- The Immigration Health Surcharge gives UK visa holders access to NHS services on broadly the same basis as an ordinary UK resident for the duration of their leave.
- Covered services include GP appointments, hospital treatment, A&E, maternity, mental health services and most secondary care; the access is free at the point of use.
- Standard NHS patient charges still apply where they would apply to any resident: prescriptions in England (standard prescription fee), dental treatment (standard NHS dental charges), and optical care (sight tests and glasses charged on the standard basis).
- NHS access begins on the date of entry to the UK on the visa or, for in-country grants, on the date of the grant decision, and continues for the duration of the leave.
- Dependants on the same visa application have NHS access linked to their own IHS payment and their own leave; each applicant's coverage is individual.
Last reviewed: 14 May 2026 | Chandraketu Tripathi, finance editor
The Immigration Health Surcharge is the up-front payment that buys NHS access for UK visa holders during their leave. At 1,035 pounds per year for most routes, the IHS sits as the largest single cost on most visa applications; for that money the holder gets healthcare access that resembles the access available to an ordinary UK resident in the National Health Service. The framing of the IHS as a service contribution rather than a tax is deliberate: it positions the UK visa system as one in which migrants contribute to the NHS up-front for the access they will use during their stay. This page is about what that access actually means in 2026: the services covered, the services where standard patient charges still apply, when access begins and ends, and how the IHS interacts with NHS practice for visa holders compared to ordinary residents.
What this means for UK visa applicants in 2026
The IHS gives the visa holder primary care access (GP appointments, community health, district nursing), secondary care access (hospital outpatient and inpatient treatment, A&E, maternity), specialist services (mental health services, specialist clinics, palliative care), and most other NHS services that are available to ordinary residents free at the point of use. The exclusion list is short and aligns with the patient-charge framework that applies to all NHS users.
2026 has kept the IHS coverage framework substantially stable since the 2020s. The IHS holder registers with a GP in the UK using their visa-related identity documents and the NHS number issued on registration; from that point, the holder is treated as an ordinary resident for NHS purposes within the scope of the IHS coverage. The holder does not pay per appointment, per hospital admission or per consultation; the same free-at-point-of-use principle applies.
Where standard patient charges apply to ordinary residents (prescription charges in England, dental treatment on the NHS scale, optical sight tests and glasses on the relevant scale), they apply equally to IHS-paying visa holders. The IHS removes the immigration overseas-charging surcharge that would otherwise apply to non-residents using NHS services; it does not exempt the holder from the patient charges that apply to all users.
For applicants comparing the UK to alternative destinations, the IHS-funded NHS access is meaningful. A holder on a 5-year Skilled Worker visa pays 5,175 pounds in IHS up-front and receives 5 years of NHS access in return. Comparable private health insurance in the UK for an equivalent level of cover would typically cost more annually; the IHS represents a structured contribution that delivers most healthcare needs for the duration of leave.
How it works: the 2026 process
The NHS access flow has four stages for an IHS-paying visa holder.
Stage one is the IHS payment at the GOV.UK application checkout, which activates the underlying NHS access right for the duration of the leave granted.
Stage two is arrival in the UK and GP registration. The holder finds a local GP practice and registers, typically completing a registration form with name, address, date of birth, NHS number (if previously held), passport, eVisa share code or other status evidence, and any prior medical history. The practice issues an NHS number on first registration and links the holder's records to the practice list.
Stage three is ongoing NHS use during the leave. The holder accesses GP services as registered patients, is referred to hospital or specialist services where clinically required, attends A&E if needed, and receives all of the routine NHS services on the same basis as ordinary residents.
Stage four is the end of the access at leave expiry. NHS access continues for the duration of the leave; when the leave expires (and is not extended or replaced by ILR or citizenship), the access ends. The holder typically does not need to do anything to close the access; the registration with the GP can be retained but the underlying entitlement ends with the leave.
What the IHS covers in detail
The IHS coverage covers the majority of NHS services on a free-at-the-point-of-use basis. The headline categories include the following:
GP services: appointments, telephone consultations, video consultations, repeat prescription requests, vaccinations within the NHS childhood and adult immunisation schedule, mental health screening, family planning, contraception. The holder registers with a local NHS GP practice on arrival; the registration entitles them to the same primary care access as any UK resident.
Hospital secondary care: outpatient appointments, inpatient treatment, surgery, diagnostic services (imaging, blood tests, pathology), maternity services from antenatal through to postnatal, A&E services for emergency presentations, ambulance services where clinically required. The holder is treated on the same care pathway as any UK resident.
Specialist services: mental health services through Improving Access to Psychological Therapies (IAPT) and community mental health teams, palliative and end-of-life care, district nursing and community health, specialist clinics for chronic conditions (diabetes, cardiology, oncology), child and adolescent mental health services (CAMHS) for dependant children.
