Immigration Health Surcharge (IHS): The Complete Guide to UK Visa Healthcare Fees
The £1,035 annual rate, the 6-month rounding rule that quietly adds hundreds, the 14-day top-up trap, and the NHS exemption myth that costs healthcare workers thousands.
The Immigration Health Surcharge (IHS) has risen 417% since it was introduced in 2015, from £200 per year to £1,035 per year today. For a Skilled Worker with a partner and two children on a five-year visa, the combined surcharge before submitting a single form is over £18,000. Paid in full. Upfront. No instalments.
If you are reading this at the kitchen table with a calculator and a sinking feeling in your stomach, you are not alone.
It is the single biggest upfront cost most applicants never see coming. It must be paid in full before your application moves forward.
This guide tells you exactly what you will pay for your specific visa, who is genuinely exempt, what you actually get for the money, and what to do when the portal gets it wrong.
What is the Immigration Health Surcharge, and Why Do You Have to Pay It?
The Immigration Health Surcharge, also known as the NHS surcharge, is an upfront fee added to most UK visa applications. It was introduced under Section 38 of the Immigration Act 2014 and came into effect in April 2015. It now sits at the heart of how the UK funds NHS access for temporary migrants.
Paying it is not optional. Under paragraph 34(4) of the Immigration Rules, paying the correct IHS is a validity requirement, meaning if the payment is wrong, your application is not just delayed; it is technically invalid.
UK Visas and Immigration will normally give you one chance to fix an underpayment within 14 calendar days before treating it as fatal. Still, you should not plan around that courtesy.
14-Day Top-Up Deadline
If UKVI flags an IHS underpayment, you have only 14 calendar days to pay the shortfall. Miss it, and your application is refused or rejected as invalid. You only get one chance; treat any top-up notice as urgent.
An invalid application can affect Section 3C leave protection. That is the kind of mistake that turns a visa problem into an employment problem overnight.
Caseworker Insight
Payment of the surcharge is treated as part of the validity of the application. If the surcharge is due and not paid correctly, the application can become invalid rather than simply delayed.
Where the Rate Has Gone Since 2015
| Year | Standard Rate | Student / Child Rate |
|---|---|---|
| April 2015 | £200 per year | £150 per year |
| January 2019 | £400 per year | £300 per year |
| October 2020 | £624 per year | £470 per year |
| February 2024 to current published rate | £1,035 per year | £776 per year |
That is a 417% increase from introduction to today. An adult visa that cost £200 in 2015 now costs £1,035 for the same year of NHS access.
Where the Money Actually Goes
The scale of IHS revenue is the single most important factor in understanding why it keeps going up. The government's position is that temporary migrants should make a direct contribution towards the average cost of NHS use while they hold temporary immigration permission.
Migrants who pay IHS also pay National Insurance and income tax once employed. The government treats the surcharge as a separate upfront contribution toward NHS access. Many applicants see it as effective double payment. Both points matter when explaining why the fee is politically controversial but unlikely to disappear.
How Much is the Immigration Health Surcharge?
The Immigration Health Surcharge costs £1,035 per year for most adult applicants, or £776 per year for students, children under 18, and Youth Mobility Scheme applicants. The total depends on your visa length and is rounded up to the nearest 6-month block.
| Applicant type | Annual rate | Per 6 months | 3-year total | 5-year total |
|---|---|---|---|---|
| Standard adults | £1,035 | £517.50 | £3,105 | £5,175 |
| Students / under 18 / Youth Mobility | £776 | £388 | £2,328 | £3,880 |
| Health and Care Worker visa | £0 | £0 | £0 | £0 |
| ILR / settlement | £0 | £0 | £0 | £0 |
The rate is locked at the date you submit, not the date a decision is made. If the government announces a rise, applications filed before the change takes effect normally keep the old rate, even if the decision comes weeks later.
