The health surcharge: paying and claiming back

The Immigration Health Surcharge (IHS) is a mandatory upfront fee that most non-British visa applicants must pay to access the NHS during their stay. Unlike many visa costs that might seem optional or flexible, the IHS is charged per year, calculated upfront for your entire visa duration, and payment is a legal requirement before your application can be processed.

How much is the IHS and when do you pay it?

As of 2026, the IHS costs £1,035 per year for most adult applicants. If you are a student, under 18 on the date of application, or on a Youth Mobility Scheme visa, you pay a reduced rate of £776 per year. These rates have remained unchanged since February 2024.

You must pay the full amount upfront, before your visa application is submitted. There are no instalments and no payment plans. For example, a three-year Skilled Worker visa costs £3,105 in total; a two-year student visa costs £1,552. The fee is calculated by multiplying the annual rate by the length of leave you are applying for, and periods shorter than six months are rounded up to a full year.

The IHS applies only to visas lasting longer than six months. If you are applying from outside the UK for a visa of six months or less, you do not pay the IHS at all. If you apply from inside the UK, you must pay for any period longer than six months, regardless of visa length.

Who does not have to pay?

Most visa applicants must pay the IHS, but a small number of categories are entirely exempt. Health and Care Worker visa holders and their dependants do not pay at all and still receive full NHS access. If you are applying for Indefinite Leave to Remain or British citizenship, the IHS does not apply. Irish citizens are also exempt under the Common Travel Area agreement.

Automatic refunds: when your visa is refused or granted for less time

If your visa application is refused, you receive a full automatic refund. This happens without you needing to do anything; the refund is processed by the Home Office's IHS portal and should reach your original payment method within six weeks of the decision.

If your application is withdrawn before a decision is made, or if your visa is granted for a shorter period than you paid for, you also receive a full or partial automatic refund. For example, if you applied for a three-year spouse visa but were granted two years, you will be refunded the cost of one year. Again, no claim is needed; the refund is automatic.

Refunds are calculated and issued to the original payer. If your employer, parent, or an immigration agent paid the IHS on your behalf, the refund will go back to their card or account. Note that if the original payment card has been closed or the details have changed, the refund may be delayed while the Home Office tries to recover the funds.

IHS refunds for EU and EEA students with an EHIC

If you are a full-time student from an EU country, Switzerland, Norway, Iceland, or Liechtenstein and you hold a valid European Health Insurance Card (EHIC) issued in your home country, you may be eligible to claim back some or all of your IHS. However, claiming an EHIC refund is a strategic choice with important trade-offs, and you should consider them carefully before applying.

What you need to be eligible

• You are enrolled full-time at a UK higher education institution
• You have a valid EHIC issued in an EU country, Switzerland, Norway, Iceland, or Liechtenstein
• Your visa started on or after 1 January 2021 (for EU, Norway), 1 November 2021 (for Switzerland), or 1 January 2024 (for Iceland and Liechtenstein)
• You do not work, and do not intend to work, in the UK during the period you are claiming for

The last condition is crucial. If you work in the UK while your EHIC refund is in place—even part-time or in an unpaid role—your EHIC will very likely become invalid, and your health cover will be lost. You cannot undo a refund claim if your circumstances change.

What you get and what you lose

If approved, you receive a refund calculated in six-month periods, based on how long your EHIC is valid for. If your EHIC is valid for your entire visa period, you receive a full refund. If it expires partway through, you receive a partial refund for the period it covers.

However, downgrading to EHIC coverage means your NHS access becomes much narrower. Instead of accessing the full range of free NHS services available to other visa holders, you will only be entitled to medically necessary treatment as defined by the medical provider. This can mean paying out of pocket for conditions or treatments the provider considers non-emergency. You must present your EHIC every time you seek care.

How to apply

You must apply within 12 months of arriving in the UK. For IHS payments made on or after 1 January 2024, you can apply online via the NHS Business Services Authority (NHSBSA). You will need your IHS reference number, visa share code, UK address, and a scanned copy of your EHIC and your Confirmation of Acceptance for Studies (CAS) or university acceptance letter.

