UK Immigration Health Surcharge: Costs and Refunds

How the IHS works

The IHS is paid online during the visa application. The calculator on GOV.UK gives the figure based on the route, the visa length and the number of dependants. Payment is upfront for the full visa period.

Once paid, the visa holder has the same access to NHS services as ordinarily resident people for most purposes. Some services (prescription charges in England, dental charges) follow the same rules as for everyone, with exemptions for under-18s and other categories.

Rates and discounts

The standard rate per year applies to most routes. Students, their dependants, Youth Mobility Scheme applicants, and under-18s pay a reduced rate per year. Visit visas (under 6 months) do not pay the IHS.

Total cost can be substantial for families on multi-year visas. A family of four on a 3-year Skilled Worker visa pays significant total IHS upfront. Some employers reimburse the IHS as part of relocation packages; others do not.

Exemptions

Health and Care Worker visa applicants are exempt; dependants of Health and Care Worker visa holders are also exempt. Diplomats, certain Crown servants, and applicants for some specific routes (such as the Hong Kong British National Overseas visa in some circumstances) have specific exemptions.

Asylum seekers and refugees do not pay the IHS as they have different NHS access rules. Visitors do not pay it; they have private pay NHS access rules for non-emergency care.

Refunds

Refunds are available in defined circumstances: the visa application is refused, the application is withdrawn before a decision is made, or the visa is granted for a shorter period than paid for (in which case the difference is refunded).

Refunds are processed automatically by UKVI after the relevant event. Refund timing varies; refunds for refused applications are typically processed within 6-8 weeks of the refusal. Refunds are made to the original payment card where possible.

NHS access in practice

After arrival, the visa holder registers with a local GP using the eVisa share code or BRP and proof of address. The IHS receipt is not usually requested at GP registration. Hospital services, mental health services and most other NHS care follow the same access rules as for ordinarily resident people.

Some services have direct charges that apply to everyone: prescription charges in England (Scotland, Wales and Northern Ireland have free prescriptions), dental charges at NHS rates, eye tests in some cases. The IHS does not cover these direct charges.

IHS rate structure and payment

Standard adult rate: set per year of visa requested. The rate was substantially increased in February 2024 as part of broader immigration changes. The current rate is published on GOV.UK. The rate applies to most Skilled Worker, family route, Student, Global Talent and other long-term route applicants.

Reduced rates: under-18 dependants and students/Youth Mobility/dependants of students pay a reduced rate per year. The rates reflect lower expected NHS use by these categories.

Calculation: the rate per year multiplied by the years of visa requested. The calculation is for the full visa period in a single upfront payment. The IHS calculator on GOV.UK provides the figure based on route, length, and applicant category.

Family total: a family of four (2 adults at standard rate, 2 children at reduced rate) on a 5-year Skilled Worker visa pays a substantial total IHS upfront. The total is one of the largest cost items in a UK move alongside the application fees.

Exemptions and partial coverage

Health and Care Worker visa holders: exempt from IHS. The exemption recognises that these workers are recruited into the NHS and care sector and shouldn't contribute extra. The exemption extends to their dependants.

Diplomats and certain Crown servants: exempt where the underlying visa category is for diplomatic or government service. The Vienna Convention on Diplomatic Relations 1961 and the relevant UK legislation provide the framework.

Visitor visa holders: do not pay IHS. Visitors have specific NHS access rules: emergency care is free for all in any case; non-emergency care is generally chargeable at private rates for visitors. The Immigration (Health Charge) Order 2015 specifies who pays the IHS.

Asylum seekers and refugees: have separate NHS access rules and do not pay IHS. Refugees granted leave have NHS access on the same basis as ordinarily resident people without the IHS.

Refunds and shorter-grant adjustments

Refund triggers: visa refusal (full IHS refund), application withdrawal before decision (full refund), visa granted for shorter period than paid for (proportionate refund). Refunds are automatic; UKVI initiates the refund after the relevant event.

Refund timing: typically 6-8 weeks from the refund-triggering event. Refunds are paid to the original payment card; where the card has expired or been cancelled, refunds are made by alternative means with verification.

