individuals and looked after children 15 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who— a has been granted temporary protection, asylum or humanitarian protection under the immigration rules; aa is a dependant of a person described in paragraph (a) (“the principal overseas visitor”) and— i has leave to enter or remain in the United Kingdom as the dependant of the principal overseas visitor; or ii is born in the United Kingdom to the principal overseas visitor. b has made an application, which has not yet been determined, to be granted temporary protection, asylum or humanitarian protection under the immigration rules ; ba is treated as a dependant of a person described in paragraph (b) for the purposes of an application described in that paragraph; c is currently supported under section 95 (persons for whom support may be provided) of the Immigration and Asylum Act 1999 (“ the 1999 Act ”); d has made an application to be granted temporary protection, asylum or humanitarian protection under the immigration rules which was rejected and who is supported under— i section 4(2) (facilities for the accommodation of a person) of the 1999 Act ; ... ii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; or iii Part 1 (care and support) of the Care Act 2014 or section 35 or 36 of the Social Services and Well-being (Wales) Act 2014, by the provision of accommodation; ... da is treated as the dependant of a person described in paragraph (d) for the purposes of the provision of support under that paragraph; or e is a child who is looked after by a local authority within the meaning of section 22(1) (general duty of local authority in relation to children looked after by them) of the Children Act 1989 or, as the case may be, section 74(1) of the Social Services and Well-being (Wales) Act 2014 (child or young person looked after by a local authority) . Victims of modern slavery 16 1 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor, where a competent authority— a has identified the overseas visitor as a victim of modern slavery; or b considers that there are reasonable grounds to believe that the overseas visitor is a victim of modern slavery, and— i a competent authority is required to make a conclusive determination; and ii there has not been a conclusive determination by a competent authority that the overseas visitor is not a victim of modern slavery. 2 In this regulation— “competent authority” means a designated competent authority of the United Kingdom for the purposes of the Trafficking Convention; “Trafficking Convention” means the Council of Europe Convention on Action against Trafficking in Human Beings (agreed at Warsaw on 16th May 2005); “victim of modern slavery” means a victim of— trafficking in human beings, which has the same meaning as in the Trafficking Convention, as set out in article 4 of that Convention; or slavery, servitude, or forced or compulsory labour, which have the same meaning as they have for the purposes of article 4 of the Convention for the Protection of Human Rights and Fundamental Freedoms (agreed at Rome on 4th November 1950). Exceptional humanitarian reasons 17 1 Where an overseas visitor who has been granted leave to enter the United Kingdom outside the immigration rules— a applies (or someone applies on the overseas visitor's behalf) for exemption from charges in respect of relevant services for a course of treatment; and b the Secretary of State determines that exceptional humanitarian reasons justify it, no charge may be made or recovered in respect of relevant services provided to that overseas visitor for that course of treatment. 2 A determination under paragraph (1)(b) may only be made by the Secretary of State if the Secretary of State is satisfied, in the case of that overseas visitor, that— a the treatment specified is not available in that person's home country; b the necessary arrangements have been made for temporary accommodation for that person, any authorised companion and authorised child for the duration of the course of treatment; and c the necessary arrangements have been made for the return of that person, any authorised companion and any authorised child to their home country when the course of treatment is completed. Overseas visitors detained in hospital or subject to court ordered treatment 18 No charge may be made or recovered in respect of relevant services provided to an overseas visitor— a who is liable to be detained in a hospital, received into guardianship or subject to a community treatment order under the Mental Health Act 1983 ; b who is detained in a hospital in circumstances which amount to deprivation of the overseas visitor's liberty and that deprivation of liberty is authorised under any of the following provisions of the Mental Capacity Act 2005 — i section 4A (restriction on deprivation of liberty) ; ii section 4B (deprivation of liberty necessary for life-sustaining treatment etc) ; iii section 16 (powers to make decisions and appoint deputies: general); or iv Schedule A1 (hospital and care home residents: deprivation of liberty) ; c whose detention in hospital is authorised by any other enactment authorising detention in a hospital; or d who is required to submit to a specified form of treatment that is imposed by, or included in, an order of a court and paragraph (a), (b) or (c) does not apply. Prisoners or detainees 19 1 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor— a who is detained in prison or in a place in which a person may be detained that is provided by the Secretary of State under section 43(1) (remand centres and young offender institutions) of the Prison Act 1952 ; or b who is detained under any of the following provisions— i Schedule 2 (administrative provisions as to control on entry etc) or Schedule 3 (supplementary provisions as to deportation) to the 1971 Act; ii section 62 (detention by Secretary of State) of the Nationality, Immigration and Asylum Act 2002 ; iii section 40(7)(c) (searches: contracting out) of the Immigration, Asylum and Nationality Act 2006 ; or iv section 2 (detention) or 36 (detention) of the UK Borders Act 2007 . 