NATIONAL HEALTH SERVICE, ENGLAND AND WALES Citation, commencement and interpretation 1 1 These Regulations may be cited as the National Health Service (Charges to Overseas Visitors) Regulations 1989 and shall come into force on 1st April 1989. 2 In these Regulations, unless the context otherwise requires– “ the 1971 Act ” means the Immigration Act 1971; “the 2014 Act” means the Immigration Act 2014; “ the Act ” means the National Health Service Act 1977; “authorised child” means a child who has either been granted leave to enter the United Kingdom with his parent for the purpose of the parent obtaining a course of treatment in respect of which no charges are payable under regulation 6A or is the 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 charges are payable under regulation 6A; or ordinarily resident in Ukraine and is obtaining a course of treatment; “Authority” means, as the case may require, a Regional Health Authority, a District Health Authority, or a special health authority; “child” means a person who is– under the age of sixteen; or under the age of nineteen and treated for the purposes of the Child Benefit Act 1975 , or the Child Benefit (Northern Ireland) Order 1975 , as receiving full-time education at an educational establishment recognised under that Act or that Order; “competent institution” has the same meaning as in Regulation (EC) No 883/2004 or Regulation (EEC) No 1408/71 , as the case may be; “Continental Shelf”, except in reference to a designated area of the Continental Shelf, means the sea-bed and subsoil of the submarine area (other than in the Baltic or Mediterranean Seas, including the Adriatic and Aegean, or the Black Sea) adjacent to the coasts, lying north of the latitutde of 25 degrees north and between the longtitude of 30 degrees west and 35 degrees east, of the territory (including islands) of– any country situated on the Continent of Europe, or the Republic of Ireland, where the submarine area is outside the seaward limits of the territorial limits of those countries and the Republic of Ireland and is an area with respect to which the exercise by any of them of sovereign rights in accordance with international law is recognised by Her Majesty’s Government in the United Kingdom; “designated area of the Continental Shelf” means any area which is for the time being designated by an Order in Council under the Continental Shelf Act 1964 as an area within which the rights of the United Kingdom with respect to the sea-bed and subsoil and their natural resources may be exercised; “equivalent document” means a document which, for the purposes of a listed healthcare arrangement is treated as equivalent to an S1 healthcare certificate; “ 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 Immigration Act 1971; “listed healthcare arrangement” has the meaning given in regulation 1(3) of the Healthcare (European Economic Area and Switzerland Arrangements) (EU Exit) Regulations 2019; “Local Health Board” has the meaning assigned to it by section 11 of the National Health Service (Wales) Act 2006; “member of the family” has the same meaning as in Regulation (EC) No 883/2004 or Regulation (EEC) No 1408/71 as the case may be; “member State” means a State which is a Contracting Party to the Agreement on the European Economic Area but until that Agreement comes into force in relation to Liechtenstein does not include the State of Liechtenstein ; “ NHS foundation trust” has the same meaning as in section 1(1) of the Health and Social Care (Community Health and Standards) Act 2003; “ NHS trust” means a National Health Service trust established under Part I of the National Health Service and Community Care Act 1990; “overseas visitor” means a person not ordinarily resident in the United Kingdom; “Primary Care Trust” means a Primary Care Trust established under section 16A of the National Health Service Act 1977; “reciprocal agreement” means arrangements mutually agreed between the Government of the United Kingdom and the Government of a country or territory outside the United Kingdom for providing health care; “refugee” means a person who is a refugee within the meaning of Article 1 of the Convention relating to the Status of Refugees 1951 and Article 1 of the Protocol relating to the Status of Refugees 1967 and any other person taking refuge in the territory of a member State with leave of the Government of that State; “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 implementation period 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 implementation period completion day; “relevant services” means accommodation, services or facilities which are provided, or whose provision is arranged, under the National Health Service (Wales) Act 2006 other than— primary medical services provided under Part 4 (medical services); primary dental services provided under Part 5 (dental services); general ophthalmic services provided under Part 6 (ophthalmic services); or equivalent services which are provided, or whose provision is arranged, under that Act; ... “services forming part of the health service” means accommodation, services and other facilities provided under section 3(1) of the Act (the Secretary of State’s duty to provide accommodation and services) and includes accommodation, services and other facilities provided by an NHS trust or a Primary Care Trust , but does not include any accommodation, service or facility made available or provided under section 18A(4) or (5) of the Act (accommodation and services for private patients of Primary Care Trusts and powers of Primary Care Trusts to make more income available), section 65 of the Act (accommodation and services for private patients of health authorities), section 7(2) of the Health and Medicines Act 1988 (powers to make more income available for the health service) or