Immigration Health Surcharge (IHS) Cost & Rules 2026

Section A: What is the Immigration Health Surcharge?

The Immigration Health Surcharge (IHS) is an upfront charge paid as part of most UK visa and immigration applications for time-limited immigration permission, including most grants exceeding 6 months and in-country applications to extend or vary permission.

It applies each time limited leave is granted, including extensions and switching applications unless an exemption applies, meaning it will not be a one-off cost if part of a longer-term UK immigration journey.

The IHS is paid by individual applicants and operates as a condition of a valid application. If the surcharge is not paid correctly, leave cannot be granted.

The surcharge is mandatory for most non-settled nationals applying for temporary permission to enter or remain in the UK. It is not a tax and it is not an NHS contribution in the conventional sense. It functions as part of the immigration control framework and is assessed alongside other validity requirements.

The Immigration Health Surcharge does not, however, apply in every scenario. It is not payable for visitor visas, for visas of six months or less where the application is made from outside the UK or for settlement applications.

Where the surcharge is required and is unpaid or underpaid, the visa or immigration application will not be granted. UKVI will usually issue a short payment window to correct the error, but if that deadline is missed the application will be turned down. So while liability sits with the applicant, if the surcharge is mishandled, the impact is frequently felt by their employer as much as by the worker through delayed start dates and right to work and sponsorship compliance risks.

On the flipside, the Immigration Health Surcharge does replace the need for private health insurance as a condition of UK immigration status. That removes the requirement to arrange or maintain separate insurance cover and reduces ongoing compliance risk, even though the cost is paid upfront. For employers and applicants planning long-term sponsorship or family relocation, this trade-off is often an overlooked feature of the UK system compared with other countries.

1. What does the Immigration Health Surcharge actually pay for?

Payment of the Immigration Health Surcharge allows the visa holder to access NHS services during the period of valid immigration permission, on broadly the same basis as permanent UK residents for the duration of their immigration permission, subject to NHS charging rules.

It does not guarantee free access to all healthcare, create ordinary residence, override NHS charging rules or survive loss of lawful immigration status.

For employers, the relevance of the surcharge lies less in healthcare access and more in the fact that failure to pay it correctly prevents a visa being granted.

2. How much is the Immigration Health Surcharge in 2026?

As at 2026, the Immigration Health Surcharge is charged at £1,035 per year for most adult applicants, or £776 per year for students, their dependants, Youth Mobility Scheme visa holders and for child applicants under 18 at the date of application.

The surcharge is calculated for the full period of leave applied for and is paid in full at the point the application is submitted.

Visas issued for longer periods result in substantial upfront charges. By way of illustration:

Adult dependants will usually pay the same annual rate as the main visa applicant unless they qualify for a different category, such as the student rate.

3. How is the Immigration Health Surcharge calculated?

The exact amount payable depends on the length of leave granted and where the application is made from.

For applications made from outside the UK, the IHS is not charged at all where the visa is for six months or less. Where the visa is for more than six months but less than 12 months, the IHS is charged as a full year.

For applications made inside the UK, an application for six months or less is charged at half the annual rate.

For longer grants, the IHS is charged in 6-month periods. Where the period applied for includes a part-year, the IHS is rounded up to the next 6-month period, so relatively small differences in visa length can change the total payable. Where an applicant ends up with less time on their visa than requested, a partial refund can arise, but refunds are calculated by reference to complete 6-month periods and are rounded down where relevant.

4. What happens if the Immigration Health Surcharge is not paid correctly?

If the surcharge is not paid when required, or if the wrong amount is paid, the visa or immigration application will not be granted. UKVI will usually issue a payment request, and the timeframe is short. UKVI will issue a payment request with a short deadline. GOV.UK states the applicant is normally given 10 working days to pay for in-country applications or 7 working days for out-of-country applications, although internal processing systems can operate on a 14-calendar-day window for top-up links. If payment is not made within the deadline, the application will be turned down.