The 6-Month Rounding Rule: Why 16 Months Costs the Same as 18
IHS is not charged pro-rata. It is charged in 6-month blocks, rounded up. A 13-month visa costs the same as an 18-month visa. A 33-month spouse visa costs the same as a 36-month one. A single extra day over a 6-month boundary bumps you into the next block.
| Visa length | Rounds up to | Cost (standard) | Cost (student) |
|---|---|---|---|
| 6 months or less (entry clearance) | £0 charged | £0 | £0 |
| 6 months or less (in-country) | 6 months | £517.50 | £388 |
| 7 to 12 months | 12 months | £1,035 | £776 |
| 13 to 18 months | 18 months | £1,552.50 | £1,164 |
| 19 to 24 months | 24 months | £2,070 | £1,552 |
| 25 to 30 months | 30 months | £2,587.50 | £1,940 |
| 31 to 36 months | 36 months | £3,105 | £2,328 |
| 55 to 60 months | 60 months | £5,175 | £3,880 |
The 6-month rounding rule means a 13-month visa costs the same as an 18-month visa. A 7-month visa costs the same as a 12-month visa. Small differences in visa length can significantly affect your total cost.
When the Portal Charges Your Dependants More Than It Should
In some cases, the IHS portal calculates dependants using the maximum period allowed for the visa route rather than the period actually granted to the main applicant.
Real-World Overpayment
A Skilled Worker gets a two-year visa, but the adult dependant is charged for three years, creating a possible overpayment of £1,035.
The practical move is to screenshot the calculation, pay, submit, and let the application proceed. If there is a true overpayment, it should normally be refunded after the decision. If nothing has arrived after around six weeks, use the UKVI refund route and be ready to chase.
What Happens if a Child Turns 18 During the Visa
A child who is under 18 at the date of application is charged at the lower £776 rate for the entire visa period, even if they turn 18 halfway through. The rate is locked at the moment of application.
How Much Will IHS Cost for My Specific Visa?
Formulas are useful, but most people want to see the arithmetic on their actual situation. Here are the worked totals for common scenarios, with the rounding rule applied.
Example 1: Spouse or Partner Visa Entry Clearance
Grant length: 2 years 9 months (33 months). Rounds up to 3 years.
Main applicant: 3 × £1,035 = £3,105
One child under 18: 3 × £776 = £2,328
Family total: £5,433
Example 2: Student Visa, 3-Year Degree
A 36-month course can produce a longer visa period because of time added before and after the course. If the total period rounds to 42 months, the IHS is 3.5 × £776 = £2,716.
Example 3: Skilled Worker, 5-Year Visa, Main Applicant Only
5 × £1,035 = £5,175.
Example 4: Skilled Worker Family, 5-Year Visa, 2 Adults Plus 2 Children
Main applicant: £5,175
Adult dependant: £5,175
Child 1: £3,880
Child 2: £3,880
Family total: £18,110
Example 5: Global Talent, 3-Year Endorsement, 1 Adult Dependant
Main applicant: £3,105
Adult dependant: £3,105
Couple total: £6,210
Example 6: In-Country FLR(M) Extension, 2 Years 6 Months
2.5 × £1,035 = £2,587.50.
A family of four on a five-year Skilled Worker visa pays £18,110 in IHS before a single application form is submitted. Factor this in from day one.
IHS portal charged you the wrong amount?
Dependants charged for the route maximum rather than your actual grant length is one of the most common portal issues.
Book a Review →Who Must Pay the Immigration Health Surcharge?
If you are applying to stay in the UK for more than six months on a temporary route, you will almost certainly pay IHS.
Routes Where IHS is Mandatory
- Spouse, partner, civil partner, and unmarried partner visa applicants
- Skilled Worker, Scale-up, and Global Business Mobility applicants and dependants
- Student and Child Student visa applicants and dependants
- Graduate visa applicants
- Global Talent visa applicants and dependants
- Innovator Founder visa applicants and dependants
- Youth Mobility Scheme applicants
- Temporary work route applicants
- Dependants of the above are charged separately based on their own visa duration and rate category
The Misconceptions that Cost People Money
“My visa is only six months, so I do not pay IHS”
This applies mainly to entry clearance applications from outside the UK. In-country applications for six months or less can still attract IHS at half the annual rate.
“I am an EU national, so I am exempt”
EU nationality, on its own, exempts no one. EU nationals on Skilled Worker, Student, or family routes pay the same as everyone else unless a specific exemption applies.
“My employer is paying, so it is not my problem”
The obligation to pay IHS sits with the applicant. If an employer pays, any refund normally returns to their card. Pay it yourself wherever possible.
“I am switching from Student to Skilled Worker, so I will transfer my existing IHS”
You cannot simply transfer IHS between routes. You pay fresh IHS on the new application. Refund availability depends on the specific overlap and refund rules.