Partial refunds: where the visa is granted for shorter period than paid for, the difference is calculated by the per-year IHS rate. Example: paid IHS for 5 years but visa granted for 3 years 6 months produces a refund for the unused 1.5 years (rounded according to current policy).

No refund where the holder leaves the UK early: the IHS is paid for the visa period regardless of actual UK presence. A visa holder who leaves the UK after 2 years of a 5-year visa does not get a refund of the remaining 3 years' IHS.

How the IHS funds the NHS and the policy debate

Time on the Skilled Worker route counts towards 5 years of continuous lawful residence for ILR under Appendix Skilled Worker, with permitted absences capped at 180 days in any rolling 12-month period. Changes of employer within the route do not reset the clock as long as continuous sponsored employment is maintained.

Switching to Health and Care Worker, Senior or Specialist Worker, or Scale-up routes can preserve the continuous-residence count under Appendix Continuous Residence. Switching to Global Talent (with endorsement at Exceptional Talent level) can shorten total time to settlement to 3 years from the Global Talent switch point.

British citizenship by naturalisation under the British Nationality Act 1981 requires 12 months of ILR (or sooner for spouses of British citizens with 3 years' UK residence), the standard residence test with the absence cap, B1 English (typically met for ILR), Life in the UK test (also typically met for ILR), and the good character requirement assessed under Home Office guidance.

NHS use and the IHS in practice

GP registration: visa holders register with a local NHS GP using the eVisa share code or BRP and proof of address. The practice records the patient's NHS number. Standard NHS services are available from registration onwards.

Hospital and specialist care: GP referrals to NHS hospital outpatient and inpatient services follow the standard NHS pathway. IHS-paid visa holders access services on the same basis as ordinarily resident people.

Mental health services: NHS Talking Therapies (IAPT) for common conditions, specialist mental health services through GP referral. NHS access via the IHS covers these services on the same basis as for residents.

Maternity care: full NHS maternity care for IHS-paid visa holders. Pregnancy and birth in the UK use the standard NHS maternity pathway through GP referral.

Direct charges that apply to everyone: prescription charges in England (£9.90 per item in late 2024), dental band charges (£26.80 to £319.10 in late 2024 figures), eye test charges where applicable. The IHS does not cover these; they apply to UK residents and IHS-paid visa holders alike.

Records of IHS payments and refunds

Document organisation: a structured folder system (physical or digital) for immigration documents reduces friction across the years of the visa. Categories: identity (passports, BRPs, eVisa records), employment (CoS, payslips, employer letters), finances (bank statements, tax returns), relationships (where applicable), education (where applicable), travel (boarding passes, hotel receipts).

Digital preservation: scan and back up all documents to secure cloud storage. Multiple backups (separate cloud, USB drive, family member's copy) protect against loss. Encryption is sensible for sensitive documents (tax records, financial statements).

Long-term retention: documents from the visa period are needed at extension, ILR, and potentially naturalisation. Keep documents for at least 6 years after the visa period; immigration records are often referenced years later.

Records during the qualifying period: from day one of the initial visa, track UK presence and absences for the eventual settlement calculation. Travel logs, employer travel records, and supporting evidence all build the documentary picture.

Using GOV.UK and official sources effectively

GOV.UK as the primary source: the UK government's single online portal for most public services. Immigration Rules, caseworker guidance, current fees and IHS rates, application forms, and updates are all on GOV.UK. The site is the authoritative reference for any current rule or process.

Subscribing to updates: GOV.UK allows email subscriptions to specific topics including immigration. Updates arrive when guidance is amended or new Statements of Changes are published. Practitioners and engaged applicants commonly subscribe.

Statements of Changes (SoCs): published on GOV.UK as PDF documents. Each SoC has a HC number identifying it; recent SoCs HC 590 of 2023, HC 1496 of 2023, HC 246 of 2024 introduced significant changes. The consolidated Immigration Rules on GOV.UK reflect the current text after all SoCs.

Modernised caseworker guidance: published separately from the Rules. Covers practical application; not binding but highly influential. Updates flow through new versions with effective dates.

