What Happens if You Deliver Your Baby Out of Countey

This information sheet outlines the entitlement to free NHS maternity care in England for women from abroad (or UK citizens returning to England after living abroad).

• The ordinary residence exam
• EEA nationals
• Exemptions from charges
• the wellness surcharge
• Access to maternity intendance
• How to deal with NHS charges and debt
• How to challenge charging decisions.
• Where to go for more help.

New regulations are being introduced in the Autumn 2017. This data sheet contains details of those changes.

If y'all alive in Scotland, Wales or Northern Ireland, we accept produced a separate information sheet.

Am I entitled to free NHS maternity care?

NHS motherhood care is provided complimentary of charge to women who are;

• considered to be 'ordinarily resident' in the UK, or
• EEA nationals who are insured by another European state, or
• exempt from charges (including people who have paid the immigration health surcharge).

If you do not autumn into any of these groups you may exist asked to pay for your intendance, but yous cannot be refused intendance if y'all cannot pay at the time you receive care.  It is very of import for your health and your baby's wellness that y'all attend for maternity intendance even if you are unable to pay.

Maternity intendance includes all antenatal, birth and mail-natal care.

The NHS charging regulations outlined in this data sheet currently only apply to NHS hospital care. If y'all are using customs maternity services, yous should check whether these services are provided (and funded) by a hospital. If they are, the charging regulations will all the same utilise.

If y'all are uncertain about your clearing status, you should seek specialist immigration advice – see organisations listed at the stop of this information sheet.

Who will decide if I am going to be charged for my maternity care?

All NHS hospitals must make reasonable enquiries to decide who is not ordinarily resident and charge overseas visitors for their NHS care. This will normally exist carried out by Overseas Visitors Managers (OVM) at the hospital. Government guidance on charging for NHS intendance states that hospitals should follow these steps:

1. Patients should be asked if they are insured by some other state,
2. "All patients must be assessed against the exam for ordinary residence in the United kingdom of great britain and northern ireland…If the patient is ordinarily resident in the UK they must non be charged".
3. Patients who are not normally resident in the UK, and are not insured by another EEA country must be assessed against the exemptions.
4. Patients who are bailiwick to charges must be charged. Maternity intendance must non be withheld or delayed if you are unable to pay in advance.

Do I take to pay the charges upfront?

Upfront charging for NHS care is being introduced from 23 Oct 2017. This will allow hospitals to ask for accelerate payment for an estimated corporeality of charges providing they have:

• made reasonable enquiries as to whether yous have to pay for NHS intendance or you autumn inside one of the exemptions, and
• securing advance payment volition non prevent or delay an 'immediately necessary service' or an 'urgent service'.

An 'immediately necessary service' specifically includes antenatal care, care in childbirth and postnatal care of mother and baby. This means that your maternity care must never be refused or delayed if you cannot pay for treatment in advance.

An urgent service includes intendance that is necessary to save a person's life or prevent a condition condign life-threatening or to prevent serious damage.

Is there any data on my NHS records about whether I have to pay for care?

From 21^stAugust 2017 hospitals have a new duty to put a 'flag' on a patient'due south record to state whether the patient is chargeable or exempt and the date that they made that conclusion. Withal, the NHS has a duty to bear out 'reasonable enquiries' before charging a patient. This duty applies every time that the NHS applies charges to your treatment. If your immigration status or residence status changes you should provide new evidence to the NHS.

If y'all are wrongly charged for treatment you should get specialist communication from the organisations listed below.

The ordinary residence test

Who is 'ordinarily resident' in the UK?

Individuals who are considered to be 'ordinarily resident' in the United kingdom are entitled to free NHS care. In police force, a person is usually resident here if they are:

"living lawfully in the Great britain voluntarily and for settled purposes every bit part of the regular gild of their life for the time existence, whether of brusque or long duration."

You must first establish whether you are living lawfully in the UK.

Am I living lawfully in the UK?

You lot are considered to exist living lawfully in the UK if you have permission from the UK Government to live here, for example, if y'all are a British Citizen, accept get out to remain or are exercising your European union Treaty rights.  The following may be living here lawfully:

• Non-EEA Citizens with get out to remain in the UK.
• EEA/Swiss nationals who are working, studying or self-sufficient and their family members,
• Not-EEA carers of British and EEA nationals,
• Some Republic citizens with a right of abode,
• Refugees and people with humanitarian protection, and
• Some temporary residents under the immigration rules.

There is a detailed Section of Wellness guide to ways in which y'all can exist lawfully resident in the Britain. If you lot are uncertain you should get advice from a registered immigration adviser: world wide web.gov.uk/authorities/uploads/system/uploads/attachment_data/file/496967/lawfully-resident-uk.pdf

Am I ordinarily resident in the UK?

If yous have established that you are lawfully resident in the United kingdom, you must then establish whether y'all are unremarkably resident.

The following people are considered ordinarily resident:-

• "Qualified" EEA Citizens (i.e. EEA Citizens who are exercising treaty rights [working, work-seeking, self-employed, cocky-sufficient]) in the Great britain.
• Family unit members of qualified EEA Citizens, whether or not they themselves are EEA Citizens.
• United kingdom Citizens who are in the UK for settled purposes as part of the regular order of their life for the time being.
• People with indefinite leave to remain (ILR) and who are in the UK for settled purposes equally role of the regular order of their life for the time-existence.

