Immigration Health Surcharge (IHS) 2026: Cost, Exemptions and Refunds
The Immigration Health Surcharge (IHS) is the largest single Government charge on most UK visa applications. It is paid with the application fee and gives the visa holder access to the NHS for the length of the visa, on broadly the same terms as a UK resident.
Seven things to know about the Immigration Health Surcharge
What is the Immigration Health Surcharge?
The Immigration Health Surcharge (IHS), commonly called the NHS Surcharge, is a payment most UK visa applicants must make alongside their application fee. Payment gives full NHS access for the duration of the visa, on the same basis as a settled resident.
The NHS stands for the National Health Service. It is the publicly funded healthcare system in the United Kingdom, providing medical care free at the point of use for residents.
When the IHS started
The IHS was introduced on 6 April 2015 under the Immigration Act 2014. The original rate was £200 per year (£150 for students). Subsequent rises brought it to £400 in 2019, £624 in October 2020, and to the current rate in February 2024.
Why it exists
The Government's stated rationale is that visa holders should contribute to the NHS in addition to general taxation, given that they have access to NHS services from the first day of arrival. Income from the IHS is allocated to NHS budgets across the four UK nations.
What it covers
Once the applicant has paid the IHS, the applicant has the same NHS access as a UK resident:
- Free GP appointments and treatment
- Free hospital treatment in NHS hospitals
- Maternity care
- Mental health services
- Emergency care
- Most prescription medication (subject to standard NHS prescription charges, the rate is reviewed each April; check the current rate at NHSBSA)
- Eye examinations (charges may apply)
- NHS dental treatment (charges apply)
What the IHS does not cover
- Private healthcare
- Most dental treatment outside NHS dental services
- Cosmetic procedures
- Assisted conception services in England (specifically excluded under the IHS rules)
- Treatment specifically excluded from NHS coverage
- Travel insurance for trips outside the UK
How much is the IHS in 2026?
As of June 2026, the IHS is £1,035 per adult per year on most visa routes, and £776 per year for students and child dependants. Health and Care Workers pay £0. These rates are set by the Immigration (Health Charge) Order 2015 (as amended) and are subject to change.
| Visa route / category | IHS per year |
|---|---|
| Spouse / partner / fiance visa | £1,035 |
| Skilled Worker (general) | £1,035 |
| Innovator Founder, Scale-up, Global Talent | £1,035 |
| Student visa (main applicant) | £776 |
| Child dependant under 18 (any route) | £776 |
| Youth Mobility Scheme | £776 |
| Health and Care Worker (main applicant and dependants) | £0 (full waiver) |
| Visitor visa (any duration) | No IHS |
| Indefinite Leave to Remain (ILR) | No IHS |
| Naturalisation / citizenship | No IHS |
The IHS rate has risen sharply since 2019: from £200 to £400, then £624, and now £1,035, a fivefold increase in seven years. Further rises are possible whenever the Government revises the Immigration (Health Charge) Order 2015. Always check the live GOV.UK IHS rates page before submitting an application.
How is the IHS calculated?
The IHS is charged in 6-month blocks. Any visa period that includes part of a 6-month block is rounded UP to the next block. So a 33-month spouse visa pays for 36 months, and a 16-month visa pays for 18 months. Half-year payments are £517.50 at the adult rate or £388 at the student/child rate. The full amount is paid upfront with the visa application.
The calculation method
The Home Office calculates the IHS using these steps:
- Identify the length of leave the applicant is applying for (in months)
- Round UP to the next 6-month block (e.g. 33 months → 36 months; 16 months → 18 months)
- Multiply that rounded duration by the annual rate, £1,035 per year for adults, £776 per year for students and under-18s
- Pay the total upfront with the visa application
A common shortcut: the half-year rate is exactly half the annual rate. £1,035 ÷ 2 = £517.50 (adult). £776 ÷ 2 = £388 (student/child).
Worked calculations by route
Student grants typically include a one-month buffer before the course and a four-month buffer after. The IHS portal calculates against the rounded total, not the raw course length.
When the applicant pays the IHS
The IHS is paid online when you submit the visa application through the Home Office portal. It is paid at the same time as the application fee. The applicant cannot submit the application without paying both. There are no instalments and no payment plans. Standard payment methods are debit and credit card.
The IHS is paid for the full duration of the visa upfront, even where you intend to leave the UK before the visa expires. There is no refund for unused visa time. Where you leave the UK 18 months into a 5-year visa, the remaining 3.5 years of IHS are not returned. A refund applies only where the application is refused or withdrawn before a decision is made.
Who pays the Immigration Health Surcharge?
