Immigration Health Surcharge Explained 2026: Who Pays, How Much and What It Covers

Last reviewed: 14 May 2026 | Chandraketu Tripathi, finance editor

The Immigration Health Surcharge has become the single largest cost line for most UK visa applicants. At 1,035 pounds per year of leave granted, a 5-year Skilled Worker application generates 5,175 pounds of IHS before the application fee is added; a 33-month Spouse Visa generates around 2,847 pounds before the application fee; a Student on a one-year taught Master's generates 776 pounds at the discounted rate. The IHS is the legal mechanism by which non-British residents on time-limited UK leave contribute to the NHS, and the rate has stepped up over the past decade in line with policy decisions about migration cost recovery. This page is the deep dive on the surcharge itself: how it is calculated, who pays, who is exempt, how the up-front payment interacts with the application, and how refunds work where the application does not produce the leave applied for.

What this means for UK visa applicants in 2026

The IHS is paid as part of the visa application, not separately. At the GOV.UK checkout, the applicant pays the application fee plus the IHS together; both are required before the application can be submitted. The IHS amount is calculated automatically by the application system based on the route selected and the leave duration requested; the applicant does not need to compute the figure manually but should know how it is calculated to budget correctly.

The 2026 rate structure is the same as the 2025 rate following the 2024 increase. The standard rate of 1,035 pounds per year applies to most routes; the discounted rate of 776 pounds per year applies to Students and Youth Mobility participants. There is no further differentiation by nationality, by income, by age (for adults) or by family size; the rate is applied per applicant. Children pay the same rate as adults on routes that include them as dependants.

The exemption framework is narrow but operationally important. The Health and Care Worker visa exemption removes the IHS for the principal applicant and all dependants for the duration of the leave. Other narrow exemptions cover specific bilateral schemes, short-term visit categories where the IHS does not apply (Visitor visas do not pay IHS), and certain exceptional routes. The exemption list is published on the GOV.UK IHS guidance page; the Health and Care Worker exemption is the only one that affects substantial volumes of applicants.

For applicants comparing the cost of a UK visa to alternative destinations (Canada, Australia, Germany), the IHS is often the figure that makes the UK relatively expensive. The Skilled Worker total on a 5-year route is 6,694 pounds in UKVI fees and IHS, of which 5,175 pounds is IHS alone. The UK has positioned the IHS as a contribution to NHS access; the calculation an applicant has to make is whether the NHS access provided in return is worth the up-front cost.

How it works: the 2026 process

The IHS lifecycle has four stages.

Stage one is calculation at the application checkout. The GOV.UK application system calculates the IHS based on the route (standard rate or discounted rate) and the leave duration. For a 5-year Skilled Worker application: 5 years multiplied by 1,035 pounds equals 5,175 pounds. For a 33-month Spouse Visa: 33/12 multiplied by 1,035 equals 2,846.25 pounds, rounded as the system applies. The applicant sees the IHS line and the application fee line as two separate items in the checkout total.

Stage two is payment. The IHS is paid alongside the application fee in a single transaction at the GOV.UK checkout. Payment is by debit or credit card; the system supports most international payment methods. The IHS is not refundable as a routine matter once paid; refunds apply only in the specified circumstances.

Stage three is NHS access activation. The IHS payment activates NHS access for the leave period. The activation is automatic; the applicant does not register separately for NHS access on the basis of the IHS payment. From the date of entry to the UK (or, for in-country applicants, the date of the grant), the applicant is treated as an ordinarily resident for most NHS purposes.

Stage four is refund processing where applicable. Where the application is refused, the IHS is refunded automatically as part of the refusal processing. Where the application is withdrawn before grant, the IHS is refunded on request. Where less leave is granted than applied for, a partial refund is processed automatically for the unused duration. Refunds are typically processed within 5 to 10 working days of the trigger event; payment is returned to the original payment method.

Who pays the IHS in 2026 and the exemption framework

The IHS applies to most leave-to-remain routes where the leave is for 6 months or longer. The standard rate of 1,035 pounds per year applies to Skilled Worker, Spouse Visa and other Family routes, Global Talent, High Potential Individual, UK Ancestry, parent of British child and most other work and family routes. The discounted rate of 776 pounds per year applies to Students on Student and Child Student visas and to Youth Mobility Scheme participants.

The Health and Care Worker exemption removes the IHS for the principal applicant and dependants. The exemption applies for the duration of the leave granted on the Health and Care Worker route. Where a Health and Care Worker switches off the route (for example, to a Skilled Worker non-healthcare role), the exemption ends and the IHS applies to subsequent applications. The exemption was introduced in 2020 specifically to support the NHS workforce position and has been retained as a policy decision through 2026.

