The Immigration Health Surcharge, or IHS, is an additional charge levied on most visa applications as a means of increasing contributions from migrants to the cost of healthcare. It was introduced by the UK government to help fund the National Health Service (NHS) and has been subject to several increases since its introduction in 2015. This post provides an up to date guide to the IHS: why we have it, who needs to pay it, how much it costs, how to pay it and how to get a refund if your application is refused.
Why Do I Have to Pay the Immigration Health Surcharge (IHS)?
Section 38 of the Immigration Act 2014 grants the Home Secretary permission to require payment of an immigration health charge in order to access NHS healthcare as a migrant. The IHS itself was first introduced on 6 April 2015 by The Immigration (Health Charge) Order 2015, specifically section 3 of the Order.
The IHS grants you full access to all NHS treatment free at the point of use from the date your visa is granted until it expires. It is important to note that this does not include services that permanent residents also have to pay for, such as prescription charges in England, eye tests, and dental treatment.
Who Needs to Pay the Immigration Health Surcharge (IHS)?
Most people need to pay the IHS covering the duration of the leave period applied for as part of their immigration application, on top of the application fees. If required, you must pay the IHS covering the duration of the immigration permission you apply for in order for your application to be successful. This is the case even if you will be paying National Insurance contributions whilst you are in the UK.
This payment is not optional and there is no provision for opting out on the basis that you do not anticipate using the NHS during your permission. This is true even if you have private health insurance that you would use instead of the NHS.
If you are an applicant outside of the UK, applying for a period of leave of more than 6 months, you will need to pay the IHS unless you are covered by an exemption. If you are applying from inside the UK and do not fall under an exemption, you will need to pay the IHS irrespective of your period of leave, unless you are applying for indefinite leave to remain, in which case no IHS payment is required. Those applying to extend their leave are required to pay for the extension period applied for.
Visitor Visas and Fiancé Visas are examples of visas that do not exceed 6 months and therefore do not require payment of the IHS. However, you will not be able to access the NHS free of charge on these visas or other permissions not exceeding 6 months; any NHS care you get must be paid for at the point of use. This is subject to a few services which are free, including GP and nurse consultations in primary care, treatment provided by a GP and other primary care services.
The IHS must be paid by each applicant. Where one application covers more than one applicant, the IHS must be paid for each person at the relevant level.
Am I Exempt From Paying the Immigration Health Surcharge?
The exemptions from the Immigration Health Surcharge are quite narrow. Those who are exempt are:
- Applicants to the EU Settlement Scheme;
- Diplomats or members of visiting armed forces not subject to immigration control;
- Dependants of members of the UK's armed forces;
- Dependants of a member of another country's armed forces not subject to immigration control;
- British Overseas Territory citizens resident in the Falkland Islands;
- Relevant civilian employees at NATO or the Australian Department of Defence in the UK (or their dependants);
- Health and care workers eligible for a Health and Care Worker Visa (or their dependants);
- S2 Healthcare Visitors;
- Someone eligible for a Frontier Worker Permit with an S1 certificate;
- Children under 18 who have been taken into care by a local authority;
- Applicants for the Ukraine Extension Scheme or for a visa under the Homes for Ukraine Sponsorship Scheme; and,
- Those in protection cohorts (or their dependants), including asylum seekers or applicants for humanitarian protection, victims of slavery or human trafficking, victims of domestic violence, applicants for leave to remain on the basis of Article 3 ECHR, or stateless individuals.
You will not receive an IHS reference number if you fall into one of these categories. Those who do not need to pay the IHS are still able to access the NHS free of charge.
If you are eligible for a fee waiver for your application, this will mean your IHS fee will be waived too. However, the threshold for a fee waiver is very high; it is very difficult to prove you cannot afford to pay the application fee. In the event that you are granted a full fee waiver, you will be issued with a fee waiver token, which means that you are not required to access the IHS portal. If you are granted a partial fee waiver, you will need to specify that you have been granted a partial fee waiver in the IHS portal.
How Much Is the Immigration Health Surcharge?
