Working in the UK

How does Immigration Health Surcharge work

Understanding how the Immigration Health Surcharge (IHS) works is crucial for individuals planning to immigrate to the United Kingdom. The IHS is a fee imposed on most non-EEA nationals seeking to live in the UK for more than six months. It grants access to the National Health Service (NHS) and helps cover the cost of healthcare services during their stay. 

In this article, we will delve into the details of the Immigration Health Surcharge, explaining its purpose, eligibility criteria, payment process, and the benefits it provides. By understanding the IHS comprehensively, you can navigate the immigration process with clarity and ensure that your healthcare needs are appropriately covered while residing in the United Kingdom.

health surcharge

Table of Contents

How much is the Immigration Health Surcharge? 

From 27th October 2020, the immigration health surcharge costs:

  • £624 per year primary rate for visa and immigration applications
  • £470 per year discounted rate for student visa holders, those on the Youth Mobility Scheme and children under the age of 18

Dependents will usually pay the same amount as the main visa applicant.

The exact amount you have to pay depends on how much leave you are granted.

You pay half of the yearly amount if your application includes part of a year under six months.

You must pay for the entire year if your application covers a portion of a year exceeding six months.

Failure to pay the healthcare surcharge will result in the denial of your visa or immigration application, or your application will experience delays if the correct amount is not paid.

How does the Immigration Health Surcharge work?

If you have paid the surcharge or were exempt from paying it, and your visa allows you to be here for more than six months, you will be entitled to free NHS hospital treatment in England on the same basis as an ordinarily resident person. This will apply from the date your visa is granted until it expires.

However, if your visa is curtailed or ended earlier than planned by the Home Office, you will become chargeable for any further NHS hospital treatment from that date on, even if you have paid the surcharge. You will also be charged for any non-exempt treatment you received before the start date of your visa.

When requesting a visa extension, there may be an additional fee involved. However, if you successfully apply for and receive indefinite leave to remain, you will be exempt from this surcharge.

The surcharge payment grants you access to the services provided by the NHS. It is important to note that paying the surcharge does not guarantee faster treatment. Medical professionals will evaluate your condition’s urgency similarly to those of ordinarily resident patients. If needed, you will be placed on a waiting list accordingly.

Do you have to pay the Immigration Health Surcharge?

For visa applications made outside the UK, you have to pay if you:

  • Are a national of a country outside the European Economic Area.
  • Are you applying for a visa to work, study or join your family in the UK for more than six months (but you’re not applying to remain in the UK permanently)?
  • Have applied and paid your visa fee on or after 6th April 2015

For immigration applications made from within the UK, you have to pay if you:

  • Are a national of a country outside the EEA.
  • Are making an immigration application for any length of time (but you are not applying to remain in the UK permanently)?
  • Have applied and paid your application fee on or after 6th April 2015.

The IHS will be extended to future EEA temporary migrants coming to the UK after 1st January 2021.

When you need an IHS reference number

To obtain an immigration health surcharge reference number, you are still required to utilize the service. However, payment is not necessary if you fall into one of the following categories:

  1. You are a child under 18 who has been placed under the care of a local authority.
  2. You are a relevant civilian employee working for NATO or the Australian Department of Defence in the UK or depend on such an employee.

Since April 2017, the IHS has applied to all those applying for a visa for more than six months under the Tier 2 (ICT) category (i.e. the previous exemption no longer applies).

If you fall under one of these exemptions, the IHS online system will recognize your status and that you are exempt from the fee and will issue your healthcare surcharge reference number that you need for your application.

You can use the National Health Service (NHS) even if you’re exempt from paying.

When you don’t have to pay or get an IHS reference number

You are exempt from obtaining an immigration health surcharge reference number or making healthcare surcharge payments if:

  • You are applying for a visitor visa; instead, you will be responsible for paying for any healthcare services you receive through the NHS.
  • You are applying for indefinite leave to remain.
  • You are a diplomat or a member of visiting armed forces and are not subject to immigration control.
  • You are a dependent of a member of the UK’s armed forces.
  • You are a dependent of a member of another country’s armed forces who is exempt from immigration control.
  • You are an EU citizen or a family member exercising European Union treaty rights or making applications under the EEA Regulations or EU settlement scheme.
  • You are a British Overseas Territory citizen residing in the Falkland Islands.
  • You are an asylum seeker or applying for humanitarian protection, or you are the dependent of such an individual.
  • You are a domestic worker identified as a victim of slavery or human trafficking.
  • You are applying for discretionary leave to remain in the UK as someone identified as a victim of slavery or human trafficking, or you are the dependent of such an individual.
  • The Home Office’s domestic violence concession applies to you, or you are the dependent of an individual to whom it applies.
  • Being forced to leave the UK would infringe upon your rights under Article 3 of the European Convention of Human Rights, or you are the dependent of an individual to whom it applies.

