Immigration Health Surcharge FAQ

Immigration Health Surcharge FAQ

The UK Government is increasing the immigration Health Surcharge to be paid by overseas nationals looking to enter and stay in the United Kingdom (UK). In our Immigration Health Surcharge FAQ blog, we outline the nature of the changes and the reasons given for the increase and answer other frequently asked questions,

What are the Immigration Health Surcharge changes?

On 8 January 2019, the Immigration Health Surcharge (IHS) will increase by £200 to £400 per year for non-European Economic Area (EEA) nationals seeking to enter the UK for over 6 months.

The surcharge will also double for non-EEA students and Tier 5 (Youth Mobility) visa applicants from £150 to £300 per year.

How is the Immigration Heath Surcharge calculated?

If the applicant applies for a Tier 2 work for visa for a term of 3 years, the applicant will incur a surcharge of £1,200. Students on the other hand can expect to pay £300 per year.

When was the Immigration Health Surcharge introduced?

On 6 April 2015, the UK Coalition Government introduced the IHS for EEA nationals seeking to live, work and study in the UK for over 6 months. The purpose of the surcharge was to raise funds for the National Health Service (NHS) from overseas nationals in the UK,

In addition to visa application fees, non-EEA nationals were required to pay a surcharge of £200 per year, before the increase, for each year of the length of their visa, payable at the time of the submission of the application.

Students on the other hand were expected to pay £150 per year, prior to the increase.

Why was the Immigration Health Surcharge introduced?

At the time of the introduction, the Government said:

‘Currently non-European nationals coming to work, study or join family members receive free medical treatment under the UK’s NHS in the same way as a permanent resident.’

The Government also quoted Charles Hay, UK Ambassador to South Korea, who said:

‘We, of course, recognise the very valuable contribution that Koreans who come the UK to study and work make to the wider economy and so have deliberately kept the surcharge at a competitive level – lower than most private health insurance policies.’

Unfortunately, the Government neglected to recognise that, not only do non-EEA nationals pay high visa application fees which go towards the State, rather than directly to the Home Office, but that many overseas nationals contribute to the State and NHS by way of income tax.

What are the Immigration Health Surcharge benefits?

In exchange for payment of the IHS, visa nationals will be allowed to access NHS services. The UK Government argues that the surcharge represents good value for money to non-EEA nationals, carrying a lesser fee than some private medical insurance policies.

Why is the Immigration Health Surcharge being increased?

In October 2018, the UK Government asserted that the National Health Service (NHS) received £600 million from the IHS since April 2015. It is projected that IHS increase could rise an extra £220 million for the NHS.

Home Office Immigration Minister Caroline Nokes said:

‘Our NHS is always there when you need it, paid for by British taxpayers. We welcome long-term migrants using the NHS, but the NHS is a national, not international health service and we believe it is right that they make a fair contribution to its long-term sustainability.’

The Minister added,

‘It is only fair that people who come to the UK make a contribution to the running of the NHS, and even with the increase we still continue to offer a good deal on healthcare for those seeking to live in the UK temporarily.’

Overseas nationals working in the UK will still be expected to make National Insurance contributions from their UK salary and pay income tax.

Yet, perhaps the Government also wishes to minimise any shortfall in tax receipts resulting from the UK’s departure from the European Union from April 2019.

How is the Immigration Health Surcharge payment made?

Payment is made online at the time of submission of the visa application, and prior to the visa biometric appointment.

When submitting the visa application, the overseas national will be directed to a separate portal where the IHS will need to be paid. Once completed, the applicant will be issued with an IHS reference.

It will not be possible to submit the application unless the IHS has been paid in full.

Will the Home Office send an Immigration Health Surcharge email?

In some limited circumstances, such as an Ancestry dependant visa applications, payment of the IHS may be requested by the Home Office at a later.

If so, the Home Office will communicate this to the applicant, via email. If so, the applicant must make payment of ant outstanding surcharges within 7 working days if applying from outside of the UK, and 10 working days if applying from within the UK.

Will the Home Office issue an Immigration Health Surcharge refund?

