The Immigration Health Surcharge (IHS) is a fee that most individuals must pay when applying for a UK visa that grants permission to stay in the country for more than six months. The charge is paid as part of the visa application process and allows the applicant to access the National Health Service (NHS) during the period of their permission. Access is provided on the same basis as individuals who are ordinarily resident in the UK, although some services such as prescriptions, dental care and optical treatment may still incur additional charges.
Anyone applying for a work, study or family visa for longer than six months will usually have to pay the IHS. The same applies to dependants included in the application. The charge is also payable by applicants who are extending their leave from within the UK. It is a significant financial consideration and must be paid in full before the visa application can be submitted. While sponsors are not legally required to pay the fee on behalf of the applicant, some may choose to do so as part of an employer-sponsored relocation package.
The standard IHS rate is £1,035 per person per year. A reduced rate of £776 applies to students, their dependants, applicants under the Youth Mobility Scheme and children under 18 at the time of application. These rates apply to applications submitted on or after 6 February 2024. The amount payable is calculated automatically during the visa application process based on the type and length of the requested leave.
The term “IHS fee UK” is commonly used to refer to the Immigration Health Surcharge. It appears frequently in search results and informal guidance but refers to the same statutory charge described in UK immigration rules. Whether described as the IHS, the healthcare surcharge or the IHS fee, all terms refer to the mandatory payment required from most long-term visa applicants to access NHS healthcare services while in the UK.
Section A: What Is the IHS Fee in the UK?
The Immigration Health Surcharge (IHS) is a statutory fee that applies to most individuals applying for a UK visa that grants permission to stay for more than six months. In some in-country applications, the surcharge may apply even where the duration of stay is shorter. The IHS must be paid during the visa application process and is separate from the visa application fee. It was introduced in April 2015 under the Immigration (Health Charge) Order 2015 and is a mandatory part of the UK’s immigration system.
Payment of the IHS allows visa holders to access NHS services throughout the period of their leave. This includes GP services, hospital treatment and emergency care. The surcharge does not cover every NHS service, and additional charges still apply for prescriptions, dental treatment and optical services in England. The amount payable is calculated automatically during the application process and is based on the length of leave being requested and the type of visa route.
Since its introduction, the IHS has been subject to several increases. As of 6 February 2024, the standard rate is £1,035 per person per year. A reduced rate of £776 per year applies to children under 18 at the time of application, full-time students and those applying under the Youth Mobility Scheme. The full amount must be paid in advance and is calculated by rounding the length of leave to the nearest full year, with any part-year over six months charged as an additional year.
The IHS is frequently confused with private medical insurance, but the two are not interchangeable. The surcharge grants access to publicly funded healthcare in the UK and does not provide access to private hospitals or services. It cannot be waived on the basis that the applicant already holds private health cover. If the visa category is one in which the IHS applies, payment is required regardless of other arrangements.
In summary, the Immigration Health Surcharge is a legally required charge linked to visa applications for long-term stays in the UK. It must be paid in full before the application can be submitted and applies based on the visa route and length of stay. The charge is linked to access to NHS services and is calculated on eligibility, not usage.
Section B: Who Has to Pay the IHS?
The Immigration Health Surcharge applies to most individuals applying for a UK visa that grants permission to stay in the country for more than six months. In some cases, the surcharge also applies to in-country applications for temporary leave where the duration of stay may be shorter. The IHS is a legal requirement for a wide range of immigration routes, and failure to pay the correct amount will usually result in the application being rejected as invalid.
The surcharge must be paid by individuals applying under most work, study and family visa categories. This includes routes such as Skilled Worker, Student and family visas including spouse and partner applications. Health and Care Worker visa applicants may be exempt from the IHS, but only where the role and sponsor meet specific eligibility criteria. The Certificate of Sponsorship must confirm that the exemption applies. Applications for indefinite leave to remain and British citizenship do not attract the surcharge.
Dependants applying with the main applicant must pay the IHS separately. The fee is charged per person, with no group discounts. Each person included in the application must pay the appropriate rate for the full duration of the visa. Children under 18 are eligible for the reduced rate only if they are applying in a category where the lower rate applies, such as Student or Youth Mobility Scheme. Where a child is a dependant on a visa route that does not qualify for the reduced rate, the full annual IHS rate must be paid.