For employers, this can lead to delayed start dates, loss of lawful status protection and immediate right to work risk.

5. Can you get a refund on the Immigration Health Surcharge?

Immigration Health Surcharge refunds may be available, but they are tightly restricted and are not based on fairness, hardship or employment outcomes. Refunds are governed by Home Office rules and are issued only where specific immigration conditions are met.

In practice, this means that most situations employers and sponsored workers expect to result in a refund do not qualify. Refunds are linked to how an immigration application is decided, not to whether employment ends early, a role changes or the individual leaves the UK.

A refund is usually issued where a visa application is refused, rejected or withdrawn before a visa is granted, where the surcharge has been paid twice for the same period of leave, or where a visa is granted for a shorter period than requested and complete unused six-month periods remain.

No refund is issued simply because a worker resigns, is dismissed, changes sponsor, leaves the UK early, has their visa curtailed or is later granted indefinite leave to remain. These scenarios are the most common sources of misunderstanding for both applicants and employers.

Section B: Who pays the Immigration Health Surcharge and who is exempt?

For employers and sponsor licence holders, identifying who must pay the Immigration Health Surcharge is not a theoretical exercise. It directly affects workforce cost forecasting, visa timelines and the legality of continued employment. Incorrect assumptions about exemptions are a common source of application delay and compliance failure.

1. Which sponsored workers must pay the Immigration Health Surcharge?

As a general rule, the Immigration Health Surcharge is payable by sponsored workers applying for temporary permission to work in the UK, unless a specific exemption applies under the Immigration Rules or associated regulations. This includes most of the mainstream work routes used by UK employers.

Sponsored workers who will normally be required to pay the IHS include those applying under the Skilled Worker route, the Global Business Mobility routes and the Scale-up route. The surcharge is also payable where an existing sponsored worker applies to extend their permission, change sponsor or switch into another temporary work route from within the UK.

From a sponsor perspective, the legal obligation to pay the surcharge rests with the applicant. However, the compliance consequences of non-payment or incorrect payment fall squarely on the employer. A sponsored worker cannot lawfully start work, or continue working, if their application is not valid because the surcharge has not been paid correctly.

2. Do dependants of sponsored workers have to pay the Immigration Health Surcharge?

Dependants of sponsored workers are generally subject to the Immigration Health Surcharge in their own right. Each dependant’s liability is assessed individually by reference to their immigration status and application route, not simply by reference to the main applicant.

Adult dependants will usually pay the same annual rate as the main sponsored worker, unless they fall within a reduced-rate category. Child dependants are charged at the reduced child rate. Where the main applicant is a student, student dependants are charged at the student rate.

Employers frequently underestimate the total cost exposure created by dependants, particularly where sponsorship is granted for multiple years. Even where the business does not pay the surcharge contractually, delays or errors in dependant applications can still affect the sponsored worker’s ability to relocate, remain in post or accept an assignment.

3. Who is exempt from paying the Immigration Health Surcharge?

The Immigration Health Surcharge is subject to a defined and limited set of exemptions. These exemptions are set by law and policy and should not be applied by analogy or assumption.

Key exemptions relevant to employers include applicants under the Health and Care Worker route and their dependants. Where an application is properly made under that route and the relevant conditions are met, the applicant does not need to pay the surcharge.

Applicants for indefinite leave to remain are also exempt from the Immigration Health Surcharge. That exemption applies only at the settlement stage. Where an application for settlement does not succeed and results instead in a grant of limited leave, the surcharge will be payable for that grant of leave.

Certain humanitarian categories, including victims of slavery or human trafficking and individuals granted leave on specific human rights grounds, may also be exempt. These cases are highly fact-specific and exemption should never be assumed in advance of a decision.

4. Are there any Immigration Health Surcharge waivers?

There is no general waiver of the Immigration Health Surcharge. In most cases, the surcharge is mandatory and must be paid in full upfront for the application to be processed.

