International health insurance for British digital nomads

Free NHS care is based on residence, not citizenship or National Insurance contributions. Entitlement rests on being ordinarily resident in the UK, which the guidance defines as living here lawfully, voluntarily and on a properly settled basis as part of the regular order of your life. Being British does not by itself entitle you to free non-emergency NHS treatment if you no longer live here.

Moving abroad to live ends that status. Once you are no longer ordinarily resident you become an overseas visitor in NHS terms, and hospital treatment beyond A&E and a short list of always-free services becomes chargeable. Those charges are set at 150% of the national NHS tariff. There is no fixed day count that triggers this; what matters is where your settled life actually is. A&E, treatment of certain infectious diseases and family planning stay free to everyone, but planned hospital care does not.

The GHIC, and the older EHIC, is not a bridge for people who have emigrated. The UK GHIC is only issued to people ordinarily and legally resident in the UK, and it only covers necessary state healthcare during a temporary stay in the EEA, meaning care that cannot reasonably wait until you return, provided on the same terms as a local resident. Once you have moved abroad you are no longer ordinarily resident, so the card is not valid for you. Even for a genuine tourist the NHS is explicit that it is not a substitute for travel insurance: it does not cover repatriation or private treatment.

While you are away, entitlement to free non-emergency NHS care simply lapses for the duration. There is nothing banked to draw on, and your GP can remove you from their patient list once you are no longer resident in the area.

The return is the straightforward part, and this is where the UK differs sharply from Canada. There is no waiting period. A returning UK national is treated as ordinarily resident from the day they move back intending to settle, so free NHS entitlement resumes immediately. In practice you re-register with a GP, and the first time you seek non-emergency treatment you may be asked, once, for a couple of documents showing you live here again, a tenancy agreement, a utility bill, a UK bank statement or evidence of work. No qualifying period applies.

There is one route that keeps the UK paying for your care after you move, but it is not for working-age nomads. If you receive the UK State Pension and move to an EU or EEA country or Switzerland, you and your dependants can apply for an S1 certificate. It makes the UK fund your healthcare in your new country on the same terms as a local resident, and it also restores free NHS access when you visit England. But it is limited to pensioners and a small number of other groups, such as certain posted or frontier workers. A self-employed thirty-something working remotely does not qualify, and the S1 is simply not available.

The UK does keep some reciprocal healthcare agreements, but it is worth reading what they actually are. The GHIC covers the EEA and Switzerland, and separate bilateral agreements exist with a handful of places such as Australia, New Zealand and Montenegro. Every one of them covers only immediate or medically necessary treatment during a temporary visit, on the same basis as a local, and several exclude anyone who travelled specifically to get treatment or who has settled in the country. None is designed for someone who has moved, none covers the routine, ongoing and preventive care a resident actually needs, and none covers repatriation or private treatment.

Your NHS prescriptions do not travel either. The NHS only accepts responsibility for supplying your regular medication for temporary absences of up to three months, and an English NHS prescription cannot be dispensed at a pharmacy in another country. If you are going to be away longer, the NHS expects you to arrange an alternative local supply once you arrive, which in practice means finding a local doctor and often paying for both the consultation and the drugs.

The trickiest part is the grey zone around ordinary residence. It is a factual test about where the settled centre of your life is, and it is decided separately from HMRC's rules on tax residence. The Statutory Residence Test that HMRC uses is a day-counting exercise for tax and does not directly determine NHS entitlement, so you cannot assume that being non-resident for tax, or the reverse, settles your NHS status. Keeping a UK house and a UK bank account and returning from time to time does not by itself preserve ordinary residence if your real life is now abroad, and an NHS trust can decide you are chargeable. It is a judgement made when you present for treatment, not a status you can point to on a card.