Employers and sponsors are not legally required to pay the IHS on behalf of the applicant, although some may choose to cover it as part of a relocation or benefits package. This differs from the Immigration Skills Charge, which is paid directly by the sponsor to the Home Office. The IHS remains the responsibility of the applicant and is linked to their personal visa record.
The IHS applies to both entry clearance applications made outside the UK and in-country applications to extend leave or switch categories. For example, someone switching from a Student visa to a Skilled Worker visa from within the UK will be required to pay the IHS again for the new grant of leave. Those applying to extend an existing visa must also pay the surcharge again based on the length of additional leave being requested.
In summary, the IHS must be paid by most individuals applying for temporary leave to remain in the UK for more than six months. This includes those applying from outside and within the UK. Each applicant, including dependants, must pay the correct rate for the relevant visa route and length of stay. Sponsors are not required to pay the charge, although some may choose to reimburse it.
Section C: Current IHS Fee Rates 2025
The Immigration Health Surcharge is calculated automatically during the online visa application process. The total amount payable depends on the visa type and the length of permission requested. The charge applies to each applicant individually and covers the full duration of stay, including any part-years that exceed six months.
The current rates took effect from 6 February 2024 under the Immigration (Health Charge) (Amendment) Order 2023. The standard rate is £1,035 per year. This applies to most work, family and other long-term visa categories. For example, a Skilled Worker visa issued for three and a half years would incur an IHS fee of £4,140, as part-years over six months are counted as a full year.
A reduced rate of £776 per year is available to certain applicants. This includes those applying under the Student route, the Youth Mobility Scheme and children under 18 who are applying under one of those reduced-rate routes. Children applying as dependants on visa routes that do not attract the reduced rate must pay the standard IHS. For instance, a student applying for two years and eight months of leave would be charged £2,328 (£776 × 3), as the part-year exceeds six months.
The surcharge is calculated in full-year blocks. Any period longer than six months into the next year is treated as a full additional year. Applicants should refer to the total period of leave on their application to understand the number of years used for the IHS calculation. The system rounds automatically and includes dependants in the calculation where applicable.
For illustration, a Skilled Worker applicant applying for four years would be charged £4,140 at the standard rate. A student applying for 18 months of leave would be charged £1,552 at the reduced rate. A family of two adults and one child applying under the Skilled Worker route for three years would pay a total of £9,315. If the child was applying as a dependant on a qualifying student route, the reduced rate could apply depending on eligibility.
IHS charges are determined based on visa route, duration and applicant category. The calculation includes part-years and applies to each individual in the application. The correct rate must be paid in full at the point of submission, as underpayment will usually result in the application being rejected as invalid.
Section D: How to Pay the IHS
The Immigration Health Surcharge must be paid in full before a UK visa application can be submitted. The payment is integrated into the online application process and applies whether the application is made from overseas or within the UK. The amount owed is calculated automatically by the GOV.UK system based on the visa route, the length of permission requested and whether the applicant qualifies for the reduced rate. For applications submitted on or after 6 February 2024, the standard rate is £1,035 per year and the reduced rate is £776 per year.
Once the applicant has completed the online application form, the system redirects to the IHS payment page. Payment must be made using a valid debit or credit card. Most major cards are accepted, and a receipt is issued once the payment is successful. The payment and submission steps should be completed in the same session to avoid losing the reference number. If the session expires or is closed before final submission, the process may need to be restarted.
Each IHS payment generates a unique reference number, which usually begins with the letters “IHS”. In most cases, this reference is automatically linked to the visa application. However, applicants should always check that it appears in the final application summary and retain a copy of the IHS confirmation email. If the number is missing or entered incorrectly, the application may be rejected as invalid.
The surcharge applies to all types of long-term applications, including those made to extend existing leave, switch visa categories or apply as a dependant. The same rules and calculation methods apply across entry clearance and in-country applications. The system will prompt for payment automatically, and applicants cannot defer or bypass the payment step.
In summary, payment of the Immigration Health Surcharge is a mandatory part of the visa application process. The amount is calculated during the application and must be paid in full before submission. The reference number acts as proof that the fee has been settled and must be included in the application. Failure to complete this step correctly can result in the application being treated as invalid.
Section E: Exemptions and Special Categories
While the Immigration Health Surcharge applies to most individuals applying for permission to stay in the UK for more than six months, some categories are exempt under immigration legislation or policy. The exemption depends on the visa route or status of the applicant, and in many cases the system will apply it automatically. In other cases, such as the Health and Care Worker visa, eligibility must be confirmed through documentation provided at the time of application.