paragraph 14 of Schedule 2 to the National Health Service and Community Care Act 1990 (accommodation and services for private patients of NHS trusts) or made available or provided by an NHS foundation trust to a patient other than for the purposes of the health service ; “ship or vessel” includes hovercraft; “stateless person” has the meaning assigned to it in article 1 of the Convention relating to the Status of Stateless Persons 1954 ; “treatment” includes medical, dental and nursing services required for the care of women who are pregnant or in childbirth or for the prevention or diagnosis of illness; “treatment the need for which arose during the visit” means diagnosis of symptoms or signs occurring for the first time after the visitor’s arrival in the United Kingdom and any other treatment which, in the opinion of a medical or dental practitioner employed by, or under contract with, an Authority Local Health Board or NHS trust or NHS foundation trust , or a Primary Care Trust , is required promptly for a condition which arose after the visitor’s arrival in the United Kingdom, or became, or but for treatment would be likely to become, acutely exacerbated after such arrival. “the United Kingdom Government” as referred to in regulation 4(1)(a)(iii) includes the National Assembly for Wales. “walk-in centre” means a centre at which information and treatment for minor conditions is provided to the public under arrangements made by or on behalf of the Secretary of State. 3 In calculating, for the purpose of any provision of these Regulations, a period of residence in the United Kingdom, any interruption by reason of temporary absence of not more than three months shall be disregarded. 4 Unless the context otherwise requires, in these Regulations any reference to a numbered regulation or Schedule is a reference to the regulation or Schedule bearing that number in these Regulations. Making and recovery of charges 2 1 Where an Local Health Board or NHS trust or NHS foundation trust , or a Primary Care Trust provides an overseas visitor with services forming part of the health service, that Local Health Board or NHS trust or NHS foundation trust , or a Primary Care Trust , having determined, by means of such enquiries as it is satisfied are reasonable in all the circumstances, including the state of health of that overseas visitor, that the case is not one in which these Regulations provide for no charge to be made, shall make and recover from the person liable under regulation 7 charges for the provision of those services. 2 An Local Health Board or NHS trust or NHS foundation trust , or a Primary Care Trust which makes and recovers a charge in accordance with paragraph (1) of this regulation shall give or send to the person making the payment a receipt for the amount paid. Services exempted from charges 3 1 No charge shall be made in respect of any services forming part of the health service provided for an overseas visitor– a at a hospital accident and emergency department or , casualty department ... unless and until he has been accepted as an in-patient at the hospital, for treatment of the condition in respect of which such services are provided; or aa at a walk-in centre in respect of services similar to those at an accident and emergency department of a hospital; or b otherwise than at, or by staff employed to work at, or under the direction of, a hospital; or bb consisting of the provision of family planning services; or c for treatment in respect of a disease listed in Schedule 1; or d at a special clinic for the treatment of sexually transmitted diseases or in respect of a sexually transmitted disease by virtue of a reference from such a clinic, but in the case of services which relate to infection with any Human Immunodeficiency Virus, only to the extent that they consist of a diagnostic test for evidence of infection with any such Virus and counselling associated with that test or its result; e who is detained in a hospital, or received into guardianship, under the Mental Health Act 1983 or any other enactment authorising orders for admission to, and detention in, hospital by reason of mental disorder; or f with a view to the improvement of his mental condition where submission to the treatment is, under section 3(1) of the Powers of the Criminal Courts Act 1973 , included by the Court in a probation order under section 2 of that Act. 2 Services provided to an overseas visitor for the treatment of monkeypox on or after 23 May 2022 but before this paragraph came into force are to be treated for the purposes of these Regulations as if, at the time that the services were provided, they were relevant services in respect of which no charge may be made or recovered. 3 Where paragraph (2) applies, a Local Health Board or NHS Trust— a yet to make charges under regulation 2 (making and recovery of charges) must not make the charges; b that made charges under regulation 2 but has yet to recover the charges, must not recover the charges; or c that made charges under regulation 2 and received payment in respect of the charges, must repay any sum paid in respect of the charges in accordance with regulation 8 (repayments). Overseas visitors exempt from charges 4 1 No charge shall be made in respect of any services forming part of the health service provided for an overseas visitor, ...