UK nationals, who have been living/working abroad, may also have to prove their ordinary residence.  If y'all have emigrated, y'all are likely to exist charged for NHS care on visits to the United kingdom but you are non chargeable if you tin show that you are all the same ordinarily resident here.

EEA nationals living in the UK will need to demonstrate that they are exercising European union treaty rights in the UK (e.g. are employed, self-employed, a student or a family member of someone exercising their European union treaty rights) or accept permanent residence in the UK.

I am not a UK Citizen, EEA Denizen or the family member of an EEA.   Am I commonly resident?

Under the 2015 charging regulations, people who crave exit to remain in the UK, must have indefinite leave to remain (ILR) , in order to be considered normally resident.

If y'all have ILR you must however be able to demonstrate that y'all are ordinarily resident here and not only visiting.

If you are in the UK on a short term visa (e.m. a spouse or student visa), yous cannot exist classed as ordinarily residenteven if you have been in the UK for more than than 6 months and tin can evidence that you are settled here.  You may not take to pay for NHS maternity care if you are covered past one of the exemptions beneath or y'all pay the wellness surcharge when renewing your visa.

Not-EEA nationals without ILR tin can simply be considered ordinarily resident if they are not subject to immigration command, for example, a family member of an EEA national who is resident here.

You are non considered to exist living lawfully in the UK if you have overstayed your Visa or your claim for asylum and any subsequent appeals take been refused but you may not have to pay for NHS maternity care if you are covered by one of the exemptions below.

You are entitled to some NHS intendance if you are from a non-EEA country that has a reciprocal healthcare understanding. For more than information, see the Authorities guidance.

I accept been hither for less than vi months tin I still be considered to exist usually resident here?

You lot can exist considered to be unremarkably resident in the Uk if you take lived hither for less than six months only can show that you are in the UK for settled purposes.  For example, you have taken a chore here, your children take started school here, or you have taken out a lease on your accommodation.  It is possible to be ordinarily resident from day one.

What sort of evidence can I give to testify that I am unremarkably resident here?

Information technology is of import to provide as much data as you can to show that yous are resident here, for case:-

• Your tenancy understanding.
• Utility and Quango Tax bills.
• Employment contract
• Letter from higher, confirming course duration.
• Alphabetic character from children's school, confirming enrolment.

If you accept recently returned from working or studying abroad it is a good idea to provide evidence to show that your job or course was for a temporary flow and provide details of where you lived and why you were not settled there, for example, how often you lot returned to the UK and what you are intending to exercise now.

You tin ask friends and family to provide bear witness for you, for example, if you are living with relatives. If you are unable to provide evidence immediately y'all may be charged but if y'all later provide satisfactory evidence charges tin can be cancelled. See below for how to challenge charging decisions.

EEA/EU nationals

I am from an Eu/EEA country.  Am I entitled to gratuitous NHS care?

Countries in the EEA are:Austria,Kingdom of belgium,Bulgaria, Republic of croatia, Republic ofCyprus, Czech Republic,Denmark,Estonia, Finland,France, Germany, Greece, Hungary, Iceland, Republic of ireland,Italia,Latvia, Liechtenstein, Republic of lithuania,Luxembourg, Republic of malta,Netherlands, Norway, Poland, Portugal, Romania,Slovakia, Slovenia, Spain, Sweden

EEA and Swiss nationals and their family members are subject field to the same rules as other nationals for entitlement to free NHS healthcare which means they must exist normally resident in the UK.

For more data about maternity rights and benefits for EEA nationals come across Maternity rights and benefits: EU, EEA and Swiss nationals.

I have a (European Health Insurance Bill of fare) EHIC.  What am I entitled to?

EEA or Swiss nationals or their family unit members, who have a valid European Health Insurance Menu (EHIC), are entitled to some handling without charge, even if they are not ordinarily resident, considering the Uk can claim dorsum the costs of treatment. The EHIC covers 'all handling that is medically necessary before their planned date of return'. The EHIC covers motherhood care, including antenatal and postnatal care, provided the reason for the woman'southward visit was not specifically to give nascency or receive maternity handling and the treatment is necessary before her return.

EHICs are issued by the land where you work or are settled.  If you don't have an EHIC or have lost it, you can request a Provisional Replacement Certificate (Prc) from the EEA country responsible for providing the EHIC.  This will give yous access to the aforementioned free treatment as an EHIC.

An EHIC/Mainland china will but cover the cost of your NHS care if you are hither temporarily and take not settled here. You can be here temporarily and use an EHIC, even if you are planning to be here for a while and do not yet have a date of return.

EEA nationals who plan to take their infant whilst they are in the United kingdom of great britain and northern ireland will exist asked to provide an S2 form issued by the EEA country in which they are resident.  Nevertheless, the NHS guidance states that:

 'since not all EEA states automatically event the S2 (formerly E112) for maternity, discretion can be applied if a valid EHIC is presented instead. If no valid entitlement document is presented, then payment will be required from the patient (unless a unlike exemption applies)'.

If you have been charged you may be entitled to reimbursement from your dwelling house state or if yous provide an EHIC valid for the menses of your treatment y'all may be able to claim a refund from the NHS.

I am an EEA national and I've come to England to alive and piece of work. Am I entitled to free NHS care?

