UK Immigration Health Surcharge (IHS) 2026, Who Pays, How Much, Exemptions

The Immigration Health Surcharge (IHS) is a fee paid upfront by most non-UK visa applicants, giving them access to the National Health Service for the duration of their leave. In 2026 it costs £1,035 per year for most visa types and £776 per year for students and children under 18. It is paid as a lump sum before the visa is granted, not monthly, not after arrival.

This guide covers who must pay, who is exempt, exactly how it is calculated, when you get a refund and the common mistakes that cause people to overpay or underpay.

The 2026 rates

The student rate applies to anyone holding a Student visa (Tier 4 or post-2021 Student visa). If you switch from Student to Skilled Worker, the higher adult rate applies from the date of the Skilled Worker visa.

Who must pay IHS

You must pay IHS if you are applying for:

• Skilled Worker visa (any duration over 6 months)
• Student visa (any duration)
• Family visa (spouse, partner, children, parents)
• Graduate visa
• Health & Care Worker visa
• Innovator Founder / Global Talent
• Youth Mobility Scheme
• Any visa valid for more than 6 months

Visas of 6 months or less (standard visitor, short-term student, transit) do not require IHS payment.

Who is exempt from paying IHS

Exemptions in 2026 are narrow. You do not pay IHS if you are:

• A national of a country with a reciprocal healthcare arrangement with the UK, as of 2026 this list is limited to Australia and New Zealand (partial exemptions only; check gov.uk for current list)
• Applying for or already hold ILR or Indefinite Leave to Enter
• A British citizen or settled person (no visa required)
• An asylum seeker whose claim is being processed
• Applying for a visa of 6 months or less
• A victim of domestic violence on the Destitution Domestic Violence Concession

Former exemptions for healthcare workers, diplomats, and some others have been significantly narrowed since 2023. Do not assume a previous exemption still applies without checking.

How IHS is calculated, the key rules

Partial years count as full years. This is the most expensive rule. If your visa is for 3 years and 4 months, you pay IHS for 4 years, not 3.33 years.

Round up, always. The formula is: total months ÷ 12, round up to the nearest whole year, multiply by the annual rate.

Worked example:

• Skilled Worker visa: 3 years and 1 day
• Years charged: 4 (3 full years + any remainder = +1 year)
• IHS: £1,035 × 4 = £4,140

This catches many people off-guard. A Skilled Worker visa is typically granted for the CoS duration plus a buffer. If your employer issues a CoS for "3 years" and the Home Office grants leave for "3 years and 14 days," you pay for 4 years.

Tip: Check the exact months on your visa and calculate before paying to avoid surprises.

How to pay IHS

IHS is paid during the online visa application process, before the application is submitted. You cannot bypass this step.

1. Complete the online visa application form on gov.uk.
2. The system automatically calculates the IHS amount based on visa duration and applicant type.
3. Pay by Visa, Mastercard, or Maestro (debit or credit). American Express not accepted.
4. Once paid, you receive an IHS reference number which must be included in the application.
5. If you have dependants applying simultaneously, they each need their own IHS payment.

You can pay IHS online and then submit the application days or weeks later, the IHS reference is valid for the application session. However, if you start a new application session, you may need to pay again (check the gov.uk system guidance).

Dependants and IHS

Each dependant applying simultaneously pays IHS separately:

• A spouse applying on a Skilled Worker dependant visa: £1,035/year × visa duration
• A child under 18 accompanying a parent: £776/year × visa duration
• A child turning 18 during the visa: the rate is set at application, if under 18 when applying, the child rate applies for the whole visa

Family example: Adult + spouse + 2 children, 3-year visa:

• Adult: £1,035 × 3 = £3,105
• Spouse: £1,035 × 3 = £3,105
• Child 1: £776 × 3 = £2,328
• Child 2: £776 × 3 = £2,328
• Total IHS: £10,866

IHS refunds

Full refund: If your visa application is refused, the IHS is refunded in full within 6 to 10 weeks. No application is needed, the refund is processed automatically to the card used.

Partial refund: If your leave is curtailed (shortened) after being granted, for example you leave the UK voluntarily, your visa is revoked, or you switch to a lower-surcharge visa, you can claim a refund for complete unused months. Apply via the IHS refund form on gov.uk within 3 months of your leave ending.

No refund if: you use your leave fully, or you are removed from the UK following an immigration breach.

