NHS in the UK - need info pretty quickly!

Yes, we have had confirmation that it's different in Scotland for short-term visitor students than in the rest of the UK. Tier 4 has to pay the (incredibly cheap) fee for a year's worth of healthcare - quite a bargain there - and applies across all the countries in the UK (as far as I can tell).

That's good to know about Scotland, and yes, the IHS surcharge applies to the whole of the UK.

It may seem cheap compared to US healthcare, but considering that 8 months ago, NHS healthcare was completely free to Tier 4 students, with no surcharge at all, it's quite a lot now!

It's more of an issue for people who come to the UK and work while they are here... because they will already be paying for the NHS through their income taxes, just like UK citizens, but then they also have to pay an extra £200 per year extra on top of that because they have a visa.

To satisfy the UC’s health insurance requirement for enrolled students, the plan held by the student must be:
1)  A Medi-Cal [my note - this is the California program for the medically indigent and the coverage provided is the absolute minimum of care - people die on this plan for lack of care], Medicare or Tricare/military insurance policy or a Covered California plan,
OR
2) An employer-sponsored group health plan or individual plan that meets the following criteria:
a) Has unlimited lifetime benefits
b) Has an annual out-of-pocket maximum of up to $6,600 for an individual but no more than $13,200 for a family. Deductibles, copayments and coinsurance paid by the member accrue toward meeting the out-Of-pocket maximum. A higher out-of-pocket maximum is allowed if the subscriber has a Health Savings Account (HSA) or a Health Reimbursement Account (HRA).
c) Covers the following services (ACA Essential Health Benefits):
(i) Preventive health care services, including an annual physical exam, preventative immunizations and laboratory/diagnostic tests to help determine your state of health
(ii)Chronic disease management for such conditions as asthma, diabetes or other chronic medical conditions
(iii)Hospital stays for medical and surgical care
(iv)Hospital stays for mental health and alcohol/drug abuse conditions, covered the same as any other medical condition
(v) Doctor office visits for medical, mental health, and alcohol/drug abuse conditions
(vi) Emergency room services
(vii) Diagnostic services including laboratory tests
(viii) Medications prescribed by a doctor (including contraceptives)
(ix) Pre-natal and maternity care, with no pre-existing condition limitation

 

Okay, I've had a search around and it's difficult because there's not really any one place that lists everything, because there's no need to list it - it all comes under GP/hospital services.

Since it's a completely different type of system, everyone is entitled to everything and there's no concept of things like pre-existing conditions, co-pays or deductibles on the NHS, it's hard to find something that satisfies their criteria.

However, I just found this - a document about patients' rights and responsibilities in Scotland - and I'm wondering if it might be suitable:
http://www.nhsinform.co.uk/rights/publications/patientscharter/~/media/hrisdocuments/charter/the%20charter%20of%20patients%20rights.ashx

Essentially, the statement that covers everything that the US university wants to know is:
"NHS services are provided free of charge. This includes NHS services provided by GP practices, local pharmacies, hospitals or clinics and emergency services. There is also a right to free NHS eye examinations and free NHS dental examinations"

Because that's all there is to it. As long as you are entitled to NHS care, it's free and it's covered.

In terms of what's on their list:
a) NHS covers you from birth to death, providing you remain eligible based on your visa type
b) Your annual out-of-pocket maximum in Scotland is likely to be $0 (unless you need dental treatment, in which case you might have to pay a subsidized fee, and eye exams/glasses may not be free)
c)
i) there are no standard annual check ups because the NHS just doesn't do them  as routine (though I suppose you could try to ask for one), but preventative immunizations and tests are all covered
ii) All treatment for chronic illnesses is covered and prescriptions in Scotland are free anyway
iii) All hospital stays for any reason are free
iv) All hospital stays for any reason are free
v) All doctor visits for any reason are free
(vi) All Emergency room services are free to everyone
(vii) Lab tests are free
(viii) All prescription are free to everyone in Scotland (and contraceptives are free to all across the UK, even visitors)
(ix) All pre-natal and maternity care is free, and there's no such thing as a pre-existing condition, since everyone is covered for everything at all times

The only things that aren't covered on the NHS are things like elective cosmetic surgeries and new treatments that are expensive/haven't been tested extensively yet (things like brand new cancer drugs)... but the chances of needing something that isn't covered on the NHS is pretty small.

