The Immigration Health Surcharge and the NHS.
On most UK visas you pay for the NHS before you arrive. It buys hospital care on the same terms as a resident, not free everything, and visitors are billed 150% of the cost.
In brief
How much is the Immigration Health Surcharge, and what does it buy?
£1,035 per year of visa for most people, paid with the application.
- Students, Youth Mobility applicants and under-18s pay £776 a year. Private medical insurance does not replace it.
- From the day the visa starts it buys NHS care on the same basis as a resident, except assisted conception. Prescriptions and dental are charged, as for residents.
- Visitors pay no surcharge. NHS hospitals bill them 150% of the cost, in advance unless the treatment is urgent.
Do you need private health insurance on a UK visa? Four options.
The surcharge is not optional, so the question is what, if anything, to add to it. Each option answers a different need.
| Cover type | When to consider it | Before you choose |
|---|---|---|
| The NHS, through the surcharge | You hold a visa of more than six months and expect to be treated in the UK. | Register with a GP straight away. Budget for prescription, dental and optical charges, and accept elective waits or plan for them. |
| UK private medical insurance | You want faster elective treatment in the UK on top of the NHS. | Ask what happens to conditions you already have, what the outpatient limits are and whether anything applies outside the UK. Ask before buying rather than assuming. |
| International health insurance | You travel a lot, have family abroad, or the UK is one chapter of a longer move. | Check the area of cover, evacuation and what happens to the policy if you leave the UK. Do not pay again for the part the NHS already gives you. |
| Travel insurance | Visitors, and the weeks before your visa starts. | Check the medical limit and the policy’s residence rules. The NHS bills a visitor 150% of the cost of hospital treatment. |
Start from what the surcharge already buys. Resident-level NHS hospital care is real cover. What a private or international policy can add is speed, treatment outside the UK and continuity if you move on, and those are worth pricing on their own.
We read your visa, your family’s situation and any policy you already hold, then set out what is worth adding and what would only duplicate the NHS.
How the Immigration Health Surcharge works, in three steps.
The surcharge is part of the visa application, not an insurance policy. It decides when the NHS treats you as a resident and when it sends you a bill.
The surcharge is paid with the application
On a visa of more than six months applied for from outside the UK, or any visa applied for from inside it, you usually pay the Immigration Health Surcharge up front for the whole visa. It is £1,035 a year, or £776 for students, their dependants, Youth Mobility applicants and under-18s. Dependants aged 18 or over usually pay the same as you. GOV.UK is plain that you still need to pay “even if you have private medical insurance”.
NHS access starts the day the visa starts
While the visa is valid, a surcharge payer can use NHS services on the same basis as an ordinary resident, except assisted conception (DHSC charging guidance). Anyone in England can register with a GP free of charge, and practices are not required to ask for proof of identity, address or immigration status. Prescriptions, dental treatment and eye tests follow the same charging rules as for residents.
Outside the surcharge, the NHS bills you
Visitors, and people on visas of six months or less applied for from outside the UK, pay no surcharge. They pay for NHS hospital care when they use it, unless the service is free to everyone, such as A&E or a GP. The charge is 150% of the cost of treatment, collected in advance unless the treatment is urgent or immediately necessary.
England unless stated. NHS charging is devolved, and Scotland, Wales and Northern Ireland set their own rules.
From the visa application to settlement, what to check when.
The surcharge is priced on the visa you are granted, paid before the decision and restarted at every extension.
| When | What it involves |
|---|---|
| Before you applycount the visa, not the job | The surcharge follows the length of the visa granted, which can be longer than the contract or the course. Six months or less, applied for from inside the UK, costs half a year; more than six months and under a year costs a full year. Price every adult dependant separately. |
| With the applicationpay, or be refused | You pay by card during the online application and get a reference number for the visa form. If you underpay, UKVI emails you: you then have 10 working days to pay from inside the UK, or 7 from outside, or the application is refused. |
| Before the decisionthe gap people miss | GOV.UK warns that you may need to pay for NHS treatment if the Home Office has not yet decided your visa. Keep travel or international cover running until the visa start date. |
| From the visa start dateregister with a GP | GP registration, A&E and hospital care on resident terms. In England a prescription costs £9.90 per item and a 12-month prepayment certificate £114.50 (NHSBSA, from April 2026). |
| Extending, switching or settlingthe meter restarts | An extension or a switch made inside the UK is a new surcharge payment. If you paid twice for the same period of six months or more, the refund is rounded down to whole six-month blocks. Indefinite leave to remain carries no surcharge; NHS entitlement then turns on ordinary residence. |
| Leaving earlyno refund | There is no refund if you leave before the visa ends, are granted a visa but never travel, or switch to a visa that is exempt from the surcharge. |
What the NHS covers for expats, and what it charges for.
A surcharge payer is treated as an ordinary resident for NHS care while the visa is valid. That is a lot: GP care, A&E and hospital treatment without a bill at the point of use.
It is also exactly what a resident gets, charges and queues included. Prescriptions and NHS dentistry are paid for in England, assisted conception is closed to surcharge payers, and the referral-to-treatment figures show how long elective care can take.
