Who Can Use the NHS Without Paying the Immigration Health Surcharge? Exemptions, ordinary residence, and what the surcharge does and does not cover
Some migrants can use the NHS without ever paying the surcharge. Others pay thousands upfront but are still charged for prescriptions, dental treatment, and eye care. Understanding which category you fall into — and exactly what the IHS does and does not cover — is not bureaucratic detail. For many families, it is thousands of pounds.
What the Immigration Health Surcharge is
The Immigration Health Surcharge (IHS) is a fee paid upfront as part of most UK visa applications for stays of more than six months. Introduced in April 2015 under the Immigration Act 2014, it operates on a simple basis: temporary migrants contribute to NHS funding before their visa is granted, rather than at the point of using services.
The surcharge is paid per person for the full length of the visa, rounded up in six-month increments. A nine-month visa attracts twelve months of IHS; a sixteen-month visa attracts eighteen. It cannot be deferred or paid in instalments. Holding private medical insurance does not reduce or remove the requirement, and neither does paying National Insurance. Both are entirely separate obligations.
Once paid, the visa holder can use NHS services for the duration of their visa under the same conditions as a UK resident — not faster and not with priority.
The surcharge covers hospital treatment and GP care. It does not cover prescription charges, dental treatment, eye tests, or assisted conception services such as IVF. These are chargeable to IHS payers and to UK residents alike.
Who is exempt from paying the IHS
A defined set of people do not pay the IHS and can still access NHS care without charge. The main exempt categories are:
- Health and Care Worker visa holders and their dependants — exempt since 2020, reflecting their direct contribution to the NHS
- Applicants for Indefinite Leave to Remain or British citizenship — at this stage, ordinary residence rather than the IHS governs NHS entitlement
- EU Settlement Scheme applicants — those applying for pre-settled or settled status do not pay the surcharge
- Asylum seekers and those applying for humanitarian protection, and their dependants
- Victims of human trafficking or modern slavery, formally identified or suspected, and their spouse, civil partner, or children under 18 who are lawfully present
- People granted leave under the Ukraine Family Scheme or Homes for Ukraine Scheme
- Dependants of UK armed forces members not subject to immigration control
- Certain diplomatic and international organisation personnel, including some NATO staff
- Children under 18 in local authority care in the UK
- People granted a full fee waiver — those who successfully apply for a fee waiver also have the IHS waived
People in exempt categories can access NHS treatment without charge and do not need an IHS reference number. A full and current list of exemptions is available on GOV.UK.
The important point is that NHS entitlement does not begin and end with the surcharge. For some groups, access exists independently of it.
Ordinary residence: the other route to free NHS care
People with Indefinite Leave to Remain or British citizenship do not pay the IHS — they access the NHS on the basis of ordinary residence instead. Ordinary residence, broadly speaking, means living in the UK lawfully and on a settled basis. It does not depend on nationality, tax payments, or property ownership.
For most people on time-limited visas, ordinary residence does not yet apply. Their NHS entitlement comes through the IHS for the duration of the visa, and ordinary residence becomes relevant only once they have ILR. Some immigration categories are more complicated than this summary suggests — in those cases, the GOV.UK migrant health guide or a regulated immigration adviser are better placed to assess the specific position than any general guide can be.
What the IHS covers — and what it does not
Paying the IHS entitles you to use NHS services on the same basis as someone who is ordinarily resident. In practice, that means you can register with a GP, attend hospital outpatient appointments, receive inpatient treatment, and use mental health services without additional charges at the point of care.
What it does not cover reflects the same charges that apply to UK residents:
| Service | Covered by IHS? |
|---|---|
| GP consultations and referrals | Yes |
| Hospital outpatient and inpatient treatment | Yes |
| Mental health services | Yes |
| A&E treatment | Yes — free for everyone |
| NHS prescription charges in England | No — standard charges apply |
| NHS dental treatment | No — standard charges apply |
| Eye tests and glasses | No — standard charges apply |
| Assisted conception and IVF | No — not covered |
Source: GOV.UK — Pay for UK healthcare as part of your immigration application
What happens if your situation changes
If your visa application is still pending
The IHS must be paid before a visa decision is made. If your application is still pending and you need NHS treatment in the meantime, you may be charged at the point of use for some services. Immediately necessary and urgent treatment cannot be refused on grounds of inability to pay upfront, but a bill may follow.
