Health Surcharge for UK Visa: What It Covers, Who Must Pay & How to Get a Refund

If you’re applying for a UK visa right now, the chances are the Immigration Health Surcharge has already caught your eye — usually because of the size of the bill. I’ve advised on UK immigration matters for more than a decade, and the IHS is, without fail, the charge that generates the most questions from clients. Not the visa fee itself. The health surcharge for UK Visa.

This guide sets out exactly what the UK Immigration Health Surcharge is, how much it costs in 2026, who has to pay it, who’s exempt, what it actually buys you in terms of NHS access, and — the part most guides skate over — how and when you can genuinely get a refund.

What Is the UK Immigration Health Surcharge (IHS)?

The Immigration Health Surcharge, usually just shortened to IHS, is a mandatory charge built into most UK visa applications. It was introduced on 6 April 2015 under the Immigration Act 2014, and the logic behind it is fairly straightforward: if you’re coming to the UK for more than six months, you contribute towards the NHS upfront, as part of your visa application, rather than through National Insurance contributions over time.

Pay it, and you get NHS treatment on broadly the same footing as a permanent UK resident. Don’t pay it — or pay the wrong amount — and your application will not be granted. There’s no discretion built in here. A caseworker cannot simply wave it through as a goodwill gesture, whatever the circumstances.

The UK Immigration Health Surcharge (IHS) sits alongside the visa application fee itself and, for sponsored workers, the Immigration Skills Charge that employers pay separately. Together, these three costs are really what push the total price of a UK visa so high — and the surcharge is very often the biggest single line item of the three.

How Much Is the Health Surcharge for UK Visa in 2026?

This is the figure everyone wants first, so here it is, straight from current Home Office rates published on gov.uk.

Applicant category	Annual IHS rate
Most adult applicants (Skilled Worker, Spouse/Partner, Global Talent, etc.)	£1,035
Students and their dependants	£776
Youth Mobility Scheme applicants	£776
Any applicant under 18 at date of application	£776
Health and Care Worker visa (main applicant and dependants)	£0 (exempt)

These rates have applied since 6 February 2024, when the surcharge rose by a fairly brutal 66% overnight. Before that it was £624. Before that, £400. When the IHS was first introduced back in 2015, it stood at just £200 a year (£150 for students). The trend, it’s fair to say, only ever moves in one direction.

How the UK Immigration Health Surcharge (IHS) Is Calculated?

• Applying from outside the UK for six months or less — no IHS payable at all.
• Applying from inside the UK for six months or less — half the yearly rate.
• Longer grants are charged in six-month blocks, and always rounded up, never down.

So a visa for 2 years and 2 months gets billed as if it were 2.5 years. Nobody rounds in the applicant’s favour here — worth remembering when you’re budgeting.

Worked Examples for UK Visa Health Surcharge

• 5-year Skilled Worker visa, standard rate: £5,175
• 3-year Student visa, student rate: £2,328
• Spouse/partner visa granted for 2 years 9 months, rounded to 3 years: £3,105 per applicant

Who Has to Pay the Immigration Health Surcharge (IHS)?

As a general rule, anyone applying for UK entry clearance or leave to remain of more than six months, on a route that isn’t specifically exempt, must pay. This covers the vast majority of applications solicitors deal with day to day, including:

• Skilled Worker visa (and other sponsored work routes)
• Student visa (what used to be called Tier 4)
• Spouse, Partner and Fiancé(e) visas
• Child and Parent routes
• Global Talent visa
• Graduate visa

Dependants aged 18 or over generally pay the same rate as the main applicant, unless they qualify independently for a different category — for example, a spouse joining someone on a Student visa would usually pay the student-linked rate.

Who Is Exempt From the UK Visa Health Surcharge?

Exemptions are set out in legislation, not left to caseworker discretion — an applicant is either exempt in law or they’re not. The main categories are:

• Health and Care Worker visa — main applicants and their dependants are entirely exempt. This is one of the more generous carve-outs and reflects the sector’s ongoing recruitment needs.
• EU Settlement Scheme (EUSS) applicants — EU, EEA and Swiss nationals whose rights are protected under the Withdrawal Agreement do not pay the IHS.
• Diplomats and international agreement cohorts — diplomatic staff and certain categories covered by treaty obligations, including some NATO and visiting forces personnel.
• Indefinite Leave to Remain and citizenship — these are not time-limited leave, so the IHS simply doesn’t apply.
• Asylum seekers and dependants
• Victims of human trafficking or modern slavery
• Children looked after by a local authority
• Ukraine Scheme applicants (Ukraine Family Scheme, Homes for Ukraine)
• Fee waiver recipients on Family, Human Rights, or Hong Kong BNO routes — provided the fee waiver was applied for and granted before the visa application was submitted, not after.

A common mistake we see: applicants submit the visa application first and only then ask about a fee waiver. By that point it’s too late — the waiver application has to come first.

What Does the Immigration Health Surcharge Actually Cover?

Once the surcharge is paid, you’re entitled to NHS treatment broadly on the same basis as a permanent UK resident. That includes:

• Registering with a GP and attending consultations
• Hospital treatment, both planned and emergency
• NHS mental health services
• Maternity care
• Ambulance services
• Prescriptions, subject to the standard NHS prescription charge (reviewed each April — check current rates with the NHS Business Services Authority)

What it doesn’t cover: NHS dental treatment (patient charges still apply), routine sight tests unless you’re otherwise entitled, most forms of IVF, and social care, which remains means-tested at local authority level. Cosmetic and elective procedures outside NHS clinical criteria are also excluded.

How to Pay the Immigration Health Surcharge (IHS) for UK Visa?