The only way the Immigration Health Surcharge can be waived is where a Home Office fee waiver is granted. Fee waivers are limited to specific family and human rights applications, most commonly partner visa applications, and are available only where the applicant can demonstrate that paying the application fee and Immigration Health Surcharge would render them destitute, breach their human rights or involve exceptional circumstances.

Where a fee waiver is granted, both the visa application fee and the Immigration Health Surcharge are waived. Outside the fee waiver framework, there is no instalment plan, hardship reduction or discretionary exemption from the surcharge.

5. Common employer errors around exemptions

One of the most frequent errors made by employers is assuming that EU nationals are exempt from the Immigration Health Surcharge. That is no longer correct. Exemption applies only where an individual is applying under the EU Settlement Scheme. EU nationality alone does not remove liability.

Another common mistake is misapplying the Health and Care Worker exemption, particularly where a worker switches immigration routes or where dependants’ applications are handled separately. If an application is not made under the Health and Care Worker route, the exemption will not apply, even if the individual works in the healthcare sector.

Employers also sometimes assume that short grants of leave or in-country applications attract different IHS rules. In practice, where an application is made from inside the UK, the surcharge applies regardless of the length of leave sought, unless the route itself is exempt.

Section C: How much does the Immigration Health Surcharge cost?

For employers and sponsor licence holders, the Immigration Health Surcharge is not a marginal or incidental fee. When applied across multi-year visas, sponsored dependants and repeat applications, it becomes a material workforce cost that needs to be understood, forecast and managed.

1. What are the current Immigration Health Surcharge rates?

The Immigration Health Surcharge is charged on an annual basis, with different rates depending on the applicant’s category.

The standard annual rate is £1,035 per person. A reduced annual rate of £776 applies to students, their dependants, Youth Mobility Scheme visa holders and to children under the age of 18 at the date of application. These rates apply per applicant, including dependants, unless a specific exemption applies.

The surcharge is payable in full at the point the application is submitted. For sponsored workers, this means the total amount for the entire period of leave applied for is paid upfront, rather than spread over the duration of the visa.

2. How is the Immigration Health Surcharge calculated in practice?

The total amount payable depends on the length of leave granted and where the application is made from, rather than simply the immigration route label.

For applications made from outside the UK, no Immigration Health Surcharge is payable where the visa is for six months or less. Where the visa is for more than six months but less than 12 months, the surcharge is charged as a full year.

For applications made from inside the UK, an application for six months or less is charged at half the annual rate. Longer grants are charged by reference to defined charging bands applied across the total length of leave.

For employers, this matters because relatively small differences in the length of sponsorship or the grant of leave can produce meaningful differences in total cost, particularly where dependants are included.

3. How do Immigration Health Surcharge costs scale across a sponsored workforce?

When applied to a single worker, the Immigration Health Surcharge may appear manageable. When applied across multiple sponsored employees, longer sponsorship periods and accompanying family members, the cost exposure increases quickly.

For example, a five-year sponsorship for a single Skilled Worker and their partner can result in a combined surcharge running into several thousand pounds. Where children are included, the total cost increases further. For employers sponsoring multiple workers, these charges can form a significant component of overall immigration spend.

Even where the employer does not pay the surcharge directly, cost pressure can influence recruitment decisions, retention risk and a worker’s willingness to accept or extend sponsorship.

4. Who pays the Immigration Health Surcharge in practice?

Legally, responsibility for paying the Immigration Health Surcharge rests with the applicant. In practice, many employers choose to fund all or part of the cost as part of a wider immigration or relocation support package, particularly for senior hires or hard-to-fill roles.

Where employers pay the surcharge, the arrangement needs to be managed carefully. Repayment clauses, clawback provisions and equality considerations can all arise. Inconsistent treatment between employees can create employment law and discrimination risk.

Where employers fund the surcharge, repayment terms should be documented clearly, as inconsistent clawback arrangements can raise employment law and discrimination issues.

