Fillable Overseas Healthcare Services UK Global Health Insurance Card (UK National Health Service)

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Overseas Healthcare Services UK Global Health Insurance Card (UK National Health Service)

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Overseas Healthcare Services
UK Global Health Insurance Card (GHIC) application form
The quickest way to apply for a card is online at www.nhs.uk/ghic
or by calling 0300 330 1350 from the UK or +44 191 279 0575 from abroad.
Lines are open Monday to Friday 8am to 6pm, and Saturday 9am to 3pm (UK time).
How to complete this form
As the main applicant, you can also apply on behalf of your partner and/or any dependent children. For
each applicant or family member you are applying for, you must complete all the questions asked. For
more detailed information visit www.nhs.uk/healthcareabroad.
Post your completed application to: NHS Business Services Authority, Overseas Healthcare Services,
Bridge House, 152 Pilgrim Street, Newcastle upon Tyne, NE1 6SN.
How we use your information
The NHS Business Services Authority (NHSBSA) and the Department of Health and Social Care are
jointly responsible for this service. We will use the information that you have given us to process
and verify your applications and to make payments to and recover treatment costs from countries
within the EEA, Switzerland and Gibraltar. We may share your information with the Department for
Work and Pensions, HM Revenue and Customs, NHS England, Scotland, Wales and Northern Ireland
and Gibraltar Health Authority (to validate your information), NHS Counter Fraud Authority and
international healthcare providers and administrators (to prevent, detect and investigate fraud and
error). We may share patterns and trends gained from patient information with NHS commissioners,
service providers and NHS England, Scotland, Wales and Northern Ireland (to plan and improve NHS
services). We will not transfer your Personal Data outside of the UK, EEA, Switzerland or Gibraltar.
Data will be deleted from our systems and files no later than 48 months after the expiry date of
your UK GHIC. Further details are available at www.nhsbsa.nhs.uk/yourinformation.
1. Declaration - Read before signing
I understand that should the main applicant have a change to residency status, move abroad to live, or
work on a long-term basis, then he or she may no longer be entitled to a UK GHIC. In these
circumstances NHSBSA must be informed and, if required, all associated UK GHICs returned.
I understand that if I have used the UK GHIC to access healthcare abroad when I am not entitled to do
so, I may be liable for the full cost of the treatment. I also understand that this also applies to UK GHICs
for other people named on this application.
I understand that the UK GHIC does not prove entitlement to NHS services, and does not prove
entitlement to planned treatment outside the UK. I also understand that this card is not a proof of
identity or residency in the UK and is not an alternative to travel insurance.
I have read and understood the eligibility requirements for receiving a UK GHIC in the ‘Important
information’ section (page 6 of this application form). I confirm that I will give complete and accurate
information in relation to this application. I understand and accept that if I provide NHSBSA with false or
misleading information I may be liable for criminal prosecution.
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1. Declaration (cont.) - Read before signing
I understand that the administration of the UK GHIC is the responsibility of the NHSBSA.
I will supply any additional information which might be reasonably required by NHSBSA to verify
information I have given on this form.
I understand that the information on this form and otherwise in connection with this application may
be shared with:
• NHS Counter Fraud Authority
• International healthcare providers and administrators you are treated by
• Department of Health and Social Care – International Division and Anti-Fraud Unit
• Local Authorities
• Credit reference agencies
• Bodies performing functions on behalf of the above organisations
• Law enforcement organisations, as required by law
for the purposes of the prevention, detection and investigation of fraud and error. The information can
also be used for the purposes of prosecution of fraud or any other unlawful activity affecting the NHS.
I understand the information on this form may be shared with:
• The Department for Work and Pensions
• HM Revenue and Customs
• NHS England, Scotland, Wales, Northern Ireland and Gibraltar Health Authority
for the purposes of verification.
I understand to support more effective planning and improvements to NHS services and patient care,
patterns and trends gained from patient information may be shared with:
• NHS Commissioners and service providers
• NHS England, Scotland, Wales and Northern Ireland
• Department of Health and Social Care
• NHS Counter Fraud Authority
We may contact you to discuss your application by any of the methods you have provided on the
application.
I confirm that:
• The main applicant specified in this application is ordinarily resident in the UK, and aged 16
or over.
• The persons named in this application have consented to their personal details being disclosed.
• I have read the Privacy Notice at www.nhsbsa.nhs.uk/overseas-healthcare-privacy
I am the main applicant
/ /
Signature Date
I am a representative for the main applicant
Full name of representative Relationship to main applicant
If you are an organisation processing UK
Permanent address of representative
GHIC applications on behalf of a customer,
you must state your full business name
and address, as well as Companies House
registration or charity number (if applicable).
If you fail to provide this information the
application will not be processed.
Signature Date
/ /
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2. The main applicant
Title: Mr Mrs Ms Miss Other
Surname:
Forename(s):
Date of birth (must be aged 16 or over):
/ /
NHS number (England and Wales), Community Health Index
number (Scotland) or Health and Care number (Northern Ireland):
You can find this on hospital appointment letters or NHS prescriptions. Ask your GP if you cannot
find it.
Name of your Local Authority, find yours at www.gov.uk/find-local-council
What is your nationality?
If you are not a UK or Irish national, send a copy of your visa or residence permit.