Yous are entitled to complimentary NHS care if you are exercising Treaty rights to work or study in the Uk and yous are ordinarily resident here. Y'all will need to provide evidence to the NHS, as outlined to a higher place, to testify that you are now settled here.

Even if you lot are entitled to complimentary NHS care because you lot are ordinarily resident here, you tin still exist asked to provide an EHIC/PRC to enable the NHS to merits dorsum the costs of your treatment.

A spouse, civil partner, dependent kid or parent of an EEA national who is usually resident hither is also entitled to be treated equally unremarkably resident.

A student who is here for a long menstruum of study may be asked to provide an EHIC/Cathay. If the student does not have a valid EHIC and is intending to study in the Britain for a long menstruum, the NHS should consider if they are normally resident as the student may be settled here for the time being.

Exemption from charges

Am I exempt from charges for NHS care?

Some people are non "ordinarily resident" in the United kingdom but are "exempt" from NHS charges.

You will be entitled to free NHS motherhood care if you are in ane of the post-obit exempt groups:-

• You have claimed asylum or Article 3 get out (including humanitarian or temporary protection) and are waiting for a decision or, following a refusal, you wait the outcome of an appeal,
• You accept been granted refugee status or Commodity three leave, (including humanitarian or temporary protection),
• You are a Great britain Authorities employee (including members of the military machine). This exemption as well covers the employee'south spouse/civil partner and children aged under 18,
• You lot are covered by reciprocal health care agreements
• You have been detained for mental health treatment or are subject to court ordered treatment,
• You are in prison or immigration detention,
• You are a refused asylum seeker who receives support under Department 4(2) or Section 95 of the Immigration and Asylum Act 1999 or Local Authority back up nether section 21 of the National Assistance Act 1948 or Part 1 of the Care Act 2014,
• You are a adult female who has been recognised as or suspected of being a victim of trafficking or modern slavery (her spouse/ceremonious partner and children are besides exempt),
• You lot are a child in the care of the Local Authority.

You should seek advice if y'all are uncertain most your immigration status or whether you are covered by an exemption (run across list of advice agencies below).

What happens if I was exempt from charging and I was receiving free treatment just my application has now been refused?

Many of the exempt groups listed above tin can continue to receive free treatment if they had already started a course of treatment before their application is refused.

The following people tin can keep to receive free existing treatment:

• Asylum seekers whose applications and appeals have been refused,
• Refused aviary seekers who stop receiving s.4(2) support, s.21 or Part 1 support,
• People no longer in prison, immigration detention, looked after past the local authority or detained for mental health handling, and
• Suspected victims of modern slavery who is found not to have been a victim.

Whatsoever new treatment would be chargeable, unless you lot fall within an exempt group. The authorities guidance says that immediately necessary treatment (which includes maternity care) must non be refused to this vulnerable group if they cannot pay in accelerate.

I received NHS maternity care in the UK earlier I became exempt from charging; practice I however accept to pay the charges for the motherhood care I received?

You must exist treated as being exempt from charges for any motherhood intendance y'all received before you were granted aviary or temporary or humanitarian protection or were identified as a victim of modern slavery if you:

• Came to the UK to apply for aviary or temporary or humanitarian protection, or every bit a victim of modernistic slavery, and
• Accessed NHS maternity services before you had applied for asylum or temporary or humanitarian protection or earlier you had been identified as a victim of modern slavery, and
• Take subsequently been granted aviary, temporary or humanitarian protection or identified every bit a victim of modern slavery.

This ways that any charges made for the services you received will be cancelled and must not be pursued by the NHS. If you have already paid the charges, they must be refunded to you.

Which services are exempt from charges for NHS intendance?

The following services are exempt from charges for everyone that needs them, any your immigration or residence status is.  If you are an EEA national, the NHS can ask for your EHIC/PRC in club to claim reimbursement from some other EEA country but you lot cannot be charged.

No charges may exist made for the post-obit services:

• Accident and emergency (A&East) services upwards until the signal that the person is accepted every bit an inpatient. A&E services provided at an outpatient appointment are chargeable.
• Services provided outside of an NHS hospital, unless the staff providing the services are employed by or working under the direction of an NHS hospital
• Family unit planning services (not including pregnancy termination). Temporary EEA nationals can use an EHIC for termination of a pregnancy as long as it is necessary before you lot return to your own country.
• Diagnosis and treatment of certain contagious diseases e.thou. TB or HIV,
• Diagnosis and treatment of sexually transmitted infections
• Treatment of a physical or mental condition caused by torture, female person genital mutilation (FGM), domestic violence or sexual violence when the patient has non travelled to the United kingdom in order to seek treatment, run across below for more details.

Which services are costless of charge for victims of violence or FGM?

You lot are entitled to treatment for any status, including chronic conditions that are a direct consequence of the torture, female genital mutilation, domestic violence or sexual violence that y'all take suffered. Torture includes cruel, inhuman and degrading treatment or punishment.

This means that you are not entitled to allNHS services free of accuse only yous are entitled to those services that are needed as a directly result of the torture, violence or FGM. NHS treatment includes psychological treatment and information technology covers the initial treatment and ongoing treatment. Regime guidance says that 'Treatment will include mental health services and maternity services needed equally a consequence of sexual violence.'  Yous are likewise entitled to any antenatal, perinatal and postpartum treatment that is needed as a result of FGM.