Even where the employer does not fund the surcharge, HR teams and hiring managers should understand the cost implications for candidates. Failure to do so can lead to delayed acceptance of offers, failed relocations or early attrition.

Section D: What happens if the Immigration Health Surcharge is paid incorrectly or not paid at all?

From an employer and sponsor licence perspective, errors relating to the Immigration Health Surcharge are rarely confined to the application itself. In practice, they can invalidate immigration applications, disrupt lawful status and expose the business to right to work and sponsorship compliance risk.

1. What happens if the Immigration Health Surcharge is not paid when required?

Where the Immigration Health Surcharge is due and has not been paid, UK Visas and Immigration will normally contact the applicant and request payment. The timeframe is short. Applicants are usually given 10 working days to pay if the application was made from inside the UK, or 7 working days if the application was made from outside the UK.

If payment is not made within the deadline set by UKVI, the application will be turned down. The precise outcome depends on the type of application, but the practical effect is that there is no valid pending application once the deadline has passed.

For employers, this can result in a sponsored worker being unable to start work as planned or, where the issue arises during an extension or change of employment application, losing the ability to continue working lawfully.

2. What if the wrong amount of Immigration Health Surcharge is paid?

Underpayment of the Immigration Health Surcharge is treated in the same way as non-payment. UKVI does not validate an application where the incorrect amount has been paid. The applicant will be required to pay the shortfall within the timeframe specified in the payment request.

Overpayment does not prevent an application from being processed, but it does not guarantee an immediate refund. Refunds for overpayment are governed by specific Home Office rules and are not automatic in all cases, particularly where visa lengths change or leave is granted for a shorter period than requested.

From an employer perspective, relying on refunds to correct IHS errors is not a safe compliance strategy. Delays in refund processing do not mitigate the operational impact of an invalid or delayed application.

3. How do IHS errors create right to work risk?

Right to work risk arises where an application intended to extend or vary a worker’s immigration permission is not validly made. If the Immigration Health Surcharge is unpaid or underpaid, statutory protection does not arise because the application is not treated as valid.

In these circumstances, the worker’s existing permission will expire as scheduled, even if an application has been submitted. If the employer continues to employ the individual after their permission has expired, this may amount to illegal working.

For sponsor licence holders, the risk is compounded by reporting and record-keeping duties. UKVI expects sponsors to understand whether an application has been validly submitted and to take appropriate action where a worker’s status is no longer lawful.

4. What are the sponsorship and enforcement consequences?

Errors relating to the Immigration Health Surcharge can come to light during sponsor compliance audits, particularly where there is a pattern of administrative failure. UKVI does not assess sponsorship compliance in isolation. Failures in visa administration, including IHS errors, are often treated as indicators of weak HR systems and inadequate immigration control.

Consequences can include:

• increased scrutiny during compliance audits
• mandatory action plans
• sponsor licence downgrading, suspension or revocation in serious cases

Even a single incident can be relevant where it results in unlawful working or significant disruption to sponsored roles.

Section E: How does the Immigration Health Surcharge affect NHS access, curtailment and visa duration?

Employers often assume that payment of the Immigration Health Surcharge guarantees comprehensive healthcare access for sponsored workers throughout their time in the UK. That assumption is inaccurate and can lead to incorrect information being passed to employees, creating welfare issues and reputational risk for the business.

1. What access to NHS services does the Immigration Health Surcharge provide?

Payment of the Immigration Health Surcharge allows the visa holder to access NHS services during the period in which they hold valid immigration permission, broadly on the same basis as ordinarily resident patients, subject to NHS charging regulations.

Payment of the surcharge does not create ordinary residence for NHS purposes. Certain services remain chargeable, including prescriptions, dental treatment and optical services, in line with rules that also apply to UK residents.

For employers, this distinction matters because sponsored workers may assume that paying the surcharge provides comprehensive or unrestricted healthcare access. Employers should avoid giving assurances that go beyond what the law provides.

