Immigration Health Surcharge Explained

The Immigration Health Surcharge must be paid when submitting most visa applications for a stay of more than six months. It is paid through the IHS online service at immigration-health-surcharge.service.gov.uk, which generates a reference number that is entered into the visa application form.

The IHS is calculated based on the length of the visa applied for. For example, a Skilled Worker Visa for five years currently costs £1,035 × 5 = £5,175 for an adult applicant. Dependants must also each pay the IHS in full. For a family of two adults and two children applying for five-year visas, the total IHS cost would be substantial — over £14,000 at current rates.

The IHS is separate from the visa application fee and is in addition to it. Both must be paid before the application is processed. The IHS fee is set by the government and has increased significantly in recent years — always check the current rate before calculating your total costs.

Several categories of migrants are exempt from the IHS:

• Health and Care Worker Visa holders and their dependants;
• Global Talent Visa holders and their dependants;
• Victims of domestic violence or modern slavery applying under dedicated routes;
• Those on certain visitor visas (short stays under 6 months do not require the IHS);
• Diplomats and their households;
• EU Settlement Scheme holders (who have digital status rather than a visa);
• Those on the Afghan Relocations and Assistance Policy (ARAP) and similar humanitarian routes.

If you are in an exempt category, you should not pay the IHS — paying it incorrectly is difficult to reverse during the application process. Check carefully whether an exemption applies before proceeding.

Paying the IHS entitles you to use the NHS in broadly the same way as a UK resident — including GP registration, hospital treatment, mental health services, and prescriptions (prescription charges apply in England). However, it does not entitle you to treatment that is specifically excluded or charged to overseas visitors, such as certain fertility treatments.

A partial refund of the IHS may be available if your visa application is refused, if you leave the UK significantly earlier than the visa expiry, or if you are granted ILR or citizenship before the visa expires. Refund requests are made through the IHS service. The amount refunded is calculated on a pro-rata basis for complete remaining months.

Employers cannot legally deduct the IHS from an employee's salary without agreement, and some employers voluntarily cover the IHS as part of a relocation package — it is worth negotiating this when accepting a sponsored job offer.

The Immigration Health Surcharge has been increased substantially in recent years as part of successive government policies to recover the cost of NHS care provided to migrants. The current rate of £1,035 per year for adults (£776 for students and children) represents a significant cost for families applying for multi-year visas. The Migration Advisory Committee and independent researchers have noted that the total IHS paid by a typical Skilled Worker family over a five-year visa period can exceed £10,000–£15,000, raising questions about affordability, particularly for lower-paid sponsored workers. The Government has maintained the surcharge on the basis that it funds the cost of NHS treatment and supports the sustainability of the health service.

In addition to the named exemptions listed above (Health and Care Worker Visa, Global Talent, diplomats, domestic violence victims), several other categories qualify for exemption or reduced charges. Afghan nationals arriving under the Afghan Relocations and Assistance Policy (ARAP), the Afghan Citizens Resettlement Scheme (ACRS), or as locally employed civilians are exempt. Ukrainian nationals arriving under the Homes for Ukraine or Ukraine Family Scheme have their IHS waived for the first twelve months of their leave, with the surcharge applying for extension periods. Applicants under the Stateless Person route and some other protection-based routes may also be exempt or waived — the full exemption list is set out in the Immigration (Health Charge) Order 2015 as amended.

The Illegal Migration Act 2023 and the Safety of Rwanda Act 2024 made significant changes to the UK asylum and irregular migration landscape but did not directly alter the IHS exemption categories for those on lawful visa routes. However, the 2023 Act created a new category of persons who are subject to the duty to remove and who are not entitled to be in the UK on a lawful basis — people in this category do not have immigration leave and are therefore not subject to the IHS (as the IHS applies at the point of leave grant). The implementation of the Rwanda scheme was suspended following legal challenges and the change of Government in 2024, and as of 2026 the policy has been formally discontinued. People who were detained under the 2023 Act's "Rwanda cohort" provisions have in most cases been released on bail and are subject to reporting conditions pending further decision-making by the Home Office on their cases.