If you are a student from Norway applying for IHS paid between 1 January 2021 and 31 December 2023, you must apply by paper; contact the NHSBSA for an application form. Students from Iceland and Liechtenstein can apply online for payments from 1 January 2024 onwards, though your refund will be backdated only to 1 January 2024 even if your visa started earlier.

IHS refunds for EU and EEA workers with an S1 certificate

If your healthcare costs in the UK are covered by an EU, EEA, or Swiss government through an S1 certificate, you may be eligible for a full or partial IHS refund. This typically applies to workers who are in receipt of an exportable benefit or state pension from their home country, or who are frontier workers (living in an EU country and working in the UK).

The S1 certificate is issued by the healthcare authority in your home country and confirms that your treatment costs will be reimbursed by that country to the UK. You must register your S1 with the NHSBSA in the UK before claiming an IHS refund. Your visa must have started on or after 1 January 2021.

If you paid the IHS yourself, you can claim the refund directly. If a dependent paid it on your behalf (for example, a spouse), the dependent must apply separately. The refund is calculated pro rata based on the dates your S1 is valid, and is backdated to include periods from 1 January 2021 onwards if you registered your S1 late.

IHS refunds for healthcare workers

If you are employed in an eligible health or care role but are not on the Health and Care Worker visa (for example, you are on a Student visa working part-time in the NHS or a care home), you may be able to claim an annual reimbursement of the IHS for the periods you are employed.

Refunds are calculated in six-month periods, starting from 31 March 2020 onwards. You can claim only for full six-month blocks in which you worked continuously. If you had unpaid leave or were unemployed for more than 28 days in any six-month period, you cannot claim for that period.

You must apply online via GOV.UK every six months if you want to claim for additional periods. You will need your IHS number, National Insurance number, employment contract, and payslips for the six months you are claiming. The NHSBSA will respond within six weeks. Your dependants can also claim if you include them in your application.

How to claim a manual IHS refund

Most IHS refunds are automatic and require no action. However, if you believe you are entitled to a refund that has not been processed automatically, or if you are applying for an EHIC or S1 refund, you will need to submit a manual claim.

Visit GOV.UK and use the official online IHS refund form. You will need to provide your IHS reference number (from your WorldPay confirmation email), your visa application reference number, your personal details, and any supporting documents requested. If you are applying for an EHIC or S1 refund, also provide copies of your EHIC certificate, S1 documentation, CAS letter, or other evidence of eligibility.

Check that all information matches the records held by the Home Office (UKVI). Any mismatch in name, reference number, or application details may cause your claim to be delayed or rejected.

Timelines and what to expect

• Automatic refunds (visa refusal, withdrawal, or shorter grant): processed within 6 weeks of the decision
• Manual refunds (EHIC, S1, healthcare worker): processing time up to 6–8 weeks after claim approval
• Deadline to claim an EHIC or S1 refund: 12 months from arrival in the UK for EHIC; within 5 years of payment for S1
• Deadline to claim any other refund: within 5 years of the IHS being paid
• Refund goes to: the original payer's card or account

If you have not received your refund after eight weeks, contact the UKVI via the online enquiry form on GOV.UK. Have your IHS reference number and application reference number ready.

What the IHS covers and does not cover

Paying the IHS gives you access to the NHS on broadly the same basis as a UK resident for the duration of your visa. This means you can see a GP, attend hospital, and receive treatment, investigations, and prescriptions through the NHS at no additional cost.

However, certain services remain chargeable to everyone, including IHS payers: standard prescription charges, dental treatment, optical services, and some assisted fertility treatments. These charges apply equally to UK residents and visa holders.

The IHS does not cover private healthcare. If you choose to see a private doctor, dentist, or optician, you pay the full private fee. Private health insurance is optional and does not exempt you from paying the IHS.