2. What happens if a visa is curtailed or ends early?

If a sponsored worker’s visa is curtailed or otherwise ends before its original expiry date, entitlement to NHS services linked to the Immigration Health Surcharge does not continue automatically. NHS chargeability is determined by lawful immigration status, not by whether the surcharge was paid in advance.

Once a worker no longer holds valid leave, they may become chargeable for NHS services, subject to statutory exemptions and overseas visitor charging regulations. This often comes as a surprise to individuals who believe that prepayment of the surcharge guarantees access regardless of immigration status.

From an employer perspective, early termination of employment, sponsor reporting action or curtailment can therefore have welfare and employee relations implications, particularly where workers remain in the UK pending departure or a new application.

3. How does the Immigration Health Surcharge interact with visa extensions and settlement?

The Immigration Health Surcharge is payable again where a worker applies to extend their visa or switch into another temporary immigration category, unless a specific exemption applies. Payment made for a previous grant of limited leave does not carry over into a new application.

Where a worker applies for and is granted indefinite leave to remain, no Immigration Health Surcharge is payable at the settlement stage. Grant of settlement does not in itself create an entitlement to a refund of Immigration Health Surcharge paid in respect of an earlier period of limited leave.

Employers should therefore not assume that proximity to settlement reduces surcharge exposure. Each application for limited leave is assessed separately, and the surcharge is recalculated each time unless the route itself is exempt.

4. Employer risks arising from misunderstanding NHS access

Misunderstanding the scope and limits of the Immigration Health Surcharge can lead employers to provide incorrect or over-reassuring information to sponsored workers during onboarding or relocation. This can damage trust and expose the business to complaints or reputational harm.

More seriously, confusion around the link between NHS access and lawful immigration status can mask underlying right to work risk. Employers who fail to recognise that healthcare entitlement falls away with loss of leave may also fail to identify that a worker’s immigration permission has ended.

Section F: Summary

The Immigration Health Surcharge is a core component of the UK immigration system and a decisive factor in whether a visa application is treated as valid. While the surcharge is paid by individual applicants, errors in assessment or payment frequently create operational and compliance risk for employers. Costs can be substantial when applied across multi-year visas and dependants, and misunderstandings around exemptions, refunds and NHS access are common. For sponsor licence holders, IHS failures can delay recruitment, undermine right to work compliance and attract Home Office scrutiny. A controlled, rules-based approach to IHS management is therefore a practical necessity, not an administrative detail.

Section G: Need assistance?

If you are an employer, sponsor licence holder or HR team managing visa applications, Immigration Health Surcharge errors can quickly translate into delayed start dates, right to work exposure and wider compliance risk. Taking advice before applications are submitted is often far more effective than trying to resolve issues after payment deadlines are missed. For practical, employer-focused support on Immigration Health Surcharge liability, exemptions, refunds and sponsorship risk, specialist immigration advice can help you protect both your workforce and your sponsor licence.

Section H: Immigration Health Surcharge FAQs

What is the Immigration Health Surcharge?

The Immigration Health Surcharge is an upfront charge paid as part of most UK visa and immigration applications for temporary permission to enter or remain in the UK. Payment of the surcharge is a condition of a valid application unless a specific exemption applies. If the surcharge is unpaid or paid incorrectly, the application will not be granted.

Who has to pay the Immigration Health Surcharge?

The legal obligation to pay the Immigration Health Surcharge rests with the visa applicant. Most people applying for temporary permission to work, study or join family in the UK are required to pay it, including dependants, unless they fall within a defined exemption. Employers are not legally required to pay the surcharge, but payment errors can still create compliance and right to work risk for the business.

How much is the Immigration Health Surcharge?

The standard annual rate of the Immigration Health Surcharge is £1,035 per person. A reduced annual rate of £776 applies to students, their dependants, Youth Mobility Scheme visa holders and children under 18 at the date of application. The surcharge is calculated for the full period of leave applied for and paid in full when the application is submitted.

