The Immigration Health Surcharge and what it covers

If you are moving to the UK on most work, study or family visas, the Immigration Health Surcharge is an upfront fee you pay when you apply, granting you access to NHS care on broadly the same terms as UK residents.

What is the Immigration Health Surcharge?

The Immigration Health Surcharge, usually called the IHS, is a mandatory charge paid alongside your visa application. It was introduced in April 2015 to ensure that people coming to the UK on temporary visas contribute toward the cost of NHS services. Unlike in some other countries, there is no ongoing insurance premium to maintain once you have paid the IHS. You pay once, in full, for the entire length of your visa, and that gives you access to most NHS healthcare.

Almost everyone applying for a visa lasting longer than six months, or for any period at all if applying from within the UK, must pay the surcharge. Visitor visas are exempt, as are applications for permanent settlement such as Indefinite Leave to Remain, and certain exemptions exist for health and care workers, asylum seekers and others covered by international agreements.

Current IHS rates in 2026

As of early 2024, and still in force throughout 2026, the standard adult rate is 1,035 pounds per year. If you are a student, the dependant of a student, under 18 years old at the time of application, or applying for a Youth Mobility Scheme visa, you pay a reduced rate of 776 pounds per year. Each person on the application, including every dependant and child, must pay their own IHS. A family of four coming for three years on a Skilled Worker visa, for example, would collectively pay many thousands of pounds in IHS charges.

The charge is calculated in six-month blocks and rounded up. If your visa will run for one year and seven months, you will be charged for two full years. The surcharge is worked out based on the visa period granted by the Home Office, not the actual dates of your employment or course. Payment is required upfront and in full; you cannot pay in instalments, and you must pay even if you already have private health insurance.

What the IHS covers: free NHS care

Once you have paid the IHS and your visa is granted, you have the right to register with a GP surgery and access NHS hospital treatment and emergency services free at the point of use, just like UK residents. This includes appointments with your GP, referrals to specialists, diagnostic tests, surgery, emergency care at Accident and Emergency departments, hospital inpatient and outpatient treatment, maternity care and mental health services. In short, the range of NHS services available to you is the same as for someone who has lived in the UK their whole life.

The IHS does not give you preferential treatment; you will join NHS waiting lists and follow the same pathways as everyone else. Your IHS reference number will be generated when you pay, and you can use this when registering with a GP, although in practice your visa status and registration will usually be sufficient proof of entitlement.

What you still pay for: prescriptions, dental and optical

The IHS grants you access to NHS care, but it does not cover every charge within the NHS. In England, you will still pay prescription charges, currently 9.90 pounds per item as of April 2026. Each medication on a prescription is charged separately, so a prescription for three items will cost you nearly 30 pounds. Prescriptions are free in Scotland, Wales and Northern Ireland for all residents, but in England the charge applies unless you qualify for an exemption, such as being under 16, over 60, pregnant, or receiving certain benefits.

NHS dental treatment in England operates on a three-band system. As of 2026, Band 1 treatment such as a check-up and basic care costs 26.80 pounds, Band 2 including fillings and extractions costs 73.50 pounds, and Band 3 covering more complex procedures such as crowns or dentures costs 319.10 pounds. You pay once per course of treatment, not per appointment. Dental charges are different in Wales, Scotland and Northern Ireland, and some groups including children, pregnant women and those on certain benefits receive free dental care.

Eye tests and glasses are also not fully covered. NHS-funded sight tests are available for children, those over 60, people on qualifying benefits, and certain medical conditions, but otherwise you pay for an eye test and for glasses or contact lenses. Optical vouchers toward the cost of glasses are available if you qualify for help with health costs.

• GP appointments, hospital treatment, emergency care, maternity services and mental health support: free at the point of use
• Prescriptions in England: 9.90 pounds per item, but free in Scotland, Wales and Northern Ireland
• Dental treatment in England: 26.80 to 319.10 pounds per course of treatment depending on complexity
• Eye tests and glasses: charges apply unless you qualify for an exemption or voucher

EHIC, GHIC and visitors versus residents

The European Health Insurance Card, or EHIC, and its UK successor, the Global Health Insurance Card, or GHIC, work in a different way to the IHS and are for temporary visitors rather than residents. If you are a UK resident traveling to EU countries or certain other destinations, a GHIC allows you to access state healthcare in those countries on the same terms as a local resident, often free or at reduced cost. The GHIC does not cover private treatment, repatriation or travel cancellation, so travel insurance is still necessary.

If you are from an EU or EEA country visiting the UK temporarily, your EHIC card may entitle you to medically necessary NHS treatment, but the rules have changed significantly since Brexit. EU citizens who hold Settled or Pre-Settled Status under the EU Settlement Scheme access the NHS free without needing to pay the IHS. However, new arrivals and short-term visitors without such status are generally not entitled to free NHS care beyond emergency stabilization. Visitors on short-term visas of six months or less are not charged the IHS but are instead charged for most NHS treatment they receive at 150 percent of the NHS tariff rate unless a reciprocal healthcare agreement applies.

The key distinction is residency and visa type. If you are living in the UK on a visa longer than six months and have paid the IHS, you are treated as ordinarily resident for NHS purposes and your care is free at the point of use. If you are visiting briefly without residency or on a visitor visa, you may need to pay for treatment unless emergency care is provided, which is free for everyone at Accident and Emergency departments regardless of status. Follow-up hospital care after emergency treatment can still be charged to visitors.

Exemptions and special cases

Certain groups are exempt from the IHS entirely. The most significant exemption is for Health and Care Worker visa holders and their dependants. This exemption was introduced in 2020 during the pandemic and remains in place, recognizing the contribution of health and social care professionals to the NHS. If you are on a Health and Care Worker visa, you do not pay the surcharge, yet you still receive full NHS access.

Other exemptions include applicants for asylum and protection routes, victims of human trafficking and modern slavery applying for discretionary leave, victims of domestic abuse, and those applying under the now largely closed EU Settlement Scheme. Irish nationals do not require a UK visa and have automatic NHS access under the Common Travel Area arrangements. People applying for Indefinite Leave to Remain are also exempt from the IHS, though if you apply for permanent settlement but are only granted limited leave instead, you will need to pay the surcharge.

Some applicants on family and human rights routes may qualify for a fee waiver, which includes exemption from the IHS, if they can demonstrate genuine inability to afford the charges. The waiver application must be made before the visa application itself and is assessed on financial circumstances.

Refunds and what happens if your visa is refused

If your visa application is refused, the IHS is automatically refunded to the bank account used to make the original payment, usually within about six weeks. If you are granted a shorter period of leave than you applied for, you may receive a partial refund for complete six-month periods you will not use. However, the IHS is non-refundable simply because you change your mind, leave the UK early, or do not use NHS services during your stay.

If you extend your visa or switch to a different visa category from within the UK, you must pay the IHS again for the new period of leave. The surcharge is tied to each grant of immigration permission, not to you as an individual, so every time you apply you pay afresh.

Private insurance: do you still need it?

Having paid the IHS, you are not required to take out private health insurance and many people do not. Your IHS payment gives you full access to NHS services, which are comprehensive. However, some employers offer private medical insurance as a workplace benefit, and some people choose to buy it for faster access to specialists, private hospital treatment, or to avoid NHS waiting times. Private insurance can also cover dental and optical costs more fully than the NHS does.

You cannot use private insurance to avoid paying the IHS; the surcharge is mandatory regardless of any other coverage you have. Think of the IHS as your entry ticket to the NHS, while private insurance is an optional extra for those who want additional choice or speed.