Alongside the visa fee itself, most people moving to the United Kingdom for more than six months pay a second charge before their application can even be decided: the immigration health surcharge, usually shortened to the IHS. It is the payment that gives visa holders access to the National Health Service while they live in the UK, and for many families it is the single largest cost in the whole application. A three-year work visa, for example, carries a surcharge of more than three thousand pounds per person, before the visa fee is added at all. Because the charge is paid in full, up front, for the whole length of the visa, anyone planning a move to the UK needs to understand exactly how it is worked out, who has to pay it, and when the money can come back.

What the immigration health surcharge is

The surcharge is a charge set under the Immigration Act 2014. It is not private health insurance, and it is not a voluntary extra. Once you have paid it and your visa has started, you can use the NHS broadly in the same way as someone who lives in the UK permanently. That means GP appointments, hospital treatment and most other NHS services are available without further charge at the point of use. There are limits, though. You still pay the same charges that UK residents pay for some services, including prescriptions in England, dental treatment, eye tests and assisted conception. Treatment received before the Home Office has decided your application may also be chargeable, and when you use healthcare you may be asked to prove your immigration status online with a share code if you hold a digital status.

Two points catch people out more than any other. First, you still have to pay even if you already hold private medical insurance. Having your own cover does not remove the surcharge, and it does not reduce it. Second, the surcharge is a condition of a valid application. If it is not paid correctly, leave cannot be granted, so an underpayment is not a minor admin error but something that can stall or sink the whole application.

How much the surcharge costs in 2026

There are two yearly rates. Most visa and immigration applicants pay 1,035 pounds per year. Students, their dependants and people on a Youth Mobility Scheme visa pay 776 pounds per year, and the same reduced rate applies to applicants who are under 18 at the date of application. You pay for the whole length of the permission you are applying for, in one payment, at application stage, not year by year. That is why the totals surprise people. A three-year visa at the standard rate costs 3,105 pounds per person. A two-year visa at the reduced rate costs 1,552 pounds. A five-year visa at the standard rate costs 5,175 pounds per person, and that is before the visa application fee itself.

Dependants pay too, each in their own right. GOV.UK says dependants aged 18 or over usually pay the same amount as the main applicant, while student dependants and under-18s fall under the 776-pound rate. A family budget therefore needs a surcharge line for every person, for every year. A couple on three-year work visas, for instance, would usually face 6,210 pounds in surcharge between them, and a family of four on a long grant can face a five-figure bill before any other cost is counted.

The part-year rules, where budgets go wrong

Visas rarely run for neat whole years, so GOV.UK rounds part-years in a fixed way, and the rounding is where careful budgeting matters most. If you are applying from outside the UK for six months or less, you do not need to pay the surcharge at all. If you are applying from inside the UK for six months or less, you pay half the yearly rate: 388 pounds at the reduced rate or 517.50 pounds at the standard rate. Wherever you apply from, a visa of more than six months but less than one year is charged as a full year. If the visa runs for more than a year but no more than 18 months, you pay the yearly rate plus half the yearly rate. If it runs for more than 18 months but less than two years, you are charged for two full years, and the same rounding pattern continues for longer grants.

The practical lesson is that the charge follows the length of permission granted, which can be longer than your course of study or your job contract. A grant that runs just over six months, or just over eighteen months, costs far more in surcharge than a slightly shorter one. Before you apply, work out the total as rate, multiplied by years with the part-year rounding applied, multiplied by the number of people, and check the figure with the official GOV.UK calculator on the day you apply.

Who has to pay

In general, you need to pay if you are applying for a visa or immigration permission for more than six months from outside the UK, or for any length of time from inside the UK, for example when switching or extending a visa while already here. That covers most work, study and family routes, including Skilled Worker, Student, partner and parent routes, and most extensions and switches made inside the UK. Extensions are not free of the charge either. Each new period of permission brings a new surcharge payment for that period, so someone extending a visa pays again for the new grant.

Who does not have to pay

You do not need to pay, and do not need a surcharge reference number, if you are applying for a visitor visa, or for a visa of six months or less from outside the UK. You also do not pay if you are applying to remain in the UK permanently, for example for indefinite leave to enter or remain. Health and Care Worker visa holders and their dependants are exempt, as are people applying to the EU Settlement Scheme, diplomats and members of visiting armed forces who are not subject to immigration control, dependants of members of the UK armed forces, asylum seekers and people applying for humanitarian protection, and people identified as victims of slavery or human trafficking in the situations listed on GOV.UK, including those given discretionary leave on that basis. The Home Office domestic violence concession, S2 Healthcare Visitors, Frontier Worker permit holders with an S1 certificate, children under 18 taken into care by a local authority, stateless people, and people applying under the Ukraine Extension Scheme or the Homes for Ukraine Sponsorship Scheme are also covered, and no surcharge is payable for a visa for the Isle of Man or the Channel Islands, although you will need to pay for NHS-type care when you use it there.

