The immigration health surcharge

Most foreign nationals applying for temporary permission to live in the UK are required to pay an immigration health surcharge (IHS) in addition to the visa application fee. At time of writing, the standard rate was £624 per year of the visa, paid in advance. The Government has tabled legislation to increase this to £1,035 in early 2024.

The IHS was introduced in 2015 to raise money from migrants for the National Health Service

A £200 per year surcharge was introduced in April 2015, under a power granted by section 38 of the Immigration Act 2014. The Government said the purpose was to “ensure that migrants make a proper financial contribution to the cost of their NHS care” (in addition to their contribution as UK taxpayers).

Previously, temporary migrants had access to free NHS care soon after arrival in the UK. The Coalition Government considered this overly generous.

Healthcare workers and certain other groups are exempt

People in work, family and student visa categories typically have to pay the surcharge in full when applying for their visa or visa extension. There is no scope to opt out by getting private health insurance but there are exemptions for certain groups.

Those with visitor visas are exempt, as are certain other groups such as asylum seekers. Healthcare workers get an exemption, or a refund, under a policy introduced during the height of the coronavirus pandemic in 2020. In addition, people applying for certain family and human visas can get an exemption (‘waiver’) if they can prove they cannot afford to pay.

An calculator to work out how much the surcharge will cost is available on the Government website, alongside other practical information.

The IHS has raised over £5 billion for healthcare spending since 2015

The Government raised £1.7 billion in gross surcharge revenue in 2022/23, and £5.1 billion since it was introduced in 2015. Funds are transferred to the health departments in England, Scotland, Wales and Northern Ireland but there is no central record of how much is spent on the NHS specifically.

The surcharge rate has increased from £200 per year originally to £624 now. Draft legislation to increase this to £1,035 per year is before Parliament and will require positive approval by each House. Assuming parliamentary approval, the change would come into force on 16 January 2024 (or 21 days after the measure is finalised, whichever is later).

Government policy is to charge an amount equivalent to the estimated average cost of providing healthcare to migrants. The Department of Health and Social Care has estimated this as £1,036 per person per year; the proposed increase reflects this calculation.

Migrants and charities argue that the IHS represents double taxation

The surcharge has been controversial since its inception.

Some people object on principle, noting that migrants already contribute to the NHS through regular taxes in the same way as British citizens. Other common objections relate to how the surcharge is applied in practice (such as the scope of exemptions and inability to pay by instalments).

Successive ministers have argued that the surcharge is a good deal for temporary migrants compared to private insurance, as well as benefitting NHS finances. The proposed increase in 2024 is explicitly framed as raising money to pay doctors more.