Other exempt categories include: Visitor visa applicants (no IHS because the visit is under 6 months); some bilateral agreement routes where the home country contributes to the visa-holder's NHS access through a separate mechanism; certain diplomatic and official routes; and specific intra-corporate or short-term assignment categories.

Children and dependants pay the IHS at the same rate as adults on most routes. A 5-year Skilled Worker dependant child generates 5,175 pounds of IHS. The discounted rate does not apply to children on adult routes; the standard rate applies regardless of the dependant's age.

Applicants applying for ILR or citizenship do not pay IHS because these are settlement and naturalisation applications, not leave-to-remain applications. The IHS has already been paid during the qualifying period.

The calculation: part-years, multiple-applicant families and route specifics

The IHS calculation is mechanical: the rate multiplied by the leave duration, with part-years calculated proportionally. The proportional calculation is to the nearest 6-month block in most route implementations, with the system rounding up for any part of a 6-month block. A 30-month Spouse Visa attracts 2.5 years multiplied by 1,035 pounds equals 2,587.50 pounds. A 33-month initial Spouse Visa attracts 33/12 multiplied by 1,035 pounds equals 2,846.25 pounds. The system applies the actual calculation; the figures published in this article are illustrative.

For a family application, each applicant has their own IHS calculation. A family of four on a 5-year Skilled Worker route generates 5,175 pounds per family member, totalling 20,700 pounds across the family. The IHS is paid as four separate amounts within the same checkout transaction, with each amount linked to the respective applicant's application file.

Route specifics: the Skilled Worker route can be initially granted for up to 5 years; longer durations (such as 6-year grants in some specialist routes) generate IHS for the full duration. The Spouse Visa route is granted for 33 months initially and 30 months on extension; IHS is paid for each grant separately. The Student route is granted for the duration of the course plus a short additional period; IHS is paid for the full granted duration. The Health and Care Worker exemption removes the IHS calculation entirely for eligible holders.

In-country extensions and switches generate fresh IHS for the new leave duration. A Spouse Visa holder applying for the 30-month extension at the 2.5-year point pays a fresh IHS for the new 30 months: 30/12 multiplied by 1,035 pounds equals 2,587.50 pounds. The previously paid IHS for the initial 33 months covers the initial period only; the extension is a fresh payment.

Refund calculations apply the same proportional logic in reverse. Where 5 years was applied for but only 3 years was granted, the difference (2 years multiplied by 1,035 pounds equals 2,070 pounds) is refunded automatically. Where the application is refused entirely, the full IHS is refunded.

Costs, timings and what to budget

For a single Skilled Worker on a 5-year application: 5,175 pounds in IHS at the standard rate. For a Health and Care Worker on the same 5-year application: zero IHS (exempt). For a Student on a one-year taught Master's: 776 pounds in IHS at the discounted rate. For a Youth Mobility participant on a 2-year stay: 1,552 pounds at the discounted rate. For a Spouse on the 33-month initial visa: approximately 2,847 pounds. For a Spouse extension at the 30-month mark: 2,587.50 pounds. For ILR or citizenship: no IHS.

Family multiplications: a family of four on a 5-year Skilled Worker generates 20,700 pounds in IHS at the standard rate, paid up-front. A family of four on a 5-year Health and Care Worker generates zero IHS. A family of two adults and two children Spouse-route family across initial visa and extension generates approximately 21,737 pounds.

Timing of payment: the IHS is paid at the application checkout, in a single transaction with the application fee. The payment is non-refundable in normal course; refunds apply only on refusal, withdrawal before grant or short-grant variation.

Refund timing: where the application is refused, the IHS refund is processed automatically within 5 to 10 working days of the refusal. Where withdrawn before grant, refund on request within similar timeframe. Where less leave is granted than applied for, the partial refund is processed automatically as part of the grant communication.

Worked example: A family of four on a Spouse Visa route paying IHS up-front

Consider Yusuf, a 38-year-old Turkish national in Ankara whose Turkish-British wife Aysha has lived in Leeds for 12 years. They have two children aged 6 and 9. Yusuf applies for a Spouse Visa from outside the UK; the children apply as dependants on his application file under Appendix FM.

The initial Spouse Visa is for 33 months. Each applicant generates IHS at the standard rate of 1,035 pounds per year: 33/12 multiplied by 1,035 equals 2,846.25 pounds per applicant. For Yusuf, Aysha (not applying, as she is British), and the two children, the IHS is calculated only for Yusuf and the two children as applicants: three applicants multiplied by 2,846.25 pounds equals 8,538.75 pounds.

The visa fees are 1,938 pounds for Yusuf and 1,938 pounds for each child (the dependant child fee is the same as the principal fee on the family route): three multiplied by 1,938 pounds equals 5,814 pounds. The combined UKVI bill at the GOV.UK checkout is 5,814 plus 8,538.75 equals 14,352.75 pounds, paid up-front in a single transaction.

