When planning a move abroad, healthcare is a major consideration, as healthcare coverage and services in different countries varies drastically. In the United Kingdom, healthcare is free at the point of use through the National Health Service (NHS) for permanent residents and citizens in the UK. Nearly all those subject to immigration control will be required to pay an Immigration Health Surcharge (IHS) fee to access the NHS.
It is important to understand how health care coverage works in the NHS system to successfully apply for your visa and smoothly make your move to the UK.
This article will explain how the IHS fee works in relation to UK visas, outline the categories of migrants required to pay the IHS fee, and identify how much you can expect to be required to pay in the immigration application process.
What is the National Health Service (NHS)?
The National Health Service (NHS) was founded in 1948 as a publicly funded system of healthcare. The NHS was created out of the post-war social reform movement that aimed to create a health service system based on three primary principles:
- Services should be comprehensive
- Services should be universal
- Services should be free at the point of use
Each of the devolved nations in England, Scotland, Wales, and Northern Ireland have their respective healthcare systems which are all fundamentally linked under one umbrella system of healthcare funded by taxpayer contributions. These funds are distributed amongst the devolved health systems through what is known as the ‘Barnett formula’ in accordance with budget constraints, population numbers, health needs, and other various factors.
The NHS is a point of great pride for many British people. As a person moving to the UK, you and your family would have access to this healthcare system through payment of the Immigration Health Surcharge (IHS) fee.
What is the Immigration Health Surcharge?
The IHS fee requirement has been part of the UK immigration system since 2015.
The vast majority of foreign nationals who apply for leave to enter or remain in the UK for more than six months will be required to pay an IHS fee to the UK Home Office as part of the immigration process. As the NHS is free at the point of use through taxpayer contributions, the rationale behind the IHS fee is that migrants must pay into the costs of the NHS system that they access.
Funds collected from IHS fees are distributed amongst the four developed health administrations in Scotland, Wales, Northern Ireland, and Wales. This currently sits at an estimated £200 million per year and more than £1 billion since the introduction of the IHS fee in 2015.
After the Brexit transition period, the system previously in place for European Economic Area (EEA) nationals seeking to move to the UK drastically change. EEA nationals will also be required to pay for the IHS fee as part of their respective immigration processes rather than be subject to free access to NHS treatment.
You must pay the full IHS fee associated with the length of your visa or immigration status upfront at the point of submitting your application. By paying the IHS fee, you will have access to 24/7 emergency healthcare, can register with a GP to access non-emergency care, and request prescription medications.
How much is the IHS fee?
The IHS fee is charged depending upon the length of your visa or immigration status. As such, the amount you will pay is dependent upon your specific situation.
In July 2023, the UK Government announced it would be increasing the rate of the Immigration Health Surcharge by 66% to £1,035 per year for most immigration applications. This will take effect on either 16 January 2024 or 21 days after both Houses of Parliament have approved the new legislation, whichever is the later date.
Until the new rate takes effect in 2024, the current IHS rates apply:
- £470 per year for a Student Route Visa, their dependants, or Youth Mobility Scheme Visa
- £470 per year for applicants under the age of 18 at the point of application
- £624 per year for all other visa categories and immigration applications
If the length of your visa includes a part of a year that is less than 6 months in length, you will pay half of the annual amount – for example, 1 year and 5 months. If the length of your visa includes part of a year that is more than 6 months, you will pay for a whole year of IHS fee costs – for example, 1 year and 7 months.
These amounts are calculated depending upon the length of your visa, and you will be required to pay for the entire amount upfront at the point of application. For example, for a 5-year Skilled Worker Visa, you will be required to pay £3,120 before finalising your online or postal application.
Please note that your visa or immigration application will be rejected if you do not pay the IHS fee or do not pay enough. If you get an email from UK Visas and Immigration to pay additional funds towards this surcharge, you must respond within the following time frames:
- Inside the UK – 10 working days
- Outside the UK – 7 working days
If you do not pay the additional funds towards the IHS fee within the prescribed time period, your application will be rejected outright.
Who pays the IHS fee?
Most individuals applying for a temporary UK visa will need to pay the IHS fee. Generally, you will need to pay the IHS fee if you are submitting an immigration application outside the UK for a visa length of more than 6 months, or for any length of time if you are applying from within the UK.
The following categories of visas will be required to pay for the IHS fee as part of their immigration application:
- Skilled Worker Visa
- Global Business Mobility Visas
- Minister of Religion Visa
- Sportsperson Visa
- Temporary Worker Visa – Charity Worker
- Temporary Worker Visa – Creative and Sporting Visa
- Temporary Worker Visa – Government Authorised Exchange
- Temporary Worker Visa – International Agreement Worker
- Temporary Worker Visa – Religious Worker
- Temporary Worker Visa – Seasonal Worker
- Youth Mobility Scheme Visa
- Innovator Visa
- Start-Up Visa
- Global Talent Visa
- Entrepreneur Visa
- Investor Visa
- UK Ancestry Visa
- British National (Overseas) Visa
- Overseas Domestic Worker Visa
- Representative of an Overseas Business Visa
- Graduate Route Visa
- Student Visa
- Child Student Visa
- Study English in the UK (Short-Term Study) Visa
- Family Visas
This list is subject to amendment. If you believe that your specific situation would not require you to pay the IHS fee but your visa category is listed above, the UK Home Office website provides an online IHS fee calculator to determine this consideration. If the Home Office identifies that you are indeed required to pay the IHS fee but you do not pay it, your application will be refused.