1. Diplomats, Armed Forces and NATO Personnel
Applicants covered under international agreements such as the NATO Visiting Forces Agreement or the UK–US Status of Forces Agreement are exempt from the IHS. This includes certain diplomatic staff, members of visiting armed forces and their dependants. The exemption is based on the immigration route and supporting documentation. In most cases, no separate request is needed, provided that the correct immigration route is selected and the evidence is submitted.
2. EU Settlement Scheme Applicants
Applicants under the EU Settlement Scheme, including those making late applications or joining family members under Appendix EU, are not required to pay the IHS. The exemption applies to both pre-settled and settled status applications and reflects the UK’s commitments under the EU Withdrawal Agreement. Applications falling under this category will not be prompted for IHS payment during the application process.
3. Health and Care Worker Visa Route
Applicants under the Health and Care Worker visa route may be exempt from the IHS if their role appears on the government’s list of eligible occupations and their Certificate of Sponsorship confirms that the exemption applies. The CoS must state that the applicant is eligible, and the exemption is only applied if all criteria are met. The same exemption may extend to dependants, but only where the main applicant’s exemption is correctly documented and applied. Applicants should review the eligible occupation list and confirm with their sponsor that the appropriate wording appears on their CoS.
4. Asylum and Humanitarian Protection
Individuals applying for asylum or humanitarian protection are also exempt from the IHS. The exemption includes dependants and applies throughout the duration of the claim and any related appeal. The exemption reflects the UK’s international obligations and is applied automatically in most cases when the correct route is selected at the point of application.
5. Refunds Where Exemption Was Missed
If an applicant is eligible for an exemption but pays the IHS in error, a refund may be available. Refunds are typically issued automatically if the system later identifies the exemption. In cases where this does not happen, a manual refund request may be submitted through the GOV.UK IHS refund form. Supporting evidence may be required depending on the route and the nature of the exemption.
In summary, the IHS does not apply to certain applicants, including diplomats, armed forces personnel, eligible Health and Care Workers, EU Settlement Scheme applicants and those seeking asylum or humanitarian protection. Some exemptions are built into the application system, while others must be confirmed through supporting documents such as the Certificate of Sponsorship. Where an exemption is missed at the time of application, a refund may still be available through the standard refund process.
Section F: IHS Refunds and Reimbursements
While the Immigration Health Surcharge is generally non-refundable once paid, there are certain circumstances in which some or all of the fee may be returned. Refunds are either issued automatically or claimed manually, depending on the reason and the stage of the application. There is also a separate reimbursement scheme available to qualifying health and care workers.
1. Automatic Refunds
Automatic refunds are processed where a visa application is refused and no appeal or administrative review is lodged, withdrawn before a decision is made or declared invalid. In these cases, the refund is usually returned to the original payment method, provided the IHS was paid online by debit or credit card. While most refunds are processed within six weeks, processing times can vary. Where a duplicate application was submitted or payment was made in error on a case that was later withdrawn, UKVI may also issue a refund without requiring a formal request.
2. Refunds After Refusals or Administrative Reviews
If an applicant appeals a refusal or requests an administrative review, the IHS will not be refunded while the case is ongoing. If the outcome confirms the original refusal, a refund may follow depending on whether NHS access was used during that time. Where the refusal is overturned, no refund will be issued because the applicant retains leave and NHS access.
3. Manual Refund Applications
Manual refunds must be claimed through GOV.UK in cases involving overpayment, input errors, technical faults or other situations not captured by the automatic refund process. Applicants must complete the IHS refund form online and provide the IHS reference number, visa application number, full name, date of birth and contact details. Supporting documentation may be required, such as a curtailment letter or proof of withdrawal. UKVI does not guarantee a specific processing timeframe, but manual refunds are generally processed within 60 working days.
4. NHS Reimbursement Scheme for Health and Care Workers
The NHS Business Services Authority (NHSBSA) operates a separate reimbursement scheme for eligible health and care workers. This scheme is available to applicants who paid the IHS on or after 31 March 2020 and who worked continuously for at least six months in a qualifying health or care role. The surcharge must have been paid by the individual, not their employer or sponsor. Dependants can be included in the claim if they were part of the same application and the main applicant meets the eligibility criteria. Reimbursement is issued directly by NHSBSA, and claims must be submitted through the official NHS IHS reimbursement portal, not the Home Office or UKVI platform.