The table is England’s position, dated. It is the baseline any private or international policy should be compared against.
| Area | Position | The note that matters |
|---|---|---|
| GP registration and consultations | Free to everyone | No proof of identity, address or immigration status needed to register. GOV.UK migrant health guide |
| A&E, walk-in and urgent treatment centres | Free to everyone | Not emergency care once you are admitted as an inpatient. GOV.UK migrant health guide |
| Hospital care, surcharge payer | As an ordinary resident | While the visa is valid; assisted conception excluded. DHSC charging guidance |
| Hospital care, visitor or visa of six months or less from outside the UK | Charged at 150% of cost | In advance, unless urgent or immediately necessary. DHSC charging guidance |
| Prescriptions | £9.90 per item | 12-month prepayment certificate £114.50; from April 2026. NHSBSA HC12 |
| NHS dental treatment | £27.90 / £76.60 / £332.10 | The three bands, from 1 April 2026. NHSBSA HC12 |
| Assisted conception | Not available to surcharge payers | The one service the surcharge does not open. DHSC charging guidance |
| Elective waits | 65.4% within 18 weeks | 7.3 million pathways, July 2026; the standard is 92%. NHS England, 10 September 2026 |
| Scotland, Wales, Northern Ireland | Their own charging rules | The surcharge is UK-wide; charging is devolved and not covered on this page. GOV.UK migrant health guide |
Charges are England’s, from April 2026; the waiting-time figures are NHS England’s July 2026 data. Both change: the dates are part of the figures.
Four situations, four different checks.
The Skilled Worker with a family
Every adult dependant usually pays the same surcharge as you, and children £776 a year. Ask whether your employer reimburses it; nothing obliges them to. Then decide whether a private plan is buying speed or duplicating hospital care you have already paid for.
The health and care worker
If you qualify for a Health and Care Worker visa, you and your dependants are exempt from the surcharge. Other health and care workers may be able to claim refunds for periods of six months or more worked in the sector.
The student
£776 a year, dependants included. A full-time student in UK higher education who holds an EHIC from an EU country, Switzerland, Norway, Iceland or Liechtenstein, and does not work, may be able to claim a refund.
The Brit coming home with a non-British partner
You are likely to be ordinarily resident from the day you return to settle, so you pay no surcharge and are treated as a resident. Your partner pays the surcharge on a family visa. Keep cover in place until their visa starts.
Four ways this goes wrong, and all four are avoidable.
Paying twice and calling it prudence
The surcharge is compulsory even if you hold private medical insurance. Many arrivals keep a full international plan on top without asking what it adds to resident-level NHS hospital care. The useful part is often narrower: speed of elective treatment, cover outside the UK, evacuation or treatment back home. Price that part, not the whole plan.
The weeks before the visa starts, and the visiting relatives
Before the visa decision, and for any visitor, NHS hospital care is charged at 150% of cost, in advance for non-urgent treatment. NHS bodies must report unpaid debts of £500 or more, outstanding for 2 months, to DHSC, and the Home Office may use them to refuse a later immigration application. A parent visiting for the summer needs cover of their own.
Reading “NHS access” as “free”
For surcharge payers, assisted conception is excluded entirely. Prescriptions, NHS dental bands (£27.90, £76.60, £332.10 in England from 1 April 2026) and eye tests follow the same charging rules as for residents. Dental and optical are where most people meet the difference.
The waiting list is part of the cover
Resident-level access means resident-level queues. At the end of July 2026 there were 7.3 million NHS England referral-to-treatment pathways, and 65.4% had waited up to 18 weeks, against a 92% standard (NHS England, published 10 September 2026). Whether that matters depends on your health, not on your visa.
Any of these sound like your situation? See how a review works
What a first review actually looks like.
Arranging international cover for the first time, or checking what you already hold — the process is the same, in this order.
The demand intake
Right after you book, we email you a short intake form. Where you are, where you're going, who's coming with you, anything you already hold. It takes a few minutes, and it means the 45 minutes start prepared — with your situation, not with paperwork.
We study your situation
Not products first. Your life first. We look at the country you're moving to and what it legally requires, the country after that if there is one, who depends on you, and where the real exposure sits. We don't quote anything at this stage.
The consultation
45 minutes, by video, in English. We work through the questions that matter in your situation: underwriting, renewal, exclusions and treatment geography. If you already hold cover, we read its wording and personal endorsements. We identify what is clear and what still needs the insurer's written confirmation.
Your Private Client Report
One working day later, your Private Client Report arrives — around twelve pages setting out what we found, the alternatives considered, available cost information, and the reasons for our recommendation. Any missing documents or insurer answers are identified as open questions. What to arrange, what to keep, and where you are paying for something that isn't doing any work. Sometimes the report says: keep what you have. It is yours either way.
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The people who'll actually review your situation.
Specialists by topic, not a rota. You'll know who you're speaking to before you book, and you'll speak to the same person again next year.