You can use the NHS if you are exempt from paying – except if you are on a visitor visa, in which case you will have to pay for any care you get through the NHS when you use it.

You must pay the healthcare surcharge if you applied for indefinite leave to remain but are only given limited leave. UK Visas and Immigration will tell you if this happens.

When should the Immigration Health Surcharge be paid? 

The payment for the Immigration Health Surcharge, for both yourself and any dependents, must be made before submitting or sending your visa or immigration application or before booking an appointment at a premium service centre.

If you fail to pay the surcharge or an insufficient amount, UK Visas and Immigration will contact you as part of your visa or immigration application process.

If you do not pay the total amount, your visa or immigration application will be rejected within the following timeframes:

  • Within ten working days if you are inside the UK.
  • Within seven working days if you are outside the UK.

How to make the Payment for the Healthcare Surcharge 

To complete your visa or immigration application and pay the healthcare surcharge, you need to follow these five steps:

  1. Register to use the service.
  2. Answer the relevant questions to determine if you are exempt from paying the healthcare surcharge or if payment is required.
  3. If you are not exempt, make the payment online. The healthcare surcharge should be paid in the same currency as your visa application fee.
  4. You will receive an email containing an immigration health surcharge reference number. This reference number will also be displayed on the screen after you have made the payment. You must write this reference number on the cover of your visa application if you are applying online from outside the UK, on the cover sheet if applying online from within the UK, or on the application form if applying by post. Even if you are exempt from paying the healthcare surcharge, you must provide this reference number.
  5. Complete your application form and pay the required visa or immigration application fee.

Payment methods vary depending on the country:

  • If you are in Bangladesh, Myanmar, or the Democratic People’s Republic of Korea, you must pay in cash at an embassy or visa application centre.
  • If you are in Nepal, you can pay in cash or use the online service.

Information needed for making the Payment 

You will be asked to provide the following information:

  • Your name
  • Your nationality
  • The type of visa you are applying for
  • Your passport or travel document number
  • Date of birth
  • An email address
  • The visa application centre if you are applying from overseas
  • Your course dates if you are applying as a student

Additionally, you will need the exact details for the following individuals:

  • Anyone applying for a visa or other immigration application with you, such as a dependent.
  • Any person you are applying to join or remain with who is already in the UK. (You do not need to provide this person’s details if they are a UK or EEA citizen).
  • If you are joining someone in the UK, you will also need their leave expiry date or immigration health surcharge reference number, if applicable.

IHS Refund Rules

The Immigration Health Surcharge (IHS) is a fee levied on visa applicants seeking leave to enter or remain in the UK. In this way, visa holders will have free access to NHS services.

As a successful visa applicant, you can start using these services once you have paid the IHS or are exempt from paying it. If your visa application is unsuccessful or withdrawn, you will be entitled to an IHS refund. You may also be reimbursed in various other instances.

Below we look at the IHS refund and IHS reimbursement rules in more detail.

IHS Refund and Reimbursement Rules

When applying for a visa to the UK to live or work, you might need to pay a healthcare surcharge. This is called the Immigration Health Surcharge (IHS). Whether or not you need to pay, and how much, will depend on the type of immigration status that you are applying for.

You will usually need to pay the IHS if you are applying for a visa or immigration application outside the UK for more than six months or if you are applying inside the UK for any length of time. Where the surcharge applies, the current rates are:

  • £470 per year for a student or Youth Mobility Scheme visa.
  • £470 per year for those under 18s.
  • £624 per year for all other applications.


You will pay for a whole year if your application includes part of a year over six months but just half the yearly amount for any part less than six months. Any dependants aged 18 or over usually need to pay the same amount as you. In either case, payment must be made when you submit your application.

The exact surcharge you will have to pay will depend on how much leave is granted by UK Visas and Immigration (UKVI). You'll automatically get a partial IHS refund if you paid for more years than granted leave or any dependants on your application are refused leave. You will receive a full IHS refund if:

  • you paid the surcharge twice
  • your visa application is refused
  • you withdraw your application before a decision has been made.


If you're entitled to a full or partial refund for any of these reasons, you will not have to do anything to get it. It will automatically be paid to the account or card you paid with. You will usually get your refund within six weeks of getting a decision on your application. However, it can take longer if you appeal or seek an administrative review after refusing your visa application. If any appeal or administrative review is successful, but you've already received your IHS refund, you must repay the surcharge based on your successful application.

If you have not received your IHS refund within six weeks of any decision on your visa application, appeal or administrative review, you should contact UKVI. You will not receive a refund if your visa application is successful but you decide not to come to the UK or if either you leave the UK or are told to leave before your visa expires.

You may also be eligible for an IHS refund if an EU country pays for your healthcare, you're a qualified healthcare professional, or you work in a healthcare setting.

