If you are planning to apply for a visa to work, study, or join your family in the UK, you may have to pay an immigration health surcharge (IHS) as part of your application. The IHS is a fee that helps fund the UK’s National Health Service (NHS), which provides free or subsidized health care to residents and visitors. In this article, we will explain what the IHS is, why it is charged, on which visa types it applies, and how you can get an exemption or a refund if you are eligible.
What is the IHS, and why is it charged?
The IHS was introduced in 2015 to ensure that non-EEA migrants who come to the UK for more than six months make a fair contribution to the cost of their health care. The IHS allows migrants to access the NHS on the same terms as UK citizens, without having to pay extra charges for most services. However, some services, such as prescriptions, dental treatment, eye tests, and assisted conception, may still require a fee.
The IHS is charged at a flat rate per year for each applicant and each dependant. The current rates are:
- £470 per year for students, youth mobility scheme applicants, and Tier 5 (Temporary Worker – Charity Worker) applicants
- £624 per year for all other applicants
The IHS must be paid in full at the time of the visa application, and it is usually calculated based on the duration of the visa. For example, if you apply for a three-year work visa, you will have to pay £1,872 (£624 x 3) for yourself and the same amount for each dependent.
On which visa types does the IHS apply?
The IHS applies to most visa types that allow you to stay in the UK for more than six months, such as:
- Work visas, such as Skilled Worker, Health and Care Worker, Intra-company Transfer, etc.
- Study visas, such as Student and Child Student
- Family visas, such as Partner, Parent, and Child
- Ancestry visas
- Settlement visas
- Indefinite leave to remain applications
However, there are some exceptions where you do not have to pay the IHS or you may be eligible for a partial refund. We will discuss these in the next sections.
Exemption from the IHS on Health and Care Worker visa
If you are applying for a Health and Care Worker visa, which is a special category of work visa for medical professionals who have a job offer from the NHS or an NHS supplier, you and your dependents will automatically be exempt from paying the IHS. This means that you can access the NHS for free during your stay in the UK.
To qualify for a Health and Care Worker visa, you must:
- Be a qualified doctor, nurse, health professional or adult social care professional
- Work in an eligible health or social care job
- Work for a UK employer that has been approved by the Home Office
- Have a certificate of sponsorship from your employer with information about your role
- Be paid a minimum salary that depends on your type of work
- Prove your knowledge of English
The Health and Care Worker visa can last for up to five years before you need to extend it. You can also apply to settle permanently in the UK after five years if you meet the eligibility requirements.
Tier 5 visa used for MTI program
Another exception where you may not have to pay the full amount of the IHS is if you are applying for a Tier 5 (Government Authorised Exchange) visa under the Medical Training Initiative (MTI) program. The MTI program is designed to allow doctors from overseas to come to the UK for up to two years to benefit from training and development in the NHS before returning to their home countries. The program is sponsored by various medical royal colleges and associations that issue certificates of sponsorship and recommend applicants for GMC registration and Tier 5 visas.
If you are applying for an MTI program under Tier 5 visa, you will still have to pay the IHS upfront as part of your application. However, you may be eligible for a reimbursement of the IHS depending on your individual circumstances. The reimbursement scheme is administered by the NHS Business Services Authority (NHSBSA) on behalf of the Department of Health and Social Care (DHSC). To qualify for reimbursement, you must:
- Have paid the IHS on or after 31 March 2020
- Have worked in an eligible health or social care role for at least six months
- Have evidence of your employment contract and payslips
- Apply online through the NHSBSA website
The reimbursement will be paid in six-month instalments directly into your bank account. You can apply for reimbursement every six months until your visa expires or you leave the UK.
IHS charges on different visa categories
As we have seen, the IHS charges vary depending on the type of visa you are applying for and the duration of your stay. Here is a table that summarizes the IHS charges for some common visa categories:
| Visa category | IHS charge per year |
| Skilled Worker | £624 |
| Health and Care Worker | £0 |
| Student | £470 |
| Partner | £624 |
| Ancestry | £624 |
You can use the online IHS calculator to estimate how much you will have to pay based on your visa type, duration, and number of dependants.
When does the IHS need to be paid?
The IHS needs to be paid in full at the time of your visa application, either online or at a visa application centre. You will not be able to submit your application without paying the IHS. If your visa application is refused or withdrawn, you will get a full refund of the IHS. If your visa is granted for a shorter period than you applied for, you will get a partial refund of the difference.
What services can migrants get from the NHS?
Once you have paid the IHS and your visa is granted, you can access the NHS on the same terms as UK citizens. This means that you can get free or subsidized health care services, such as:
- Seeing a GP or a nurse at a GP surgery
- Getting emergency treatment at a hospital
- Getting hospital treatment for a medical condition
- Getting maternity care
- Getting mental health care
- Getting some public health services, such as vaccinations and screening
However, some services may still require a fee, such as:
- Prescriptions (unless you have an exemption)
- Dental treatment
- Eye tests and glasses
- Assisted conception
- Cosmetic surgery
You may also have to pay for some services if you are visiting another country in the European Economic Area (EEA) or Switzerland. To avoid this, you should apply for a free European Health Insurance Card (EHIC) before you travel.
Conclusion
The immigration health surcharge is a fee that non-EEA migrants have to pay as part of their visa application to access the NHS in the UK. The IHS varies depending on the type and duration of the visa, and it must be paid upfront. However, some visa categories, such as Health and Care Worker and MTI Tier 5, are exempt from paying the IHS or eligible for reimbursement. The IHS allows migrants to get free or subsidized health care services in the UK, but some services may still require a fee.
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