ONS, HMRC and other primary data: GOV.UK aggregates data from across government. ONS migration statistics, HMRC tax and customs data, sectoral statistics from departments. The data underlies policy decisions and is publicly accessible.

Frequent practical questions about UK immigration

What if my application is delayed? UKVI publishes service standards on GOV.UK. Most cases are decided within the published standard; complex cases can take longer. Contact UKVI's helpline after the standard time has expired. Formal complaints through the dedicated channel can prompt review.

What if I cannot afford the fee? Fee waivers are available on family route, human rights, and some other immigration applications where destitution or child welfare is affected. The MN1 fee waiver application is on GOV.UK; specialist support from charities helps with the evidence.

What if I need specialist advice? OISC-regulated advisers handle most immigration matters at the appropriate level. Solicitors authorised under the Solicitors Regulation Authority handle complex cases including Tribunal appeals and judicial review. Legal aid is available for some matters.

What about appeals and challenges? Refusals carry route-specific remedies. Most points-based routes have administrative review for caseworker errors. Family route human rights refusals have Tribunal appeal rights. Judicial review applies where no other remedy exists.

What if circumstances change? Visa conditions and the surrounding circumstances can change. Reporting material changes (address, employer, family circumstances) to UKVI through the UKVI account or formal change of circumstances applications maintains the visa's integrity.

What about future return to the country of origin? UK immigration status does not prevent eventual return; the leaving-the-uk articles on this site cover the tax and practical aspects of departure.

Disclaimer

This article provides general information about UK immigration, tax and consumer matters and is not legal, financial or tax advice. Rules, fees and thresholds change. Always check GOV.UK and the relevant UK regulator before acting, and consider taking professional advice tailored to individual circumstances.

Frequently asked questions

How much is the UK Immigration Health Surcharge?

Standard rate per year for adults on most routes; reduced rate per year for students, Youth Mobility, and under-18s. The total depends on the visa length. Current figures are on GOV.UK and updated periodically.

Who is exempt from the UK Immigration Health Surcharge?

Health and Care Worker visa holders and their dependants; diplomats and some Crown servants; visitors; asylum seekers and refugees (who have different rules). Most other long-term visa holders pay the IHS.

Can I get a refund of the Immigration Health Surcharge?

Yes, in defined circumstances: visa refusal, withdrawal before decision, or grant of a shorter visa than paid for. Refunds are automatic; processing typically takes 6-8 weeks after the relevant event.

Does the IHS give me free NHS treatment?

The IHS gives the same NHS access as ordinarily resident people for most services: GP, hospital, mental health, maternity, A&E. Direct charges that apply to everyone (prescriptions in England, dental, eye tests) are not covered.

Do I pay the Immigration Health Surcharge for my children?

Yes. Each dependant pays separately, at the under-18 reduced rate for children and the standard rate for adult dependants. Health and Care Worker dependants are exempt.

Frequently asked questions

How much is the UK Immigration Health Surcharge?

Standard rate per year for adults on most routes; reduced rate per year for students, Youth Mobility, and under-18s. The total depends on the visa length. Current figures are on GOV.UK and updated periodically.

Who is exempt from the UK Immigration Health Surcharge?

Health and Care Worker visa holders and their dependants; diplomats and some Crown servants; visitors; asylum seekers and refugees (who have different rules). Most other long-term visa holders pay the IHS.

Can I get a refund of the Immigration Health Surcharge?

Yes, in defined circumstances: visa refusal, withdrawal before decision, or grant of a shorter visa than paid for. Refunds are automatic; processing typically takes 6-8 weeks after the relevant event.

Does the IHS give me free NHS treatment?

The IHS gives the same NHS access as ordinarily resident people for most services: GP, hospital, mental health, maternity, A&E. Direct charges that apply to everyone (prescriptions in England, dental, eye tests) are not covered.

Do I pay the Immigration Health Surcharge for my children?

Yes. Each dependant pays separately, at the under-18 reduced rate for children and the standard rate for adult dependants. Health and Care Worker dependants are exempt.