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Memorandum of understanding between the Government of the United Kingdom of Great Britain and Northern Ireland and the Isle of Man Government represented for these purposes by the Department of Health and Social Care, dated 6 July 2023

The governments of the United Kingdom of Great Britain and Northern Ireland and the Isle of Man:

• acknowledging the participants鈥� previous healthcare agreement dated 9 September 2010, setting out arrangements for the provision of necessary healthcare treatment to residents of each participant whilst visiting the territory of the other participant, which is terminated by this arrangement
• desiring a new arrangement for the provision of necessary healthcare to eligible persons during their stay in the territory of the other participant
• also desiring that the new arrangement provide for pre-authorised treatment by a healthcare provider in the United Kingdom to eligible persons who have been referred by the Isle of Man

have jointly decided:

1. Interpretation

For the purposes of this memorandum of understanding the following definitions apply:

• 鈥榓rrangement鈥� means this memorandum of understanding
• 鈥榓ssisted conception services鈥� means any medical, surgical or obstetric services provided for the purpose of assisting a person to carry a child
• 鈥榚ligible person鈥� means:
  • a person who is ordinarily resident in the Isle of Man for healthcare purposes
  • a person in respect of whom the United Kingdom has issued a valid eligibility document
• 鈥榚ligibility document鈥� means one or more documents, issued by or on behalf of one participant which indicates a person鈥檚 eligibility for healthcare in the other participant鈥檚 territory as set out in Annex A. Each participant at its discretion may accept additional documents that are not listed in the annexes as an alternative such indicator
• 鈥榞uidance鈥� means the guidance issued from time to time by each participant to assist in the implementation and understanding of this arrangement
• 鈥榟ealthcare鈥� means healthcare provided under the healthcare legislation of the United Kingdom or the Isle of Man, as the case may be. Assisted conception services are not covered by this arrangement
• 鈥榩articipant鈥� means the United Kingdom of Great Britain and Northern Ireland (鈥榯he United Kingdom鈥�) and the Isle of Man (represented for this purpose by the Department of Health and Social Care of the Isle of Man Government), together, 鈥榯he participants鈥�
• 鈥榮tay鈥� means a period not exceeding and not expected to exceed 6 months. For students it means the duration of a student鈥檚 course of study if this is longer than 6 months

2. Pre-authorised treatment arrangements

a) Manx Care (a statutory board of the Isle of Man Government responsible for operational provision of health care) may refer eligible persons to a healthcare provider in the United Kingdom for treatment to be funded by the Isle of Man (鈥榩re-authorised treatment鈥�).

b) The United Kingdom will facilitate the provision of pre-authorised treatment in the United Kingdom for eligible persons referred by Manx Care in accordance with this paragraph.

c) The Isle of Man will determine their application process for making referrals and will only refer an eligible person to a healthcare provider in the United Kingdom where the treatment cannot be provided or is not appropriate to be provided in the Isle of Man.

d) The healthcare provider may decline to accept a referral from Manx Care.

e) A person accepted for pre-authorised treatment in the United Kingdom will have the same access to that treatment, based on clinical priority and subject to any waiting lists for the treatment, as those persons ordinarily resident in the United Kingdom.

3. Reimbursement for pre-authorised treatment

a) The Isle of Man will reimburse the cost of healthcare provided under paragraph 2 (pre-authorised treatment) to the healthcare provider.

b) The costs payable under this paragraph in respect of healthcare provided will not exceed the amount the healthcare provider would assess as the costs of that healthcare if it had been provided to a person who is ordinarily resident in the United Kingdom.

c) The reimbursement of costs will be determined and made in accordance with the principles set out in Annex C.

4. Necessary healthcare arrangements

a) Each participant will afford necessary healthcare to an eligible person during their stay in the participant鈥檚 territory on the same terms as would apply to a resident of that participant.

b) Healthcare will be afforded under this paragraph where:

i) the healthcare is medically necessary in the opinion of the healthcare provider having taking into account the nature of the healthcare and the expected length of stay

ii) the person did not travel to the participant鈥檚 territory for the purpose of receiving that healthcare unless the person is a passenger or member of the crew on a vessel or aircraft travelling to that participant鈥檚 territory and the healthcare became necessary on medical grounds during the voyage or flight

iii) in a case where the healthcare is listed in Annex B, the person obtained agreement in advance from the healthcare provider providing the healthcare (the institution may decline the advanced request for such healthcare for example where it does not have the capacity to provide that healthcare)

iv) a valid eligibility document is produced in respect of the person

c) For the avoidance of doubt, necessary healthcare may include routine healthcare that the healthcare provider providing the healthcare deems medically necessary, having regard to the nature of the healthcare and the expected length of the stay, in order to manage a long-term condition or pregnancy

d) no charge will be made by one participant to the other for healthcare provided under this paragraph.

5. Protection of personal data

a) Any personal data received under this arrangement will be protected as such in accordance with the receiving participant鈥檚 domestic law.

b) Any personal data received under this arrangement will be used solely for the purposes of this arrangement and in accordance with the domestic law of the receiving participant.

c) Where transfer of personal data is required pursuant to this arrangement, such transfer will take place in accordance with the transferring participant鈥檚 rules on cross-border transfers of personal data.

6. Commencement of arrangements and termination of existing agreement

a) This arrangement will come into operation on 19 July 2023 and will continue until terminated pursuant to paragraph 7 of this arrangement.

b) Upon the commencement of this arrangement the existing healthcare agreement between the government of the United Kingdom and the Department of Health for the Isle of Man dated 9 September 2010 will be immediately terminated in accordance with article 7.1 of that agreement.

7. Termination

Either participant may terminate this arrangement by giving not less than 12 months鈥� notice in writing to the other participant.

8. Amendment

At any time during the operation of this arrangement the participants may jointly decide to amend this arrangement. Any amendment will be set out in writing and signed by both participants.

9. Transitional arrangements

When these arrangements cease to have effect, the participants will continue to apply these arrangements for a period of not less than 6 months in respect of any persons in the course of treatment or whose healthcare has been authorised under paragraph 2.

10. Review

The participants will carry out a review of this arrangement (including the operations under it) at least every 5 years to review the operation of this arrangement.

11. Governance

a) The participants will maintain such administrative arrangements as are necessary to give effect to the commitments resulting from this arrangement.

b) Officials from the participants will continue to co-operate with and provide assistance to each other as necessary.

c) Any questions or disagreements as to the operation of the arrangement will be resolved by discussion between the participants.

Annex A

Eligibility documentation

Part 1: documents which evidence the eligibility of a UK eligible person:

• Global Health Insurance Card (GHIC)
• UK issued European Health Insurance Card
• other evidence that a person is ordinarily resident in the UK, examples of which are set out in guidance

Part 2: documents which evidence the eligibility of an Isle of Man resident:

• evidence that a person is ordinarily resident in the Isle of Man, examples of which are set out in guidance

In each case above the document presented must be current and in date. Where the document does not incorporate a photo, additional photo ID may be requested by the healthcare provider.

Annex B

Healthcare for which advance agreement must be obtained:

• kidney dialysis
• oxygen therapy
• special asthma treatment
• echocardiography in the case of autoimmune diseases
• chemotherapy

Annex C

Reimbursement principles for pre-authorised treatment:

• reimbursement will be on the basis of the actual cost of the treatment given
• the Isle of Man will reimburse the healthcare provider within 30 days (or such other period as is specifically agreed with a particular healthcare provider) of receiving their correct and valid invoice together with any necessary supporting information