If you accept been a victim of violence or FGM it is important that you try to speak to your medical professionals and so that they tin aid you to admission these services gratuitous of accuse. Some of the organisations listed beneath may be able to assistance you. The NHS should take evidence of torture, violence or FGM from your GP or other organisations such as Liberty from Torture. If yous are refused free handling you can get gratuitous, confidential communication from the Maternity Action Maternity Care Access Communication Service, encounter contact details below.

More than information on the exemption for NHS services for victims of violence can be found in chapter 7 of the Regime Guidance: www.gov.britain/government/uploads/system/uploads/attachment_data/file/496951/Overseas_visitor_hospital_charging_accs.pdf

Am I entitled to be refunded charges for my motherhood care if I am now exempt equally a upshot of new regulations for supported refused asylum seekers and victims of FGM?

If y'all received NHS care and were charged for it merely have subsequently go exempt from charges, equally a result of amendments to the regulations in February 2016 for failed aviary seekers supported under Part one of the Care Act and victims of FGM performed exterior the Great britain, any charges should exist cancelled.  If you have paid for NHS services, you can apply to the Department of Wellness for consideration of a refund.

The Clearing Health Surcharge (IHS)

What is the clearing wellness surcharge?

The Immigration Health Surcharge (IHS) was introduced in April 2015 for people who are applying for leave to enter or to remain in the U.k. for more 6 months.

People who have paid the IHS will be entitled to NHS healthcare gratis of charge, as soon equally their leave to remain begins.

The IHS is £200 per twelvemonth per person (with a discounted rate of £150 per year per person for students). It must exist paid in respect of the applicant and all their dependents.The IHS is payable in full with the immigration application fee and must include the charge for every year or part-year of residence in the UK covered by the visa.  For case, a visa for two and a one-half years volition include a surcharge of £500 to cover that period for the applicant and each dependant.

Failure to pay the IHS could result in an immigration application existence refused or get out to remain in the UK being cancelled.

If y'all are exempt from paying the IHS, see beneath, or you came to the Uk before the IHS was introduced, and you make an in-fourth dimension application for leave to remain (before your existing visa expires) and your get out is extended while your application is considered, you remain exempt from NHS charges until your extended leave expires.

Once your get out expires or while you are an overstayer, you are chargeable for your NHS care, including whatsoever treatment that has already begun.

Am I exempt from the wellness surcharge?

The Clearing Health Surcharge (IHS) cannot be paid if the visa is for 6 months or less (e.g. visit and fiancée visa).  People with those visas are chargeable for their NHS maternity care.

Some people are exempt from paying the health surcharge including:

• People (and their dependents) who apply for leave to remain in the UK for asylum/humanitarian protection or every bit a victim of modernistic slavery or under the Abode Role Destitution Domestic Violence Concession
• Dependents of a member of the HM forces.

If you are exempt from paying the HIS, you should not exist charged for NHS maternity care.

If you have paid the IHS, your baby will also be exempt from charges until s/he is iii months' one-time.  After this fourth dimension, your infant will exist assessed in his/her own right for exemption or liability for NHS healthcare charges.  For more information about healthcare charges for children, see the organisations listed below,

I came to the United kingdom of great britain and northern ireland earlier the Clearing Wellness Surcharge was introduced; am I entitled to free NHS maternity care?

Regulation 11 of the 2015 Charging Regulations gives transitional protection to people who made an application for leave to remain in the Great britain for more than vi months earlier Apr 2015.  This regulation says that you lot are not liable to pay the IHS retrospectively and should be exempt from charges until the end of your current visa (including any extension to your current visa). If you use for farther leave to remain, you will exist assessed for liability to pay the surcharge as part of this application.

Is there whatsoever discretion to waive the Immigration Health Surcharge for women who are destitute?

The IHS must be paid at the time you make your immigration application unless you are in ane of the exempt groups (meet above).  Women who can prove they are destitute at the time of applying for an extension to their clearing go out can ask to take the application fees waived. Information technology is also possible to ask to take the clearing health surcharge waived, reduced or refunded although this is rarely granted.  You will need to be able to prove that you lot are destitute to the Dwelling house Role. You can go communication from the Maternity Action Maternity Intendance Access Advice Line, see contact details beneath.

Entitlement to NHS health care

Do NHS maternity services have the discretion to turn down to provide motherhood care?

No.  All maternity care is classed every bit " immediately necessary" , and must not be refused for whatever reason.  Maternity care includes all antenatal, birth and post-natal care.

Fifty-fifty if you are unable to pay for services at the time of treatment, you lot must receive maternity care.  You lot should ask to speak to the Overseas Visitors Manager at the hospital to explain your circumstances and talk over your options (e.yard. whether you might be exempt or to hold a repayment program [see below]).

If yous are refused maternity intendance you lot should contact the Patient Advice and Liaison Service (PALS) at your infirmary, Healthwatch or seek further communication from the organisations listed beneath. You tin can make a complaint to the NHS, encounter beneath. You tin can also contact the Maternity Care Access Advice Service (details beneath) who can propose yous and refer y'all for emergency legal activeness if necessary.

Do I have to evidence my passport to go NHS maternity intendance?

NHS motherhood care must be provided, whatever your nationality and regardless of whether you have go out to remain in the Uk.