If the visa application is refused, applicants will receive a refund of the IHS. This does not mean that the applicant will receive a refund of the visa application fees in the event of a refusal.

Refunds are also automatically paid if the applicant mistakenly incurred the surcharge twice.

The Home Office states that refunds are normally paid within 6 weeks of the application outcome, though from experience refunds are processed much sooner.

If the refund is not received within the 6 weeks’ timeframe, contact should be made with the Home Office.

What is an Immigration Health Surcharge partial refund?

An overseas national applicant will automatically get a partial refund where the surcharge was paid for a longer period that they were granted leave for.

Are visitors required to pay the Immigration Health Surcharge?

The surcharge will not apply to overseas travellers entering the UK for less than 6 months or those seeking indefinite leave to remain.


The UK Government has doubled the Immigration Health Surcharge payable by non-EEA nationals in order to raise additional funds for the National Health Service.

In exchange, overseas nationals travelling to the UK for over 6 months will have access to national health services. Nevertheless, as set out this Immigration Health Surcharge FAQ blog, overseas nationals will need to factor in this cost, in addition to any visa application fees and relocation costs.

Further, there are number of practical considerations, set out in the Immigration Health Surcharge FAQ blog that non-EEA nationals may wish to bear in mind when taking forward their visa applications.


Written by Carla Thomas – Managing Director at Thomas Chase Immigration.

Thomas Chase Immigration offer immigration assistance to individuals, families and organisations.

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Overseas Visitors and UK Healthcare

We look at overseas visitors to the UK from the EEA and non EEA countries and and access to healthcare
It is holiday season and millions of travellers from all over the world are expected the visit the UK. Most visitors will have adequate medical insurance. Yet what happens if your travel insurance doesn’t go far enough or you don’t have travel insurance at all, but require healthcare.

And what impact will rule changes have from October 2017. We answer those questions, and more, in this post on overseas visitors and healthcare.

In 2015, there were 36.1 million visitors to the UK from overseas visitors, 5.1% higher than in 2014. In 2016, the number of overseas visits to the UK reached record levels of 37.6 million. 

Access to healthcare treatment during a person’s travels depends on whether the visitor is travelling from within or outside of Europe.


For those visitors to the UK, from within the Economic European Area (EEA), it is recommended to apply for the European Health Insurance Card (EHIC).

The EHIC entitles EEA nationals to access necessary treatment at a reduced cost, or sometimes at no cost, in certain European countries with state provided healthcare, and is free.

Treatment for pre-existing medical conditions are covered. Yet, the EHIC has its limitations. For instance, it will not cover private medical healthcare costs such as the cost of being flown back to the European country of residence.

And while routine maternity care is covered, it will not cover the cost of specifically travelling to the UK to give birth within the UK’s National Health Service (NHS)

For this reason, it is highly recommended that EEA nationals travelling to the UK on holiday hold both an EHIC card and valid and adequate travel insurance.

Only EEA nationals from the following countries are required to hold adequate medical and travel insurance and need not possess a EHIC:

  • The Channel Islands, including Guernsey, Alderney and Sark
  • The Isle of Man
  • Monaco
  • San Marino
  • The Vatican

If an EEA national visiting the UK finds themselves in need of medical treatment, they may dial 112, the free European emergency number, for immediate assistance.

The EU Directive route

The European Union (EU) Directive route entitles EEA visitors to purchase NHS or private healthcare in England and seek reimbursement for medically necessary treatment from their country of residence.

The reimbursements are limited to the amount the treatment would normally cost in their home country. It does not cover emergency treatment and prior authorisation may be required


Visitors to England, more specifically, from outside of the EEA must have personal medical provisions or travel insurance to cover for the length of their visit.

If a visitor requires certain emergency treatment, the NHS will not turn the person away and some NHS services and treatments are free, making them exempt from charges.

These include:

  •  Accident and emergency services
  • Family planning services though it does not include infertility treatment
  • Treatment for most infectious diseases, including sexually transmitted infections (STIs)
  • Treatment required for a physical or mental condition caused by torture, female genital mutilation (FGM), domestic violence or sexual violence.

