Maternity cover in the UK: who gets free NHS care and who is charged

The UK does not run on insurance, it runs on residence

If you have moved to the UK from a country with health insurance, the mental model has to change. There is no maternity policy to buy, no waiting period to serve and no pre-authorisation to obtain. What determines whether your care is free is where you live and on what legal basis.

GOV.UK puts it directly: for secondary care services, the UK's healthcare system is residence-based. You must be living lawfully in the UK on a properly settled basis to be entitled to free healthcare. The test is called ordinary residence.

Primary care is free to everyone

Start with the good news, because it is broader than most people expect. GP and nurse consultations in primary care, treatment provided by a GP and other primary care services are free of charge to all, whether you register with a GP as an NHS patient or access services as a temporary patient. A temporary patient is someone in the area for more than 24 hours and less than 3 months.

GP practices are not required to ask for proof of identity, address or immigration status from patients wishing to register, and NHS guidance is explicit that a practice cannot refuse a patient because they do not have proof of address or immigration status. Anyone in England can register and consult with a GP without charge.

If a practice does turn you down, they must still provide any immediately necessary treatment you request, free of charge, for up to 14 days, and must tell you in writing within 14 days why they refused. Pregnancy and maternity is also a protected characteristic, so refusing to register you on that basis is unlawful discrimination.

Hospital care and the ordinary residence test

For hospital care the test bites. To be ordinarily resident in the UK, people from countries outside the European Economic Area who are subject to immigration control need to also have the immigration status of indefinite leave to remain. People who are not ordinarily resident may be required to pay for their care in England, although some services and some individuals are exempt.

The charging rules sit in the National Health Service (Charges to Overseas Visitors) Regulations 2015. Services that are free irrespective of where an overseas visitor normally lives include accident and emergency services, and the diagnosis and treatment of certain communicable diseases.

The immigration health surcharge

Citizens of the EU, Norway, Iceland, Liechtenstein and Switzerland who move to the UK from 1 January 2021 for more than 6 months pay the immigration health surcharge as part of any visa application. People covered by reciprocal healthcare agreements, holding an EHIC, or who have paid the surcharge may be exempt from payment for certain services.

The rule that matters most if you are pregnant

Here is the sentence to hold on to. GOV.UK's migrant health guide, writing about refused asylum seekers, states that any treatment clinicians consider is needed immediately or urgently will be provided even if payment is not made in advance, and that maternity care will always be provided, even when charges apply.

Read that carefully, because it does two things. It means no one should be turned away from maternity care in England for inability to pay up front. It also means a bill may still follow. Care first, invoice later, is not the same as free.

If you think you may be chargeable, get advice before your booking appointment rather than after the birth. GOV.UK itself points people at Maternity Action for information on maternity rights and benefits for migrants, asylum seekers and refugees.

What about private health insurance?

Private cover in the UK sits alongside the NHS rather than replacing it, and it is bought for choice and speed rather than for maternity, which UK policies commonly restrict. Because policy terms are set by individual insurers and are not published in any government schedule, we are not going to make a general claim about what your policy covers. Read your policy wording and ask the insurer, in writing, what maternity benefits it provides and what waiting periods apply.

The four nations

Health is devolved. The charging regulations described here apply in England, and Scotland, Wales and Northern Ireland run their own arrangements, which is why GOV.UK links separately to NHS Inform factsheets on accessing NHS services in Scotland. If you are outside England, check your own nation's guidance rather than assuming the English rules apply.

What to do next

Register with a GP first, because that costs nothing and cannot be refused for want of documents. Refer yourself to maternity services early. If your immigration status is unsettled, get specialist advice on chargeability early in the pregnancy, when there is still time to establish an exemption, rather than after your baby is born.

Registering with a GP in practice

You will be asked to complete a GMS1 form as part of applying to register. People who are not ordinarily resident are asked supplementary questions, which ask for details of a valid non-UK EHIC or S1 form, and whether they consider themselves exempt from charge for NHS secondary care services if those are needed.

Answering those questions does not create a charge for GP care, which is free to everyone. It is information-gathering for any later hospital treatment.

The services that are always free

Regardless of where an overseas visitor normally lives, and provided they have not travelled to the UK for the purpose of seeking that treatment, certain services carry no charge. Accident and emergency services, including at an A&E department, walk-in centre, minor injuries unit or urgent care centre, are free, though services provided after admission as an inpatient are chargeable unless the person is exempt. The diagnosis and treatment of certain communicable diseases is also free.

If you have difficulty registering with a GP practice, GOV.UK lists the bodies to contact, and NHS England has produced GP access cards to support registration.