Nether the 2015 Charging Regulations, NHS hospitals are entitled to make reasonable enquiries to determine who is commonly resident and accuse overseas visitors for their NHS care.  This will commonly be carried out by Overseas Visitors Managers (OVM) at the hospital.  In order to show that you are entitled to complimentary NHS intendance, you have to prove that you are usually resident in the Great britain by showing that you are here lawfully and you are settled for the time beingness.  Yous may also exist entitled to free NHS care if you lot are in ane of the categories of people who are exempt due east.grand. aviary seekers or you are seeking treatment that is exempt from charging eastward.g. emergency care.  See to a higher place on exemptions from charging for more than data.

Ordinary residence is explained in chapter 3 of the Department of Health 'Guidance on implementing the Overseas Infirmary Regulations 2015' and explicitly states on page 29:

'A person is non ordinarily resident in the Britain simply considering they take British nationality; hold a British passport; are registered with a GP; take an NHS number; ain property in the UK; or have paid (or are currently paying) National Insurance contributions and taxes in the Uk.'

For more data on what documentation might be needed to prove ordinary residence, see above on the ordinary residence test. In some circumstances y'all may demand to prove your passport to prove your residence status but it volition not exist necessary in all cases.

Where can I find the Regime guidance on access to maternity care?

Department of Wellness guidance for England is independent in 'Guidance on implementing the overseas visitor infirmary charging regulations'.  Chapter eight of the Guidance says:

'Due to the severe health risks associated with conditions such every bit eclampsia and pre-eclampsia, and in order to protect the lives of both female parent and unborn baby, all motherhood services, including routine antenatal handling, must be treated as being immediately necessary. No woman must ever be denied, or take delayed, maternity services due to charging issues. Although she must be informed if charges apply to her treatment, in doing so she should non be discouraged from receiving the residue of her motherhood treatment. Overseas Visitor Managers (OVMs) and clinicians should be specially careful to inform significant patients that farther maternity healthcare will not be withheld, regardless of their ability to pay.'

The latest version was updated in Feb 2016 and is bachelor at

https://www.gov.britain/government/uploads/system/uploads/attachment_data/file/496951/Overseas_visitor_hospital_charging_accs.pdf

I am a refused aviary seeker.  Can I admission NHS motherhood care?

In England, if you accept been refused aviary, humanitarian or temporary protection and yous are in receipt of Section 4(2) or Section 95 support or local dominance accommodation support under south.21 NAA or Part 1 of the Care Deed you are entitled to free NHS care.

If yous are not receiving support you cannot be refused NHS maternity care simply you volition be asked to pay unless you are entitled to free care under any of the other exemptions.

I am non 'usually resident' or covered past an EHIC or exemption.  Tin I obtain NHS maternity care?

If you are not 'ordinarily resident' in the United kingdom of great britain and northern ireland and are not exempt, yous may exist asked for pay for motherhood care.  Maternity care is classed every bit 'immediately necessary treatment'and cannot be refused for any reason.  If you cannot pay, y'all must not exist refused care.

If you lot have overstayed a visa or are uncertain about your immigration condition, you should seek specialist immigration communication – run into organisations listed at the finish of this information sheet.

I am not ordinarily resident or exempt from charges; volition I be charged if I have an abortion?

Yes, yous will be charged if y'all accept an abortion at an NHS hospital. If you are an EEA national and you lot have an EHIC/PRC, y'all are entitled to a termination free of charge providing it is necessary before yous can return to your country.

If you are thinking of having an abortion, seek further advice from the abortion charities listed. In some cases, charities may be able to waive or reduce charges if y'all can testify that you are unable to pay.

I am not 'ordinarily resident' in the UK.  Am I entitled to GP care?

There is no police preventing GPs from treating anyone.  GPs have the discretion whether or non to register patients, and so long as they exercise non discriminate against anyone. GPs may only refuse registration if the local Health commissioner has agreed that they tin can close their lists to new patients or you live exterior the GP'due south catchment area or for other reasonable grounds. GPs take a duty to provide free of charge handling which they consider to exist immediately necessary or an emergency, regardless of whether that person is an overseas visitor or registered with that practice.

NHS England has produced guidance for registering with a GP do. A GP practice is entitled to inquire yous to prove that yous alive inside their practise expanse only there are no regulations that say you must provide proof of identity, address or residence in gild to be registered with a GP and you must non have registration or appointments refused because you are unable to provide these documents.

www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Documents/how-to-annals-with-a-gp-leaflet.pdf

NHS healthcare charges

Am I entitled to proof of payment if I pay for my maternity intendance?

Yep, you lot are entitled to a receipt for any payments made for NHS care. It is important to keep a record of any payments yous make and proceed all receipts equally proof of payment.

How much will maternity care cost?

The amount you will be asked to pay will depend on the care that you and your baby need. Charges can be based on a local price arrangement or the National Tariff Payment System and overseas visitors are charged 150% of the cost.

The National Tariff Payment System provides prices and rules for NHS providers; yous tin can notice more data about how charges are broken down in Chapter 13 of the NHS Charging guidance.

Motherhood care is divided into antenatal care, nascency and postnatal intendance; guess charges for these services are:

• Antenatal care £1590-£4233,
• Birth £2244-£3282 (plus boosted payments if yous need a long stay in hospital),
• Postnatal care £355.l-£1207.50

The amount yous are charged could exist more or less than these amounts. For more than information, the latest National Tariff can be found at world wide web.gov.uk/government/publications/nhs-national-tariff-payment-system-201617

If you lot are in the UK in the early stages of pregnancy but are planning on having your baby abroad, you should only exist charged for the care that y'all actually receive.  Hospitals have three charging options: they can accuse for a whole package, a proportion of a bundle and per appointment.