Who is Exempt from the Immigration Health Surcharge?
Exemptions are set by legislation. A caseworker cannot grant one by sympathy, analogy, or common sense; either your application falls into an exempt category defined in law, or it does not.
The Full Exemption List
- Health and Care Worker visa applicants and eligible dependants where the application is made under that route
- Indefinite Leave to Remain and settlement applicants
- Visitors applying for entry clearance of 6 months or less
- Applicants under the EU Settlement Scheme, where eligible
- Irish nationals who are not subject to immigration control
- Diplomats and members of visiting armed forces
- Dependants of members of the UK’s armed forces
- Applicants for a visa for the Isle of Man or Channel Islands
- British Overseas Territory citizens resident in the Falkland Islands
- Asylum seekers, humanitarian protection applicants, and dependants
- Certain victims of slavery, trafficking, or domestic abuse
- Children in local authority care
EU Students with an EHIC or S1 Certificate
Some EU students with a valid EHIC or S1 certificate, who do not intend to reside permanently in the UK, may be exempt. Verify current eligibility before applying.
Fee Waivers: The Narrow Human-Rights Exception
A fee waiver is a separate mechanism that may waive both the visa fee and the IHS for specific family and human-rights applications. Low income on its own is not enough. Fee waivers are not available for work or student routes.
The Health and Care Worker Trap
The Misconception
“I work for the NHS, so I am exempt from IHS.”
The reality: the exemption is route-specific, not job-specific. You are exempt from IHS only if your visa application is made under the Health and Care Worker route and the Certificate of Sponsorship supports that route. An NHS worker applying for a standard Skilled Worker visa may still pay IHS in full.
Some healthcare workers who have paid IHS may apply for reimbursement from the NHS Business Services Authority every six months if they meet the scheme rules. Reimbursement is not automatic and is not the same thing as an exemption.
How Do You Pay the Immigration Health Surcharge?
The payment process is built into the online visa application. The GOV.UK system redirects you to the payment portal as part of the application flow, and you cannot move past that screen without paying unless you are exempt.
Step-by-Step Payment Process
Complete Your Online Visa Application
Complete your application on GOV.UK. The system will redirect you to the IHS payment portal automatically.
Portal Calculates Your IHS
The portal calculates your liability using your visa route, grant length, CAS or CoS dates, dependant count, and ages.
Pay by Debit or Credit Card
Payment is made by card. You cannot pay by cheque, bank transfer, or PayPal.
Receive Your IHS Reference Number
After payment, the portal issues a unique reference number. Keep it safe for your records and any later refund query.
Payment Rules: No Exceptions
- No instalments. The full amount for the entire visa period is due upfront.
- No opt-outs. Private health insurance does not replace IHS.
- No monthly plans. UKVI offers no payment plan, deferral, or financing.
- Refund routing. If someone else pays, any refund normally returns to their card.
What NHS Services Does IHS Actually Give You Access to?
Paying IHS gives you access to NHS services broadly on the same basis as UK permanent residents while you hold valid immigration permission. “Broadly the same” matters because some NHS services are still charged.
What is Free with IHS
- GP visits and consultations
- Hospital treatment, including emergency A&E
- Mental health services
- Maternity care
- Cancer treatment
- Surgery and specialist referrals
What is Still Charged, Even with IHS
| Service | Cost / position |
|---|---|
| Prescriptions in England | Standard NHS prescription charge unless exempt |
| NHS dental treatment | Standard NHS dental charges unless exempt |
| Eye tests | Charged unless in an NHS sight test exemption category |
| Assisted conception services | Not covered by IHS in England |
Prescription, dental and eye test charges vary across the UK. Check current NHS guidance in the country where you live before relying on a figure.
IHS Access Ends When Your Leave Ends
NHS access is tied to your current immigration status, not simply to how much IHS you paid. If your visa is curtailed or expires, your free NHS entitlement may stop even if your IHS receipt covered a longer period.
Unpaid NHS charges for treatment not covered by your status can also cause problems in future immigration applications.
What Happens if IHS is Not Paid or is Paid Incorrectly?
If IHS is Not Paid at All
The application cannot be processed. UKVI will normally issue a payment request with a short deadline. Miss it, and the application can be refused or treated as invalid.
