Immigration Health Surcharge (IHS): 2024–2025 Guide for UK Visa Applicants
If you are applying for a UK visa, the immigration health surcharge is one of the largest upfront costs you will face. This guide covers current rates, who pays, exemptions, refunds, and what NHS access you actually receive.
Key Takeaways
The immigration health surcharge is a mandatory fee most migrants pay when applying for UK visas longer than six months, on top of standard visa application fees.
From 6 February 2024, the main IHS rate is £1,035 per adult per year. The discounted rate for children, students, and Youth Mobility Scheme applicants is £776 per year.
Paying the surcharge grants access to the National Health Service on broadly the same basis as UK residents, but additional charges for prescriptions in England, dental care, and eye tests still apply.
Certain health and care worker visa holders are exempt. Others, including dependants of EU citizens with specific rights and those granted indefinite leave, may also avoid the fee.
If your visa application is refused or you overpay, you can receive a refund, typically processed within 6 weeks.
What Is the Immigration Health Surcharge?
The immigration health surcharge was introduced in April 2015 under the Immigration Act 2014 so that temporary migrants contribute to the cost of the National Health Service. The initial IHS fee was £200 per year in 2015. Since introduction, it has raised £6.9 billion for healthcare budgets across the UK, according to the House of Commons Library.
The health charge is separate from visa application fees and is payable for each year of immigration permission requested. Once paid and the visa is granted, applicants and eligible dependants can access NHS healthcare services in a similar way to permanent residents. The terms "immigration health surcharge," "IHS fee," "health surcharge," and "health charge" are used interchangeably by the Home Office. IHS funds are distributed among the devolved health administrations of England, Scotland, Wales, and Northern Ireland; they also contribute to general UK government funds.
Current IHS Fee Rates and How They Are Calculated
On 6 February 2024, the IHS fee increased from £624 per year (the rate set in 2020) to £1,035 per year for most applicants. The new fees were enacted through the Immigration (Health Charge) (Amendment) Order 2024. Rates may change again, so always check GOV.UK before paying.
Category | Annual rate (from 6 Feb 2024) | Previous rate |
|---|---|---|
Most adult applicants (skilled worker, family route, etc.) | £1,035 | £624 |
Children under 18, students, student dependants, Youth Mobility Scheme | £776 | £470 |
Visa applications for less than 6 months incur half the annual rate. Any period exceeding six months, even by a single day, triggers a whole year charge. The total is calculated in six-month blocks, rounded up.
Worked examples:
A 3-year skilled worker visa for one adult: 3 × £1,035 = £3,105.
A family of four (two adults, two children under 18) on a 5-year family route: adults 2 × (5 × £1,035) = £10,350; children 2 × (5 × £776) = £7,760; total IHS = £18,110. The surcharge increases overall relocation costs for families by a substantial amount at this scale.
Use the official online IHS calculator before paying to confirm your exact sum, especially for routes that can lead to indefinite leave or for unusual grant periods.
Who Has to Pay the IHS Fee?
Most non-British, non-Irish nationals subject to immigration control who apply for UK entry clearance or further leave to remain for more than 6 months must pay the IHS fee upfront with the visa application, whether applying from overseas or within the UK.
Routes that typically attract the charge include:
Skilled worker visas, family visas (spouses, partners, children), student visas
Youth Mobility Scheme, Global Business Mobility, most temporary work visas exceeding 6 months
Extensions or switches between routes within the UK; each new period of leave requires a fresh IHS payment
Holding private medical insurance does not remove the obligation. Dependants must each pay their own fee based on their age and immigration category. Employers can choose to pay the IHS fee for employees on sponsorship; many do so to attract workers, though clawback clauses are common. Financial planning should account for multiple IHS payments before settlement.
Who Is Exempt from the Immigration Health Surcharge?
A limited number of visa types carry exemptions from the IHS, though exempt migrants still access NHS services under ordinary NHS charging rules. The following categories summarise the main exemptions:
Applicants under the health and care worker visa (care worker visa holders working in the care sector)
Asylum seekers, refugees, victims of modern slavery or trafficking, and those on protection routes under the European Convention on Human Rights
Diplomats and visiting armed forces not subject to immigration control
EU, EEA, and Swiss nationals with status under the EU Settlement Scheme or holding a frontier worker permit
Some workers in eligible NHS and social care roles who paid the health surcharge on a different visa can later claim reimbursement. This is different from being exempt at the point of application; they must meet certain criteria and apply through the NHS Business Services Authority. Always check the latest exemption list on GOV.UK or seek professional advice before assuming you do not need to pay.
