The Immigration Health Surcharge (IHS) is a mandatory charge which must be paid with most long‑term UK visa applications and gives the applicant broadly equivalent access to National Health Service (NHS) treatment to that of a person who is ordinarily resident in the UK for the duration of their permission to stay. If a visa application is refused, or entry clearance or permission is not granted, the IHS is normally refunded in full and, in most cases, is refunded automatically to the card or account used to make the payment, usually within around six weeks of the date of the final decision.

Where an applicant has paid the IHS for a period which is longer than the leave that is actually granted, a partial refund is usually made for the overpaid period; however, you should be aware that the IHS will not ordinarily be refunded in most situations where the migrant does not in fact travel to the UK, where illness or death occurs before arrival, or where they leave the UK earlier than planned.

1. Who must pay the Immigration Health Surcharge (IHS)?

In general, most applicants who apply for a UK visa for more than six months must pay the Immigration Health Surcharge, both when they apply for entry clearance from overseas and when they apply from within the UK to extend their stay or to switch into another immigration route. Work routes, family routes, student visas and most other long‑term categories are subject to the IHS, and the surcharge is payable in respect of the main applicant as well as each dependant partner and child included in the application, as a separate IHS amount is calculated per person. The obligation to pay the IHS is not removed simply because the applicant holds private medical insurance, which is treated only as an additional form of cover and does not replace the surcharge.

2. Who is exempt from paying the Immigration Health Surcharge (IHS)?

The circumstances in which the IHS does not have to be paid are relatively limited. Applications for indefinite leave to remain (ILR) or indefinite leave to enter, which are for permanent residence, do not attract the IHS. In addition, applicants in the Health and Care Worker route and their dependants are exempt from the IHS as part of the government’s policy to support NHS and social care staffing.

Certain protection‑based and other specific categories, such as recognised refugees, persons granted humanitarian protection, some victims of trafficking, certain members of the armed forces and some diplomatic categories, may also be exempt from paying the surcharge. There are also a small number of exemptions based on international agreements or specific concessions, but the criteria are strict, and applicants should check the latest Home Office guidance to confirm whether they qualify for an exemption before submitting an application.

3. How much is the Immigration Health Surcharge (IHS)?

The Immigration Health Surcharge is calculated on an annual basis according to the type of visa and the length of permission requested. For most long‑term routes, an adult standard rate applies, whilst reduced annual rates apply to children, some students and certain youth categories. By way of example, standard work and family route applicants generally pay the full adult rate, whereas applicants under the student route or those under 18 may qualify for the lower student or youth rate.

The UK government periodically adjusts IHS rates in line with wider fiscal and health policy, and there have been significant increases in both the adult and student/youth rates in recent years, so applicants must always check the current annual rates on official UK government sources at the time of application.

4. How is the Immigration Health Surcharge (IHS) calculated and paid?

The IHS is calculated automatically as part of the online visa application process. Once the applicant has selected the relevant visa category and entered the intended length of stay, the system calculates the total IHS payable by multiplying the applicable annual IHS rate by the number of years, rounded up to the nearest part‑year, for which permission is sought.

For example, if an applicant seeks permission for two years and six months, the system may round this up to three years and charge three years’ worth of IHS. The applicant must pay the full IHS amount online, in addition to the visa application fee, before the application can be submitted, and an IHS reference number is issued by email once payment has been made. This reference number is used by the Home Office to confirm the applicant’s entitlement to access NHS services and should be kept safe.

5. What happens if you do not pay the Immigration Health Surcharge (IHS)?

If the IHS is not paid, the visa application will not be validly submitted and, in the case of entry clearance applications for a visa of more than six months, the online form will not normally be completed, and the application will not enter the decision‑making process. For in‑country applications to extend permission or to switch into another route, payment of the IHS is treated as an essential requirement, and failure to pay can result in the application being rejected as invalid or refused under the Immigration Rules. In practical terms, the IHS is an integral part of a valid visa application, and the full amount must be paid at the point of application, together with the visa fee for the application to be processed.

6. Can you get a refund of the Immigration Health Surcharge (IHS) if your visa is refused?

Where a visa application is ultimately refused, or permission is not granted, the IHS is normally refunded in full. A full refund is also usually made where, for the same application, the IHS has been paid twice because of a system error or mistake, or where the applicant has properly withdrawn the visa application before the Home Office has made a final decision. In most cases, this refund is processed automatically without a separate application and is paid back to the card or account used to make the original IHS payment. However, the visa application fee itself is generally not refundable, so applicants should distinguish clearly between any IHS refund and the non‑refundable visa fee.

7. Can you get a refund of the Immigration Health Surcharge (IHS) if you do not travel to the UK?

Once a visa has been granted, the IHS is not normally refunded merely because the migrant decides not to travel to the UK or changes their plans for personal reasons. Likewise, illness or death before travelling, or an applicant’s voluntary decision to leave the UK early while their visa is still valid, are not commonly accepted as grounds for an IHS refund.

The fact that an individual has made little or no use of NHS services during their period of leave also does not in itself give rise to a right to a refund. However, where the period of leave granted is shorter than was applied for, or where a dependant family member’s visa is refused so that they cannot travel, a partial refund is usually made for any overpaid IHS through the Home Office’s automatic refund process within a specified timescale.

8. How long does an Immigration Health Surcharge (IHS) refund take?

Where a case falls within the IHS refund policy, the refund process is normally automatic and, in most cases, is completed within around six weeks of the date of the relevant decision. If an applicant pursues an administrative review or appeal after a refusal, the overall process may take longer, and this can delay the point at which any refund is made.

If more than about six weeks have passed since the decision, or since the conclusion of any appeal or administrative review, and no refund has been received, the applicant should contact UK Visas and Immigration (UKVI) to check the progress of the refund. Where a visa is later granted following an appeal or administrative review, but the IHS has already been refunded, the applicant will normally have to pay the IHS again to cover the period of leave that is granted.

The Immigration Health Surcharge (IHS) is a central feature of the UK immigration system and a key cost to factor in when applying for most long‑term UK visas, as it underpins access to NHS services during your stay. If you are experiencing any difficulties with the IHS, or you require assistance with a new application, extension or variation of leave, you can contact us on 020 3865 6219 or leave us a message, and we will be pleased to provide proactive, tailored support.