A 2024 Guide to the Immigration Health Surcharge
On 19 April 2024, the Home Office published an updated version of its Immigration Health Surcharge: Caseworker Guidance. The guidance has been changed to incorporate the Immigration (Health Charge) (Amendment) Order 2024.
In this article, our Immigration Solicitors explain what sponsoring employers, businesses and individual visa applicants need to know about the immigration health surcharge.
UK Online and London-Based Immigration Solicitors and Sponsorship Licence Lawyers
For immigration advice call OTS Solicitors on 0203 959 9123 or contact us online.
What is the immigration health surcharge?
The immigration health surcharge is the mechanism employed by the government to get people who are subject to UK immigration to pay for access to the National Health Service (NHS) for treatment without charge.
Payment of the immigration health surcharge entitles the payer to NHS treatment at the same level and quality as someone who isn’t subject to UK immigration control. The visa holder gets the same treatment options and should not get a better (or worse) service than any other NHS patient.
The immigration health surcharge does not cover anything that a British citizen would have to pay for. Therefore, the immigration health surcharge does not cover prescription charges. Payment does not put a visa holder at the front of the NHS queue for surgery or cover treatment not routinely provided by the NHS. For example, cosmetic surgery.
The key points about the immigration health surcharge are:
- Visa applicants are required to pay the immigration health surcharge if they are not exempt from payment. Each person has to pay the same amount. The figure does not go up or down depending on the state of a visa applicant’s health, if they are over 60 or other factors, such as whether they are having a baby or are involved in a road traffic accident whilst in the UK
- The immigration health surcharge fee does not relate to the visa applicant’s nationality. If a visa applicant is applying for a Family Visa or Work Visa from India they will pay the same immigration health surcharge as someone applying for a visa from the US or Russia
- The immigration health surcharge fee does not depend on visa type. If a visa applicant has to pay the immigration health surcharge they have to pay the same amount whether they are applying for a Skilled Worker Visa with a salary of £100,000 gross a year or a Work Visa on a wage of £40,000 or whether they are applying for a Spouse Visa
- There is no pay-and-go service – the immigration health surcharge is a flat charge that must be paid upfront before a visa is issued. A visa applicant or their sponsoring employer cannot opt to pay for NHS treatment as needed
- There is no refund for staying healthy – some visa holders are fortunate enough not to have to use the NHS for the duration of their UK stay. However, there is no refund even if a visa holder does not see a GP or visit a hospital
- There is no discount or refund for taking out private health insurance – some assume that private health insurance would at least reduce the amount of the immigration health surcharge but it does not do so even if a sponsoring employer guarantees to provide private health cover as part of the perks of the job and it is written into the overseas worker’s employment contract
- The immigration health surcharge must be paid upfront – one way to avoid bad debt is to insist on upfront payment of the immigration health surcharge for the duration of the visa grant. That can be a lot of money for a visa applicant to find, especially if they are accompanied by family on Dependant Visas. For sponsoring employers keen to recruit a skilled worker it can be necessary to offer to pay the immigration health surcharge on the sponsored employee’s behalf to attract a job applicant where their skills are in short supply. The employer needs to consider what happens if the sponsored employee decides to leave their job early to work for a competitor with a sponsor licence. Talking to Sponsorship Licence lawyers about how sponsorship and employment contracts work can help
- The immigration health surcharge is individual – it does not cover a family. The immigration health surcharge must be paid by the main visa applicant and by anyone accompanying them on a Dependant Visa. There is no family immigration health surcharge package or discount available. However, the amount of the immigration health surcharge is reduced if a dependant is under 18
- Starting a family on the NHS - assisted conception services in England are not covered by payment of the IHS but if a visa holder becomes pregnant their obstetric care is covered as well as pediatric care for the baby
- The immigration health surcharge portal - the IHS portal can calculate the immigration health surcharge liability. The amount will depend on the visa length as the full amount is due on payment. The fees cannot be paid annually or monthly. Some visa applicants complain that they are paying upfront for something they may never use with no opt-out provision
- Currency to be used if you are paying the immigration health surcharge from outside the UK – the immigration rules say that if a visa applicant is overseas and paying their immigration health surcharge using the portal they need to use the currency where they are with the portal calculating the exchange rate and the amount needed. To cover every potential aspect there is a separate Home Office guide to currency and payments
- Deadlines to pay the immigration health surcharge – the Home Office allows 7 working days to pay the immigration health surcharge when the applicant is applying for entry clearance or 10 working days when the application is for permission to stay. The Home Office will give one chance to make payment unless there are compelling or compassionate circumstances which would permit a further payment link to be issued
- Immigration health surcharge refunds – the caseworker guidance says the IHS should not be refunded if a visa application is refused until the applicant has exhausted their appeal and administrative review rights. If the application is refused on administrative review or appeal the immigration health surcharge should be refunded. For more information on immigration health surcharge refunds take a look at our blog on refunds
Who has to pay the immigration health surcharge?
