The Immigration Health Surcharge: who pays, who is exempt and when refunds arise

The Immigration Health Surcharge, usually called the IHS, is paid as part of many UK immigration applications. It allows the person to access NHS services during the period of immigration permission, although some NHS services can still carry separate charges.

Most applicants seeking temporary immigration permission for more than six months from outside the UK, or for any period from inside the UK, must pay unless an exemption applies. The position depends on the route being applied for.

Exemptions include applications for settlement, the EU Settlement Scheme and certain humanitarian or protected categories. Standard Visitors and people applying from outside the UK for permission of six months or less do not pay the surcharge, although they may be charged for NHS treatment when they use it.

An applicant who qualifies for the Health and Care Worker visa, and qualifying dependants applying under that route, does not pay the IHS. Eligibility depends on meeting the requirements of that specific route, not simply working somewhere in the health or care sector.

Children are not generally exempt merely because they are under 18. Where the route is chargeable, a child normally pays at the applicable rate unless a separate exemption applies.

No. An applicant who is required to pay the IHS must normally pay even if they have private medical insurance and do not expect to use the NHS.

A person can generally use NHS services from the start date of their visa once the required surcharge has been paid. Charges can still apply for services such as prescriptions, dental treatment, eye tests and assisted conception.

The surcharge is calculated and paid during the online immigration application process. The amount depends on the route, applicant's age and length of permission. UKU does not embed the amount in evergreen website copy because the charge can change.

A full or partial refund can arise in circumstances including refusal, withdrawal before decision, duplicate payment, a shorter grant than paid for or overlapping periods of paid surcharge. A refund is not normally given simply because the person did not use the NHS.