UK Skilled Worker Healthcare Surcharge: Complete IHS Payment Guide

Executive Summary

The Immigration Health Surcharge (IHS) is a mandatory fee that UK skilled worker visa applicants must pay to access NHS healthcare services during their stay. This charge ensures you receive healthcare coverage from day one of your visa, but understanding the payment requirements, calculation methods, and your rights can save you time, money, and potential complications.

What this means for you: The IHS isn’t optional—it’s a required part of your visa application that must be paid upfront before submission. Getting this wrong can delay your application or result in unexpected costs. Whether you’re applying from Nigeria, India, or anywhere else, the process is the same, but the financial impact varies significantly based on your visa duration and family size.

This guide walks you through everything you need to know about IHS payments, from accurate calculation to NHS access rights, so you can navigate this requirement confidently.

Understanding IHS Surcharge Calculation

Annual Rates and Current Fees

The IHS operates on an annual payment structure with specific rates for different visa categories:

• Main applicant: £1,035 per year
• Dependents: £1,035 per year (same rate applies)
• Students and Youth Mobility: £776 per year (different visa category)

What this means for you: Every person on your application pays the same annual rate. A family of four applying for a 5-year skilled worker visa will pay £20,700 in IHS fees alone (4 people × £1,035 × 5 years).

Duration Calculation Method

The IHS calculation is based on your visa duration, rounded up to the nearest complete year. Here’s how it works:

Visa Duration Examples:

• 3 years 2 months = 4 years for IHS purposes
• 5 years exactly = 5 years for IHS purposes
• 2 years 11 months = 3 years for IHS purposes

Real mistake we’ve seen: Applicants often miscalculate their visa duration, especially when their start date isn’t immediately after approval. The IHS system calculates from your intended travel date, not your application date.

If you’re applying from countries with high refusal rates: Plan your finances carefully. The IHS fee is paid upfront and only partially refundable if your visa is refused. From our experience with Nigerian and Pakistani applicants, having IHS funds readily available separate from your maintenance funds shows stronger financial planning.

Available Discounts and Exemptions

Limited discounts apply to specific circumstances:

50% Discount Categories:

• Applications under 18 years old
• Health and care sector workers (specific roles only)
• Shortage occupation list workers in healthcare

Complete Exemptions:

• Diplomatic visa holders
• Visitors (not applicable to skilled workers)
• Asylum seekers

What this means for you: Most skilled worker applicants pay the full rate. If you work in healthcare, verify your specific role qualifies for the discount before assuming you’ll pay less.

IHS Payment Process

Online Payment Requirements

The IHS payment must be completed online through the official gov.uk IHS payment system before submitting your visa application. The process is integrated into your visa application journey:

Step-by-Step Process:

1. Complete your visa application form
2. Reach the IHS payment section
3. Review your calculated surcharge amount
4. Pay using accepted payment methods
5. Receive IHS reference number
6. Continue with visa application submission

Payment Methods Accepted:

• Credit cards (Visa, Mastercard)
• Debit cards (UK and international)
• Bank transfers (limited availability)

Timing and Confirmation

Critical Timing Requirements:

• Payment must be completed before visa application submission
• IHS reference number required for application
• Payment confirmation needed for biometric appointments

What this means for you: Don’t start your visa application unless you have immediate access to IHS payment funds. The system won’t let you save and return to pay later—you must complete the payment to proceed.

Real mistake we’ve seen: Applicants starting applications without sufficient funds available, then having to abandon partially completed applications because they couldn’t immediately complete IHS payment.

Technical Payment Issues

Common technical problems and solutions:

Payment Failures:

• Card declined: Try different card or contact bank
• System timeout: Start fresh, don’t refresh during payment
• International card issues: Verify international transactions enabled

If you’re applying from Nigeria or similar: International card restrictions are common. Ensure your card is enabled for UK online payments and has sufficient limits before starting your application.

Optional—but strongly recommended by AVID experts: Have backup payment methods ready. Technical issues during payment can derail your entire application timeline.