– a who is shown to the satisfaction of the Local Health Board or NHS trust or NHS foundation trust , or Primary Care Trust to be present in the United Kingdom or in a designated area of the Continental Shelf or ..., in or over any area of the Continental Shelf, or on a stationary structure within the territorial waters of the United Kingdom, for the purpose of– zi engaging in employment with an employer which has its principal place of business in the United Kingdom or which is registered in the United Kingdom as a branch of an overseas company, or i being a self employed person whose principal place of business is in the United Kingdom; ii working as a volunteer with a voluntary organisation that is providing a service similar to a relevant service as defined in sections 64 and 65 of the Health Services and Public Health Act 1968 , or service to which Article 71 of the Health and Personal Social Services (Northern Ireland) Order 1972 applies; or iii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv taking up permanent residence in the United Kingdom; or b who has resided lawfully in the United Kingdom for a period of not less than one year immediately preceding the time when the services are provided unless this period of residence followed the grant of leave to enter the United Kingdom for the purpose of undergoing private medical treatment or a determination under regulation 6A; c who has been accepted as a refugee in the United Kingdom, or who has made a formal application for leave to stay as a refugee in the United Kingdom ...; or d who is employed on a ship or vessel registered in the United Kingdom; or e who is in receipt of any pension or other benefit under a Personal Injuries Scheme, service pensions instrument or a 1914-1918 War Injuries Scheme as defined in regulation 2(1) of the Social Security (Overlapping Benefits) Regulations 1979 ; or f who is a diplomatic agent for the purposes of the Articles of the Vienna Convention on Diplomatic Relations set out in Schedule 1 to the Diplomatic Privileges Act 1964 ; or g who is a member of Her Majesty’s United Kingdom Forces; or h who is some other Crown servant employed in the right of Her Majesty’s Government of the United Kingdom having been recruited in the United Kingdom; or i who is an employee, recruited in the United Kingdom, of the British Council or the Commonwealth War Graves Commission; or j who is working in employment that is financed in part by the Government of the United Kingdom in accordance with arrangements made with the Government of some other country or territory or a public body in such other country or territory; or k who has at any time had not less than ten years continuous lawful residence in the United Kingdom and is engaged in employment as an employed or self-employed person outside the United Kingdom that has lasted for a period of no more than five years. l who is employed in a member State and who is contributing as an employed or self-employed earner under the Social Security Act 1975 or the Social Security (Northern Ireland) Act 1975 ; or m who, in the case of a national of a member State or a British citizen , a refugee or a stateless person, has entitlement to the provision of the services in question by virtue of Regulations made by the Council of the European Union under Article 48 of the Treaty on the Functioning of the European Union or, in the case of a national of another country, is entitled to be provided with such services by virtue of an agreement entered into between that Community and any other country; or n whose detention in prison or in an institution provided by the Secretary of State under section 43(1) of the Prison Act 1952 is for the time being authorised by law; or who is detained under the provisions of the Immigration Act 1971 ; or o in whose case the services are provided in circumstances covered by a reciprocal agreement— i with a country or territory specified in Schedule 2; or ii with an EEA state or Switzerland where that agreement is a listed healthcare arrangement; or p who— i is not a national of a Member State, and ii is a national of a State which is a signatory to the European Social Charter, and iii is not entitled to be provided with such services under a reciprocal agreement specified in Schedule 2, and iv is without sufficient resources to pay the charge ; or q who is working outside the United Kingdom as a missionary for an organisation that is established in the United Kingdom, regardless of whether he— i derives a salary or wage from the organisation, or ii receives any type of funding or assistance from the organisation for the purposes of working overseas for the organisation , or r who the competent authorities of the United Kingdom for the purposes of the Council of Europe Convention on Action Against Trafficking in Human Beings (in this regulation “the Convention”), i consider that there are reasonable grounds to believe is a victim within the meaning of Article 4 of the Convention, and the recovery and reflection period in relation to him under Article 13 of the Convention has not yet expired; or ii have identified as a victim within the meaning of Article 4 of the Convention. s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Where a person meets the residence qualification in paragraph (1)(b) on a date during a course of treatment for which charges could have been made prior to that date no charge shall be made in respect of services received subsequently; 3 Where it is established that a person does not meet the residence qualification in paragraph (1)(b) and that person has already received services as part of a course of treatment on the basis that no charges would be made, no charges may be made for the remainder of that course of treatment. 