If you lot are asked to pay, you should ask for an itemised pecker so yous tin can encounter what you accept been charged for. If you disagree with the amount you take been charged you should talk to the hospital'south Overseas Visitors Director.  You tin also speak to the OVM virtually repayment options (for example, whether you tin set up a repayment plan) and, if necessary, y'all should become advice.

I have been told that I will exist charged for NHS motherhood care; what if I decide to have the baby at abode?

If you conform a home birth with NHS maternity services, you will be charged every bit higher up.

Whilst it is not illegal to requite nativity to your baby at home without midwife/medical support (i.east. on your own or with the back up of friends or family), if you are considering this it is very important for the safety and well-being of y'all and your baby that y'all get medical communication before the birth to make sure you understand any potential risks to you or your baby and to talk over your birth options.

If you have a habitation birth without midwife/medical support you will not be charged. Yet, if you have whatever complications and need medical treatment during or following the birth, you could be charged.

If you need emergency treatment because your or your baby's life is at risk, whatever handling yous receive from a hospital's blow and emergency service will be complimentary of charge only if you are and so admitted to infirmary for further treatment, you lot will exist charged for all medical care you receive as an inpatient (even if it arises from an emergency).

What should I do if I am asked to pay and I am unable to do and so?

If you lot are unable to pay for your maternity care, then you should inform the hospital.  Ideally, this should exist washed in writing.  Citizens Advice Bureaux and local community organizations may be able to assist with this.

Yous tin can ask to repay the debt through regular monthly payments.  The amount you lot pay should exist based on your income and expenses so even a small monthly repayment (due east.g. £five) should exist accepted if that is all you lot can afford.

Infirmary trusts have a duty to recover charges, just should not go across what is reasonable when pursuing charges.  If the trust or a debt collector is aggressively pursuing payment, and then you can brand a formal complaint to the trust.  Your local PALS service or Healthwatch may be able to help yous negotiate with the trust.

You can also get specialist debt advice, including advice virtually debt collection, from the organisations listed beneath.

The NHS can write off debt if:

• the patient has died and the debt is non recoverable from their estate,
• the patient is not traceable,
• information technology is not cost-effective to go on to pursue the debt because of the patient's fiscal circumstances, for example, the patient is destitute or genuinely has no ways to pay it, or
• reasonable steps have been taken and there are no farther means to recover the debt.

The debt must be written off if it is afterward found that the charges should not accept practical. Yous should go on to attend for motherhood care fifty-fifty if yous are unable to pay the charges.

It is very important to keep a record of all payments and you are entitled to a receipt for any payments made.

My husband has been asked to sign a form to say that he will act as a guarantor to pay my debts. Does he have to sign it?

Only the patient is liable to pay a debt for their NHS care. Debts for healthcare are only linked to the person who owes the money and debts are not 'registered' against a particular address. If the NHS asks you and your married man (or anyone else, including family unit, friends or relatives) to sign a joint agreement to repay the debt so they will as well exist liable to repay the debt. In some circumstances you may both be required to repay the debt if you lot have joint property or a joint bank account. Y'all should become advice earlier signing a articulation understanding from a specialist debt adviser. Yous can get free debt advice from the organisations listed below.

A guarantor is someone who agrees to pay a debt if the person named on the understanding falls behind with payments. A guarantor should have the means to repay the debt, if necessary, and should get communication on the consequences if they are unable to pay. You practise not have to provide a guarantor and if you and/or your husband/partner or anyone else are pressurised into signing a joint repayment agreement or a guarantee form yous should seek legal advice.

Call back: maternity care is regarded as immediately necessary handling and must non be delayed or refused because of charging issues or inability to pay. Motherhood care must not be delayed or refused whilst a repayment plan is negotiated or because you exercise not accept a guarantor.

Anyone asked to human activity every bit guarantor should seek advice from a specialist debt adviser earlier signing a guarantee agreement and should bank check the understanding carefully. You lot can get free debt advice from the organisations listed below.

Can the NHS tell the Home Office virtually the debt?

Aye, the NHS tin tell the Dwelling house Office if a non-EEA patient has unpaid debts:

• over £k (that are more than than three months old) from 1/eleven/11 to 5/four/16 or 23/eleven/16 (depending of type of leave).
• over £500 (that are more than 2 months old) from six/four/16 and from 24/11/16 (depending on type of get out).

The Home Office is able to have this into business relationship when considering future immigration applications for leave to enter or remain in the land.

The NHS cannot notify the Habitation Function of outstanding debts in whatsoever of the following circumstances:

• The NHS must not tell the Abode Office well-nigh a debt owed by an EEA national, her/his family member or a non-EEA national who has derived residence rights in the Uk considering they are the carer of a British or EU citizen (known every bit Zambranocarers).
• The NHS must nontell the Habitation Office of outstanding debts if you are challenging the decision to charge you, for case, where in that location is a dispute virtually your immigration status or whether y'all are ordinarily resident.
• The NHS must not tell the Home Role if yous have an agreed payment plan in place and you are sticking to it.
• The NHS must not inform the Dwelling Office of outstanding debts where the debt has been cancelled.
• In Northern Ireland, the guidance states that the NHS must not inform the Habitation Office of a debt, if it has been written off. The England guidance is silent on this signal.