As of 6 February 2024, the rates of IHS payable per person per year are:
- £1,035 for most applications
- £776 for students, student dependents, applicants for the Youth Mobility Scheme and children under 18 at the date of application
The total IHS payable per person depends on the length of immigration permission you apply for. It is charged in 6 month periods, meaning that where the total length of permission applied for includes part of a year, it is rounded up to the next 6 month period. Therefore, if you only apply for a period of 9 months, you will be required to pay the IHS for 12 months. Likewise, if you apply for entry clearance under Appendix FM, which grants you 33 months, you will have to pay for 36 months. There is an online calculator available to make the calculation simpler.
The currency exchange rate used is set by the Home Office at 4% above the Oanda live bid rates, which the Home Office justify as a means to ensure exchange rates charged reflect commercial exchange rates, and to minimise the risk to the Home Office and UK taxpayer of fluctuating exchange rates.
How Do I Pay the IHS?
You will make the IHS payment as part of your online application. You will be automatically routed to the IHS portal to pay the IHS before paying the application fee, making it impossible to submit your application without paying the charge first. You must pay the IHS by debit or credit card. The portal will inform you of how much you need to pay and, once paid, UK Visas and Immigration (UKVI) will provide you with a unique IHS reference number.
What Will Happen if I Don't Pay the Immigration Health Surcharge?
If you submit your application without paying the IHS, UKVI should email you to request payment; you then must pay within either 10 working days if you are within the UK, or 7 working days if outside the UK. Paragraph 34(4) of the Immigration Rules states that an application for permission to enter or remain in the UK must include payment of the Immigration Health Surcharge (where required). Therefore, under paragraph 34A, failure to pay the IHS will result in an invalid application, since the application was not made in accordance with the Rules and does not meet the requirements. The application will therefore not be considered.
Can I Get an IHS Refund if My Visa Application Is Refused?
You'll receive a full refund of your IHS payment if:
- Your visa application is refused;
- Your visa application is voided or rejected;
- You withdraw your visa application before a decision is made; or
- You have paid the IHS twice for the same visa application.
You'll receive a partial IHS refund if your visa application is successful but:
- You receive less time on your visa than you asked for
- Any dependants on your visa application are refused a visa. You will be refunded their IHS back, but the IHS for any successful visa applications will not be refunded;
- You're applying to extend or switch your visa in the UK and have paid the IHS twice for the same period;
- You've paid the IHS fee twice for the same 6+ month period. You will receive a partial refund rounded down to the nearest 6 months. For example, paying twice for a period of 9 months will mean you get a refund for 6 months' worth of IHS.
You can apply for a full or partial IHS refund if all of the following applies:
- You're a student in full time UK higher education;
- Your visa started on or after 1 January 2021;
- You have a European Healthcare Insurance Card (EHIC) issued in an EU country, Switzerland, Norway, Iceland or Liechtenstein; and
- You do not work and you do not plan to work while you study.
The amount you can get refunded will depend on the date your EHIC expires.
You will not be able to request a refund if:
- Your visa application is successful, but you do not come to the UK;
- You chose to or are told to leave the UK before your visa expires; or,
- You apply for indefinite leave to remain or switch to another visa where you do not need to pay the IHS.
How Long Will My IHS Refund Take?
Unfortunately, it is not entirely clear when you will receive an IHS refund, as the government has provided conflicting information.
If your application is voided or rejected, the IHS will be refunded when you are notified of this.
If your application is refused, and no appeal or administrative review is lodged, the IHS will be refunded 28 days after you receive a refusal.
Confusion arises over what happens where an appeal or administrative review is lodged after your visa application is refused. The UKVI page states that if you have applied from:
- inside the UK then you will get a refund up to 28 days after your appeal or administrative review is dismissed
- outside the UK then you will get your refund up to 28 days after your visa application is refused
The website also states that you will have to repay the IHS if your appeal or administrative review is successful and you've already got your IHS refund. However, the caseworker guidance asserts that in the case of an appeal or administrative review, a refund should only be issued once any appeal rights are exhausted. Therefore, it is unclear in these cases whether you should expect to receive a refund within 28 days of refusal, and have to repay the IHS if later successful, or whether the Home Office will hold onto your IHS payment until you receive a final answer on proceedings.
This also has implications on partial refunds. If the length of your stay changes or you get less time granted on your visa than you applied for, it is not clear whether you will be refunded in full within 28 days, and then expected to repay the correct, lower amount, or whether you will be automatically refunded the difference.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.