4 No charge is to be made in respect of any services forming part of the health service provided for a iin the case where sub-paragraph (g), (h), (i), (j), (q) or (r) of paragraph (1) applies to an overseas visitor, the spouse, civil partner or child of the overseas visitor; or b in the case where any other sub-paragraph applies to an overseas visitor, the spouse, civil partner or child of the overseas visitor, if the spouse, civil partner or child lives on a permanent basis with the overseas visitor in the United Kingdom. Exemption from charges during long term visits by United Kingdom pensioners 4A 1 No charge shall be made or recovered in respect of any overseas visitor who— a is in receipt of a retirement pension under the Social Security Contributions and Benefits Act 1992 or the Social Security (Contributions and Benefits) (Northern Ireland) Act 1992 or a state pension under Part 1 of the Pensions Act 2014 or Part 1 of the Pensions Act (Northern Ireland) 2015 ; b resides in the United Kingdom for at least six months and in a member State for less than six months each year; and c is not registered as a resident of a member State; for services forming part of the health service which he receives during the period he resides in the United Kingdom. 2 No charge shall be made in respect of any services forming part of the health service provided for the spouse , civil partner or child of an overseas visitor to whom this regulation applies where he lives on a permanent basis with the overseas visitor during the period they reside in the United Kingdom. Overseas visitors with citizens’ rights 4B 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 Subject to paragraphs (3) to (5) 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 another overseas visitor (“the 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 changes under paragraph (1). 3 The exemption in paragraph (2) only applies if both conditions in paragraphs (4) and (5) are satisfied. 4 The first condition is that— a the overseas visitor does not have a right under an agreement mentioned in paragraph (1), 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 ). 5 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 under an agreement mentioned in paragraph (1) if the overseas visitor had such a right. 6 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. 7 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 a United Kingdom issued S1 healthcare certificate or equivalent document 4C 1 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 implementation period completion day, b continues to be ordinarily resident in an EEA state or Switzerland on and after implementation period completion day, c receives a state pension paid by the United Kingdom Government, and d holds a S1 healthcare certificate, or an equivalent document, issued to or in respect of that person by a competent institution of the United Kingdom. 2 No charge may be made or recovered in respect of any relevant services provided to— a the spouse or civil partner of an overseas visitor; or b a child in respect of whom an overseas visitor has parental responsibility, if that overseas visitor is exempt from charges under paragraph (1). Persons who make late applications under Appendix EU to the immigration rules 4D 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 on the date on which the application mentioned in paragraph (2)(b) or (3)(b), as the case may be, is made and which ends on 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 Local Health Board or NHS trust— 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. Overseas visitors with Trade and Cooperation Agreement Rights 4E 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. Immigration health charge 4F 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 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. 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 6 April 2016, under Part 2 of the immigration rules (visitors to the UK); or ii on or after 6 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 paragraph 1(o) of Schedule 2 to 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 27 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 4G 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 6 April 2015. 3 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. 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 4F(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. Children of overseas visitors exempt from charges by virtue of regulations 4F and 4G 4H 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 4F (immigration health charge); or ii regulation 4G (overseas visitors who have made applications for entry clearance or leave to remain prior to the commencement of the immigration health charge); b is aged 3 months or less; and c has not left the United Kingdom since birth. Overseas Visitors from Ukraine 4I 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 No charge may be made or recovered in respect of any relevant services provided to an overseas visitor who is lawfully present in the United Kingdom and is— a the spouse or civil partner of another overseas visitor who is exempt from charges under paragraph (1); or b a child in respect of whom another overseas visitor, who is exempt from charges under paragraph (1), has responsibility. 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 paragraph (1); b is aged 3 months or less; and c has not left the United Kingdom since birth. 4 This paragraph applies to an overseas visitor who, during the relevant period— a received relevant services from a Local Health Board or NHS trust and who is exempt from charges for those services by virtue of— i paragraph (1); ii paragraph (2); or iii paragraph (3); or b received relevant services consisting of treatment the need for which arose during the visit from a Local Health Board or NHS trust 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). 5 An overseas visitor to whom paragraph (4) 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. 6 A Local Health Board or NHS trust which, in respect of an overseas visitor to whom paragraph (5) applies, has— a yet to make charges under regulation 2 (making and recovery of charges), must not make the charges; b made charges under regulation 2 but has yet to recover the charges, must not recover the charges; or c made charges under regulation 2 and received payment in respect of the charges, must repay any sum paid in respect of the charges in accordance with regulation 8 (repayments). 