Most non-EEA nationals applying for temporary leave to remain in the UK must pay an 'Immigration Health Surcharge' (IHS) to the Home Office, in addition to the immigration application fee. The Government has a manifesto commitment to increase the charge and extend it to EEA nationals after the Brexit transition period. The charge, and the proposed increases, have generated some controversy, particularly against the backdrop of the Covid-19 pandemic. Following a recent change of policy, the Government now intends to exempt NHS and care workers from the IHS in the future, although it has not yet confirmed when this will take effect.

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Most non-EEA nationals applying for temporary leave to remain in the UK are required to pay an ‘Immigration Health Surcharge’ (IHS) in addition to the visa application fee.

The purpose of the IHS is to “ensure that migrants make a proper financial contribution to the cost of their NHS care.”

The IHS must be paid to the Home Office during the visa application process. There is no scope to opt-out of paying the IHS by making alternative healthcare arrangements, such as through insurance cover.  

Money raised from the charge goes to general government funds and is then distributed to devolved health administrations under the Barnett formula. Around 763,000 visas granted in 2019 attracted the IHS. It has raised around £900 million since it was introduced in 2015. 

The IHS will also apply to EEA nationals moving to the UK after the end of the Brexit transition period (i.e. from January 2021).

How much is it?

The actual amount that applicants must pay depends on the type and duration of the visa they (and any dependants) are applying for.

The regulations specify the annual charge per person. In January 2019 the charges as introduced were doubled to £400 per year (£300 for certain visa categories).

The IHS is scheduled to increase again, in October 2020, to £624 per year (£470 for certain visa categories). That increase is intended to ensure that the IHS broadly reflects the full costs to the NHS of temporary migrants accessing NHS services.

From October 2020 all applicants under 18 will become subject to the lower rate. The Government says this is to ensure that the IHS “remains affordable for family groups”.

Controversy and recent developments

The charge has been controversial since its inception.

Successive Ministers have argued that the IHS remains competitive by international standards and is a good deal for temporary migrants, as well as benefitting NHS finances.

Some people object to the IHS on principle, arguing that it represents a double taxation for temporary migrants who, like other UK residents, already contribute to the NHS through regular taxes. Other common objections relate to how the IHS is applied in practice. For example, there is limited scope for exemptions and no provision for payments by instalment.

The scheduling of a further increase to the IHS in October, and the Covid-19 pandemic, raised the profile of the IHS again. Over recent months there has been growing pressure on the Government to introduce an exemption for migrant workers in the health and social care sectors in particular.

Until 21 May, the Government’s position was that this would not be appropriate. But, following an exchange with the Leader of Opposition at Prime Minister’s Questions on 20 May, a change of policy was announced. A Government spokesperson stated that NHS and care workers would be made exempt from the IHS as soon as possible. 

In the meantime, NHS and care workers are still required to pay the charge as part of the visa application process. However, refunds will be available for those who have paid the charge since 21 May.

Some critics continue to press for further changes, such as extending the IHS exemption to other categories of “essential” worker, or simply abolishing the IHS for everyone.

A scheme launched by the Government a few weeks previously, to provide free automatic visa extensions for certain categories of frontline healthcare workers whose visas are due to expire before October 2020, remains in place. Those visa extensions are not subject to the IHS. The scheme does not apply to social care workers, or NHS frontline support staff such as porters and cleaners.

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