At the 2.5-year point, Yusuf applies for the in-country extension under FLR(M). The extension is for 30 months. The IHS for the extension is 30/12 multiplied by 1,035 equals 2,587.50 pounds per applicant. For three applicants, the IHS at extension is 7,762.50 pounds. The visa fee for the in-country FLR(M) is 1,321 pounds per applicant; three multiplied by 1,321 equals 3,963 pounds. Total extension cost: 7,762.50 plus 3,963 equals 11,725.50 pounds.

At the 5-year point, the family applies for ILR. ILR is 3,029 pounds per applicant: three multiplied by 3,029 equals 9,087 pounds. No IHS applies to ILR. Total ILR cost: 9,087 pounds.

Total family cost across initial visa, extension and ILR: 14,352.75 plus 11,725.50 plus 9,087 equals 35,165.25 pounds, of which 16,301.25 pounds is IHS. The IHS makes up 46 per cent of the total. Health and Care Worker eligibility would have removed this entire IHS line.

Getting regulated help: OISC, IAA and SRA advisers

The IHS calculation does not require regulated advice; it is mechanical. Where regulated advice may be appropriate is in cases where the exemption framework affects route choice (the Health and Care Worker exemption can shift the route decision for some applicants), where a fee waiver may be available (rare but applicable on some human-rights based family route applications inside the UK), or where IHS refund disputes arise.

A Level 1 adviser can confirm the IHS calculation and exemption position. A Level 2 adviser is appropriate where the IHS sits alongside complex casework or where fee waivers are being considered. The Immigration and Asylum Act 1999 framework applies to all paid immigration advice.

Verify any adviser's current authorisation on the OISC register at oisc.gov.uk/register or the SRA register at sra.org.uk/consumers/register.

Common mistakes and how to avoid them

The IHS produces a predictable set of avoidable mistakes. The first is underestimating the IHS in the total budget. The headline visa fee is often quoted in marketing materials and informal channels; the IHS is the silent multiplier that doubles or triples the actual cost. The fix is to compute the IHS at the rate multiplied by the leave duration before any other cost analysis.

The second is forgetting the IHS is paid up-front for the full duration. Applicants planning a 5-year Skilled Worker route who expect to pay the IHS as they go are budgeting incorrectly; the full 5,175 pounds is paid at the GOV.UK checkout before the application is submitted. The fix is to plan the cash flow with the up-front IHS as the largest single payment.

The third is overlooking the Health and Care Worker exemption. Applicants on healthcare roles sometimes use the standard Skilled Worker route by default; switching to the Health and Care Worker sub-route, where eligibility applies, removes the IHS entirely. The fix is to check eligibility for the Health and Care Worker sub-route before submitting on the standard route.

The fourth is failing to claim a refund where less leave is granted than applied for. Where the application is granted for shorter than the duration applied for, the IHS for the unused period should be refunded automatically; some applicants miss the refund if it does not appear within the expected window. The fix is to follow up with UKVI customer service if the partial refund does not arrive.

The fifth is paying IHS on routes that do not require it. Visitor visa applicants do not pay IHS; some applicants mistakenly pay it. The fix is to check the route's IHS position before paying.

The sixth is treating the IHS as a tax rather than a service contribution. The IHS gives NHS access; failing to register with a GP, failing to use NHS services, or paying privately for things the NHS would cover does not produce a refund. The fix is to register with a GP within the first weeks of UK residence and to use NHS services rather than duplicating cost privately.

How Kaeltripton verified this article

The Immigration Health Surcharge rate, calculation methodology, exemption framework and refund processes described in this article are drawn from the GOV.UK Immigration Health Surcharge guidance, the Health and Care Worker visa guidance, the UK Visa Fees document and the published NHS surcharge regulations. The Health and Care Worker exemption position is drawn from the published IHS exemption guidance. ILR and citizenship fee exemption from IHS is drawn from the respective route pages. The OISC tier framework is drawn from the Immigration Advice Authority's Code of Standards.

No rate, exemption, calculation or refund timing on this page has been estimated. Every figure is the 2026 published rate; where rates change by statutory instrument, applicants are referred to the live IHS guidance for current confirmation.

Frequently asked questions

Sources

• GOV.UK - Immigration Health Surcharge
• GOV.UK - Immigration Health Surcharge: how much you have to pay
• GOV.UK - Immigration Health Surcharge: when to pay
• GOV.UK - Immigration Health Surcharge: refunds
• GOV.UK - Health and Care Worker visa
• GOV.UK - UK visa fees
• GOV.UK - Indefinite Leave to Remain
• Immigration Advice Authority - Immigration Advice Authority (formerly OISC)