What IHS actually covers

IHS gives you access to NHS treatment on the same basis as a UK resident:

• ✅ GP appointments
• ✅ A&E and urgent care
• ✅ Hospital treatment (inpatient and outpatient)
• ✅ NHS mental health services
• ✅ Maternity care (most)

Not covered (you pay regardless of IHS):

• ❌ NHS prescription charges (currently £9.90 per item unless exempt)
• ❌ NHS dentistry (you pay NHS treatment charges)
• ❌ Optical (NHS sight tests reduced-cost; glasses full-price)
• ❌ Assisted conception and some fertility treatments
• ❌ Cosmetic procedures

Frequently asked questions

How the IHS is calculated, the exact formula

The IHS is calculated based on:

• The length of your visa (in years and months)
• Your route (standard rate or reduced student rate)
• The number of applicants (main applicant + each dependant)

Formula: IHS = (visa length in complete years + any remaining months as a fraction) × annual rate × number of applicants

For a 3-year visa (exactly) at the standard rate, single applicant: 3 × £1,035 = £3,105

For a 5-year, 0-month Skilled Worker visa with one dependant spouse: 2 × 5 × £1,035 = £10,350

For a 1-year, 6-month Student visa (18 months): 18/12 × £776 = £1,164

The calculation rounds to the nearest pound. The Home Office's online payment system performs the calculation automatically, you don't need to calculate it manually. However, understanding the formula helps you verify the amount shown is correct.

What IHS pays for, and what it doesn't

The IHS entitles you to use the National Health Service (NHS) on the same basis as a UK resident:

• GP consultations
• Hospital treatment (A&E, inpatient, outpatient)
• Maternity care
• Mental health services
• NHS dentistry (via NHS dentist, with any applicable patient contributions)
• Prescriptions (at the standard prescription charge of £9.90 per item in England)

What IHS does not cover:

• Private healthcare (that's separate private insurance)
• Emergency dental treatment outside the NHS
• Elective cosmetic procedures
• Repatriation flights if you are medically unfit to travel
• Travel insurance (a common misconception, IHS is not travel insurance)

Many migrants pay IHS and also take out private healthcare insurance. This is their choice, there's no obligation to use private care when IHS is paid. The benefit of private healthcare is speed of access and specialist choice, not a different level of coverage entitlement.

IHS when you change visa type mid-period

If you extend or switch visa type before your current visa expires, you pay new IHS for the new visa period. The remaining IHS on your old visa is not refunded unless:

• Your leave is curtailed (cut short by UKVI action)
• You voluntarily leave the UK and notify UKVI

Simply extending from one Skilled Worker period to the next does not generate a refund for unused IHS on the original visa. The new visa's IHS covers the new period.

Example: you hold a 3-year Skilled Worker visa (paid £3,105 IHS). At the 3-year mark you extend for another 2 years (pay £2,070 IHS). No refund is due because you used the full 3 years. But if at year 2.5 you extended for reasons of job change, you'd be paying the new IHS while having 6 months of old IHS still "live." The overlap is not refunded.

The IHS exemption for NHS and care workers, detail

The IHS exemption for Health and Care Worker visa holders applies automatically when the route is correctly processed. The UKVI system checks whether your CoS was issued under the Health and Care Worker route and applies the zero-IHS calculation.

How it works in practice: When your employer assigns you a CoS under the Health and Care Worker route (not the generic Skilled Worker route), the UKVI online application system displays £0 for IHS at the payment stage. If it shows any amount for IHS, stop and verify with your employer that they assigned the CoS under the correct route (SOC 2020 code must be an eligible healthcare occupation on the HC route list).

Who else is exempt:

• British citizens and Irish citizens (they're not migrants, so not subject to IHS)
• Those with ILR (settled, IHS doesn't apply to settled persons)
• Those with long-term permission to stay as a stateless person (discretionary exemption)
• Australian and New Zealand citizens temporarily covered by reciprocal healthcare arrangements (very limited, check current gov.uk guidance)

IHS rate history, how it has increased

The IHS has increased substantially since its introduction:

From 2015 to 2026, the standard rate increased by 417%. The student rate increased by 417% as well. The rate is set by statutory instrument and can be changed by the Government without primary legislation. All projections suggest the rate will continue to increase.