Exemptions to the IHS fee
There are some visa categories and immigration statuses that are exempt from paying the IHS fee. They include the following:
- Standard Visitor Visa
- Marriage Visitor Visa
- Fiancé(e) Visa
- Indefinite Leave to Enter
- Indefinite Leave to Remain
- Health and Care Worker Visa
- Dependant of a Health and Care Worker
- Applicant to the EU Settlement Scheme
- S2 Healthcare Visitor Visa
- Individuals eligible for a Frontier Worker Permit with an S1 Certificate
- Diplomat or member of a Visiting Armed Forces and not subject to immigration control
- Dependant of a member of the UK Armed Forces
- Dependant of a member of a Visiting Armed Forces and are not subject to immigration control
- Visa applicant for the Isle of Man or the Channel Islands
- Citizens of a British Overseas Territory resident in the Falkland Islands
- Individuals seeking asylum or applying for humanitarian protection
- Dependants of individuals seeking asylum or applying for humanitarian protection
- Individuals who are domestic workers who have been identified as victims of slavery or human trafficking
- Individuals applying for discretionary leave to remain in the UK due to their identification as victims of slavery or human trafficking
- Dependants of individuals applying for discretionary leave to remain in the UK due to their identification as victims of slavery or human trafficking
- Individuals who meet the criteria of the Home Office domestic violence concession
- Dependants of individuals who meet the criteria of the Home Office domestic violence concession
- Individuals applying for visas under the European Convention of Human Rights Article 3 grounds
- Dependants of individuals applying for visas under the European Convention of Human Rights Article 3 grounds
You can confirm your exemption from the IHS fee by using the online IHS fee calculator available on the UK Home Office website.
Do you have to pay the IHS payable if you private health insurance?
Some individuals choose to purchase private health insurance or receive this benefit through their employer. You may want to use private health insurance to have more options for healthcare providers, to avoid potentially long waitlists at specialists, or to have elective medical procedures. However, you would need to pay for this private health insurance in addition to the IHS fee – you cannot avoid paying the IHS fee due to possessing alternative healthcare coverage.
If you already possess private medical insurance through your home country, you can inquire with the insurance company to find out if this coverage can be extended whilst abroad. This should be taken into account when considering your move to the UK.
How to pay the IHS fee
You can for the IHS fee in one of two ways, depending on how you plan to submit your immigration application form.
If you plan to submit your immigration application via the online UK government form, you can pay for your application as part of your online application or at the point of booking a biometrics appointment. As part of the online application, you will be issued an IHS reference number to include with your application as proof of payment. You will not be able to progress with your application without paying this fee unless you are exempt.
If you plan to submit your immigration application via the post, you will need to pay for your IHS fee online in advance of sending off your hard-copy immigration application.
When can you start using NHS healthcare services?
You will be able to start using NHS healthcare services as soon as you have both paid for your IHS fee and had your visa application or immigration status granted. At this point, you can access all NHS services, such as the following:
- GP and nurse consultations in primary care settings
- GP and nurse treatments in primary care settings
- Urgent and emergency care services
- Mental health services
- Sexual health services
- Pregnancy services
- Specialist hospital clinics
- Health and wellbeing services
Depending on your UK nation of residence and the services you seek, you will additionally gain access to the following healthcare services but may be subject to charges:
- Pharmacies (subject to a charge for some prescriptions in England)
- Opticians (subject to a charge for some services such as eye tests)
- Dentists (subject to a charge for some services such as dental cleanings)
IHS fee refund rules
There are several situations in which you may be eligible for a refund of your IHS fee, subject to certain criteria being met. IHS refunds may apply if:
- You paid your IHS fee twice – full refund
- You paid your IHS fee but your visa application was refused – full refund
- You paid your IHS fee but withdrew your visa application – full refund
- You received less time on your visa than you requested in your application – partial refund
- Your visa dependant(s) are refused – partial refund
- You work in health and social care
The following situations are not eligible for a refund of your IHS fee:
- You are applying for Indefinite Leave to Remain
- You are required to leave the UK before the expiration of your visa or immigration status
- You decide to leave the UK before your current visa ends
- Your visa or immigration application is successful but you decide not to come to the UK
If you are eligible for a full or partial refund of your IHS fee, you will be automatically be granted the refund to the card or account you originally used to pay the fee online. You do not need to manually request a refund. Generally, you can expect to receive your refund within 6 weeks of receiving a decision on your immigration application.
You may additionally be eligible for a refund of your IHS fees if you are a health and care worker in the UK even if you are not in the UK on a specific Health and Care Worker Visa. For example, you may be living in the UK on a Family Visa and gain employment as a Nurse within the NHS. If you have worked within this role for 6 months and have workers an average of at least 16 hours per week, you are eligible to request a refund of your IHS fee from the UK Home Office.
Author
Gill Laing is a qualified Legal Researcher & Analyst with niche specialisms in Law, Tax, Human Resources, Immigration & Employment Law.
Gill is a Multiple Business Owner and the Managing Director of Prof Services - a Marketing & Content Agency for the Professional Services Sector.