Most UK visa applicants must pay the IHS as part of their application, as set out in the GOV.UK guidance on paying for UK healthcare as part of your immigration application. The main categories where the IHS does not apply are visitor routes, Indefinite Leave to Remain, citizenship applications, and Health and Care Worker visa holders.
Routes where IHS applies
- Spouse, civil partner, unmarried partner, and fiance visas
- Family route extensions (FLR-M, FLR-FP)
- Skilled Worker visa
- Innovator Founder and Scale-up routes
- Global Talent (limited leave stages)
- Student and Graduate visas
- Temporary Worker routes (Creative Worker, Religious Worker, and similar)
- Youth Mobility Scheme
- Most other limited leave categories
Routes where IHS does not apply
- Standard Visitor visa (any duration up to 10 years multiple-entry)
- Marriage Visitor visa
- Transit visa
- Indefinite Leave to Remain (ILR)
- Naturalisation as British citizen
- Registration as British citizen
- Right of Abode
- EU Settlement Scheme
Each dependant pays separately
Where you apply with a spouse, partner, or children as dependants, each pays their own IHS at the applicable rate. There is no family discount. A family of four (two adults and two children) pays four separate IHS amounts, totalling £3,622 per year of visa duration.
Who is exempt from paying the IHS?
Several narrow categories are exempt from the IHS even on routes where it would otherwise apply. The exemptions are set out in regulations and apply automatically; you do not need to claim them separately, provided the application clearly identifies your category.
Categories exempt from IHS
The full list of exempt cohorts under the Immigration (Health Charge) Order 2015 (as amended) and the Home Office IHS caseworker guidance:
- Health and Care Worker visa main applicants and dependants, full IHS waiver
- Indefinite Leave to Enter or Remain applicants, ILR is not limited leave, so the IHS does not apply
- EU Settlement Scheme (EUSS) applicants
- Frontier Workers Permit holders
- S2 Healthcare Visitors entering for pre-arranged treatment funded by an EEA member state
- Diplomats and family members not subject to UK immigration control
- Visiting armed forces personnel not subject to immigration control, and their dependants
- Dependants of serving HM Forces members
- Asylum seekers, refugees and humanitarian protection applicants and dependants
- Victims of modern slavery / human trafficking, including domestic workers identified as victims, applicants under Appendix Temporary Permission to Stay for Victims of Human Trafficking, and discretionary leave for trafficking victims
- Stateless persons applying under Appendix Statelessness
- Migrant Victims of Domestic Abuse concession applicants
- Article 3 ECHR applicants whose removal would be contrary to the European Convention on Human Rights
- Ukraine Visa Schemes, Ukraine Extension Scheme and Homes for Ukraine Sponsorship Scheme
- Looked-after children under 18 in local authority care
- Civilian employees at NATO or the Australian Department of Defence in the UK, and dependants
- British Overseas Territory citizens resident in the Falkland Islands
- Visitor visas and applications for entry clearance of 6 months or less from outside the UK do not pay the IHS, but are directly charged for any NHS treatment received, at 150% of cost
The Health and Care Worker exemption explained
The Health and Care Worker visa is a sub-category of the Skilled Worker visa route, available to applicants working in an eligible health or social care role for the NHS, an NHS supplier, or a registered adult social care provider. Eligible roles are listed on the GOV.UK Health and Care Worker visa eligibility page.
The exemption covers:
- The main applicant on the Health and Care Worker visa
- Their spouse or partner as dependant
- Their children as dependants
The exemption applies for the full duration of the Health and Care Worker visa. It does not extend to subsequent applications in different routes. Where a Health and Care Worker applies for ILR or naturalisation, the standard rules for those routes apply (and no IHS arises at either stage in any case).
How does the Health and Care Worker IHS waiver work?
Health and Care Worker visa applicants pay no IHS. The waiver applies to the main applicant, their spouse or partner, and their children. For a family of four on a 5-year visa, the waiver represents a saving of approximately £18,110 compared to the standard Skilled Worker visa rate.
Eligible roles
The waiver applies where the applicant is working in an eligible occupation for an eligible employer. Common eligible roles include:
- NHS doctors, nurses, and midwives
- NHS allied health professionals, including physiotherapists and radiographers
- Care workers and senior care workers in adult social care
- Healthcare assistants and pharmacy roles
- Mental health and learning disability nurses
Check the GOV.UK Health and Care Worker visa eligibility page for the current eligible occupations list.
Eligible employers
- NHS bodies (NHS England, Welsh NHS, Scottish NHS, and Northern Irish NHS)
- NHS suppliers providing healthcare services
- Adult social care providers registered with the Care Quality Commission or the equivalent devolved regulator
Where your role changes
Where you hold a Health and Care Worker visa and change to a non-eligible role with a different employer, the applicant may need to switch to a standard Skilled Worker visa. The IHS exemption ceases at the point of switch, and standard IHS applies to the new visa. A regulated immigration adviser should be consulted before any change of employment that may affect the visa category.