Thank you. Yes, that's my problem. They are asking us to produce a summary document, and not something I cut and paste together. We are still waiting to hear from the University there - hopefully something from them on letterhead will suffice.

fyi:

http://staging.nhsinform.com/~/media/hrisdocuments/leaflets/10359peoplecomingtoscotlandtostudyv5.ashx

and

http://www.gov.scot/Topics/Health/Services/Overseas-visitors

Isn't it really just an extra charge?  One would expect the University of California, as a major healthcare provider and also a provider of education abroad courses in the UK, to have a bit more of a clue about how the NHS works.  They surely must know that the questions they're asking you just don't fit the model.  Even the IRS accepts the NHS as adequate coverage under the ACA requirements.

Call me cynical but if it was me I'd be thinking I might just have to factor this extra cost into my budget.

Isn't it really just an extra charge?  One would expect the University of California, as a major healthcare provider and also a provider of education abroad courses in the UK, to have a bit more of a clue about how the NHS works.  They surely must know that the questions they're asking you just don't fit the model.  Even the IRS accepts the NHS as adequate coverage under the ACA requirements.

Call me cynical but if it was me I'd be thinking I might just have to factor this extra cost into my budget.

Not giving them that money without a fight, no.  

It's systemic idiocy. It took me six phone calls, several emails, and basically emailing the top of a division just to reach someone who could tell us the "logic" behind this. (And this is after my daughter spent the better part of a day during final exam week trying to do the same thing, with no luck!) And, basically, the answer I got  it comes down to "oh, we didn't think of that."

fyi:

http://staging.nhsinform.com/~/media/hrisdocuments/leaflets/10359peoplecomingtoscotlandtostudyv5.ashx

and

http://www.gov.scot/Topics/Health/Services/Overseas-visitors

Thank you. These are the best yet, so I'll send them along.

Not giving them that money without a fight, no.  

It's systemic idiocy.

No advice here, just an enthusiastic, 'YES!' from me - with heaping helpings of hope that it all gets sorted out for your daughter.   

There are many intelligent, thinking people who work within bureaucratic systems, but sometimes you wonder if the person spouting rules is actually using their brain at all.   

Correcting myself - I said

Even the IRS accepts the NHS as adequate coverage under the ACA requirements.

Maybe yes, maybe no.  The IRS includes "Certain foreign coverage" in its summary of what constitutes minimum essential coverage" (https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Minimum-Essential-Coverage). I was assuming this included the NHS, because US citizens who are resident in the UK and covered by the NHS are treated by the IRS as having qualifying coverage; but it seems this is an exemption from the requirement for US citizens who are non-US-resident for at least 330 days of the tax year - which it sounds like might not be the case for your daughter.

If the individual shared responsibility applies for your daughter, then I may have been doing the U of Calif an injustice in suspecting them of just trying to sell their healthcare product.  Their blurb about their Travel Insurance says:

The UCEAP travel insurance policy does not constitute minimum essential coverage under the new U.S. health law, the Affordable Care Act (ACA) and does not satisfy a person’s individual obligation to secure the requirement of minimum essential coverage under the law.

(http://eap.ucop.edu/ForParents/Pages/insurance.aspx).

The University may have a double interest here - wanting to sell its product but also perhaps having a legal obligation to try to ensure that their "education abroad" students have this required coverage before leaving the country under the University's auspices.

So if the NHS is included under "Certain Foreign Coverage", and you can prove that to the University, that might persuade them to accept it.  Maybe you could ring the IRS to find out?

If the NHS is not included under "Certain Foreign Coverage", then she might have to have a qualifying plan for her time abroad, despite having NHS access.

So if the NHS is included under "Certain Foreign Coverage", and you can prove that to the University, that might persuade them to accept it.  Maybe you could ring the IRS to find out?

This is quality thinking here...

But an administrator's answer may be simply, "Well we don't use IRS guidelines as the basis for our requirements."

But it might work.

This is quality thinking here...

But an administrator's answer may be simply, "Well we don't use IRS guidelines as the basis for our requirements."

But it might work.