In relation to the last point, it should be noted that charges will apply if the visitor enters England for the purpose of seeking that treatment

What happens if they then seek unplanned medical treatment from the NHS?

Unfortunately, it’s not uncommon visitors to book their travel and omit or forget to purchase travel insurance or even seek the minimum travel insurance cover available. In such cases, overseas visitors receive a medical bill for fees chargeable at 150% of the NHS standard rate. Ouch!

Different rules apply for overseas visitors requiring medical assistance in Scotland, Wales and Northern Ireland.

It is also worth pointing out that some non-EEA visitors may be exempt from NHS charges. They include those traveling for longer than 6 months to work, to study or join family members, as they will have paid a separate Immigration Health Surcharge.

Changes to Healthcare rules from October 2017

As of 23 October 2017, non-EEA nationals must pay for non-urgent treatment and services, in advance.

Visitors will be given an estimate of the treatment costs and will be expected to pay for this upfront, or treatment will not be provided.

From October 2017, failure to pay such charges will adversely impact upon any future immigration applications.

Reciprocal Agreements

Exemptions also apply to visitors from countries that have reciprocal healthcare agreements with the UK.

The reciprocal agreements entitle visitors, from specified countries, to access immediate emergency medical treatment free of charge. They are:

  • Anguilla
  • Australia
  • Bosnia and Herzegovina
  • British Virgin Islands
  • Falkland Islands
  • Gibraltar
  • Isle of Man
  • Jersey
  • Kosovo
  • Macedonia
  • Montenegro
  • Montserrat
  • New Zealand
  • Serbia
  • St Helena
  • Turks and Caicos Islands

The nature and access to free treatment will differ for each country under their respective reciprocal agreements.

The agreements do not normally apply when the person has traveled to the UK for the purpose of obtaining healthcare.

There are non-EEA countries which previously held reciprocal healthcare agreements with the UK. Those agreements came to an end on 2016.

As a result, visitors from the following countries must ensure they have adequate travel and health insurance, as they will be charged for accessing healthcare and treatment on the NHS.

  • Armenia
  • Azerbaijan
  • Barbados
  • Belarus
  • Georgia
  • Kazakhstan
  • Kyrgyzstan
  • Moldova
  • Russia
  • Tajikistan
  • Turkmenistan
  • Ukraine
  • Uzbekistan

On another note, from 21 August 2017, employers of overseas visitors working on UK-registered ships will be charged for NHS fees incurred.


With travel season well underway, it is important, whether you are from within the EEA or a non-EEA national, to know what emergency and non-urgent treatment and services you can access in the UK.

Having adequate travel and medical insurance can provide a great deal of comfort, but if that, for whatever, reason is not the case, there may be other measures in place to help you get the treatment you need at reduced costs.

By keeping informed, you can ensure you have a safe and enjoyable holiday, avoid a huge bill and at worse, for non-EEA nationals in particular, prevent adverse consequences in any future immigration applications.

Happy travels!

Key information

Call 999 if someone is seriously ill or injured and their life is at risk

Call NHS 111 if you urgently need medical help or advice but it’s not a life-threatening situation. You can also call NHS 111 if you’re not sure which NHS service you need.

Written by Carla Thomas – Managing Director at Thomas Chase immigration. Thomas Chase Immigration provide an end-to-end immigration service to individuals and families to help make the process as smooth as possible

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7 Changes to Tier 2 That You Need To Be Aware Of

The UK Government recently announced fundamental changes to the Tier 2 categories.

In 2015, the government had commissioned the independent Migration Advisory Committee (MAC) to review the Tier 2 immigration categories. The MAC were specifically requested to advise on how to make the Tier 2 criteria more robust yet flexible enough to allow key skills shortages to be met within the UK.

Having considered MAC’s recommendations and in March 2016 announced key changes to Tier 2.