For a family of four on a 5-year Health and Care Worker visa, the IHS waiver saves approximately £18,110 compared to the standard Skilled Worker route. This is one of the most significant cost differences between immigration routes for families. Where an applicant may be eligible for either route, verifying Health and Care Worker eligibility at the outset is essential to accurate cost planning.
When does an IHS refund apply?
The IHS is refunded automatically where the visa application is refused or withdrawn before a decision is issued. No claim form is required. The refund is processed within 6 weeks of the decision and returned to the original payment method.
Situations where IHS is refunded
- Visa refused: Full IHS refunded automatically.
- Application withdrawn before decision: Full IHS refunded.
- Visa granted for less time than applied for: Difference refunded automatically.
- Visa cancelled before issue: Full IHS refunded.
- Dependant removed before decision: Where a dependant's application is removed before a decision, their IHS is refunded.
Situations where IHS is not refunded
- You leave the UK before the visa ends: No partial refund for unused time.
- Visa curtailed after issue: No refund of IHS already paid.
- You return home permanently: No refund of IHS for the period you would have remained.
- Visa converted to ILR before original end date: No refund of IHS paid for the visa period before the ILR grant.
How the refund is processed
For refused or withdrawn applications:
- The Home Office IHS team processes the refund automatically
- The refund is returned to the original payment method (card or bank account)
- Typical timeframe: 6 weeks from decision date
- An email notification is sent when the refund is processed
Tracking your refund
Where a refund has not arrived after 8 weeks, contact the IHS team via the UKVI contact page on GOV.UK. Quote the application reference and IHS reference number from the original payment confirmation.
Where the application is refused and you wish to reapply in the same or a different visa category, Whytecroft Ford can review the circumstances and advise on the appropriate route. Call 0208 757 5751 or use the contact form.
How much IHS do family route applicants pay?
The IHS is one of the largest costs on family route applications, often exceeding the visa application fee itself. Understanding the full IHS liability across the spouse-to-citizenship journey is an important part of application planning.
Spouse visa journey IHS totals
The IHS is charged in 6-month blocks. A 33-month spouse visa rounds up to 36 months; a 30-month FLR(M) extension is already a 6-month multiple, so no rounding applies.
Family with children
Children added to a spouse visa application pay £776 per child per year, also rounded up in 6-month blocks. For a couple with one child:
- Stage 1 entry (33 months → 36): £3,105 (main applicant) + £2,328 (child) = £5,433
- Stage 2 extension (30 months): £2,587.50 (main applicant) + £1,940 (child) = £4,527.50
- ILR and naturalisation: £0 IHS for any party
- Total IHS for couple and one child: £9,960.50
Where the sponsor's status changes
The sponsor (the British citizen or settled person) does not pay IHS, as they are not a visa holder. Only the migrating partner and any dependent children pay IHS.
For family visa guidance, see the Whytecroft Ford family visas hub. For the full range of work and business routes, see the work and business visas hub.
Worked total cost examples
The following examples show IHS calculations across the most common applicant scenarios, using the rates in place as of June 2026.
What are the recent and upcoming IHS changes?
The IHS rate has risen sharply in recent years and remains subject to revision by Statutory Instrument at any time.
The February 2024 rate rise
From 6 February 2024, the IHS rose from £624 to £1,035 per adult per year, a 66% increase. The student rate rose from £470 to £776 per year. This was the largest single IHS rise since the surcharge was introduced in 2015.
Rate history
- April 2015 (introduced): £200/year (£150 student)
- January 2019: £400/year (£300 student)
- October 2020: £624/year (£470 student)
- February 2024: £1,035/year (£776 student), current rate as of June 2026
2026 position
As of June 2026, the rate remains £1,035 per adult per year. No further rise has been announced. The IHS is set by Statutory Instrument and can be changed at any time subject to parliamentary procedure. The live rate should always be confirmed at GOV.UK before submitting an application.
Future rises
Future IHS changes depend on Government policy on NHS funding and immigration. The current Government has not announced further increases as at June 2026. Periodic reviews are routine, and a rate change is possible at any time. Always verify the current rate on the GOV.UK IHS rates page at the time of the application.
Glossary of terms
Frequently asked questions
Talk to a regulated immigration adviser
The Whytecroft Ford Immigration Team advises applicants and sponsors at every stage of a UK visa, settlement or nationality matter. Every file runs on a written engagement letter, with a named handler and a named supervisor.