Do children and dependants have to pay the Immigration Health Surcharge?

Dependants are assessed individually and are generally required to pay the Immigration Health Surcharge unless an exemption applies. Adult dependants usually pay the same rate as the main applicant. Child dependants are charged at the reduced child rate. Where the main applicant is a student, student dependants are charged at the student rate.

Are any applicants exempt from paying the Immigration Health Surcharge?

Some applicants are exempt from the Immigration Health Surcharge. This includes applicants under the Health and Care Worker route and their dependants, applicants applying for indefinite leave to remain and certain humanitarian and human rights categories. Exemptions are tightly defined and should not be assumed to apply unless the application clearly falls within the relevant category.

Is the Immigration Health Surcharge the same as NHS charges?

The Immigration Health Surcharge is not the same as NHS charges. Paying the surcharge allows access to NHS services while the individual holds valid immigration permission, broadly on the same basis as ordinarily resident patients. It does not create ordinary residence and does not remove all NHS charges, such as prescriptions, dental treatment or optical services.

Do UK visa holders need private health insurance?

Paying the Immigration Health Surcharge gives visa holders access to the National Health Service during the period of valid immigration permission, broadly on the same basis as UK residents and subject to standard NHS charging rules. There is no mandatory requirement for visa holders to take out private medical insurance, no requirement to provide proof of insurance at the application stage and no obligation on employers to arrange health cover as a condition of the visa. Some employers choose to offer private medical insurance as an employment benefit, but this sits outside the immigration system and has no bearing on visa eligibility.

What happens if the Immigration Health Surcharge is not paid or is paid incorrectly?

If the Immigration Health Surcharge is unpaid or underpaid, UK Visas and Immigration will usually contact the applicant and request payment within a short deadline. If payment is not made within that timeframe, the application will be turned down. Where this occurs during an extension or change of employment application, the individual may lose lawful status, creating right to work risk.

Is there a waiver for the Immigration Health Surcharge?

No. There is no general Immigration Health Surcharge waiver. The surcharge is mandatory in most cases and must be paid in full upfront unless the applicant qualifies for a Home Office fee waiver.

Is the Immigration Health Surcharge refundable if a visa is refused?

Where a visa application is refused, withdrawn or rejected before a visa is granted, the Immigration Health Surcharge is normally refunded automatically. Refunds follow Home Office rules and are not always immediate, particularly where an appeal or administrative review is pursued.

Is the Immigration Health Surcharge refunded if a visa ends early or employment finishes?

No. Leaving employment early, changing sponsor or leaving the UK before a visa expires does not in itself create a refund entitlement. Refunds depend on immigration outcomes, not employment events. In limited cases, refunds may arise only where the surcharge has been paid twice for overlapping periods of leave.

Can the Immigration Health Surcharge be waived for a partner visa or family application?

Only where a successful Home Office fee waiver is granted. Fee waivers are available for certain partner and family applications where the applicant can show that paying the application fee and Immigration Health Surcharge would render them destitute, breach their human rights or involve exceptional circumstances. Low income or lack of employer support alone is not sufficient.

Does paying the Immigration Health Surcharge guarantee NHS access for the full visa period?

Access to NHS services depends on holding valid immigration permission, not simply on having paid the surcharge. If a visa is curtailed or expires, NHS chargeability may apply even though the Immigration Health Surcharge was paid in advance.

Is the Immigration Health Surcharge payable again when a visa is extended?

Each new grant of limited leave attracts a fresh Immigration Health Surcharge calculation unless an exemption applies. Payment made for a previous grant of limited leave does not carry over into a new application.

Do employers have to pay the Immigration Health Surcharge?

There is no legal requirement for employers to pay the Immigration Health Surcharge. The obligation rests with the applicant. Many employers choose to cover all or part of the cost as part of a relocation or sponsorship package, but from a compliance perspective the key issue is ensuring the surcharge is paid correctly and on time.

Section I: Glossary

Section J: Additional resources & links