Immigration Health Surcharge (IHS): Who Must Pay, Exemptions, Refunds And Current Rates

The Immigration Health Surcharge (IHS) is a mandatory fee on most UK visa applications, introduced in 2015 to ensure long-term migrants contribute to the NHS. By law (Immigration Act 2014, section 38), migrants applying for permission to stay in the UK for longer than six months must pay the IHS. Paying the IHS entitles the visa holder to use NHS services free at the point of use for the duration of their visa, on the same basis as a UK resident. Just like British residents, migrants still pay charges for prescriptions, dental care, and eye tests in England, which are not covered by the IHS.

The Home Office IHS guidance explains that temporary migrants who have paid the surcharge “are able to access NHS treatment without charge on broadly the same basis as permanent UK residents” for the length of their stay. In practice, anyone on a work, study, or family visa longer than six months who pays the IHS can register with a GP and use hospitals in the normal way. The IHS was explicitly intended to raise funds for the NHS, and government estimates suggest it has brought in hundreds of millions of pounds since 2015.

1. Who needs to pay the Immigration Health Surcharge?

Most applicants for time-limited UK visas must pay the IHS up front as part of their online application. In general, if you apply from outside the UK for leave to enter (entry clearance) for longer than six months, you must pay the surcharge; if you apply inside the UK to extend or switch, you must pay regardless of the length of stay, provided it is limited leave and not settlement.

Each applicant, including dependants, must pay their own IHS. For example, a Skilled Worker Visa applicant bringing a spouse and child would pay three separate charges. By contrast, short-term visas of six months or less, such as a Standard Visitor visa or a UK Fiancé Visa, do not require an IHS payment. However, holders of short-term visas are not entitled to free NHS care, aside from a few exceptions such as GP and minor injury services. If you are extending your leave, you pay again for the additional period requested. Likewise, if you switch to a different long-term visa, you must pay the IHS for the new grant of leave.

Notably, an application cannot be submitted without including a valid IHS payment and reference number. In other words, if you forget or fail to pay the IHS when you apply, UK Visas and Immigration will treat the application as invalid. In practice, the Home Office will email a payment request, usually giving you 10 working days if you are in the UK or 7 days if you are outside the UK, to pay. Ultimately, however, the rules make the payment a compulsory part of a valid application. If the surcharge is not paid, the application will be rejected as invalid. Importantly, having private medical insurance or paying UK National Insurance contributions does not exempt you from the IHS; it must be paid regardless of other coverage.

2. Who is exempt from the IHS?

The IHS rules contain a narrow set of exemptions. If you fall into one of the exempt categories, you do not need to pay the surcharge and can still access NHS care without an IHS reference. Key exemptions include applicants to the EU Settlement Scheme (EUSS), holders of a Frontier Worker Permit with an S1 certificate, and health and care workers on a Health and Care Worker visa, along with their dependants. Diplomats, visiting military personnel and their exempt dependants, and certain international agreement cohorts, such as relevant NATO or Australian Defence Department employees in the UK, are also exempt. The protection cohorts are exempt as well: asylum seekers, refugees, humanitarian protection applicants, victims of trafficking or slavery, victims of domestic violence under the relevant Home Office concession, those granted Article 3 ECHR relief, stateless persons, and those on the Ukraine visa schemes. Children under 18 who are in local authority care in the UK are similarly exempt. If a migrant is granted a full or partial fee waiver, payment of the IHS will also be waived.

In summary, most work, study, and family visa applicants pay the surcharge, but permanent settlement applications, including ILR applications, do not require any IHS payment, nor do visitors and other short-term visas. The official guidance emphasises that any person exempt from paying still has full NHS access, meaning they can “access NHS treatment without charge” without needing an IHS reference. By contrast, exempt short-term visitors are directly chargeable if they use NHS services, except for a few free services available as for UK residents.

3. How much is the Immigration Health Surcharge?

The IHS is calculated per person, per year of leave. The Home Office sets fixed annual rates and charges in six-month increments, rounding up any partial year. For example, a visa of 9 months would incur 12 months of IHS, and a 16-month visa would incur 18 months of IHS. The annual rate is £1,035. A reduced rate of £776 per year applies to certain categories, specifically full-time students and their dependants, Youth Mobility Scheme applicants, and any applicant under 18 on the date of application. These charges must be paid in full at the time of application; they cannot be broken up or deferred.

4. How to calculate and pay the Immigration Health Surcharge

When you apply online for a visa, the system automatically calculates the required IHS and takes payment via the IHS portal. The visa application system will prompt you to pay the surcharge before you can submit, and will compute the total IHS owed. You must pay by debit or credit card, and upon payment, you will be issued a unique IHS reference number.

By Home Office rules, the IHS payment is required before you submit the visa application. In effect, the system forces payment first, so every successful application is recorded as having a valid IHS reference. Applicants should be careful to save proof of payment and the IHS reference, as this number ties the IHS payment to the visa and is used later if you request a refund. Note that if you discover an error, for example if you entered the wrong length of stay, you must pay any shortfall before a visa can be issued.