I suggested ringing the IRS simply as a way to find out whether the NHS is accepted as Minimum Essential Coverage.  If they say that it is, they should be able to point to where that is officially stated.  That's the proof the OP needs to cite to the University.

But I agree, the Uni might still require purchase of their healthcare, even if the NHS is treated as MEC.

If they say that it is, they should be able to point to where that is officially stated.  That's the proof the OP needs to cite to the University.

I understand....it's good.....it's showing official recognition from an official Federal source....

I was still muddling along trying to find a comprehensive list of coverage....

It may seem cheap compared to US healthcare, but considering that 8 months ago, NHS healthcare was completely free to Tier 4 students, with no surcharge at all, it's quite a lot now!

It is still free to the citizens from countries who always give Brits free healthcare in their countires too. Only Australia and New Zealand did this, which is why their citizens can still have free use of the NHS when they live in the UK and are exempt from paying the Immigration Health Surcharge. Their citizens have always had full cover for emegencies when they visit as they don't get billed for an emergency operation or for a stay on a ward as other visitors do.

It's the same with agreements between countries for youth working visas and exchange of driving licences; each country decides what they want for their citizens in certain other counries and offers the same for citizens of those countries in a reciprocal agreement.

It is still free to the citizens from countries who always give Brits free healthcare in their countires too. Only Australia and New Zealand did this, which is why their citizens can still have free use of the NHS when they live in the UK and are exempt from paying the Immigration Health Surcharge. Their citizens have always had full cover for emegencies when they visit as they don't get billed for an emergency operation or for a stay on a ward as other visitors do.

It's the same with agreements between countries for youth working visas and exchange of driving licences; each country decides what they want for their citizens in certain other counries and offers the same for citizens of those countries in a reciprocal agreement.

As much as I hate to admit it, this is the real truth. The problem is the American health care system. If a Brit is visiting the US and falls ill......they stick it to them.

I understand....it's good.....it's showing official recognition from an official Federal source....

I was still muddling along trying to find a comprehensive list of coverage....

Alternatively, if it can't be shown that the NHS = MEC,  there's another possible line of argument.

If the OP's daughter is included in the OP's own health insurance, that would presumably meet her ACA obligation, and might thus persuade UCSD to stop trying to require her to buy their healthcare plan on top.   This seems to be the practice at another U of Calif site:

Health Insurance
Students who have only UCEAP Travel Insurance may not be in compliance with the Affordable Care Act (ACA) if students do not have equivalent coverage as that of our campus health insurance. Not having a policy that complies with the ACA Minimum Essential Coverage requirements could expose you or your family to IRS tax penalties.

As a result students scheduled to participate on UCEAP in Fall quarter 2015 and beyond will be automatically enrolled in UC SHIP to ensure you meet the minimal essential coverage requirements of the ACA. If you are already enrolled in an ACA compliant health insurance program (such as through a family plan), you can waive out of the UC SHIP insurance.

http://ieo.ucsc.edu/programs-abroad/program-options/uceap/pre-departure.html#

If UCSC allows education abroad students to opt out of paying for university health insurance provided their ACA obligations are covered by a family plan, it's reasonable to ask UCSD why they can't do likewise. 

Apparently it's the same at UCSD:

Beginning with Fall, 2015, UCEAP participants also will be required to maintain major medical insurance here at UCSD while they are studying abroad. You can do this by enrolling in the UCSD Student Health Insurance Plan (SHIP) or by waiving SHIP insurance using private insurance that meets the SHIP waiver criteria.

While UCEAP Travel Insurance provides you with comprehensive travel and health insurance coverage while studying abroad, it is not considered a Minimum Essential Coverage (MEC) health plan per the Affordable Care Act (ACA) criteria. As a result, if you were covered solely by this policy while you are abroad, you could face IRS penalties for not being in compliance with the ACA. This is the main reason for the recent policy change.

All students automatically are enrolled in SHIP at the beginning of each academic term, but you have the option to waive SHIP coverage with proof of comparable private health insurance (UCEAP Travel Insurance does not satisfy SHIP waiver criteria).

https://studyabroad.ucsd.edu/participants/pre-departure/eap-pre-departure.html

So if it turns out that the NHS is not included in the "Certain foreign coverage" listed by the IRS, at least it should be possible to opt out of the university health plan as long as the ACA requirement is met.