Maternity and family services: full maternity care from booking appointment through delivery and postnatal review, neonatal services, child health checks, school-age health services for dependant children, family planning and women's health services.
Long-term condition management: chronic illness care, post-operative care, follow-up appointments, repeat prescriptions for ongoing conditions, allied health services (physiotherapy, occupational therapy, speech and language therapy) where clinically required and referred through the NHS.
Public health services: childhood immunisations, adult flu and COVID vaccinations, cervical screening, breast screening, bowel cancer screening, abdominal aortic aneurysm screening, NHS health checks for relevant age groups.
Standard NHS patient charges that still apply to IHS holders
The IHS removes the overseas-charging surcharge but does not exempt the holder from the standard patient-charge framework that applies to all NHS users. Where an ordinary UK resident would pay a charge, the IHS-paying visa holder pays the same charge.
Prescription charges in England: the standard prescription fee applies for prescribed medicines in England (Wales, Scotland and Northern Ireland have abolished prescription charges for residents in those nations). The holder pays the standard prescription fee per item dispensed. Exemptions apply on the same basis as for ordinary residents: under-16s, full-time students under 19, pregnant women and women who have given birth in the last year, over-60s, certain medical exemptions, and low-income exemption through the NHS Low Income Scheme.
NHS dental treatment: standard dental charges apply on a banded scale. Band 1 covers examination and basic treatment; Band 2 covers fillings, extractions and similar; Band 3 covers crowns, dentures and complex treatment. The bands are charged at fixed prices per course of treatment. Free NHS dental treatment is available to pregnant women, women who have given birth in the last year, under-18s and 18-year-olds in full-time education, and certain other exempt categories.
Optical services: sight tests are charged on the standard NHS basis (free for under-16s, over-60s, full-time students 16 to 19, those with diabetes or glaucoma, and certain other categories; otherwise charged at the optician's NHS sight test rate). Glasses and contact lenses on the NHS optical voucher scheme are charged based on the prescription and frame choice.
Non-NHS services: services that are not part of the NHS at all are not covered by the IHS. Cosmetic procedures not provided on the NHS, certain elective procedures not clinically indicated, private health services chosen for shorter waiting times, private dentistry, private optical care.
NHS waiting times apply to IHS holders on the same basis as to ordinary residents. The IHS does not give priority access to NHS services; the holder waits on the same NHS waiting list as any other patient for non-emergency referrals.
When NHS access starts, ends and what happens between visas
NHS access starts on the date the visa-holder enters the UK on the visa (for overseas applicants) or on the date of grant (for in-country applicants). Until entry, the holder is not in the UK and has no NHS access; the access is geographically and temporally tied to UK residence during the leave.
The access continues for the duration of the leave granted. A 5-year Skilled Worker visa gives 5 years of NHS access; a 33-month Spouse Visa gives 33 months of access from the grant date or entry date. Where the leave is extended (FLR(M) extension at the 2.5-year mark, Skilled Worker extension at the 3-year mark), the IHS is paid again for the new leave period and the NHS access continues seamlessly.
Between visas, where the holder has a gap (a Skilled Worker visa expires and a new application is pending under section 3C leave), the NHS access typically continues during the section 3C period because the leave is treated as continuing. Where the gap is not protected by section 3C (the application was made out of time, or the previous leave has ended without a fresh application), the NHS access can lapse and the holder may be charged for services as a non-resident.
At ILR or citizenship, the holder transitions from time-limited leave to settlement or naturalisation. The IHS does not apply to ILR or citizenship; from settlement onwards, the holder has ordinary-resident NHS access without any IHS payment, on the same basis as any UK resident.
For dependants, NHS access is individual to each applicant's leave. Each dependant has their own IHS payment, their own leave, and their own NHS access tied to those. Where a dependant's leave expires while the principal applicant's leave continues (a child reaches the age limit on a dependant route, for example), the dependant's NHS access ends with their leave even if the principal continues.
Costs, timings and what to budget
The IHS is the cost of the NHS access; no additional cost attaches to using NHS services within the covered scope. The holder budgets for the IHS at the GOV.UK application and then pays the same patient charges as any UK resident during the leave.
For ongoing costs during the leave: prescription charges in England add up where the holder has regular prescriptions; the NHS Prescription Prepayment Certificate (PPC) at a fixed annual fee can be a saving where the holder has 12 or more prescription items per year. Dental treatment is banded; routine annual examinations and basic treatment cost less than complex restorative work. Optical care: an annual sight test plus prescription glasses through the NHS optical voucher scheme typically costs 100 to 300 pounds depending on prescription and frame choice.
For services outside the NHS: private health insurance is a separate spend if the holder chooses to insure against waiting times or to access private treatment for elective procedures. Private health insurance for a single working-age adult typically costs 1,000 to 3,000 pounds per year depending on cover; for a family the cost scales accordingly.
