IHS Refund: Immigration Health Surcharge Reimbursement

Most UK visa applicants must pay the Immigration Health Surcharge (IHS) to access NHS services during their stay. Since 6 February 2024, the annual IHS has been £1,035 for most applicants, with a reduced rate of £776 for students, Youth Mobility Scheme applicants and children. The charge is paid upfront for the full length of permission sought, with part-year pro-rating (half-year where the remaining period is less than six months, full year where it exceeds six months). Each dependant usually pays the same annual amount. Certain routes are exempt and some applicants may qualify for refunds or reimbursements in specific circumstances. Payment of the IHS is a validity requirement of a visa application: if it is not paid, the application can be treated as invalid and not considered.

What this article is about: This guide explains (1) how the IHS works and when it is payable, (2) the refund rules where applications are refused, withdrawn or granted for shorter periods, (3) when no refund is due, (4) special refund and reimbursement schemes for EU/EEA/Swiss nationals with S1/EHIC and for health and care workers, and (5) practical steps, timelines and contacts for chasing payment. We align the guidance with the Immigration (Health Charge) Order 2015 (as amended), Home Office policy and NHSBSA procedures, note the 2024 rate change, and clarify that refunds are paid to the original payer and are not taxable income.

Section A – Understanding the Immigration Health Surcharge (IHS)

The Immigration Health Surcharge (IHS) is a mandatory fee payable by most visa applicants seeking leave to enter or remain in the United Kingdom. It was introduced under the Immigration (Health Charge) Order 2015 to ensure that temporary migrants contribute fairly to the cost of using NHS services. Payment of the IHS enables visa holders to access the NHS on broadly the same terms as UK residents for the duration of their permission to stay. Under paragraph 34(4) of the Immigration Rules, payment of the surcharge is a validity requirement of a visa application — failure to pay renders an application invalid.

The surcharge is collected by UK Visas and Immigration (UKVI) as part of the visa application process and must be paid in full before an application can be submitted. Applicants are required to pay for the total length of leave requested, rounded up to the nearest half-year. This means if the total period includes more than six months of an additional year, the full year’s rate applies, while applications including less than six months of an additional year attract half the yearly charge.

1. When the IHS applies

Most migrants applying to come to the UK for six months or longer from outside the UK, or for any duration from within the UK, are required to pay the IHS. This includes individuals applying for:

• Work visas such as the Skilled Worker, Scale-up Worker, or Global Business Mobility routes
• Family and partner visas
• Student or Graduate visas
• Temporary work visas such as the Government Authorised Exchange

Dependants must also pay the surcharge at the same rate as the main applicant. Certain categories, however, are exempt from the IHS, including:

• Visitors (who cannot access NHS services beyond emergency treatment)
• Health and Care Worker visa holders
• Applicants for indefinite leave to remain
• Diplomats, members of visiting armed forces, and applicants under specific international agreements

Applicants outside the UK are not required to pay the surcharge if applying for a visit visa of six months or less.

2. Current IHS rates

As of February 2024, the Immigration Health Surcharge rates are governed by the Immigration Fees (Amendment) Regulations 2024 and set as follows:

• £1,035 per year – most visa categories
• £776 per year – students, Youth Mobility Scheme applicants, and children under 18

The rates apply per person, per year of leave granted, and must be paid in full upfront for the total visa period. For example, a Skilled Worker applying for a five-year visa would pay £5,175 in IHS charges, while a student applying for a three-year course would pay £2,328. Dependants must each pay the same per-year rate as the main applicant.

3. How and when to pay the IHS

The IHS must be paid through the UKVI online payment system at the time the visa application is submitted. The system automatically calculates the total fee based on the visa category, duration, and number of dependants. Applicants cannot underpay or adjust the total, as the calculation is tied to the validity of the visa application.

If the application is later withdrawn or refused, the IHS payment is automatically refunded to the original payment method under the refund rules explained in Section B. Where payment is made using a corporate or third-party card, the refund is issued to that account, not to the applicant personally.

Where an application includes a period shorter than six months of an additional year, applicants pay half the annual charge. Where the period exceeds six months, the full annual amount applies. This ensures proportional contributions from those staying longer than six months of any year of leave.

Section Summary: The Immigration Health Surcharge is a mandatory contribution required for most UK visa applicants, designed to fund access to NHS services during their stay. It must be paid in full upfront when applying for a visa, is calculated based on the length of leave requested, and varies depending on the visa category. Some routes, such as the Health and Care Worker visa and indefinite leave applications, are exempt, and failure to pay renders an application invalid.