Robert Kolar
Health insurance expert
Twenty-plus years spent on the distance between what a health policy promises and what it pays when a claim actually lands. German and English. He has been the foreigner working out somebody else's health system from the outside, which is its own kind of qualification.
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Nicole Bohne
Life and protection expert
Spent her career inside Basler Versicherung and Zurich Insurance before crossing to this side of the table. Nicole reads a life-cover decision against the whole household — who depends on whom, what already exists, and whether the answer is a policy at all.
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Virginie Josten
IPMI expert
Came to insurance from luxury and consulting, where the clients were demanding and the work was international. Then a Swiss insurer’s international desk — cross-border employees, expats and retirees abroad. Legal training and a master’s from Paris Dauphine. English and French.
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Davide Nezel
IPMI expert
FINMA-certified independent insurance intermediary, who began in financial advice at Swiss Life. He works with globally mobile households, and coordinates with the insurer when a medical need actually arises — which is where a policy is finally tested. German, French and English.
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Chantal Leprêtre
Client Advisor
Client advisor for international private medical insurance at SIP Medical Family Office, the partner through which international cover is placed. She works from London, in English and French.
Book with ChantalImmigration Health Surcharge and the NHS: your questions.
How much is the Immigration Health Surcharge in 2026?
£1,035 per year of visa for most applicants, and £776 a year for students, their dependants, Youth Mobility applicants and anyone under 18 when they apply. You pay half a year for a visa of six months or less applied for from inside the UK, and a full year for anything over six months and under a year. Adult dependants usually pay the same amount as you.
Do I still have to pay the IHS if I have private health insurance?
Yes. GOV.UK states that you still need to pay the surcharge even if you have private medical insurance, so private cover does not replace it for the visa. The useful question is the reverse one: once you have paid for resident-level NHS hospital care, what does a private or international policy still add for you? For many people it is speed, travel and cover outside the UK.
Does the IHS cover dental treatment and prescriptions?
It gives you access on the same terms as a resident, and residents pay for these too. In England from April 2026 a prescription costs £9.90 per item, and NHS dental treatment costs £27.90, £76.60 or £332.10 depending on the band. Eye tests follow the same rules as for residents. Assisted conception is not available to surcharge payers at all.
Can I use the NHS before my visa starts?
GP care and A&E are free to everyone. Hospital care is another matter: GOV.UK warns that you may have to pay for NHS treatment if the Home Office has not yet decided your visa. Chargeable overseas visitors pay 150% of the cost, in advance for non-urgent treatment. Keep travel or international cover running until the visa start date.
I’m British and moving back to the UK. Do I pay anything?
Not the surcharge. NHS hospital entitlement turns on ordinary residence, not on nationality, tax or National Insurance history. DHSC guidance says a British citizen returning to resume properly settled residence will most likely meet that test from the date of arrival. A non-British partner coming with you pays the surcharge on their own visa.
Can my parents use the NHS when they visit me?
For GP care and A&E, yes, free of charge. For hospital treatment they are overseas visitors: hospitals must charge 150% of the cost, in advance for non-urgent care. Unpaid NHS debts of £500 or more, outstanding for two months, are reported and can count against a future visa application. They should travel with medical cover of their own.
Where these facts come from.
Every figure on this page comes from GOV.UK, the Department of Health and Social Care, the NHS Business Services Authority or NHS England, read on 13 October 2026. We left out what we could not confirm that day: whether the Home Office’s 2025 consultation on settlement changes how many years people pay the surcharge; optical voucher values; and the rules in Scotland, Wales and Northern Ireland.
The surcharge rates can change by order at any time, the charges reset each April and the waiting-time figures are monthly. We check them against these sources before every review.
- GOV.UK — Pay for UK healthcare as part of your immigration application — The surcharge rates, part-year rules, exemptions, refunds and payment deadlines; “even if you have private medical insurance”; the warning about treatment before a visa decision. Page updated 28 November 2024; read 2026-10-13.
- Immigration (Health Charge) (Amendment) Order 2024, SI 2024/55 — The order behind the current rates, in force 6 February 2024. Read 2026-10-13 from the legislation page’s summary; the full text was not opened.
- DHSC — Charging overseas visitors in England: guidance for providers of NHS services — The 150% charge and advance payment; surcharge payers treated as residents except for assisted conception; the £500 and two-month debt rule; ordinary residence and returning British citizens. Collection updated 20 May 2026; read 2026-10-13.
- GOV.UK — NHS entitlements: migrant health guide — GP and A&E free to everyone; no identity or address checks for GP registration; devolved charging. Page updated 2 October 2023; read 2026-10-13.
- NHSBSA — HC12, Help with health costs (V24, April 2026) — Prescription £9.90 per item, 12-month prepayment certificate £114.50, NHS dental bands £27.90, £76.60 and £332.10 from 1 April 2026. Read 2026-10-13.
- NHS England — Referral to treatment statistical press notice, July 2026 data — 7.3 million pathways, 65.4% within 18 weeks against a 92% standard. Published 10 September 2026; read 2026-10-13.
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