In that location are articulate guidelines that the NHS must follow before informing the Habitation Office of unpaid bills. The guidelines can exist constitute at:   www.gov.united kingdom/regime/uploads/system/uploads/attachment_data/file/507694/Overseas_chargeable_patients_2016.pdf

The NHS does not have to tell y'all that they are going to notify the Home Office or that they have already notified the Home Office about an unpaid debt merely it is proficient practice to tell you and to explain why. All the same, the NHS must tell you that they are able to contact the Dwelling house Office if you lot practise not repay the debt or practise not stick to a repayment program. If the NHS does not follow the guidelines and notifies the Home Office of your debt, you should seek advice.

Information technology is of import to talk to the NHS to hold a payment plan and try to stick to the programme. You can enquire to repay in small instalments e.g. £v per calendar month instalments if you lot can evidence that this is all you tin afford to pay. The guidelines say that information about debt may only be passed to the Dwelling Office where no reasonable arrangements have been fabricated, or kept to, for repaying the debt.

If y'all pay the debt after the Abode Office has been informed or you hold a payment plan, the NHS must inform the Dwelling Part immediately. The NHS may be liable for whatever consequences of failing to tell the Home Function nearly any changes, for example, if a visa application is wrongly refused.

The NHS tin can ask the Home Part to verify your nationality or clearing status (such as asking for confirmation that you lot have applied for asylum), but the NHS must not share any clinical information about y'all with the Home Office. These are strict rules. If you think that the NHS has passed on other data most you, you should become legal communication.

How do I make a complaint about a decision to charge me for my NHS intendance?

Government guidance on charging (see above) says that NHS staff must not discriminate when implementing the charging rules, for example, they must not target particular racial groups. You also have a correct not to exist treated in an intimidating, hostile, degrading or offensive style. This means that enquiries most your residence condition and payment should be fabricated privately and discreetly. If you have been treated unfairly or discriminated against you tin can brand a complaint.

If you are unhappy virtually the hospital's conclusion to charge yous, for instance, they have rejected evidence that you are usually resident or they have refused to provide maternity services until y'all pay for handling you can make a complaint. If information technology is after establish that the charges should not take been applied, the debts tin be cancelled (see section thirteen.lxx of the Government guidance on charging).

1. Firstly, you should try to resolve complaints informally by speaking to the infirmary and showing them the relevant department of the Government guidance: gov.uk/government/uploads/system/uploads/attachment_data/file/496951/Overseas_visitor_hospital_charging_accs.pdf
2. If y'all accept non been able to resolve it with the hospital yous tin brand a complaint using the NHS England Complaints procedure. england.nhs.uk/contact-us/complaint/#unhappy
3. If you lot are yet unhappy you tin raise the matter with the Parliamentary and Health Service Ombudsman. Run into below for contact details.
4. You tin can also get specialist legal communication about challenging charging decisions or refusal of treatment. Judicial review claims must be brought promptly and within 3 months of the decision you are lament nigh. Yous must have completed all complaints and appeals available.

Some of the organisations listed below may exist able to advise you lot and help you to make a complaint.

If yours or your infant's wellness is affected by delays to your treatment considering of charging decisions or because you were deterred from seeking treatment considering of fear of charges, you should get legal advice. You can get free, confidential advice from the Maternity Action Motherhood Care Access Advice Line, see contact details below.

If you are uncertain nigh your immigration status or y'all need help with regularising your status you should seek aid from a registered immigration specialist.

This factsheet was produced by Maternity Activeness in July 2017. It is ever of import to get up-to-date communication.

Back up our work with a donation.

Where to get for more than assist

NHS motherhood care and charges

Maternity Action
www.maternityaction.org.uk

Motherhood Care Admission Advice Service: for advice on NHS charges and access to NHS motherhood care – 0808 800 0041. Thursday 10 – 12 midday.  Email enquiries: maternitycareaccess@maternityaction.org.uk

For more information on NHS motherhood care charging see:

www.maternityaction.org.uk/advice-2/maternitycareaccess/

Migrant Women's Rights Service: Second tier advice on fiscal support and housing options for migrant women and access to NHS maternity care. – 020 7251 6189 Email enquiries: migrantwomensrights@maternityaction.org.united kingdom

This is a second tier advice service for midwives and advisers

Debt advice/repayment plans/write-offs

Debt Advice Foundation

Gratuitous debt advice and help with debts.

Tel no. 0800 043 40 l

www.debtadvicefoundation.org

StepChange

world wide web.stepchange.org

Gratuitous debt communication and assist with debts. Callers must be resident in the Great britain.

www.stepchange.org/Contactus.aspx

Citizen'due south Advice Bureau

www.citizensadvice.org.uk/debt-and-money/

Complimentary advice on dealing with debts.