Passport number:
How long have you lived in the UK? Number of years and months
Do you have any plans to study abroad or move abroad permanently within the next five years?
Posted workers should answer ‘No’ Yes No
If ‘Yes’, what date do you expect to leave the UK?
/ /
EHIC or GHIC Personal Identification Number (PIN): U K
Only for replacement or renewal EHIC or GHIC - the number is shown on your existing EHIC or GHIC
Current permanent address
House number (and/or house name):
Street:
Town:
County:
Postcode: Country:
Contact phone number (inc. area code):
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3. Spouse/partner/civil partner
Title: Mr Mrs Ms Miss Other
Surname:
Forename(s):
Date of birth:
/ /
NHS number (England and Wales), Community Health Index
number (Scotland) or Health and Care number (Northern Ireland):
You can find this on hospital appointment letters or NHS prescriptions. Ask your GP if you cannot
find it.
Nationality:
Does this person live with the main applicant at the address given at section 2?
Yes No If ‘No’, send evidence with this application that they are
dependent on the main applicant (e.g. an S1 form).
4. Dependent children If you do not know their NHS number, give the main applicant’s.
Dependent child 1 - under 16 years old
Title: Mr Ms
Surname:
Forename(s):
Date of birth:
/ /
NHS number (England and Wales), Community Health Index
number (Scotland) or Health and Care number (Northern Ireland):
You can find this on hospital appointment letters or NHS prescriptions. Ask your GP if you cannot
find it.
Nationality:
Does this person live with the main applicant at the address given at section 2?
Yes No If ‘No’, please send evidence with this application that they are
dependent on the main applicant (e.g. an S1 form).
Dependent child 2 - under 16 years old
Title: Mr Ms
Surname:
Forename(s):
Date of birth:
/ /
NHS number (England and Wales), Community Health Index
number (Scotland) or Health and Care number (Northern Ireland):
You can find this on hospital appointment letters or NHS prescriptions. Ask your GP if you cannot
find it.
Nationality:
Does this person live with the main applicant at the address given at section 2?
Yes No If ‘No’, please send evidence with this application that they are
dependent on the main applicant (e.g. an S1 form).
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4. Dependent children (cont.) If you do not know their NHS number, give the main applicant’s.
Dependent child 3 - under 16 years old
Title: Mr Ms
Surname:
Forename(s):
Date of birth:
/ /
NHS number (England and Wales), Community Health Index
number (Scotland) or Health and Care number (Northern Ireland):
You can find this on hospital appointment letters or NHS prescriptions. Ask your GP if you cannot
find it.
Nationality:
Does this person live with the main applicant at the address given at section 2?
Yes No If ‘No’, please send evidence with this application that they are
dependent on the main applicant (e.g. an S1 form).
Dependent child 4 - under 16 years old
Title: Mr Ms
Surname:
Forename(s):
Date of birth:
/ /
NHS number (England and Wales), Community Health Index
number (Scotland) or Health and Care number (Northern Ireland):
You can find this on hospital appointment letters or NHS prescriptions. Ask your GP if you cannot
find it.
Nationality:
Does this person live with the main applicant at the address given at section 2?
Yes No If ‘No’, please send evidence with this application that they are
dependent on the main applicant (e.g. an S1 form).
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Important information
A valid UK GHIC provides card holders with the right to access state-provided healthcare on temporary
stays in the European Union. Treatment should be provided on the same basis as it would be to a
resident of that country and is provided in many cases either at reduced cost or, for free. The EHIC
covers treatment that is medically necessary until the card holder returns home. This includes treatment
for pre-existing medical conditions.
If you’re covered by the EU Withdrawal Agreement, you may be able to apply for a new UK-issued
European Health Insurance card (EHIC). Visit www.nhs.uk/ehic to check if you can apply. You do not
need to apply for both an EHIC and a UK GHIC.
The UK GHIC is not an alternative to travel insurance. It is important to have both a UK GHIC and a
valid travel insurance policy in place before you travel.
You can apply for a GHIC if your healthcare is paid for by the UK. The UK operates a residency-based
healthcare system which means that insurability in the UK is generally determined by residency and not
by the past or present payment of National Insurance contributions or UK taxes.
If you are not a UK or Irish national, you need to send evidence that you are ordinarily resident in the
UK with your application. Proof could be a copy of your visa or UK residence permit.
If you are ordinarily resident and work in the UK, or if you are ordinarily resident in the UK and do not
work, then it is likely that you will be considered to be insured by the UK under EU law and will be
entitled to apply for a UK GHIC.
There are special rules for pensioners who live abroad, pensioners living in the UK who get a pension
from an EEA country or Switzerland, students studying abroad, workers posted abroad by their
employer, those who live in one country but work in another and those who live and/or work in more
than one country. If you fall into any of these categories or you are unsure about your eligibility for a UK
EHIC, please contact the enquiry line on 0300 330 1350 or +44 191 279 0575 if calling from abroad.
If you are not eligible for a UK GHIC you may be eligible for an EHIC issued by a country of the
European Economic Area or Switzerland if you are insured there.
If your circumstances change you may lose your entitlement to a UK GHIC. If you use your UK GHIC
when you are no longer entitled to it, you may be liable for the full cost of treatment received.
Circumstances that might lead to you losing your entitlement to a UK GHIC include moving abroad,
taking up work abroad or changing your residency status.
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Overseas Healthcare Services UK Global Health Insurance Card (UK National Health Service)

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Completed 22 March 2022

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