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 explanation of the UK Immigration Health Surcharge (IHS), including who must pay, how much it costs, entitlement to NHS care, payment procedures, exemptions and refund rules for visa applicants.
The Immigration Health Surcharge (IHS) is a mandatory charge applied to most visa and immigration applications in the United Kingdom. Its purpose is to ensure that temporary migrants contribute financially to the cost of the National Health Service (NHS) before being granted permission to live, work, study or join family in the UK. Understanding the IHS is essential for anyone navigating UK immigration – from students and workers to families and dependants.
This article explains what the Immigration Health Surcharge is, who must pay it, how it is calculated, when it must be paid, how healthcare access works under the surcharge, exemptions and refunds. It draws on official guidance and current policy to provide clear, practical information for applicants, advisers, solicitors and the general public.
What Is the Immigration Health Surcharge?
The Immigration Health Surcharge is a fee collected by UK Visas and Immigration (UKVI) as part of most visa applications. Paying the IHS entitles migrants to access NHS services in the UK on broadly the same basis as a permanent resident for the duration of their immigration permission. This means that hospital treatment and many aspects of NHS care are available without additional NHS charges, although some services such as prescriptions, dental care and eye tests still require payment at the point of use.
The legal authority for the surcharge is found in Section 38 of the Immigration Act 2014 and the Immigration (Health Charge) Order 2015 (as amended), which set out who must pay, the amounts payable and related procedural requirements.
Who Must Pay the IHS?
Standard Liability
Most migrants applying for visas or permission to stay in the UK for more than six months must pay the Immigration Health Surcharge as part of their application. This includes people applying from outside the UK and from within the UK for extensions or switches of visa category.
Categories That Do Not Pay
Certain applications and individuals are exempt from the surcharge, including:
- Applicants for visitor visas and other short‑term visas (six months or less) from outside the UK.
- Applications for indefinite leave to enter or remain (settlement).
- Health and Care Worker visa applicants and their dependants (under the specific visa category exemption).
- Applicants under the EU Settlement Scheme or certain humanitarian routes.
- Diplomats and members of visiting armed forces not subject to immigration control.
If an exemption applies, the applicant does not need to pay the IHS but may be charged for NHS services at the point of use.
How Much Is the Surcharge?
The amount payable is calculated based on the length of the visa or immigration permission for which the applicant is applying:
- Applicants on most work, family and long‑term routes pay at the standard rate.
- A reduced rate applies to students, Youth Mobility Scheme applicants, and dependants under 18.
Rates and how they are applied:
- The IHS is charged for the entire period of immigration permission, including any part‑years that exceed six months.
- For example, if an applicant is granted three years' permission, the full IHS for three years is payable at the standard or reduced annual rate.
Exact rates are set by secondary legislation and are subject to change; applicants should check the current rates before applying.
When and How Do You Pay?
The Immigration Health Surcharge must be paid at the time of submitting your online visa or immigration application. UKVI routes applicants to a payment portal where the amount is calculated based on the dates of travel, length of stay, and visa category. After payment, a unique IHS reference number is issued which must be included on the visa application form.
Payment is typically made by debit or credit card. UKVI will not process the visa application further until the surcharge has been paid where it is due.
What Access to Healthcare Does the IHS Provide?
Once the surcharge is paid and a visa is granted, the applicant and any dependants included in the application are entitled to use NHS services in the UK without further charge for treatment ordinarily covered by the NHS. This includes most hospital care and consultations.
However, it is important to note:
- Some services - including prescriptions, dental treatment and eye tests - are not covered by the surcharge.
- Paying the surcharge does not guarantee faster access to treatment; care is provided on the same basis as for permanent residents.
Refunds and Financial Implications
When a Refund Applies
A full or partial refund of the IHS may be available in specific circumstances:
- If you have paid twice for the same period of immigration permission.
- If your visa application is refused.
- If you withdraw your visa application before a decision is made.
Partial Refunds
Partial refunds may be available if:
- The visa is granted for a shorter period than the period covered by the IHS paid on application.
- Dependants on an application are refused, meaning their surcharge portion can be refunded.
Refunds are usually processed automatically by UKVI and the NHS Business Services Authority (NHSBSA) to the account or card originally used for payment.
When Refunds Do Not Apply
No refund is normally given if:
- The visa application is successful but the applicant does not travel to the UK.
- The applicant leaves the UK before the visa expires.
- The visa is curtailed or otherwise ended early without refusal or withdrawal.
- The applicant dies before travelling (policy is that no refund is issued).
Special refund schemes also exist, for example for students from the EU, Switzerland, Norway, Iceland and Liechtenstein who hold an EHIC (European Health Insurance Card) and meet specific criteria.
Practical Considerations
Visa Planning and Costs
Because the IHS is paid in full at the time of application, it can substantially increase the upfront cost of immigration. For long‑stay visas such as work or family routes, the total surcharge for multi‑year permission may exceed several thousand pounds.
Applicants should budget for the IHS alongside visa fees and any legal or advisory costs. Clear planning helps avoid unexpected financial barriers.
Legal and Immigration History
Payment of the IHS and subsequent healthcare use does not confer any rights beyond those attached to the visa itself. It does not affect legal avenues such as appeals, administrative reviews or claims in immigration tribunals.
Key Takeaways
The Immigration Health Surcharge is a compulsory payment that enables migrants to access NHS services during their period of immigration permission in the UK. Most long‑term visa applicants must pay it when submitting their application. The charge provides broad entitlement to NHS care similar to that for permanent residents, though some services remain chargeable at the point of use.
Exemptions exist for certain categories, including short‑term visitors and specific visa classes. Refunds may be available in defined circumstances, such as refusal or withdrawal of an application. Understanding the IHS, its amounts, payment requirements, rights and refund conditions is essential for anyone planning immigration to the UK.