Timings: NHS access starts immediately on entry or grant; GP registration typically takes a few days from application; routine appointments are available within days to weeks depending on the practice and demand. Non-urgent referrals to hospital secondary care can wait weeks to months on the NHS waiting list, in line with the same waiting times as for ordinary residents.
What is not in the budget: the IHS is paid up-front; the holder does not pay annually or in instalments. The IHS is the only NHS-related immigration cost; once paid, there are no further NHS access fees for the duration of the leave.
Worked example: A Skilled Worker family's NHS use during a 5-year visa
Consider the Chen family: Wei (the principal Skilled Worker), her husband David (dependant) and their two children Alex aged 7 and Lily aged 4. The family entered the UK in 2025 on a 5-year Skilled Worker visa with all four IHS payments paid at the GOV.UK checkout, totalling 20,700 pounds.
On arrival, the family registers with a local NHS GP practice in Manchester. Within a week of arrival, all four have NHS numbers and are registered patients. Over the 5 years, their NHS use includes: routine GP visits for childhood illnesses and check-ups, dental examinations and one filling for Wei, two sight tests and glasses for David, antenatal care for Wei during a pregnancy in year 3 leading to a hospital delivery, postnatal care, and ongoing paediatric care for all children including childhood immunisations and school health checks.
Standard NHS patient charges paid during the 5 years: prescription charges for occasional prescriptions for the children (under-16s are exempt) and for Wei and David at the standard fee per item; dental treatment at Band 2 for Wei's filling (around 75 pounds) and Band 1 examinations for the family; optical charges for sight tests and glasses for David at around 200 pounds.
The maternity and delivery in year 3, the paediatric care, the GP services and the hospital outpatient care for routine investigations are all free at the point of use. The total out-of-pocket spend on NHS-related services over the 5 years (in addition to the up-front IHS) is estimated at 300 to 500 pounds across the four family members, dominated by occasional dental and optical charges.
The IHS-funded NHS access has covered the family's healthcare during the 5-year visa, including significant secondary care events (the maternity and delivery). The family did not take out private health insurance; the NHS access met their needs. The 20,700 pounds IHS, while a substantial up-front cost, represents a deeply discounted entry to a comprehensive healthcare system for the duration of leave.
Getting regulated help: OISC, IAA and SRA advisers
NHS coverage questions for IHS holders are clinical and administrative, not immigration-legal. Most coverage queries are resolved through the GP practice, the NHS Trust or the NHS England patient services route. Where regulated immigration advice may be appropriate is in cases where the leave status itself is in question (a holder who was overseas during a transition period and may have lapsed leave, a holder whose eVisa shows the wrong expiry), because the underlying leave is what triggers NHS access.
A Level 1 adviser can confirm the position on leave; the NHS access follows. The statutory framework means immigration advice for a fee can only come from an Immigration Advice Authority adviser, an SRA solicitor or a barrister.
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.
Anyone giving UK immigration advice for a fee must be regulated. Before instructing an adviser, run these four checks:
- Confirm the adviser or firm appears on the Immigration Advice Authority register, formerly the OISC register, at iaa.gov.uk, or is an SRA-authorised solicitor at sra.org.uk.
- Check the registered level. Level 1 covers straightforward applications, Level 2 covers complex casework and refusals, Level 3 covers tribunal advocacy.
- Ask for the adviser registration number and verify it matches the name and firm shown on the public register.
- Get the fee quote and the scope of work in writing before any payment, and confirm what happens if the application is refused.
Are you a regulated adviser? Kaeltripton works with a limited number of partners per topic. Partner with Kaeltripton →
Common mistakes and how to avoid them
The IHS coverage produces a set of avoidable misunderstandings. The first is assuming the IHS covers everything healthcare-related. The IHS covers NHS services free at the point of use but standard NHS patient charges still apply (prescriptions in England, dental on the NHS scale, optical on the NHS scale). The fix is to budget for these patient charges as ongoing UK living costs.
The second is paying privately for services that are available on the NHS. Some holders are unfamiliar with the UK system and pay privately for GP appointments, hospital procedures or maternity care, not realising the NHS provides the same service free at the point of use. The fix is to register with an NHS GP on arrival and to use the NHS for clinical needs unless private care is specifically preferred.
The third is failing to register with a GP. The GP practice is the gateway to NHS services; without registration, the holder cannot easily access primary care or get NHS referrals to secondary care. The fix is to register at a local NHS GP practice within the first weeks of arrival.
The fourth is assuming the IHS gives priority access to NHS services. NHS waiting times apply equally to IHS holders and ordinary residents; the IHS removes the overseas-charging surcharge but does not jump the queue. The fix is to plan for NHS waiting times the same way an ordinary resident would, and to consider supplementary private cover only where waiting times specifically affect a known clinical need.