Eligible individuals may submit reimbursement claims for multiple periods of leave, provided they remain in qualifying employment. Claims must be submitted within six months of either the end of the eligible employment period or the expiry of the visa, whichever occurs first.
5. Choosing the Correct Route
Applicants must determine whether they qualify for a UKVI refund or NHS reimbursement before submitting a claim. Using the incorrect route may result in the request being delayed or rejected. GOV.UK provides separate guidance and forms for refund and reimbursement claims. All applicants are advised to keep copies of their IHS payment confirmation, visa application reference and any supporting documents required for their chosen claim route.
In summary, IHS refunds are available in limited circumstances such as refusal, withdrawal, or overpayment. Some are processed automatically, while others require a manual claim with evidence. Health and care workers may apply for reimbursement separately through NHSBSA, subject to strict eligibility conditions. Applicants should check which process applies to their case and submit requests through the correct platform.
Section G: What the IHS Covers
Paying the Immigration Health Surcharge entitles most UK visa holders to access NHS healthcare during the period of their immigration permission. The IHS allows individuals on qualifying visas to register with a GP, access hospital services and receive care on the same basis as someone who is ordinarily resident in the UK. The scope of NHS access under the IHS includes a wide range of services but excludes certain treatments and items that attract separate charges.
1. NHS Services Included Under the IHS
Once the IHS is paid and the visa is granted, the holder may register with a General Practitioner (GP) and access routine care, urgent treatment, maternity services, mental health support and inpatient or outpatient hospital treatment. There is no charge for GP consultations, accident and emergency attendance or hospital-based care. Access is not restricted to specific medical conditions, and there is no limit to the number of times a person may use NHS services while their visa remains valid.
2. Services Not Covered by the IHS
Certain NHS services are not covered by the IHS. These include prescriptions in England, dental care, optical services and some non-essential treatments. In England, visa holders must pay prescription fees unless they qualify for exemptions based on income or benefits. In Scotland, Wales and Northern Ireland, most prescription charges are not applied. Dental treatment and eye tests are chargeable unless a separate NHS exemption applies. Some elective or cosmetic procedures may also fall outside the scope of IHS coverage and will only be provided if justified on clinical grounds.
3. Accessing NHS Care After Arrival
After arriving in the UK, visa holders should register with a local GP without delay. Proof of identity and immigration status may be required, and some practices may ask for a UK address. Once registered, the individual can access referrals, book appointments and receive NHS services on the same terms as UK residents. Emergency care can be accessed via NHS 111 or at an A&E department. Walk-in centres may also provide care for minor conditions, but access can vary depending on location and demand.
4. Conditions Linked to Immigration Status
Entitlement to NHS care through the IHS is linked to immigration status. If a person’s leave expires or is curtailed, they may become liable for NHS charges unless they qualify for another exemption under NHS regulations. The IHS does not provide any cover for private treatment or faster access to care and should not be viewed as a substitute for private health insurance.
In summary, the IHS provides access to most standard NHS services for the duration of the person’s leave, with some exceptions for treatments and services that are universally chargeable. Access is tied to lawful immigration status and eligibility under NHS charging regulations.
Section H: Conclusion
The Immigration Health Surcharge is a mandatory part of most long-term UK visa applications and forms a key element of the healthcare funding model for temporary migrants. It provides access to NHS services in line with standard entitlements for the duration of an individual’s permission to stay. While some services remain chargeable, the IHS covers a broad range of NHS treatment including GP visits, emergency care and hospital-based treatment.
The current IHS rates, introduced on 6 February 2024, are £1,035 per person per year for standard visa applicants and £776 per year for those eligible for the reduced rate. Applicants are required to pay the full amount based on the visa category and duration requested. The system calculates the charge automatically during the online application, and a valid IHS reference number must be generated and included as part of the visa submission. Without it, the application will be treated as invalid.
Private health insurance does not remove the requirement to pay the IHS. The surcharge applies regardless of personal health circumstances or additional insurance cover, and it does not provide access to private care. NHS access under the IHS remains subject to standard charging rules, and some services such as prescriptions, dental and optical care in England are not included.
Applicants should check which rate applies to their route, ensure payment is made in full and retain confirmation of the IHS reference number. Where exemption criteria or refund rights apply, these must be reviewed before and after submission to avoid issues with overpayment or delay.
Careful preparation and compliance with the IHS rules are necessary to ensure that the visa application is processed without disruption. The IHS cannot be amended or deferred once the application is submitted, and failure to pay or include a valid reference will usually result in rejection.