Here are 7 changes that HR professionals need to be aware of:

  1. Tier 2 (General) threshold to increase

From the autumn 2016, the Tier 2 (General) salary thresholds for experienced workers will be increased to £25,000 per annum. A further increase of £5,000 to £30,000 will apply from April 2017 onwards. The Government announced that some health and education professionals will be exempt from the higher threshold until July 2019. The minimum threshold of £20,800 for new entrants will be maintained.

Nurses, medical radiographers, paramedics and secondary school teachers in mathematics, physics, chemistry, computer science and Mandarin will be exempt from the new salary threshold.nurses, medical radiographers, paramedics and secondary school teachers in mathematics, physics, chemistry, computer science and Mandarin from the new salary threshold.

  1. Tier 2 ICT salary threshold

From autumn 2016, the minimum salary threshold for the Tier 2 ICT Short Term category will be £30,000 per annum. Tier 2 ICT Graduates will see the salary threshold decrease from £24,800 to £23,000 per annum.

For those Tier 2 ICT transferees looking to reside and work in the UK for between 5 and 9 and who are classed as higher earners, will see the annual salary threshold requirement fall from £155,300 to £120,000.

  1. Changes to Tier 2 ICT categories

The current intra-company transfer (ICT) provisions will be simplified by requiring all intra-company transferees to qualify under a single visa category. From autumn 2016, the Tier 2 ICT Skills Transfer category will no longer be available to new applicants. From April 2017, the Tier 2 ICT Short Term visa route will also be closed to new applicants. This will no doubt present problems for larger companies that currently transfer overseas employees to the UK to gain or impart knowledge for the benefit of the wider organization.

  1. Immigration Health Surcharge

Currently, the Immigration Health Surcharge (IHS) applies to the Tier 2 (General) category and not Tier 2 ICTs. This will change from autumn 2016, when all Tier 2 ICTs will be required to pay the IHS.

  1. Tier 2 ICT pre-qualifying period

At present, all Tier 2 ICTs must have been employed within the company for 12 months prior to the UK assignment. From April 2017, this requirement will be removed for all Tier 2 ICT applicants in receipt of over £73,900 per annum.

  1. Immigration Skills Charge

The Government recognizes that there is immediate skills gap in the UK particularly in some sectors on one hand. On the other hand, the Government wants The The to ‘incentivize’ businesses to reduce their reliance on overseas workers and instead invest in training and up-skilling UK workers. To help achieve this, an Immigration Skills Charge will be levied on Tier 2 sponsors at the sum of £1,000 per Certificate of Sponsorship issued per year.

Such a sum will prove eye watering to many employers especially small A reduced rate of £364 will apply to small and charitable sponsors, as defined by Immigration and Nationality (Fees) Regulations. PhD level occupations, the Intra Company Transfer Graduate Trainee category, and those switching from a Tier 4 student visa to a Tier 2 visa will be exempt.businesses. Therefore, a reduced rate of £364 will apply to small and charitable sponsors.

Exemptions will apply to PhD level occupations, Tier 2 ICT Graduate Trainees, and applicants switching from Tier 4 student visas to a Tier 2 visa.A reduced rate of £364 will apply to small and charitable sponsors, as defined by Immigration and Nationality (Fees) Regulations. PhD level occupations, the Intra Company Transfer Graduate Trainee category, and those switching from a Tier 4 student visa to a Tier 2 visa will be exempt.

  1. Nurses

Fortunately, nurses will remain on the Shortage Occupation List, but employers will need to carry out a resident labour market test before recruiting a non-EEA nurse.

Fortunately, nurses will remain on the Shortage Occupation List.  That said, HR professionals and employers will need to carry out a resident labour market test before recruiting a nurse from outside of the UK and EU.

What hasn’t changed?

With so many changes to the Tier 2 provisions, HR professionals and businesses may be pleased to hear that they may continue to recruit non-EEA graduates from UK universities without having to first conduct a resident labour market and without being subject to the annual limit on Tier 2 (General) places.

Further, Tier 2 (General) places will remain at 20,700 places per year.

Contact Thomas Chase Immigration for more information of the changes to the Tier 2 category and how they may impact upon you and your business.