Immigration Health Surcharge

The Immigration Health Surcharge (IHS) applies to most non-EEA/non-Swiss nationals applying for a visa or leave to remain for more than six months. From January 2024, the adult rate is £1,035 per year; students and those under 18 pay £776 per year. The total is calculated on the full length of leave granted and must be paid in full when applying — it is not refundable if the visa application is refused. IHS payers can use the NHS on the same basis as a UK resident and are not charged for most NHS treatment. Some categories are exempt, including dependants of armed forces personnel, asylum seekers, and those on certain humanitarian leave routes. There is no legal duty on a sponsor to pay the surcharge for a sponsored worker or their dependants — the applicant is liable — although many employers agree to cover it as part of a relocation package, and if they do, that should be recorded in writing.

In practice, the surcharge is usually the largest single line in a visa budget, and families underestimate it badly because it is charged per person for the whole period of leave in one payment. Each dependant pays their own surcharge at the applicable rate. Part-years are rounded, and where leave is granted for six months plus a fraction, the fraction is charged as a half or full year depending on its length, so a three-year visa can cost noticeably more than three times the annual figure.

Worked example: a family of four applies for a five-year route — two adults and two children under 18. The two adults pay the adult annual rate for five years each; the two children pay the reduced rate for five years each. All of it is due at the point of application, on top of the visa fees themselves, and none of it is refunded if the application is later refused on eligibility grounds. Only where an application is withdrawn before a decision, or where less leave is granted than applied for, is a partial refund issued automatically.

The misconceptions are worth naming. Paying the surcharge does not make NHS treatment universally free — prescription charges, dental charges and optical charges still apply in England exactly as they do for any resident. It does not cover assisted conception services in every area, and it gives no entitlement to treatment abroad. It is also separate from the visa fee and from the financial requirement evidence, so budgeting for one and not the others is a common cause of applications stalling.

The surcharge is paid alongside applications on routes such as the Skilled Worker visa, sits within the points-based system, and proof of status now comes through an eVisa rather than a biometric residence permit. Read our guide to the Immigration Health Surcharge and dependant visas before you budget for a family application.