One trap deserves its own warning. If you apply for indefinite leave to remain but are only given limited leave instead, you will need to pay the surcharge before that limited leave is given. GOV.UK also names further narrow categories, such as certain NATO and Australian Department of Defence civilian employees and British Overseas Territory citizens resident in the Falkland Islands, so check your exact route on the official page before assuming you are exempt.

How and when you pay

You pay the surcharge as part of your online visa application, by debit or credit card, before you pay the visa application fee itself. You cannot normally pay it separately in advance or in instalments afterwards. During the application you will be asked for the start and end dates on your certificate of sponsorship if you have one, or your course dates if you are applying as a student. You will need to give your own details and those of any dependants applying at the same time, and if you are joining or remaining with someone already in the UK you will usually need their details too, including their visa expiry date or surcharge reference number, unless they are a UK citizen, have EU settled status, or have permission to stay permanently.

Once you have paid, you are sent an email with a surcharge reference number, which is also shown on screen. Keep it safe. You can only use that number once, and if you reapply you will need a new one. Then finish the application form and pay the separate visa application fee.

If you do not pay, or pay too little

If you do not pay the surcharge, or do not pay enough, UK Visas and Immigration will email the address given in your application explaining how to pay the missing amount. Check your junk folder if you cannot see it. From that email you must pay the surcharge in full within ten working days if you are inside the UK, or seven working days if you are outside the UK. If you do not pay the full amount in that time, your visa or immigration application will be turned down. Do not ignore an underpayment email, and do not assume a small shortfall will be waived.

Refunds: when the money comes back, and when it does not

You will get a full refund if you paid the surcharge twice for the same visa application, if your visa application is refused, or if you withdraw your visa application before a decision is made. You will get a partial refund if your application succeeds but you are given less time on your visa than you asked for, if any dependants on your visa application are refused a visa, in which case you get only their surcharge back, or if you are extending or switching your visa in the UK and have paid the surcharge twice for the same period. Where you have paid twice for the same period of six months or more, the refund is rounded down to the nearest six months. For example, if you paid twice for a fifteen-month period, you will get a refund for twelve months of surcharge. If you paid twice for the same period of less than six months, you will not get a refund.

Where a refund is due for these reasons, you do not have to do anything to get it. It is paid automatically to the account or card you paid with, usually within six weeks of the decision on your visa application. It can take longer if you appeal or ask for an administrative review after a refusal. If your appeal or administrative review succeeds after you have already received a refund, you might have to repay the surcharge, and you might have to repay a different amount if the length of your stay changes or you get less time than you applied for.

You will not get a refund if you withdraw your visa application after your visa is granted, if your application succeeds but you do not come to the UK, if you leave the UK before your visa ends, if you are told to leave before your visa expires, if you are applying for indefinite leave to remain, or if you are switching to another visa which is exempt from the surcharge. If a visa applicant dies in the UK or before arriving, the surcharge will not be refunded. In short, refunds are tied to how the application is decided, not to whether you use the NHS or how long you actually stay.

Special refund routes worth knowing about

Separate refund routes exist in specific cases, each with its own conditions. If your healthcare is paid for by an EU country, Switzerland, Norway, Iceland or Liechtenstein and you have an S1 certificate registered with the NHS Business Services Authority, you may get a full or partial refund. Full-time students in UK higher education whose visa started on or after 1 January 2021 can apply for a full or partial refund if they hold a European Health Insurance Card issued in an EU country, Switzerland, Norway, Iceland or Liechtenstein and do not work and do not plan to work while they study. The amount refunded depends on the date the card runs out. People who work in health or care and hold a visa may also be able to get a refund of the surcharge, but only for periods they worked in health or care for six months or more, and only for dependants whose visa covers the same period. Read the GOV.UK refund section for your own situation rather than assuming any of these routes applies to you.

Mistakes that cost people money

The most common mistake is budgeting only for the visa fee. On longer routes the surcharge is often bigger than the application fee, so price both before you commit. The second is forgetting dependants, since every dependant pays for every year of their permission too. The third is assuming private insurance exempts you. It does not. The fourth is assuming visitors and settlement applicants pay. They do not, but visitors pay for chargeable NHS care at the point of use, and someone granted limited leave instead of settlement will be asked to pay before that leave is given. The fifth is guessing the length of permission, since the charge follows the permission granted, with part-years rounded as set out above. The sixth is ignoring the underpayment email, because seven working days outside the UK and ten inside is a hard window. And the seventh is expecting a refund for unused time: leaving early, not travelling, or switching to an exempt route does not bring the money back.

The bottom line is simple. Think of the surcharge as prepaid NHS access charged by the year: 1,035 pounds a year for most applicants, and 776 pounds a year for students, their dependants, Youth Mobility Scheme applicants and under-18s, paid in full up front for the whole grant, for every person applying. Visitors and people applying to settle permanently do not pay it, Health and Care Workers and a defined list of other groups are exempt, and refunds are automatic but narrow. Work out your total before you start the application, and verify the figure on GOV.UK on the day you apply, because rates and rules change. This guide is general information based on public GOV.UK guidance, not personal immigration advice, and anyone unsure about their own situation should speak to a regulated immigration adviser.