Section I: Frequently Asked Questions (FAQs)
Do I have to pay the IHS for every visa application?
The IHS must be paid each time a new visa application is submitted, including extensions and switches within the UK, unless the applicant qualifies for an exemption.
Can I use private medical insurance instead of paying the IHS?
Private medical insurance does not remove the legal requirement to pay the IHS, and it does not exempt applicants from NHS charges where applicable.
Do children pay the IHS?
Children must pay the IHS unless they qualify for an exemption. If they are applying under a reduced-rate category such as the Student or Youth Mobility Scheme, the lower rate may apply.
What happens if I do not pay the IHS?
If the IHS is not paid in full or if the reference number is missing or incorrect, the visa application will usually be rejected as invalid and will not be processed.
Is the IHS refunded if my visa is refused?
Yes, in most cases. If the application is refused and no appeal or review is submitted, the IHS is usually refunded automatically. Refunds are not issued if the visa is granted but the applicant decides not to travel.
How do I apply for a refund if I paid the IHS in error?
You can submit a refund request using the online form on GOV.UK. You will need to provide your IHS reference, visa application number and supporting documents where applicable.
Can I get a refund if I leave the UK early?
The IHS is not refunded for early departure unless leave is curtailed by UKVI or the applicant qualifies for a specific exemption or refund scheme.
What if I qualify for a refund under the health and care worker scheme?
If you are eligible, you must apply through the NHS Business Services Authority reimbursement portal. Refunds are not handled by UKVI in these cases and must meet the NHS scheme’s specific criteria.
Is the IHS paid in instalments?
The IHS must be paid in full at the point of application. Instalment payments are not available.
How can I check if I am exempt from the IHS?
You should check the latest GOV.UK guidance or consult your visa route eligibility. Some categories, such as the Health and Care Worker visa and asylum claims, may be exempt if eligibility conditions are met.
Section J: Glossary of Terms
| Term | Definition |
| IHS (Immigration Health Surcharge) | A mandatory fee paid by most UK visa applicants to access NHS healthcare during their stay. It is charged per year of leave and must be paid in full before submitting the visa application. |
| UKVI | UK Visas and Immigration, the division of the Home Office responsible for processing visa applications and administering immigration policy, including IHS payments and refunds. |
| IHS Reference Number | A unique code generated when the IHS payment is made online. It must be included in the visa application and is used to confirm payment and process refunds where applicable. |
| GWF Number | The reference number issued when a UK visa application is started through the GOV.UK platform. It is used to track applications and link supporting documents and payments. |
| Visa Curtailment | A decision by UKVI to shorten an individual’s leave to remain in the UK, usually because of a change in circumstances or breach of visa conditions. Curtailment may affect IHS refund eligibility. |
Section K: Links and Additional Resources
| Resource | Description | Link |
| IHS Main Guidance | Official UK government page explaining the Immigration Health Surcharge, including who needs to pay and when. | https://www.gov.uk/healthcare-immigration-application |
| IHS Refund Application | GOV.UK portal for submitting a refund request if you believe you paid the IHS in error or are eligible for a refund. | https://www.gov.uk/immigration-health-surcharge-refund |
| NHS IHS Reimbursement Scheme | Information on claiming IHS reimbursement for health and care workers, run by NHS Business Services Authority. | https://www.nhsbsa.nhs.uk/immigration-health-surcharge-reimbursement-scheme |
| UKVI Contact Page | Contact information for UKVI including phone numbers and online enquiry forms for IHS or visa issues. | https://www.gov.uk/contact-ukvi-inside-outside-uk |
| UKVI Complaints Process | Information on how to submit a complaint to UKVI if there is a delay or issue with IHS or visa processing. | https://www.gov.uk/government/organisations/uk-visas-and-immigration/about/complaints-procedure |
Author
Founder and Managing Director Anne Morris is a fully qualified solicitor and trusted adviser to large corporates through to SMEs, providing strategic immigration and global mobility advice to support employers with UK operations to meet their workforce needs through corporate immigration.
She is a recognised by Legal 500 and Chambers as a legal expert and delivers Board-level advice on business migration and compliance risk management as well as overseeing the firm’s development of new client propositions and delivery of cost and time efficient processing of applications.
Anne is an active public speaker, immigration commentator, and immigration policy contributor and regularly hosts training sessions for employers and HR professionals