7 In this regulation, “ the relevant period ” means the period from 24 February 2022 to the coming into force of this regulation. Exemption from charges for treatment the need for which arose during the visit 5 No charge for services forming part of the health service, provided only for the purpose of giving treatment the need for which arose during the visit, shall be made in respect of any overseas visitor who is– a a national of a member State, a British citizen, or a refugee or a stateless person, or a member of the family of any of them, resident in each case in the territory of a member State; or b a person, or the spouse , civil partner or child of a person, who has at any time had not less than ten years continuous lawful residence in the United Kingdom or not less than ten years continuous service as a Crown servant employed in the right of Her Majesty’s Government of the United Kingdom and is in receipt of a pension or benefit under the Social Security Act 1975 or the Social Security (Northern Ireland) Act 1975 or a state pension under Part 1 of the Pensions Act 2014 or Part 1 of the Pensions Act (Northern Ireland) 2015 ; or c a person resident in a country, other than Israel, or territory specified in Schedule 2; or d a person who is without sufficient resources to pay the charge and who is a national of a country which is a contracting party to the European Convention on Social and Medical Assistance 1954 ; or e a person, or the spouse , civil partner or child of a person, who has at any time had not less than ten years continuous lawful residence in the United Kingdom and who is resident in a member State or in a country, other than Israel, or territory specified in Schedule 2 , or f an authorised child or an authorised companion ; or g an individual who is in the United Kingdom– i as part of the “Commonwealth Games Family”, as defined in paragraph 1 of Schedule 4, during the period from 19 July 2014 to 7 August 2014 inclusive; ii as part of the “IPC Athletics European Championships Family”, as defined in paragraph 2 of Schedule 4, during the period from 14 August 2014 to 27 August 2014 inclusive; or iii as a “NATO delegate or accredited person”, as defined in paragraph 3 of Schedule 4, during the period from 2 September 2014 to 6 September 2014 inclusive. EU Exit: transitional arrangements 5A Where an overseas visitor who is ordinarily resident in an EEA state or Switzerland has— a before implementation period completion day received relevant services from a Local Health Board or NHS trust, or b on or after implementation period completion day received relevant services from a Local Health Board or NHS trust as part of a course of treatment which commenced before implementation period 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. Exemption from charges for treatment provided to a member of the forces of the North Atlantic Treaty Organisation 6 No charge shall be made or recovered for the provision of services forming part of the health service required for the treatment of a person to whom Article IX (5) of the North Atlantic Treaty Organisation Status of Forces Agreement applies, where such treatment cannot readily be provided by the medical services of the armed forces of his own country or of the United Kingdom. Exemption from charges for exceptional humanitarian reasons 6A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6B Regulation 6A as inserted for England shall additionally have effect in Wales subject to the modification that for the references to the “Secretary of State” there shall be substituted references to the “National Assembly for Wales. Liability for payment of charges 7 The person liable to pay charges payable by virtue of these Regulations shall be the overseas visitor in respect of whom the services are provided except that– a if the overseas visitor is employed to work on and for the purposes of a ship or vessel and is present in the United Kingdom in the course of such employment, the person liable to pay such charges shall be the owner of the ship or vessel on which the overseas visitor is employed; and b if the overeseas visitor is employed to work on and for the purposes of an aircraft and is present in the United Kingdom in the course of such employment, the person liable to pay such charges shall be his employer. Repayments 8 1 Where a sum has been paid as a charge for services forming part of the health service by or on behalf of a person who, at the time services were provided for such person, was not an overseas visitor in respect of whom, or did not receive services for which, such a charge was payable, a claim for repayment of the sum may be made by presenting to the Authority Local Health Board or NHS trust or NHS foundation trust , or a Primary Care Trust by which the charge was made and recovered– a the receipt for payment of such sum; b a declaration in support of the claim signed by or on behalf of the claimant; and c such evidence in support of the declaration as the Authority Local Health Board or NHS trust or NHS foundation trust , or a Primary Care Trust may require. 2 The Authority Local Health Board or NHS trust or NHS foundation trust , or a Primary Care Trust , if satisfied by the evidence so produced that the sum to which the receipt relates was not payable by virtue of these Regulations, shall repay to the claimant the amount of any such sum. Revocation of Regulations 9 The Regulations specified in column 1 of Schedule 3 are hereby revoked. Signed by authority of the Secretary of State for Health R. N. Freeman Parliamentary Under-Secretary of State, Department of Health 3rd March 1989