NHS Access Rights and Coverage

What’s Covered Under IHS

Once you’ve paid the IHS and received your visa, you have access to NHS services equivalent to UK residents:

Fully Covered Services:

• GP appointments and consultations
• Hospital treatments and surgeries
• Emergency care (A&E)
• Maternity care
• Mental health services
• Specialist consultations (with GP referral)

What this means for you: Your IHS payment provides comprehensive healthcare coverage. You won’t face additional charges for most medical treatments, making it valuable protection for your UK stay.

Service Limitations and Exclusions

Important limitations to understand:

Services Requiring Additional Payment:

• Prescription medications (standard NHS charges apply)
• Dental treatment (except emergency care)
• Optical services (routine eye care)
• Cosmetic procedures

Access Requirements:

• GP registration required for non-emergency care
• Proof of visa status needed for registration
• Emergency care available without registration

Real mistake we’ve seen: Assuming IHS covers all healthcare costs. Prescription charges, dental care, and optical services require separate payment even with IHS coverage.

Prescription Charges and Additional Costs

Standard NHS Prescription Charges:

• England: £9.90 per item
• Scotland: Free
• Wales: Free
• Northern Ireland: Free

Cost-Saving Options:

• Prescription prepayment certificates for regular medications
• Free prescriptions for certain medical conditions
• Age-based exemptions (under 16, over 60)

If you’re from countries with different healthcare systems: The NHS operates differently from private healthcare systems. Understanding GP registration and referral systems will help you access care more effectively.

IHS Refund Scenarios

Visa Refusal Refunds

If your skilled worker visa application is refused, you’re entitled to a full IHS refund:

Automatic Refund Process:

• Refund processed automatically after visa refusal
• Refund to original payment method
• Processing time: 4-6 weeks typically

What this means for you: While visa refusal is disappointing, you won’t lose your IHS payment. The refund provides some financial relief while you consider reapplication options.

Early Departure and Overpayment

Refund Eligibility:

• Visa curtailment (early termination)
• Overpayment due to calculation errors
• Successful visa variation reducing duration

Refund Calculation:

• Refund based on complete unused years only
• Partial years not refundable
• Administrative fees may apply

Real mistake we’ve seen: Applicants expecting proportional refunds for partial years. The IHS system only refunds complete unused years, so leaving 11 months early doesn’t qualify for refund.

Refund Application Process

Required Documentation:

• IHS reference number
• Visa refusal notice or departure confirmation
• Original payment confirmation
• Completed refund application form

Processing Timeline:

• Application review: 2-3 weeks
• Refund processing: 4-6 weeks
• Total timeline: 6-9 weeks typically

Optional—but strongly recommended by AVID experts: Keep all IHS payment documentation until your visa expires. Refund applications without proper documentation face significant delays.

Family and Dependent Considerations

Dependent Surcharge Calculation

Each dependent on your application pays the same IHS rate as the main applicant:

Family Example (5-year visa):

• Main applicant: £5,175
• Spouse: £5,175
• Two children: £10,350
• Total family IHS: £20,700

What this means for you: Large families face substantial IHS costs. Budget carefully and consider the long-term value of NHS access versus private healthcare costs.

Payment Methods for Families

Single Payment Option:

• All family members included in one IHS payment
• Single reference number for entire family
• Streamlined process for group applications

Individual Payment Considerations:

• Separate applications require separate IHS payments
• More complex tracking and documentation
• Higher risk of payment coordination issues

If you’re applying from countries with currency restrictions: Plan family IHS payments carefully. Some countries limit international transfer amounts, making large family payments challenging.

Common IHS Payment Issues

Technical Problems and Solutions

Payment System Issues:

• Browser compatibility problems
• Payment gateway timeouts
• Card verification failures

Quick Solutions:

• Use Chrome or Firefox browsers
• Clear browser cache before payment
• Disable ad blockers and VPNs
• Try different payment methods

Real mistake we’ve seen: Using unsupported browsers or having security software interfere with payment processing. Always use recommended browsers and temporarily disable security software if needed.

Documentation and Reference Numbers

Critical Documentation:

• IHS reference number (required for visa application)
• Payment confirmation email
• Transaction receipt

What this means for you: Without proper IHS documentation, you cannot complete your visa application. Save all payment confirmations immediately and keep backups.