2 In this regulation, “ prison ” has the meaning given in section 53(1) of the Prison Act 1952 . Members of the regular and reserve forces, Crown servants and others 20 1 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is— a a member of the regular or reserve forces within the meaning of the Armed Forces Act 2006 ; b a qualifying employee who is visiting the United Kingdom in the course of the qualifying employment; or c where paragraph (b) does not apply, a qualifying employee who— i was ordinarily resident in the United Kingdom immediately prior to becoming a qualifying employee; or ii where the qualifying employee has been employed in more than one position of qualifying employment, the qualifying employee was ordinarily resident in the United Kingdom immediately prior to taking up one of the positions of qualifying employment. 2 An overseas visitor will be a “qualifying employee” if the overseas visitor was recruited in the United Kingdom and is— a a Crown servant (other than a person falling within paragraph (1)(a)) employed by, or in the service of, the Government of the United Kingdom; b an employee of the British Council or the Commonwealth War Graves Commission; or c working in employment, whether or not the overseas visitor derives a salary or wage from that employment, that is financed in part by the Government of the United Kingdom in accordance with arrangements with the Government of some other country or territory or a public body in such other country or territory. 3 In this regulation “ qualifying employment ” means any period of employment during which the overseas visitor was a qualifying employee. NATO forces 21 1 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a person to whom Article IX(5) of the Agreement regarding the Status of Forces of Parties to the North Atlantic Treaty (agreed in London on 19th June 1951) applies. 2 This regulation applies where the services in question cannot readily be provided by the medical services of the armed forces of— a the overseas visitor's own country; or b the United Kingdom. War pensioners and armed forces compensation scheme payment recipients 22 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is in receipt of— a any pension or other benefit under a Personal Injuries Scheme or Service Pensions Instrument, which Scheme and Instrument are defined in regulation 2(1) (interpretation) of the Social Security (Overlapping Benefits) Regulations 1979 ; or b a payment made under article 15(1)(c) (description of benefits – injury) or article 29(1) (description of benefits – death) of the Armed Forces and Reserve Forces (Compensation Scheme) Order 2011 . Overseas visitors from Ukraine 22A 1 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who— a is lawfully present in the United Kingdom; and b is ordinarily resident in Ukraine. 2 This paragraph applies to an overseas visitor who, during the relevant period— a received relevant services from a relevant body and who is exempt from charges for those services by virtue of— i paragraph (1); ii regulation 25(2)(d) (family members of overseas visitors); or iii regulation 25(3)(a)(iii) (child aged 3 months or less born to a parent lawfully present in the United Kingdom and ordinarily resident in Ukraine); or b received relevant services consisting of treatment the need for which arose during the visit from a relevant body and who is exempt from charges for those services by virtue of being— i an authorised companion; or ii an authorised child who has been granted leave to enter the United Kingdom to accompany a person who is exempt from charges under paragraph (1). 3 An overseas visitor to whom paragraph (2) applies is to be treated for the purposes of these Regulations as if, at the time that the relevant services were provided, the overseas visitor was an overseas visitor in respect of whom no charge may be made or recovered for those relevant services. 4 A relevant body which, in respect of an overseas visitor to whom paragraph (2) applies, has— a yet to make charges under regulation 3 (obligation to make and recover charges), must not make the charges; b made charges under regulation 3 but has yet to recover the charges, must not recover the charges; or c made charges under regulation 3 and received payment in respect of the charges, must repay any sum paid in respect of the charges in accordance with regulation 5 (repayment of a sum recovered or secured by a relevant body). 5 Paragraphs (1) to (3) do not apply in respect of chargeable assisted conception services. 