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 the Immigration Health Surcharge (IHS) for UK family visa holders, explaining who must pay, current rates, exemptions, refund rules, access to NHS care, practical considerations and common issues under UK immigration law.
The Immigration Health Surcharge (IHS) is a mandatory fee that most migrants, including family visa holders and their dependants, must pay when applying for permission to stay in the United Kingdom for more than a specified period. It entitles the visa holder to access NHS healthcare services on generally the same basis as someone ordinarily resident in the UK. This article explains what the IHS is, who must pay it, how much it costs, exemptions and refunds, practical issues that families often encounter, and common questions about compliance and cost planning.
What Is the Immigration Health Surcharge?
The IHS is a charge imposed by the UK government on many visa applications to contribute to the cost of healthcare through the National Health Service (NHS). It was introduced in 2015 under powers in the Immigration Act 2014 and helps fund healthcare for migrants during their stay.
When a family visa application is made - whether for a partner, spouse, or dependent child - the surcharge must normally be paid as part of the visa application process before a decision is made. Failure to pay the correct amount can cause the application to be rejected or delayed.
Who Must Pay the IHS?
Most individuals applying for a standard family visa or dependants joining a main visa holder must pay the IHS if their intended period of stay exceeds six months.
- Applicants applying from outside the UK: IHS is payable if the visa is for more than six months.
- Applicants applying from within the UK (extensions or switching): IHS is payable regardless of the length of the stay being applied for.
The surcharge applies to each applicant individually. Main visa holders and their family dependants must each pay a separate IHS charge at the time of application.
Current Rates and How It Is Calculated
The total IHS amount for a family visa application is calculated automatically during the online application process based on the length of leave being sought. The charge applies for the entire period of immigration permission granted, including part‑years that exceed six months.
According to updated guidance and fee schedules:
- The standard rate for most family visas is £1,035 per person per year of leave.
- A reduced rate of £776 per person per year may apply to certain categories, such as some students and children (though this is more common in student contexts).
When the leave period includes a portion of a year longer than six months, it is treated as a full year for the purposes of the surcharge calculation.
The IHS must be paid upfront at the time of application, along with the visa fee, otherwise the application will not be processed.
What the IHS Covers
Paying the IHS entitles the visa holder and their dependants to access NHS services in the UK. This includes most hospital treatments and general practitioner (GP) services available to those ordinarily resident in the UK. However, some services remain chargeable at point of use, such as:
- Prescriptions (in England)
- Dental treatment
- Optical (eye care) services
- Assisted conception services (fertility treatments)
Thus, while the surcharge covers core NHS care, additional charges may still apply when accessing certain services.
Exemptions from the IHS
Not everyone applying for a family visa must pay the IHS. Specific exemptions include applicants and dependants in the following circumstances:
- Those applying for indefinite leave to enter or remain (settlement).
- Health and Care Worker visa holders and their dependants.
- Applicants under the EU Settlement Scheme.
- Certain humanitarian cases such as victims of human trafficking or stateless persons.
- Members of specified international organisations and their dependants.
These exemptions are statutory, meaning they are based on law and apply automatically once the relevant status or category is established.
IHS Refunds: When and How They Apply
Under UKVI policy, applicants and dependants may be eligible for a full or partial IHS refund in certain situations:
Full refunds are generally available if:
- The surcharge was paid twice for the same application period (for example, in repeated applications where dates overlap).
- The visa application is refused by UKVI.
- The applicant withdraws their application before a decision is made.
Partial refunds may apply when:
- A visa is granted for a shorter period than originally requested.
- Some dependants on the application are refused, and their surcharge portion is refundable.
- A switching or extension application resulted in overlapping surcharge periods.
Refunds are usually processed automatically and credited back to the same account used for payment. They are typically issued within about six weeks of the refund eligibility trigger (e.g. refusal), but this timeframe can vary if an administrative review or appeal follows a refusal.
Special Refund Scenarios
Family members of certain migrants - such as those holding an EHIC (European Health Insurance Card) under specific student conditions - may qualify for IHS reimbursements if they meet defined criteria. These provisions are specific to certain cohorts and have registration and evidence requirements.
Health and care workers who qualify for IHS exemptions may also secure refunds if they have paid IHS for periods when they were eligible for exemption. Dependants of such workers may benefit where their visa covers the same period the main applicant is exempt.
Practical Considerations for Family Visa Applicants
Timing and Payment
The IHS must be paid before submitting the visa application. If applicants miss payment or pay an insufficient amount, UKVI may stop processing the application until the correct charge is paid. This can lead to delays or rejection.
For family applications involving multiple dependants, applicants should calculate the total surcharge carefully, as each person's surcharge adds to the overall cost.
Accessing NHS Services
After payment and visa grant, visa holders should use their digital immigration status or an IHS share code (if required) to prove entitlement to NHS care when accessing services.
Planning for Cost
The surcharge can represent a significant sum, especially for families with multiple dependants. For example, a family of four seeking visa permission for three years could pay several thousand pounds in IHS alone. Families should budget for this alongside visa fees, travel costs and other application‑related expenses.
Risks and Common Issues
Non‑Payment or Incorrect Payment
If the IHS is not paid or the amount paid does not cover the full period of intended stay, the visa application may be refused or delayed until corrected.
Unused NHS Services
Even if a visa holder never uses NHS services during their stay, no refund is given solely because services were unused. The surcharge is for potential access, not usage.
Appeals and Refund Interaction
If a visa application enters an appeal or administrative review and a refund has already been credited following an initial refusal, the applicant may be required to repay the IHS if the appeal succeeds and the visa grant is later confirmed. This ensures the surcharge aligns with the ultimately granted immigration permission.
Common Questions from our Readers
Does every family visa applicant pay the same rate?
Generally yes - most family visa holders pay the standard rate of IHS for each year of permission. Exceptions exist for some categories like young dependants or specific student family members, where reduced rates may apply depending on precise visa details.
Is private medical insurance a substitute for the IHS?
No. Holding private insurance does not exempt applicants from paying the IHS when required. It is a separate requirement based on immigration status, and private cover does not replace it.
Can IHS be refunded if I leave the UK early?
No. Leaving the UK before the visa expires is not in itself a basis for refund. Refunds are tied to refusal, withdrawal, or overlapping payments, not actual length of stay.
Key Takeaways
The Immigration Health Surcharge is a key part of the UK family visa application process, ensuring access to NHS care for visa holders and their dependants. Most family visa applicants must pay the surcharge for each person and for the full duration of their stay. Exemptions and refund rules exist but apply in specified circumstances. Careful planning, timely payment and understanding of refund rights help families manage the cost and avoid application delays or refusals. Awareness of how the surcharge operates not only supports compliance with visa requirements but also broader financial planning for family migration to the UK.
