A Summary of the Changes to NHS Entitlement for Mission Workers
Historically the British government provided an exemption for missionaries working for charitable organisations that allowed them to have full access to NHS healthcare regardless of their residency status or how long they remained overseas. Unfortunately this changed in England as of April 6th 2015.
Further details of these changes can be found here - https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations
The people at Global Connections have also done a write up on this issue and the impacts on missionaries, which you can access here www.globalconnections.org.uk/interest-groups/international-hr-forum/access-to-nhs-treatment
At a summary level the ruling is that free access to the NHS in England will now be based on whether a person is deemed to be "ordinarily resident" (OR) or not.
Wales, Scotland and Northern Ireland
For Wales, Scotland and Northern Ireland different rules apply. In most cases missionaries will continue to be able to gain an exemption from charges.
England
The rules in England are that the following should continue to be free:
- GP services
- dental practices
- community pharmacists (NHS prescription charges will apply)
- walk in centres
- NHS 111
- High Street optometrists (eye testing charges will apply)
- Access to the Emergency (A&E) department, including all treatment while within that department.
- Treatment for the diseases listed here are also free www.legislation.gov.uk/uksi/2015/238/schedule/1/made
All other treatment, either once someone is transferred to a different department, or for any follow up care will be chargeable at 150% of the NHS tariff. This link is the draft 2016/17 National tariff information workbook, which gives an idea of potential costs.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/487361/National_Tariff_Information_Workbook_2016-17_18_December_2015__3__amended.xlsx
This is a very extensive spreadsheet, but some cost examples are:
- A contrast MRI of a single area is shown at £184 under the NHS tariff, which means a charge of £276 (150% of £184).
- A normal maternity birth is shown at £1,755, or £2,582 with complications, a charge of £2,632.50 or £3,873.
- A routine Ante-natal observation is shown at £422, a charge of £633.
- Nursing procedures are shown at £355, a charge of £532.50
- Hip replacement surgery (not including follow up treatment or physiotherapy) is shown at between £5,149 and £8,459, depending on the complexity, a charge of £7,723.50 to £12,688.50.
My own experience with NHS charging, as someone who has lived overseas now for 10 years, and who is unlikely to be deemed Ordinarily Resident, has been mixed. There seems to be uncertainty within the different NHS trusts on what the rules are. For instance, my wife has been told (on the phone) she would be charged £80 for a GP appointment plus any charges for treatment when she was poorly during a visit to Knebworth in Hertfordshire.
However, when my son had an eye infection when we were in Cornwall, we were seen at a clinic for free (including for medication) even though we were expecting to pay, and they just said "no this is free " even when we told them our circumstances of living overseas.
ensure you know what you are entitled to for free on the NHS 
The NHS rules seem to say that both of these cases should have been free for us. Only if there had been ongoing treatment for my wife or if she would have been given a prescription should there have been charges. So if you take nothing else from this article at least it will be good to ensure you know what you are entitled to for free on the NHS.
What options are there for missionaries who are likely to not be deemed Ordinarily Resident in England?
In the past it was possible to use renewable travel insurance policies, which would cover missionaries for smaller medical needs overseas, or repatriate them to the UK for larger treatment on the NHS. During home visits missionaries could also rely on the NHS to cover any medical needs that arose in England.
However, for missionaries who are likely to be not deemed ordinarily resident, these travel insurance policies are no longer a suitable option, as they will leave significant gaps in their cover, which could lead to someone needing to pay a large bill, or even if cover is initially provided overseas for a longer term condition, being forced to relocate back home to the UK permanently, as travel policies generally do not provide on-going long-term cover.
The solution is a Private Medical Insurance (PMI) policy that allows missionaries to have continuous cover that would not just cover them until retirement, but potentially beyond should they decide not to live overseas indefinitely. What missionaries will need to check is that the policy does not have a limiting life-time benefit maximum of cover, and does not have a maximum age of cover.
Other factors that you should consider when looking for a good product are medical evacuations with at least US$250,000 of cover (in 2014 TTc had two evacuations that were around this amount), and also check to ensure that terrorist related incidents are not excluded from cover, as unfortunately these can happen.
This video is an interview with some of our members who were caught up in a church bombing in Pakistan.
TTc aims to provide solutions that meet all these needs and provide excellent service for Christian missionaries. In addition to excellent service, we also aim to provide the benefits most needed by our members. For example through Aetna we have also partnered with Red24 to provide security advice and crisis response capabilities. We are also launching in November a 24/7 doctor on call service where members can video conference or call with UK based doctors for their medical needs.
To find out more about the policies offered by TTc you can write to Nathan Lyon directly at Nathan@talent-trust.com or visit the TTc website www.talent-trust.com