6 In this regulation “ the relevant period ” means the period from 24th February 2022 to the coming into force of these Regulations. Employees on ships 23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Treatment the need for which arose during the visit 24 1 No charge may be made or recovered in respect of any relevant services, consisting of treatment the need for which arose during the visit, provided to an overseas visitor who is any of the following— a a national of a state which is a contracting party to the European Convention on Social and Medical Assistance (agreed in Paris on 11th December 1953) or the European Social Charter (agreed in Turin on 18th October 1961) and is— i lawfully present in the United Kingdom; and ii without sufficient resources to pay the charge; b an authorised child or an authorised companion. 2 No charge may be made or recovered in respect of any relevant services, consisting of treatment the need for which arose during the relevant period, provided to an overseas visitor who— a is in the United Kingdom during the relevant period; b has been given an accreditation pass by the Organising Committee to allow them to participate in the Games; and c is not part of the Games Workforce. 3 In this regulation— the “Games” and the “Organising Committee” have the meaning given in section 1 of the Birmingham Commonwealth Games Act 2020; “ the relevant period ” means the period beginning with 14th July 2022 and ending with 17th August 2022; the “ Games Workforce ” means— a person engaged by the Organising Committee; or a person engaged to a supplier, contractor or sub-contractor of the Organising Committee. Family members of overseas visitors 25 1 For the purposes of this regulation, unless otherwise provided, “ member of the family ” means— a the spouse or civil partner of an overseas visitor; or b a child in respect of whom an overseas visitor has parental responsibility. 1A No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a member of the family of another overseas visitor (“the principal overseas visitor”) if the principal overseas visitor is exempt from charges under regulation 16 (victims of modern slavery). 2 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a member of the family of another overseas visitor (“the principal overseas visitor”) and is lawfully present if the principal overseas visitor is exempt from charges under any of the following regulations— za regulation 13 (overseas visitors with a United Kingdom issued S1 healthcare certificate or equivalent document); a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b regulation 20 (members of the regular and reserve forces, Crown servants and others); c regulation 21 (NATO forces). d subject to paragraph (2A), regulation 22A(1) (overseas visitors from Ukraine). 2A Paragraph (2)(d) does not apply in respect of chargeable assisted conception services. 3 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a child who— a is born in the United Kingdom to a parent who is exempt from charges by virtue of— i regulation 10 (immigration health charge); ... ii regulation 11 (overseas visitors who have made applications for entry clearance or leave to remain prior to the commencement of the immigration health charge); or iii regulation 22A(1) (overseas visitors from Ukraine); b is aged 3 months or less; and c has not left the United Kingdom since birth. 4 Subject to paragraphs (5) to (7) of this regulation, no charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is a member of the family of a principal overseas visitor if— a the overseas visitor is lawfully present in the United Kingdom; b the overseas visitor is visiting the United Kingdom with the principal overseas visitor; and c the principal overseas visitor is exempt from charges under— i regulation 12 (overseas visitors with citizens’ rights); or ii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii regulation 22 (war pensioners and armed forces compensation scheme payment recipients). 5 Where the overseas visitor is a member of the family of a principal overseas visitor who is exempt from charges under regulation 12 (overseas visitors with citizens’ rights), the exemption in paragraph (4) applies only if the conditions in both paragraph (6) and (7) are satisfied. 6 The first condition is that— a the overseas visitor does not have a right arising from a provision mentioned in regulation 12(1)(a) to (c) (overseas visitors with citizens’ rights), and b the reason that the overseas visitor does not have such a right is because the overseas visitor is not recognised as a member of the family (within the meaning of Article 1(i) of Regulation (EC) No 883/2004 ). 7 The second condition is that the relevant services provided to the overseas visitor are services that the overseas visitor would be entitled to receive without charge by virtue of a right arising from a provision mentioned in regulation 12(1)(a) to (c) if the overseas visitor had such a right . 8 None of the provisions of this regulation affect any entitlement which any member of the family of an overseas visitor may have to an exemption from charges for relevant services by virtue of a right arising from a provision mentioned in regulation 12(1)(a) to (c) or any other exemption which they may be entitled to in their own right. PART 5 Consequential amendments, savings and revocations Consequential amendments 26 The consequential amendments set out in Schedule 3 have effect. Savings and revocations 27 The instruments set out in column (1) of the table in Schedule 4 are saved in respect of charges made, or to be made, and recovered for courses of treatment (whether continuing or not) commenced before the 6th April 2015, but are otherwise revoked to the extent set out in column (3) of that table. Signed by authority of the Secretary of State for Health. Earl Howe Parliamentary Under-Secretary of State, Department of Health