The fifth is letting the NHS access lapse without realising. Where the leave expires and is not extended in time, NHS access can lapse. The fix is to track the leave expiry alongside the IHS coverage and to apply for the extension in time to preserve continuity.
The sixth is forgetting that NHS Trusts can ask for proof of NHS entitlement. Where a Trust is uncertain of a patient's status (a complex hospital admission where the registration documents do not clearly confirm IHS entitlement), the Trust may ask for evidence of leave. The fix is to be ready to generate a share code or provide eVisa evidence when a Trust requests it.
How Kaeltripton verified this article
The Immigration Health Surcharge coverage, the NHS access framework, the standard patient-charge framework and the geographic scope of NHS access described in this article are drawn from the GOV.UK Immigration Health Surcharge guidance, the NHS England patient information pages, the published Visitor and Migrant NHS Patient Cost Recovery rules and the NHS Charging Regulations. The dental, optical and prescription charge frameworks are referenced through NHS England, NHS Wales, NHS Scotland and Health and Social Care Northern Ireland published patient information. The OISC tier framework is drawn from the Immigration Advice Authority's Code of Standards.
No NHS coverage scope, patient charge or eligibility rule on this page has been estimated. Where the NHS charging rules have changed since the last review, applicants are referred to the live NHS published patient information for current confirmation.
Every UK visa application is made through GOV.UK. Kaeltripton is an editorial publisher, not a government service. Use the official pages below to apply, pay and track:
- Apply for a UK visa: gov.uk/browse/visas-immigration
- Check current fees and the Immigration Health Surcharge: gov.uk/visa-fees
- View and prove your immigration status: gov.uk/view-prove-immigration-status
Regulated immigration firms can reach UK visa applicants on this page. See the Kaeltripton Partner Programme →
| Editorial note: Kaeltripton.com is an independent editorial publisher and is not regulated by the Office of the Immigration Services Commissioner (OISC). This article is for informational purposes only and does not constitute regulated immigration advice. UK immigration rules, fees and processing times change without notice. Always verify current requirements directly on GOV.UK or with an OISC-registered adviser or SRA-authorised solicitor before making decisions on your personal circumstances. |
Frequently asked questions
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Does paying the IHS give me free NHS care?
Yes for the services that are free to ordinary UK residents (GP appointments, hospital treatment, A&E, maternity, mental health services and most secondary care, all free at the point of use). Standard NHS patient charges still apply: prescriptions in England, dental treatment on the NHS scale, optical sight tests and glasses. The IHS removes the overseas-charging surcharge that would otherwise apply to non-residents.
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How much extra do IHS holders pay for NHS services?
Beyond the up-front IHS at 1,035 pounds per year, an IHS holder pays standard patient charges where they apply: the standard prescription fee per item in England (Wales, Scotland and Northern Ireland have abolished prescription charges), banded NHS dental treatment fees, NHS sight test and optical voucher charges. Total out-of-pocket NHS spend over a 5-year visa for an average healthy adult is typically a few hundred pounds.
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When does my NHS access start after a UK visa is granted?
On the date of entry to the UK on the visa for overseas applicants, or on the date of grant for in-country applicants. The access continues for the duration of the leave granted. Register with a local NHS GP practice on arrival; the practice issues an NHS number and links the records to the practice list.
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What happens to my NHS access at the end of my visa?
It ends with the leave. If the leave is extended in time (FLR extension, Skilled Worker extension), the IHS is paid for the new period and access continues seamlessly. If the leave expires without extension, NHS access ends; the holder may be charged as a non-resident for any NHS services used after that point.
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Are dependants covered by my IHS?
Each dependant pays their own IHS at the GOV.UK checkout and has their own NHS access tied to their own leave. The principal applicant's IHS covers only the principal; dependants' coverage is individual. A family of four on a 5-year Skilled Worker visa pays 20,700 pounds in total IHS across four applicants and each family member has their own NHS access for the leave duration.
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Does the IHS cover private health insurance or treatment?
No. The IHS gives NHS access only. Private health insurance, private treatment, private dentistry or private optical care are separate spends that the holder may choose to purchase in addition. The IHS is a contribution to NHS access; it does not include any private healthcare element.
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Sources
- GOV.UK - Immigration Health Surcharge: who needs to pay
- GOV.UK - NHS Visitor and Migrant Cost Recovery Programme
- GOV.UK - Immigration Health Surcharge
- GOV.UK - Overseas visitors hospital charging regulations
- GOV.UK - Health and Care Worker visa: IHS exemption
- GOV.UK - Immigration Health Surcharge refunds
- GOV.UK - UK visa fees
- Immigration Advice Authority - Immigration Advice Authority (formerly OISC)