5. What happens if you do not pay the IHS?

If an applicant fails to pay the IHS, the application cannot proceed. The visa rules explicitly require the surcharge to be paid, so without it the application may be treated as invalid. In practice, UKVI will normally email you after submission if the IHS payment is missing. You are then expected to pay promptly, typically within 10 working days if applying inside the UK, or 7 days if applying from abroad. If the surcharge is still not paid by that deadline, the application may be rejected. Failure to make the IHS payment means the application does not meet the requirements, therefore, to avoid refusal, you must pay the full IHS when you apply.

6. When can you get an IHS refund?

Because the IHS is paid up front, the Home Office allows automatic refunds in limited situations where the payment turns out to exceed what is needed. You will receive a full refund if: (1) your visa application is refused and all appeal rights are exhausted; or (2) your application is voided, withdrawn, or rejected before a decision. In those cases, you did not receive the intended leave, so you overpaid. A full refund also applies if you accidentally paid twice for the same application, for instance if a system glitch charged the IHS twice for the same visa. In those cases, the duplicate payment is returned.

Partial refunds are issued in specific scenarios: if your visa is granted for less time than you asked for, or if any dependants are refused while the main applicant is granted. For example, if you applied for 3 years but are granted 2 years, the IHS for the unused 1 year will be refunded. Similarly, if you apply as a family and one dependant’s visa is refused, the IHS paid in respect of that dependant will be returned.

There are also special refund rules for full-time students from the EU, EEA, or Switzerland who hold a valid European Health Insurance Card (EHIC), who study without working, and whose visa started on or after 1 January 2021. They may claim a partial refund for the period covered by the EHIC.

Notably, no refund is given in a few key situations. If your visa is granted and you simply decide not to use it, for example because you change your mind and never travel to the UK, the IHS is not refunded. Likewise, if you leave the UK before your visa expires, except where UKVI curtails your leave, or if you switch to another status that does not require the IHS, you do not get a refund. Crucially, the Home Office confirms there is no exception allowing a refund of the IHS in the event of an applicant’s death. Finally, as noted, ILR and other settlement applications never incur an IHS in the first place, so that issue does not arise.

7. How long does an IHS refund take?

How long do refunds take? Official guidance indicates that automatic refunds are generally processed relatively quickly once the decision is final. You do not normally need to apply, as UKVI refunds the IHS to the card used for payment. In most cases, you can expect to see the refund within six weeks of the relevant decision. For a straightforward refusal or withdrawal with no appeal, that means roughly six weeks after the Home Office communicates the decision to you.

The picture is more complex if an appeal or administrative review is involved. Home Office guidance advises that, in those cases, the refund should not be issued until any rights of appeal are exhausted. In practice, the guidance says that if you appeal from within the UK, the IHS will be refunded up to six weeks after the appeal is finally dismissed, and if you applied from outside the UK, up to six weeks after the initial refusal. Because of this, applicants should be aware that refunds may be delayed if there is an ongoing appeal process. If you are owed a refund and it has not arrived after six weeks following the decision, you can contact the IHS refund team or use the online query form.

8. Summary: Immigration Health Surcharge for UK visas

In summary, the IHS is a required charge on most long-term UK visas which gives you access to NHS services. If your visa is refused or otherwise not granted, you will receive a full refund of the IHS, usually automatically and within about six weeks of the final decision. Partial refunds are made if you pay for more time than is granted. Otherwise, the surcharge is non-refundable, even in cases such as illness or death before arrival.

9. Contact Our Immigration Barristers

For expert advice and assistance on the Immigration Health Surcharge or any related visa or immigration application, contact our immigration barristers on 0203 617 9173 or complete our enquiry form.

10. Frequently Asked Questions: Immigration Health Surcharge

What is the Immigration Health Surcharge?

The Immigration Health Surcharge is a fee paid with most UK visa applications that allows the visa holder to access NHS services during the period of their visa.

Who needs to pay the Immigration Health Surcharge?

Most applicants for time-limited UK visas must pay the surcharge, including dependants, unless they fall within an exemption.

Who is exempt from paying the IHS?

Exempt groups include applicants under the EU Settlement Scheme, Health and Care Worker visa holders and their dependants, some protection-based applicants, and other specific categories set out in the rules.

How much is the Immigration Health Surcharge?

The standard annual rate is £1,035, with a reduced annual rate of £776 for certain applicants, including students, their dependants, Youth Mobility Scheme applicants, and those under 18.

Can you get an IHS refund if your visa is refused?

Yes. A full refund is usually made if the visa application is refused and all appeal rights are exhausted.

Do you get an IHS refund if you do not travel to the UK?

No. If your visa is granted but you decide not to use it, the Immigration Health Surcharge is not normally refunded.

How long does an IHS refund take?

In most cases, the refund is made within six weeks of the relevant decision or outcome, depending on the type of case.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.