How and When to Pay the IHS Fee
IHS fees must be paid upfront with the visa application. The immigration application cannot proceed without a confirmed payment or exemption.
The typical process:
Complete the online visa form.
You are redirected to the immigration health surcharge service.
Enter details of all applicants, review the calculated amount, and pay by debit or credit card.
Receive an IHS reference number; include this with your application and at your biometrics appointment.
For postal or paper applications (where still allowed), you must still pay the surcharge online first and attach the IHS reference to your documents. If the Home Office later determines the wrong amount was paid (for example, the approved period of leave is less time than expected), they will contact you for additional payment or issue a partial refund. Avoid last-minute submissions; currency limits, card blocks, or bank security checks can delay payment and therefore delay your whole application.
What NHS Healthcare Services Does the IHS Cover?
Paying the IHS and obtaining a valid visa grants access to the National Health Service on broadly the same basis as a resident who pays UK taxes. Visa holders can use NHS services on the same basis as UK residents after paying the surcharge, but healthcare is not "totally free."
Generally covered: GP registration and consultations, hospital treatment through the NHS, emergency care, maternity services, mental health services.
Still charged separately: Prescriptions in England, dental treatment, eye tests, certain elective procedures. Rules differ across England, Scotland, Wales, Northern Ireland, and the Channel Islands.
Entitlement begins once the applicant has both paid the IHS and been granted leave. Reviewing your immigration status is important: once leave expires or is curtailed, free access to routine NHS treatment may end. Private health insurance remains optional and does not reduce or replace the IHS.
IHS Refunds, Reimbursements and Common Pitfalls
The IHS fee can be refunded or reimbursed under strict rules. You cannot claim a refund simply because you did not use NHS services.
Standard refund situations:
Your visa application is refused, rejected, or withdrawn before a decision
You receive less time than applied for (partial refund for the unused period)
Duplicate or overpayment made in error
Refunds are automatically issued to the original payment method, generally processed within 6 weeks. Keep your IHS reference number and payment records.
Health and care workers who paid the surcharge may claim a refund under specific criteria after working in approved health or social care roles for a qualifying period. You cannot claim a refund if you work in health and care without meeting those criteria. People who later obtain indefinite leave to remain do not normally receive a refund for prior periods.
Common mistakes to avoid: entering incorrect passport numbers or dates, mis-stating visa duration, ignoring Home Office emails requesting additional IHS, or assuming private medical cover allows you to skip payment. If a refund is expected but not received, follow the official GOV.UK process to query it rather than submitting a new application.
Frequently Asked Questions
Do I still pay the Immigration Health Surcharge if I am coming to the UK for less than 6 months?
Visitors arriving for under 6 months usually do not pay the IHS. However, they may be charged for most NHS treatment apart from emergency care. Some short-term work routes have different rules, so check the specific visa guidance before you decide.
Can my employer pay the IHS fee for me if I am a Skilled Worker?
Employers are not legally required to cover the IHS, but many sponsors choose to pay some or all of it to assist with recruitment. Where an employer pays the health surcharge on your behalf, they may include clawback clauses requiring repayment if you leave within a set period. Review these terms before signing your sponsorship or employment contract.
What happens to my IHS coverage if I switch to indefinite leave to remain?
Once granted indefinite leave to remain, you no longer pay the IHS for future applications. Your right to NHS treatment is then based on ordinary residence. IHS payments made for past periods are not refunded when you become settled.
If my dependants join me later, do they pay a different IHS amount?
Dependants pay the IHS at the rate for their own age and visa route. Their fee may be pro-rated so their leave expiry aligns with the main applicant, which can mean fewer years of IHS than the main applicant paid, though the annual rate per category stays the same.
Can I choose not to register with a GP and just use emergency services after paying the IHS?
Emergency treatment is available regardless, but relying only on emergency care is risky and can still generate follow-up charges depending on your status and treatment. Register with a GP soon after arrival to benefit from primary care, vaccinations, and specialist referrals.