Immigration Health Surcharge: £1,035 a year, £776 for students, 10 days to top up

The immigration health surcharge (IHS) is the payment for NHS access made as part of an online immigration application. Whether you pay depends on the immigration status you are applying for.

What does it cost?

The yearly rates are £776 for students, their dependants and Youth Mobility Scheme visa holders; £776 for applicants who are under 18 at the time of application; and £1,035 for all other visa and immigration applications.

It is calculated on the length of the visa, not the course or contract — a visa may run longer than either. GOV.UK's own examples: £1,552 for a two-year student visa, £3,105 for a three-year application at the standard rate.

How are part-years calculated?

If the visa is for six months or less and you apply from outside the UK, there is no surcharge at all. Apply from inside the UK and you pay half the yearly cost: £388 for students, their dependants and under-18 applications, £517.50 for anything else.

For more than six months but less than one year you pay a full year's cost wherever you apply from.

For more than one year: the yearly cost plus half the yearly cost if the visa is for 18 months or less; two full years if it is for more than 18 months but less than two years.

Dependants aged 18 or over usually pay the same amount as the main applicant.

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Who does not pay?

The exemptions on GOV.UK are specific. There is no surcharge for a visitor visa, or for a visa of six months or less applied for from outside the UK, or for a visa for the Isle of Man or the Channel Islands. S2 Healthcare Visitors are exempt, as are people eligible for a Frontier Worker permit who hold an S1 certificate, and children under 18 taken into care by a local authority.

Also exempt: relevant civilian employees at NATO or the Australian Department of Defence in the UK and their dependants; applicants under the Ukraine Extension Scheme and the Homes for Ukraine Sponsorship Scheme; and people applying to stay as a victim of human trafficking or slavery, or as a stateless person.

One trap worth knowing: if you applied for indefinite leave to remain but are granted only limited leave, you do have to pay the surcharge — before the leave is given.

What happens if you do not pay, or underpay?

UK Visas and Immigration emails the address given in the visa application (check the junk folder). Once that email arrives you must pay within 10 working days if you are inside the UK, or 7 working days if you are outside it. Your application is refused if the full amount is not paid in time.

When does free NHS care start, and when is there a refund?

You can use the NHS free of charge from the date your visa starts, provided the surcharge has been paid. While the Home Office has not yet decided your application you may have to pay for treatment. And even after the visa starts you still pay for prescriptions, dental treatment, eye tests and assisted conception.

You get a full IHS refund if you paid it twice for the same application, or if your visa application is refused. When you access healthcare you may need to prove your status online with a share code if you hold digital immigration status.