The immigration health surcharge is the responsibility of the individual visa applicant although a sponsoring employer (Work Visa applicants) or a sponsoring partner (Family Visa applicants) may decide to pay the fees on behalf of a recruit or loved one. Employment lawyers recommend sponsoring employers take legal advice from Sponsorship Licence Lawyers before offering this as part of an incentive package. This is necessary to protect the employer’s interests.
The immigration rules say a visa applicant applying for a visa for a period exceeding 6 months is required to pay the IHS covering the duration of their visa unless they are either exempt or entitled to a fee waiver.
When a visa holder applies to renew and extend their visa they need to pay the immigration health surcharge for the duration of the extended visa.
The requirement to keep paying the immigration health surcharge stops when a visa holder secures Indefinite Leave to Remain.
If you are a UK business owner and employer inviting a person to come from overseas on a short Business Visa to carry out permissible business activities or if you are applying for a Visitor Visa of less than 6 months to see family or for tourism you need to consider health costs and insurance. If a person who is subject to immigration control receives free NHS care and treatment when they are not entitled to it and do not pay for the care this affects their immigration record. It may result in the refusal of a subsequent visa or settlement application.
The law on the immigration health surcharge
For those of you keen to understand the legislative fine detail you will find them in the:
- Section 38 of the Immigration Act 2014
- Immigration (Health Charge) Order 2015
- Immigration (Health Charge) (Amendment) Order 2024.
What does the immigration health surcharge cost?
The cost of the immigration health surcharge depends on:
- If the visa applicant is exempt or if there is a fee waiver
- The age of the visa applicant. Child and student visa applicants pay less
- The length of the visa
If the visa application was submitted on or after 9 am 6 February 2024 the immigration health surcharge is:
- £1,035 per visa applicant per year for a qualifying visa application
- £776 per visa applicant if the applicant is a student, student dependent, applicant for the Youth Mobility Scheme or a child under the age of 18 at the date of their visa application
Calculating the immigration health surcharge
A visa applicant must pay the full amount of their immigration health surcharge at the time of their visa application as the immigration rules do not provide for payment by installments.
When calculating the immigration health surcharge you need to know the visa length. Unfortunately, for some, the Home Office does not apportion the immigration health surcharge to a daily, weekly or even monthly amount. Instead, the immigration health surcharge is charged in 6-month periods.
The rules mean a visa applicant may pay more for their immigration health surcharge than the time spent in the UK. For example, if a Skilled Worker Visa applicant applied for a 16-month visa they would need to pay an amount equivalent to 18 months of immigration health surcharge (£1,552.50). For Skilled Worker Visa applicants, the immigration health surcharge portal will calculate the liability based on the length of the requested visa.
Who is exempt from paying the immigration health surcharge?
With the increase in the immigration health surcharge sponsoring employers are concerned that the surcharge will deter overseas job applicants from applying to come to the UK to work, especially when a worker may be able to choose to work in a different country where the cost of private health insurance for an individual would be less than £1,035 for a year.
Sponsorship Licence lawyers say it is important to understand who is exempt from payment. Exemptions include applications for:
- Applicants for the Health and Care Worker Visa (forming part of the Skilled Worker Visa route) - most Health and Care Worker Visa applicants are exempt from paying the immigration health surcharge provided they have a certificate of sponsorship and a job offer that qualifies them for a Health and Care Worker Visa with an eligible standard occupational classification code
- Visitor Visa applications - they must pay for any NHS healthcare received at 150% of the cost
- Visa applications of 6 months or less - they must pay for any NHS healthcare received at 150% of the cost
- Asylum seekers and refugees
- Those seeking humanitarian protection and human trafficking and modern slavery victims or those making statelessness applications
- Domestic violence applications under the Home Office Domestic Violence concession
- Human rights applications where it is claimed that an applicant's removal from the UK would be contrary to Article 3 of the European Convention of Human Rights (ECHR)
- Ukraine Visa Scheme applications
- Children in care - applications by children under 18 in the care of a local authority
- Armed forces or diplomats
- Some EU nationals making settled status applications
If you are not sure if you will be exempt from paying the immigration health surcharge it is best to take specialist immigration legal advice from an Immigration Solicitor on your immigration health surcharge liabilities and your visa options.
UK Online and London-Based Immigration Solicitors and Sponsorship Licence Lawyers
For immigration advice call OTS Solicitors on 0203 959 9123 or contact us online.
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