If your visa is refused
A full IHS refund is available if a visa application is refused and all appeal rights are exhausted. The refund goes back to the original payment account and can take up to six weeks to process. No refund is available for applications that are withdrawn.
If your visa is curtailed
If the Home Office curtails a visa early, NHS entitlement ends from the date of curtailment — even if the full IHS was paid for a longer period. A partial refund for the unused period may be available. Any NHS treatment received after the curtailment date may be charged.
If you extend your visa
When extending existing leave, the IHS must be paid again for the additional period requested. There is no rolling credit from a previous payment. Each application — including those for dependants — requires a separate IHS payment.
Children born in the UK to visa holders
A child born in the UK to a visa holder is entitled to free NHS hospital treatment for the first three months of life, provided the child remains in the UK during that period. After three months, an IHS payment is generally required unless another exemption applies. Parents should apply for a visa for the child during that three-month window.
A couple on Skilled Worker visas applying for a three-year extension, with one child, would pay over £8,500 in surcharge at current rates alone. That figure does not include prescription costs, dental treatment, or eye care — none of which the IHS covers. For families budgeting a move to the UK, or weighing up whether a visa extension makes financial sense, this is not a footnote. It is money.
Exemption categories and rates do change. If you think you may qualify for an exemption — particularly through the Health and Care Worker route, a fee waiver, or a protection-based application — the time to confirm that is before the application goes in, not after the surcharge has been paid. Refunds exist in certain circumstances but take time and are not available in every case.
If you are trying to understand the broader picture — what determines NHS entitlement beyond the IHS, what is free regardless of visa status, and where the volunteering myth comes from — our companion guide on NHS eligibility picks up where this one leaves off.
Frequently asked questions
Exempt groups include Health and Care Worker visa holders and their dependants, people applying for Indefinite Leave to Remain or British citizenship, asylum seekers and those granted humanitarian protection, victims of human trafficking or modern slavery, people granted leave under the Ukraine schemes, dependants of UK armed forces members not subject to immigration control, and EU Settlement Scheme applicants. A full list is available on GOV.UK.
Yes, in certain circumstances. People who are exempt from the IHS can still access NHS treatment without charge and do not need an IHS reference number. People with Indefinite Leave to Remain or British citizenship are considered ordinarily resident and access the NHS on that basis rather than through the surcharge. Some services — including GP consultations and A&E treatment — are free for everyone regardless of IHS status.
Yes. Health and Care Worker visa holders and their dependants are exempt from paying the Immigration Health Surcharge entirely. They can access NHS services without charge in the same way as other visa holders who have paid the surcharge, without needing an IHS reference number.
The IHS covers access to NHS hospital treatment, GP consultations, and most NHS services on broadly the same basis as a UK resident. It does not cover prescription charges, dental treatment, eye tests, or assisted conception services such as IVF — these are chargeable to IHS payers and UK residents alike. Private medical insurance does not exempt you from paying the surcharge.
A full IHS refund is available if a visa application is refused and all appeal rights are exhausted. The refund is returned to the bank account used to make the original payment and can take up to six weeks to appear. Withdrawn applications do not qualify for a refund.
No. Paying National Insurance contributions, UK taxes, or holding private medical insurance does not exempt anyone from paying the Immigration Health Surcharge. The IHS is a separate legal requirement for most people applying for time-limited visas of more than six months, regardless of any other contributions or insurance arrangements.
If a visa is curtailed or ended early by the Home Office, NHS entitlement funded by the IHS ends from that date, even if the surcharge was paid in full for a longer period. Any NHS treatment received after the curtailment date may be chargeable. A partial IHS refund may be available for the unused portion of the visa period.
Children are not automatically exempt from the IHS. Dependant children named on a visa application must each pay the surcharge separately, at the reduced rate of £776 per year. Children born in the UK to visa holders are entitled to free NHS hospital treatment for the first three months of life, after which an IHS payment is generally required unless another exemption applies.
This article is for general information only and does not constitute legal or immigration advice. IHS rates, exemption categories, and NHS eligibility rules are set by the Home Office and the Department of Health and Social Care and are subject to change. Always verify your position using current guidance on GOV.UK before submitting a visa application. For complex immigration circumstances, consult a regulated immigration adviser or solicitor.
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