1. Start your visa application through the relevant service on gov.uk.
2. You’ll be directed automatically to the Immigration Health Charge payment portal as part of that journey.
3. Enter the dates matching the length of leave you’re applying for — this determines your IHS liability.
4. Pay online by card, in full, for the entire length of the visa. There are no instalments and no payment plans.
5. Keep your IHS reference number. You’ll need it for any refund claim, or if you later switch visa category.

If UKVI issues a separate payment request, you’ll normally have 10 working days to pay if applying from inside the UK, or 7 working days if applying from outside. Miss the deadline and the application is refused — there’s very little room to argue otherwise.

How Much Is the Health Surcharge for a UK Student Visa?

Immigration health surcharge for UK student visa applicants — including what many people still call the Tier 4 route — is charged at £776 per year. A standard three-year undergraduate course therefore comes with an IHS bill of £2,328, paid upfront alongside the visa fee. Dependants joining a student, such as a partner or child, are generally charged at the same reduced student-linked rate rather than the higher standard rate.

How Much Is the Health Surcharge for a UK Spouse Visa?

Spouse and partner visas are usually granted for an initial period of 2 years and 9 months. Because the surcharge rounds up to the nearest six-month block, that period is billed as a full 3 years — meaning £3,105 per applicant at the standard adult rate. Any dependent children under 18 would fall into the £776-a-year band instead. On top of the application fee itself, the IHS is routinely the single largest cost within a spouse visa application, and it catches a lot of families off guard when they’re budgeting.

UK Visa Health Surcharge (IHS) Refunds: When You Can Actually Get Your Money Back

Refunds exist, but they’re tightly restricted and are not based on fairness or hardship. A refund is generally available where:

• The visa application is refused, rejected, or withdrawn before a decision is made
• The IHS has been paid twice for the same period of leave, in error
• The visa is granted for a shorter period than applied for, and complete unused six-month periods remain
• You switch onto an exempt route (for example, the Health and Care Worker visa) partway through your existing leave

Refunds are not available simply because a job ends, a worker resigns or is dismissed, someone leaves the UK early, a visa is curtailed, or the applicant is later granted Indefinite Leave to Remain. This trips a lot of employers up — an early departure from the UK, on its own, does not entitle a sponsored worker to any IHS refund.

How to Apply for an IHS Refund?

1. Visit the healthcare immigration refund service on gov.uk.
2. Log into the IHC Operations portal using your original IHS reference number.
3. Complete the refund form, giving your visa reference, passport details, and the reason for the refund claim.
4. For refusals or withdrawals, refunds are usually processed automatically once 14 calendar days have passed since the refusal is recorded, typically completing within six to eight weeks.
5. For a partial refund due to a shorter grant, you’ll usually need to apply manually — the refund is calculated in complete six-month blocks and rounded down, not up.

Refunds are paid back to the original payment method. If you paid from overseas, expect the amount you receive to differ slightly from the amount charged, purely down to currency conversion and bank exchange rates on the day — this is normal and not an error on the Home Office’s part.

What Happens if You Don’t Pay UK Visa Health Surcharge — Overstaying, NHS Debt and Refusal Risk

Non-payment, or underpayment, of the IHS results in automatic refusal. There’s no partial acceptance and no way around it at the application stage.

Where someone is already in the UK and their leave lapses because an IHS-linked application is refused or incomplete, they risk becoming an overstayer. That carries its own, quite separate, set of consequences — re-entry bans, real difficulty with future applications, and in some circumstances criminal liability for overstaying.

There’s also a less obvious trap. Anyone who accesses NHS treatment without having paid the surcharge where it was required — overstayers, most obviously — can be billed directly by an NHS trust for that treatment. Unpaid NHS debt above £500 is itself a ground for refusal under the Immigration Rules on future applications. So the IHS and NHS debt rules feed into each other: pay upfront through the surcharge, or risk being billed directly later and having that debt used against you down the line.

How Surcharge Increases Affect Different Visa Routes

IHS rates aren’t set by primary legislation — they’re set by statutory instrument, under the Immigration (Health Charge) Order 2015 as amended. Practically, that means government can raise the rate without a full Act of Parliament, and history shows it does so fairly regularly: £200 in 2015, £400 in 2019, £624 from October 2020, and £1,035 from February 2024 — more than a fivefold increase in under a decade.

Because the total charge is locked in at the point of application, based on the full length of leave requested, a mid-stream rate rise doesn’t touch an existing grant. It does, however, hit you the moment you come to extend or renew — you’ll pay whatever the current rate happens to be on that later date, not the rate you paid originally. Worth factoring into any long-term visa planning, particularly for spouse and Skilled Worker routes where extensions are the norm rather than the exception.

On sponsored work routes, employers are permitted to pass the IHS cost on to the sponsored worker, unlike the Immigration Skills Charge or sponsor licence fee, which can never lawfully be recovered from the employee.

Frequently Asked Questions (FAQs)

Final Words

The Immigration Health Surcharge is one of those fees that looks like a technicality until you’re the one paying it — and then it’s very much not a technicality, it’s a genuinely large sum of money due upfront, often for a family, often alongside several other visa costs landing at once. Rates move. Exemptions are narrow and legally defined, not a matter of discretion. Refunds are available, but only in specific, fairly narrow circumstances, and the paperwork matters.

Always check the current rate on gov.uk before you apply, since fees are reviewed periodically and this article reflects the position as at mid-2026. If your situation involves dependants, a possible exemption, a refund dispute, or an NHS debt issue affecting a future application, it’s worth getting advice from a qualified immigration solicitor before you submit anything — mistakes at this stage are expensive and, in some cases, very hard to undo.

This article is provided for general information only and does not constitute formal legal advice. Immigration Rules and Home Office fees change frequently — always verify current figures on gov.uk or seek advice on your specific circumstances.