This guide is maintained as a current resource for July 2026 and covers only the laws of England and Wales. Information is for general guidance, not legal advice. Consult a qualified solicitor for advice specific to your situation.
Comprehensive guide to Immigration Health Surcharge exemptions for workers in the UK, explaining who does not have to pay the surcharge, how health and care worker exemptions and reimbursements work, eligibility criteria, application practices and practical considerations for visa applicants.
The Immigration Health Surcharge (IHS) is a mandatory charge many non‑British nationals must pay as part of certain UK visa and immigration applications. It grants access to the National Health Service (NHS) on broadly the same basis as permanent UK residents for the duration of the visa holder's permission. However, not all applicants are required to pay the surcharge. Specific exemptions exist for certain workers and categories of applicants, which can significantly reduce the upfront cost of immigration applications and provide enhanced access to public healthcare without surcharge liability. This article explains the IHS, the legal basis for payment, detailed exemptions for workers, how exemptions operate in practice, and common questions and considerations.
Understanding the Immigration Health Surcharge
The IHS was introduced under Section 38 of the Immigration Act 2014 and associated regulations. Applicants for most visas of more than six months and in‑country extensions of such visas must pay the surcharge as part of the online application process. Payment is generally required before permission is granted. Those liable for the IHS become entitled to receive NHS treatment without direct charge, except for standard resident charges such as prescriptions in England.
General IHS Rules for Workers
Most workers applying for visas such as the Skilled Worker visa, Innovator Founder visa, Global Talent visa, Student visa, or various family routes must pay the IHS if their leave to remain or entry clearance is for longer than six months. Short‑term visas (under six months) and visitor visas do not attract the IHS but do not on their own confer free NHS access beyond immediate emergency or listed exempt services.
Key Exemptions from IHS for Workers
1. Health and Care Worker Visa Exemption
One of the most significant worker‑related exemptions applies to migrants on the Health and Care Worker visa (a sub‑route of the Skilled Worker category). Individuals granted this visa, and their dependants, are exempt from paying the IHS at the point of visa application. This reflects a policy decision to encourage international health and social care staff to work in the UK and relieve the surcharge burden for these roles. To benefit from the exemption, the applicant must:
- Be applying specifically under the Health and Care Worker visa policy within the Skilled Worker route.
- Have a Certificate of Sponsorship (CoS) confirming employment in an eligible health or social care role with the appropriate Standard Occupational Classification (SOC) code.
This exemption covers a wide range of health and care roles, including doctors, nurses, allied health professionals and social care staff, updated to include expanding eligible roles.
Practical context: Even when exempt, most applicants must still obtain an IHS reference number during the application process, but the required cost is zero.
2. Reimbursement for Health and Social Care Workers
If a worker is not on the Health and Care Worker visa but is employed in the health or social care sector, they may be eligible to claim reimbursement of the IHS paid, provided they meet criteria:
- They have worked continuously for at least six months in health or social care (at least 16 hours per week).
- They paid the IHS as part of an existing visa application.
- The application for reimbursement is made in six‑month blocks.
- Their dependants may also be eligible for reimbursement if covered by the same visa period.
This reimbursement scheme allows workers in eligible employment to recover surcharge costs for time worked, reflecting national policy recognising the contribution of international health and social care workers.
Example: A care worker on a five‑year Skilled Worker visa who paid the IHS can claim reimbursement for continuous periods of qualifying care work.
3. Broader Exemption Categories
In addition to health and care exemptions, other statutory exemptions in the Immigration Rules and healthcare charging regulations include:
- Indefinite Leave to Enter or Remain (ILR) applicants - no surcharge payable.
- Asylum seekers, refugees and humanitarian protection applicants, including victims of modern slavery.
- Stateless persons applying for leave under Appendix Statelessness.
- Ukrainian Schemes applicants (Ukraine Extension or Homes for Ukraine Sponsorship Scheme).
- Applicants under the EU Settlement Scheme and certain protected EEA/Swiss nationals subject to historical treaty rights.
- Diplomats and members of visiting armed forces not subject to immigration control, and their dependants.
- Dependants of serving members of HM Forces.
Other specific exemptions apply under international agreements and charging regulations, and these persons may access relevant NHS services without surcharge charge beyond what permanent residents pay (in line with NHS charging guidance).
Note: Exemption from IHS does not automatically grant free NHS treatment for categories outside the health‑care or permanent permission routes outside the scope of public health fee waivers, but it removes the surcharge requirement.
How Exemptions Operate in Practice
Application and Reference Numbers
Even if exempt, most applicants must complete the IHS section of their application and obtain an IHS reference number before submission can be accepted. The online application system will recognise eligible exemptions and set the payable amount to zero where appropriate.
Timing and Changes in Circumstances
Exemptions apply to the relevant immigration application being made. If a person's visa category changes (for example, from Skilled Worker to Health and Care Worker), the exemption status may change and the IHS obligation may be adjusted in a fresh application or, where applicable, reimbursement can be sought for previous payments.
Reimbursement Claims and Requirements
For those eligible for reimbursement (outside the Health and Care Worker visa), applications must be made periodically and supported with evidence of qualifying employment. The NHS Business Services Authority processes these claims. Reimbursements can be received for the main applicant and dependants on the same visa who meet the criteria.
Potential Risks and Practical Considerations
Misclassification of Visa Category
Incorrectly claiming an exemption due to misunderstanding visa categories can lead to refusal of the visa application or a requirement to pay the outstanding IHS amount before leave is granted. Employers and applicants must ensure that the right visa category (e.g., Health and Care Worker visa versus general Skilled Worker) is selected and that a valid CoS confirms eligibility.
Reimbursement Eligibility Conditions
Eligibility for reimbursement requires continuous employment in health or social care and meeting minimum hours and duration conditions. Periods of unemployment or unpaid leave beyond specified limits can disqualify reimbursement eligibility. Applicants should track working patterns and maintain records to support claims.
Changing Immigration Rules
The IHS regime and exemption categories are subject to legislative change. Recent updates have expanded health and care exemptions and may adjust regulated categories in future years. Staying updated with official guidance ensures correct application of exemptions.
Common Questions
Does working in the NHS automatically exempt me from IHS?
Not always. Only those applying for a Health and Care Worker visa (and dependants) are automatically exempt. Other health and care workers may need to claim reimbursement based on qualifying employment and visa conditions.
Can dependants of exempt workers also be exempt?
Yes. Dependants of those exempt under the Health and Care Worker visa are also exempt from paying the surcharge as part of the same application.
What if my application is refused after paying IHS?
If a visa application is refused, the IHS payment is generally refunded in full. This is part of the Home Office's standard refund policy.
Do exemptions apply to short‑term work visas?
Short‑term visas (under six months) do not attract the surcharge but do not themselves guarantee free NHS access beyond emergency or exempt services. Exemptions do not automatically expand short‑term visa entitlements.
Key Takeaways
The Immigration Health Surcharge is a standard cost for most long‑term visa applications, including work visas, but a range of exemptions exists that relieve many workers from paying it. The most prominent work‑related exemption applies to those on the Health and Care Worker visa and their dependants, reflecting policy recognition of contributions to the NHS and social care sector. Other exemptions apply to permanent settlement applicants (such as those seeking indefinite leave to remain), protection and humanitarian categories, certain treaty and historical rights categories, and specific diplomatic and armed forces cohorts. Additional reimbursement arrangements allow eligible health and social care workers not on the designated visa to recover surcharge costs after qualifying periods of work. Understanding these exemptions and their conditions enables applicants and employers to correctly plan immigration applications and avoid unnecessary costs or application refusals.