Section B – IHS Refund Rules and Eligibility

Once the Immigration Health Surcharge (IHS) has been paid, applicants may qualify for a refund in specific situations. The refund process ensures fairness when a visa application is refused, withdrawn, or when the period of leave granted is shorter than the period paid for. Refunds are typically automatic, but applicants should note that refunds can only be issued to the account that made the payment. Manual requests may be required for certain payment methods or if the original transaction was made by a representative or corporate account.

1. Full IHS refunds

Full refunds are made automatically when:

• A visa application is refused by UKVI.
• An application is withdrawn before a decision is made.
• The IHS was paid twice in error.

Refunds are automatically returned to the payment card or account used to pay the surcharge. Processing usually takes around six weeks from the date of the visa decision, although this may be longer if an appeal or administrative review is pending. If the applicant subsequently succeeds on appeal or review, they must repay the IHS before the visa can be granted and their Biometric Residence Permit (BRP) or eVisa reissued.

2. Partial IHS refunds

Partial refunds are issued automatically when:

• The applicant paid for more years than the period of leave granted.
• One or more dependants on the same application are refused leave.

For example, if an applicant pays the IHS for a five-year Skilled Worker visa but is granted three years, the remaining two years will be refunded automatically to the payment method used.

3. When no IHS refund is due

There are several situations where no refund will be payable, including when:

• The visa application is successful but the applicant does not travel to the UK.
• The visa holder leaves the UK early or before their visa expires.
• The visa holder switches immigration routes or makes a new application.
• The visa holder applies for indefinite leave to remain (ILR).
• The visa is curtailed by the Home Office due to breach of conditions.

In each case, the IHS covers the period of leave granted and remains non-refundable even if the individual does not use NHS services.

4. Processing time and repayment requirements

Refunds are generally processed automatically within six weeks of a visa decision or withdrawal. Where an appeal or administrative review is pending, refunds are paused until the process is concluded. If a refund is issued and the applicant later wins their appeal or review, the surcharge must be repaid before UKVI will issue the visa or revalidate digital status.

5. Contacting the IHS refunds team

If more than six weeks have passed and no refund has been received, contact the NHS Business Services Authority (NHSBSA) directly at nhsbsa.IHSreimbursements@nhs.net. When emailing, include:

• Full name
• Visa category and UKVI reference number
• IHS reference number
• Date of payment
• Payment method and cardholder name

Responses are typically issued within six weeks. Applicants should not contact UKVI or the Home Office about IHS refunds, as all refund processing is managed by the NHSBSA. Refunds are not taxable income and have no impact on immigration status or future applications.

Section Summary: The IHS refund process is largely automatic and administered jointly by UKVI and the NHSBSA. Applicants receive full or partial refunds when applications are refused, withdrawn, or granted for shorter periods than paid for. Refunds are paid to the original payment account, usually within six weeks, but are not available for curtailed visas, early departures, or unused visas.

Section C – IHS Refunds for EU Nationals and S1/EHIC Holders

Since the UK’s withdrawal from the European Union, EU, EEA and Swiss nationals who move to the UK to work, study or join family must usually pay the Immigration Health Surcharge (IHS) under the UK’s points-based immigration system. However, where healthcare costs are met by an EU member state through reciprocal arrangements, the applicant may be entitled to a refund under the S1 or EHIC refund schemes. These schemes are separate from the standard IHS refund process and are administered by the NHS Business Services Authority (NHSBSA).

1. Eligibility for IHS refund under an S1 certificate

EU, EEA and Swiss nationals whose healthcare is paid for by their home country can claim a refund if they hold a valid S1 certificate registered with the NHSBSA. The S1 confirms that the individual’s healthcare in the UK is funded by their EU member state, which reimburses the UK for treatment. It typically applies to:

• Individuals in receipt of an exportable benefit or state pension from an EU country
• Cross-border workers who remain insured in their home country
• Eligible dependants of the above

To qualify, the individual must hold a UK visa that began on or after 1 January 2021 and have registered their S1 certificate with the NHSBSA. Holders of pre-Brexit residence rights under the EU Settlement Scheme are not eligible for this refund, as they are exempt from paying the IHS altogether under Appendix EU.