If IHS is Underpaid
UKVI normally issues a top-up request with a 14-calendar-day deadline. Miss the deadline, and you are in the same position as someone who never paid.
If IHS is Overpaid
The application is not normally affected. It proceeds, and the overpayment should be refunded after the decision where the refund rules apply.
The Section 3C Trap for Sponsored Workers
Section 3C of the Immigration Act 1971 can keep existing leave alive while an in-time extension is being decided. It only protects valid applications. If an IHS underpayment makes the application invalid and the top-up window is missed, Section 3C protection may not apply.
Section 3C Trap
An unpaid or underpaid IHS does not just delay a visa. If your existing visa expires while an invalid application is pending, you may lose lawful permission and right to work. Sponsors should treat IHS payment with the same seriousness as the application itself.
Can You Get an IHS Refund?
Refunds exist, but they are narrower than most people assume. You can recover IHS in specific circumstances, mostly around refusals, withdrawals, duplicate payments, and shorter grants. You cannot get a refund simply because you leave the UK early or because you apply for settlement earlier than planned.
| Situation | Refund? |
|---|---|
| Visa refused | Yes, usually automatic |
| Withdrawn before a decision is made | Yes, usually automatic |
| Paid twice for the same application | Yes |
| Visa granted for a shorter period than applied for | Partial refund may apply |
| Visa granted, but you do not travel | No |
| You leave the UK early | No |
| Your visa is curtailed | No |
| You apply for ILR | No refund of remaining IHS |
Refunds are normally returned to the original payment card. If an employer or agent paid, the refund may go back to them rather than directly to you.
Final Steps Before You Pay
Calculate your total using the worked examples above. Verify it with the GOV.UK calculator. Build it into your budget from day one, because the portal does not wait.
Stuck on an IHS Calculation, Top-Up Notice, or Refund Delay?
The Immigration Health Surcharge looks simple until the portal charges your dependants twice, your top-up deadline arrives in fourteen days, or your refund disappears into the UKVI backlog.
Book Your Consultation →Frequently Asked Questions
The standard rate is £1,035 per year for most adult applicants and £776 per year for students, children under 18, and Youth Mobility Scheme applicants. The total you pay depends on your visa length, rounded up to the nearest 6-month block. A 3-year adult visa costs £3,105; a 5-year adult visa costs £5,175.
No. UKVI does not offer instalment, payment plan, or deferral options for the IHS. The full amount for the entire visa period must be paid upfront before your application can be processed.
Yes. Private health insurance does not exempt you from paying the IHS. IHS is mandatory regardless of whether you hold private health insurance. There is no opt-out and no reduction for alternative cover.
This can happen where the portal charges dependants using the route maximum rather than the actual expected grant length. Take screenshots, pay to avoid delaying the application, and chase any overpayment refund after the decision if it is not returned automatically.
No, unless your visa application is made specifically under the Health and Care Worker route. Working in the NHS does not by itself exempt you. Some workers who paid IHS may be able to apply for reimbursement through the NHSBSA scheme if they meet the eligibility rules.
IHS gives access to NHS services broadly on the same basis as UK residents during valid immigration permission. GP care, hospital treatment, A&E, mental health services, maternity care and specialist referrals are generally covered. Prescriptions, dental treatment, eye tests and assisted conception may still be charged depending on location and exemption status.
No. NHS access depends on holding valid immigration permission, not simply on having paid IHS. If your visa is curtailed or expires, you may become chargeable for NHS treatment even if your IHS receipt covered a longer original period.
Yes, unless they fall within a specific exemption such as the EU Settlement Scheme or another legally defined category. EU nationality alone does not exempt someone from IHS on Skilled Worker, Student, or family routes.
Legally, the applicant is responsible for the IHS. Some employers fund it as part of a relocation package. If an employer or agent pays, any refund normally returns to the original payment card, not automatically to the applicant.
No. ILR applications are exempt from IHS at the settlement stage, but applying for ILR does not refund unused IHS already paid for earlier limited leave.
- GOV.UK, Pay for UK healthcare as part of your immigration application: IHS rates
- Home Office, Immigration Health Surcharge caseworker guidance
- GOV.UK, IHS refunds
- GOV.UK, NHS visitor and migrant cost recovery programme
- DHSC, Charging overseas visitors in England guidance
- GOV.UK, IHS reimbursement for health and care workers