Suppose you're an EU citizen or a citizen of Norway, Iceland, Liechtenstein or Switzerland, and you move to the UK to work, study or settle. In that case, you will be subject to immigration control under the UK's new points-based system. This means you will need permission from UKVI to be lawfully in the UK. You may also need to pay the immigration health surcharge at the time of your visa application if you're coming to the UK for more than six months.

The total surcharge amount will need to be paid upfront for the duration of your visa. If, however, your healthcare is paid for by an EU member state, and you have a UK visa that started on or after 1st January 2021, you may be eligible for a full or partial IHS refund, provided you hold an S1 certificate registered with the NHS Business Services Authority.

You can also apply for an IHS refund if you were granted a visa on or after 1st January 2021 as a full-time student in UK higher education. You must not work in the UK and hold a European Healthcare Insurance Card (EHIC) issued in an EU country to be eligible.

Applications for IHS refund open from 1st January 2022, although your refund will be backdated to include any payments made for a visa starting on or after 1st January 2021. The amount you will be refunded will depend on the date your S1 certificate or EHIC runs out.

Under the new Health and Care Worker visa, you will be exempt from paying the immigration health surcharge. If, however, you have come to the UK on a different visa but go on to meet the eligibility criteria for the exemption, you will be reimbursed for any surcharge paid in respect of any 6-month period from 31st March 2020 where you're working in a relevant health or social care context. The backdated exemption also extends to eligible family members.

You will get a full or partial refund depending on when you paid the surcharge. You will be entitled to a full refund if you paid on or after 31st March 2020. You'd get a partial refund if you paid before 31st March 2020. You'll be reimbursed for any 6-month period that your IHS payment covered after this date you were working in a qualifying role.

Depending on your visa and job role, there are different ways to get your money back if you've paid the IHS. Suppose you hold a visa under the Tier 5 Government Authorised Exchange Medical Training Initiative or Tier 5 Medical Training Initiative. In that case, the Academy of Medical Royal Colleges will request a refund on your behalf and be processed by UKVI. You will be notified when a refund payment has been made.

If you hold a Tier 2 (General) visa and are a medical professional, you should get an automatic refund again. If you do not hold a Tier 2 (General) visa or work in another health or care role, you may be able to apply for an IHS reimbursement instead.

If you are already in the UK on a Tier 2 (General) visa, working in an eligible health or social care occupation, you should benefit from a backdated IHS exemption. Eligible job roles include nurses, doctors, and other qualified healthcare professionals. If you're eligible, you will be refunded for any time remaining on your visa after 31st March 2020. This will automatically be paid to the account or card you used to pay the surcharge.

If you have yet to receive your IHS refunds and think you qualify, email the IHS refunds team at: [email protected]. In your email, you should include your name, your sponsor's name, your Certificate of Sponsorship (CoS) number, your IHS number and the date you paid the surcharge. You will usually get a reply within six weeks, and any refund will be sent back to the account or card you paid with.

You can apply online for an IHS reimbursement if either you're a medical professional but not eligible for an automatic refund, for example, where you do not hold a Tier 2 (General) visa, or you work in another role in a healthcare setting. A healthcare setting includes hospitals, GP practices, care homes and community healthcare facilities.

To be eligible for an IHS reimbursement, you must have paid the surcharge and:

  • Work for an eligible organization, for example, the NHS or the Care Quality Commission.
  • Be working or have worked in health and social care for at least six months, and
  • Have worked 16 hours or more a week in that role.


Your job can be out of frontline care as long as it provides a health or social care delivery service. This can include providing administrative support and management, such as a receptionist in an NHS or care setting, or even a role in support facilities management, such as cleaning or catering. The qualifying period of 6 months can include paid leave, such as maternity or statutory sick leave. However, you will not qualify if you had unpaid leave or were unemployed for more than 28 days during the last six months.

You can apply for an IHS reimbursement for a single period of 6 months at a time, where the money is paid in 6-month instalments, in arrears, covering the period from 31st March 2020 onwards. This means that you must continue applying every six months to claim for additional periods where you qualify under the rules.

An application under the IHS reimbursement scheme must be made online on the UK government website. To apply, you will need your IHS number, your National Insurance number, your email address, the name of your employer and scanned or screenshot copies of your payslips for the 6-month period you're claiming. You will also need their IHS number if you apply for your dependants.

Your application will be processed by the NHS Business Services Authority (NHSBSA). If the claim falls within the scheme rules, your approved claim will be passed to UKVI for a refund to be issued within six weeks using the original payment method.

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One comment

  1. Wow! Thanks for sharing this valuable blog, these information is quite detailed and needful to a Nigerian like me looking forward to coming over to the UK on a visiting visa. I know about the IHS now!

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