2. Eligibility for IHS refund under an EHIC

Full-time students from the EU, EEA or Switzerland who hold a valid European Health Insurance Card (EHIC) issued in their home country and are studying in UK higher education may also qualify for an IHS refund. To be eligible, the student must:

• Hold a visa that began on or after 1 January 2021
• Possess a valid EHIC at the start of the visa
• Not work in the UK during the visa period

If approved, the refund covers the period of EHIC validity and is backdated to include any visa starting on or after 1 January 2021. The refund will be calculated pro rata based on the EHIC’s expiry date.

3. How to apply for an S1 or EHIC refund

Applications for S1 or EHIC refunds must be submitted to the NHS Business Services Authority using their online process. Applicants must provide supporting documents including:

• Visa details and IHS reference number
• Proof of a registered S1 certificate or valid EHIC
• Passport or national ID copy
• Evidence of visa start and end dates

Once received, the NHSBSA will review the claim and, if approved, pass it to UKVI for refund processing. Payment is made to the original account used for the IHS payment. Refunds are normally issued within six weeks of approval.

4. Backdating and payment timescales

The S1 and EHIC refund schemes opened on 1 January 2022. Refunds can be backdated to cover any eligible visa starting on or after 1 January 2021. Processing time varies depending on documentation, but most applicants receive payment within six weeks. Refunds are not automatic — each applicant must apply to the NHSBSA and provide supporting evidence of their entitlement.

Section Summary: EU, EEA and Swiss nationals whose healthcare is paid by their home country may apply to reclaim some or all IHS payments under the S1 or EHIC refund schemes. These schemes apply only to post-Brexit visa holders and must be applied for directly through the NHSBSA with full supporting documentation. Payments are backdated to 2021 and refunded to the original payment account.

Section D – IHS Refunds and Reimbursements for Health and Care Workers

Health and social care professionals form an integral part of the UK workforce. Recognising their contribution, the government has introduced specific Immigration Health Surcharge (IHS) exemptions and reimbursement arrangements. These include the Health and Care Worker visa exemption and the NHSBSA IHS reimbursement scheme for qualifying roles across the health and social care sector.

1. Exemption under the Health and Care Worker Visa

Applicants granted a Health and Care Worker visa are exempt from paying the IHS. The exemption applies automatically during the visa application process and extends to dependants applying at the same time. If a payment is made in error before the exemption is applied, the IHS is automatically refunded to the same payment method.

The exemption applies to a wide range of eligible roles across the NHS, private healthcare providers, and registered adult social care organisations. These include doctors, nurses, midwives, paramedics, and other allied health professionals, as well as qualified social workers employed by registered care providers.

2. Retrospective reimbursement scheme for healthcare workers

Individuals who entered the UK on a different visa route but later began working in an eligible health or social care role may qualify for an IHS reimbursement under the NHSBSA reimbursement scheme. This scheme covers payments made for any six-month period beginning on or after 31 March 2020.

To qualify, applicants must:

• Have paid the IHS while holding a valid visa
• Have worked in a qualifying health or social care role for at least six months
• Have worked an average of 16 hours or more per week during that period

Reimbursements also extend to dependants, provided the main applicant meets the eligibility criteria. The scheme covers both frontline and support roles, including those providing cleaning, catering, and administrative services within healthcare settings, as long as the work directly supports the delivery of health or social care.

3. Automatic refunds for Tier 2 (General) visa medical professionals

Medical professionals holding a Tier 2 (General) visa—now replaced by the Skilled Worker route—may qualify for automatic backdated IHS refunds covering any visa period after 31 March 2020. Eligible roles include doctors, nurses, and other healthcare practitioners working in the NHS or in organisations delivering NHS-funded services.

Refunds are made automatically to the original payment card once employment eligibility is verified. Where a refund has not been received, applicants should contact the NHSBSA via nhsbsa.IHSreimbursements@nhs.net, including:

• Full name
• Employer name
• Certificate of Sponsorship (CoS) number
• IHS reference number
• Date of payment

The NHSBSA typically responds within six weeks. Refunds are made to the account that made the payment, not directly to the applicant if a third-party card was used.

4. Applying for an IHS reimbursement as a healthcare worker

Healthcare workers who are not eligible for an automatic refund can apply manually via the NHSBSA online portal. To apply, the following information is required:

• IHS reference number
• National Insurance number
• Employer details
• Email address
• Payslips covering the six-month qualifying period
• Dependants’ IHS numbers, if applicable

Applications must be renewed every six months for continued eligibility. Payments are made in arrears, usually within six weeks, using the original IHS payment method. Refunds under this scheme are not taxable income and have no impact on immigration status.