To find your nearest CAB: www.citizensadvice.org.uk/about-u.s./how-nosotros-provide-advice/advice/search-for-your-local-citizens-advice/

National Debt line

Free online debt advice and tools. Tel no. 0808 808 4000.www.nationaldebtline.org

Trafficking and the National Referral Mechanism

Conservancy Regular army

If you lot remember you are a victim of trafficking or modern slavery and would like advice and support y'all can call the Salvation Regular army 24-hour confidential Referral Helpline

0300 303 8151

Open up 24 hours, seven days a calendar week

Healthcare and access to healthcare

Children's Legal Centre

www.childrenslegalcentre.com/?sfid=132&_sft_resource_topic=healthcare

Freedom from Torture

Care and treatment for victims of torture

London Centre Tel: 020 7697 7777

Due west Midlands Centre Tel: 0121 314 6825

North E Centre Tel: 0191 261 5825

North West Centre Tel: 0161 236 5744

Scottish Centre Tel:0141 420 3161

Helen Bamber Foundation

Care and treatment for survivors of torture and violence

www.helenbamber.org

Tel No 020 3058 2020

Healthwatch England

A consumer organisation that can assist with complaints against wellness intendance providers.

03000 68 3000

enquiries@healthwatch.co.uk

www.healthwatch.co.britain/about-usa

Parliamentary and Health Service Ombudsman

If you are unable to resolve a complaint with an NHS torso yous can brand a complaint to the Ombudsman:

Helpline 0345 015 4033 Monday to Friday 8.thirty – v.thirty

www.ombudsman.org.uk/make-a-complaint

Patient Advice and Liaison Service (PALS)
Help in resolving problems with the NHS.  Y'all can observe your local PALS through the website.www.nhs.uk/service-search/patient-advice-and-liaison-services-(pals)/locationsearch/363

Doctors of the World
Free healthcare for vulnerable and excluded people.

Clinic advice line: 020 7515 7534. This line is open up from 10am to 12 midday, Monday to Friday
world wide web.doctorsoftheworld.org.u.k./projectlondon

Marie Stopes International

Charity who offer a range of reproductive healthcare and communication, including abortions.
www.mariestopes.org.united kingdom

0345 300 8090

Immigration advice

You can search for accredited immigration advisers in your surface area at:
https://www.gov.u.k./find-an-immigration-adviser

Rights of Women www.rightsofwomen.org.great britain
Free legal communication on sexual violence, immigration and asylum constabulary.
Helpline 020 7490 7689.

Ceremonious Legal Advice
If y'all are eligible for legal aid you lot can become free legal advice on 0345 345 four 345 (offers translation service). To check your eligibility seewww.gov.uk/civil-legal-advice

To search for specialist legal advisers or solicitors in your surface area seedetect-legal-advice.justice.gov.uk

More Maternity Activeness data sheets

Maternity rights and benefits

European union, EEA and Swiss nationals (including A8 and A2) – motherhood rights and benefits

No recourse to public funds – maternity rights and benefits

Undocumented migrants – maternity rights and benefits

Indefinite leave to remain, right of domicile and UK citizenship – motherhood rights and benefits

Victims of trafficking or modern slavery – maternity rights and benefits

Aviary seekers – maternity rights and benefits

Refugees – maternity rights and benefits

Refused asylum seekers – maternity rights and benefits

Fiscal support and housing

Aviary seekers – fiscal support and housing

Refused asylum seekers – financial support and housing

No recourse to public funds – fiscal back up and housing

Charging for NHS maternity care

NHS care for women from abroad (England)

NHS intendance for women from away (Scotland, Wales and Northern Ireland)

Aviary-seekers and Article iii claimants – entitlement to NHS maternity  care

Refused asylum-seekers and Article 3 claimants – entitlement to NHS maternity  care

Refugees, Humanitarian Protection, Article 3 or temporary protection – entitlement to NHS maternity  care

Victims of trafficking or mod slavery – entitlement to NHS maternity care

EEA and Swiss Citizens and their family members – entitlement to NHS maternity  intendance

Non-EEA national family members of EEA and Swiss citizens – entitlement to NHS motherhood  care

No recourse to public funds or express get out – entitlement to NHS motherhood  intendance

Undocumented migrants – entitlement to NHS maternity  care

Indefinite go out to remain, right of dwelling and U.k. citizens – entitlement to NHS maternity  care

Information-sharing between the Home Office and the NHS

Dealing with debts owed to the NHS for maternity care

Smooth language guides to motherhood and parental rights

Ciaza i uprawnienia macierzynskie dla pracownic z Polski

Pregnancy and motherhood rights at work for Polish workers (in English language)

Karmienie piersia w miejscach publicznych

Breastfeeding in public places (in English)

Uprawnienia westward pracy dla ojcow i partnerow polscy pracownicy

Rights at work for Polish fathers and partners' (in English)

Spanish language guides to maternity rights and benefits

Derechos por embarazo y maternidad de las mujeres trabajadoras de habla hispana

Pregnancy and motherhood rights for Spanish speaking workers' (in English language)

Información para mujeres de habla hispana sobre ayudas económicas para progenitores y bebés

Coin for parents and babies for Spanish speakers (in English language)

Portuguese language guides to motherhood rights and benefits

Gravidez eastward direitos de maternidade para trabalhadoras que falam portugues

Pregnancy and motherhood rights for Portuguese speaking workers' (in English)

Auxílio financier para país eastward bebês que falam português

Coin for parents and babies for Portuguese speakers (in English)

What Happens if You Deliver Your Baby Out of Countey

Source: https://maternityaction.org.uk/advice/nhs-maternity-care-for-women-from-abroad-in-england/

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