Reducing IHS exposure, strategic visa length choices

Since IHS is calculated over the full visa length, your choice of visa duration directly affects the IHS bill:

Example, 5-year visa vs two 3-year periods:

• Option A: 5-year visa: IHS = 5 × £1,035 = £5,175
• Option B: 3-year visa then 2-year extension: IHS year 1 = 3 × £1,035 = £3,105, IHS year 2 = 2 × £1,035 = £2,070. Total: £5,175

The total IHS is the same (5 years × £1,035). The only difference is cash flow, the 3+2 approach costs less upfront at initial application.

For families, the difference is the same per person but multiplied by family size. For a family of four:

• 5-year visa: 4 × 5 × £1,035 = £20,700
• 3+2 split: £12,420 at year 0, £8,280 at year 3

The 3+2 split provides significant cash flow relief if the family has limited savings at the point of initial application.

Frequently asked questions

IHS payment failure, what happens if the payment is declined

The UKVI application system requires IHS payment at the time of application submission. If your payment is declined:

• The application is not submitted
• No partial payment is held
• You must retry with a different card or payment method

Common causes:

• Card daily transaction limit exceeded (IHS for a family of 4 can exceed £5,000, many cards have lower daily limits)
• International transaction blocked by your bank
• Card expired or wrong CVV

Solutions:

• Contact your bank in advance to increase the daily limit
• Use a credit card rather than debit card for large transactions
• Have a second card from a different bank as backup
• Use a Visa or Mastercard (Amex is not accepted by UKVI's payment system)

If the payment fails repeatedly, UKVI's contact centre can sometimes process payment over the phone, call 0300 123 2241.

IHS and NHS dental treatment

IHS covers NHS dental treatment on the same basis as UK residents. However, NHS dentistry in England has a patient charge system:

• Band 1 treatment (examination, X-rays): £26.80
• Band 2 treatment (fillings, extractions): £73.50
• Band 3 treatment (crowns, dentures, bridges): £319.10

These charges apply regardless of immigration status, IHS does not waive them. The charges are fixed, and treatment from an NHS dentist (not a private dentist) is covered at these rates.

Note: NHS dentists are in high demand and many are not accepting new NHS patients. This is a domestic NHS capacity issue, not an immigration matter, it affects UK residents and visa holders equally. Private dental treatment costs significantly more.

IHS for overstayers, what happens to NHS access

If your leave expires and you remain in the UK as an overstayer:

• Your IHS is no longer valid
• NHS treatment (except emergency A&E) becomes chargeable at the overseas visitor rate
• This is 150% of the NHS tariff, significantly more expensive than the IHS-covered rate

The practical implication: overstaying your visa doesn't just create immigration problems, it removes your NHS entitlement and can result in unexpected healthcare bills. This is another reason to ensure timely extensions and compliance.

IHS refund claims submitted after the expiry of your leave are assessed for the period when you were lawfully in the UK with valid IHS coverage.

Comparing IHS to private health insurance costs

A common question: is it worth taking private health insurance in addition to the NHS access that IHS provides?

In most cases, no, but it depends on your circumstances.

When NHS access via IHS is sufficient:

• GP consultations, prescriptions, A&E, hospital treatment, maternity care
• NHS treatment is free at point of use (beyond any prescription charges)
• For routine and emergency care, the NHS is comprehensive

When private health insurance adds value:

• Faster access to specialists (NHS wait times for non-emergency specialist referrals: 6 to 26 weeks; private: often within 1 to 2 weeks)
• Choice of consultant and hospital
• Private rooms for inpatient treatment
• Dental treatment beyond NHS scope

Private health insurance for a healthy 30-year-old: approximately £600 to £1,200/year. For a family of four: £2,000 to £4,000/year. This is significant cost on top of IHS.

Most Skilled Worker visa holders on modest salaries (£35,000 to £60,000) do not take private health insurance, NHS access is adequate. Those in higher income brackets often receive private healthcare as an employer benefit. If your employer offers health insurance as a perk, check whether it supplements or replaces NHS use, most UK employer health insurance is supplementary (you can still use the NHS).

The IHS and mental health treatment

Mental health services are covered by IHS on the NHS, but access varies significantly by region. IAPT (Improving Access to Psychological Therapies) services offer CBT and talking therapies via NHS referral. Wait times: 6 to 18 weeks for non-urgent therapy.

Private mental health consultations: £100 to £300 per session. If you have existing mental health conditions and anticipate needing regular support, factoring this cost into your UK move planning is important. Some employer health insurance schemes cover mental health treatment, this is worth specifically asking about when reviewing job offers.