5. Qualifying employers and working hours

Eligible employers are listed in Annex A of the NHSBSA reimbursement scheme guidance and include NHS trusts, local authorities, and registered providers regulated by the Care Quality Commission. The applicant’s job does not have to involve direct patient care—roles in cleaning, catering, maintenance, or administration within healthcare facilities can qualify, provided they contribute to service delivery.

The six-month qualifying period may include paid leave such as maternity or statutory sick leave. However, individuals who take unpaid leave or are unemployed for more than 28 days during the period will not qualify.

Section Summary: Health and social care workers are either exempt from the IHS under the Health and Care Worker visa or can claim reimbursement for eligible work from March 2020 onwards. Applications are made through the NHSBSA, must be renewed every six months, and are paid to the original account within six weeks. Refunds are not taxable and apply to both clinical and non-clinical roles within qualifying organisations.

FAQs

How long does it take to get an IHS refund?

Most Immigration Health Surcharge refunds are processed automatically within six weeks of the date a visa application is refused, withdrawn, or granted for a shorter period. Refunds made under the NHS Business Services Authority (NHSBSA) reimbursement scheme are also typically paid within six weeks of claim approval, although this may take longer if additional verification is needed or if the payment was made by a corporate or third-party account.

Do I need to apply for an IHS refund?

In most cases, you do not need to apply. Full and partial refunds for refused or withdrawn visa applications and overpayments are issued automatically through the UKVI IHS portal. However, you must apply manually if you are claiming under the S1/EHIC refund scheme or the health and care worker reimbursement scheme. These claims must be submitted directly to the NHSBSA with the required supporting documentation.

Can I get a refund if I leave the UK early?

No. Once your visa has been granted, the IHS covers the full period of leave. Leaving the UK early, changing immigration route, or deciding not to use the visa does not make you eligible for a refund. Refunds are not available where a visa has been curtailed or where the holder has voluntarily left the UK before the visa end date.

What if I appeal a visa refusal?

If you successfully appeal or win an administrative review after an IHS refund has been issued, you must repay the surcharge before your visa or eVisa can be granted. This ensures that your healthcare entitlement is reinstated for the visa period approved following appeal.

Are dependants eligible for refunds?

Yes. Dependants are eligible for automatic IHS refunds if their part of the application is refused, or if they qualify under a reimbursement scheme linked to the main applicant’s healthcare work. Each dependant’s refund is processed separately and paid to the original payment account used for the application.

Who do I contact if I haven’t received my refund?

If you have not received your refund within the expected six-week timeframe, you should contact the NHS Business Services Authority (NHSBSA) directly at nhsbsa.IHSreimbursements@nhs.net. When contacting them, include:

• Your full name
• IHS reference number
• Visa application reference number
• Date of payment
• Payment method and cardholder details

Responses are normally issued within six weeks. Refunds are administered solely by the NHSBSA, not UKVI or the Home Office.

Section Summary: Most IHS refunds are automatic, while manual applications are required for the S1/EHIC and NHSBSA reimbursement schemes. Refunds are paid to the original payer within about six weeks and are not taxable. Dependants can also qualify where linked to an eligible main applicant.

Conclusion

The Immigration Health Surcharge (IHS) ensures that migrants contribute fairly towards NHS costs while residing in the UK. Although most applicants must pay the charge in full and upfront, the system provides clear mechanisms for refunds and reimbursements where justified under UK immigration and NHS rules.

Full or partial refunds are made automatically where visa applications are refused, withdrawn, or granted for shorter durations than paid for. Refunds are issued to the original payer, usually within six weeks, and require no separate claim. However, no refund is available where the visa holder leaves the UK early, switches categories, or fails to travel to the UK after a visa has been granted. Refunds are not available following visa curtailment or early departure.

EU, EEA and Swiss nationals whose healthcare is paid by their home country can claim through the S1 or EHIC refund schemes administered by the NHSBSA, while health and care professionals are exempt from the surcharge under the Health and Care Worker visa or may apply for reimbursement for qualifying work from 31 March 2020 onward. Refunds under these schemes are not taxable and do not affect immigration status.

Employers and sponsors should ensure the correct IHS is paid when submitting a sponsored worker’s visa application. An unpaid or underpaid IHS renders the application invalid under paragraph 34(4) of the Immigration Rules and may delay employment start dates.

Section Summary: The IHS framework combines fairness with accountability: payments are required to fund healthcare access, but clear provisions ensure refunds and reimbursements where appropriate. Applicants and employers alike should verify payment accuracy and monitor refund timelines through the NHSBSA to ensure compliance and recover any overpaid charges efficiently.

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