Immigration health surcharge

Kamena Dorling, head of policy and public affairs, examines the impact on young migrants of the increased immigration health surcharge that must be paid when making an immigration application.

The immigration health surcharge (IHS), the funds from which go to the National Health Service (NHS), was introduced under the Immigration Act 2014 in a clampdown on so-called "health tourism" and as part of attempts to improve the identification of, and cost recovery from, chargeable patients receiving secondary care. It currently applies to all non-EEA nationals making an immigration application either to enter or remain in the UK for any length of time, including applications for six months or less (but not applying to remain in the UK permanently).

The IHS is payable until such time as the person is granted indefinite leave to remain in the UK, or returns to their own country at the end of their visa period. Paying the IHS exempts a person from the system which operates for undocumented migrants in the UK where they are charged up-front an estimated 150 per cent of the cost of treatment, prior to accessing secondary NHS healthcare.

Doubling of the IHS

The IHS was originally set at £200 per year of "leave" (permission to be the in the UK) applied for, with a discounted rate for students of £150 per year - so applying for 2.5 years of limited leave to remain would incur an IHS of £500. The government announced in February 2018 that it intended to double the health surcharge to £400 a year (or to £300 for students) in order "to better reflect the actual costs to the NHS of treating those who pay the surcharge", with it estimating that the NHS spends "£470 on average per person per year on treating surcharge payers". The Immigration (Health Charge) (Amendment) Order 2018 introducing this increase was laid in October and, despite being opposed by both the Labour party and the SNP in the Commons, was subsequently approved by parliament.

For some migrants, such as high-rate tax payers, the rise will not cause particular concern; the proposed higher costs are not significantly different from the cost of private health insurance in other European countries, and are less than is paid in some developed countries outside the EU. However, this increase will have a significant impact on some particularly vulnerable groups of migrants already living in the UK, including those on lower incomes, who have a right to remain under Article 8 of the European Convention on Human Rights but are already struggling to afford high immigration fees. This includes children and young people who have grown up in the UK.

In the past six years, the immigration system for children and young people with uncertain status has changed significantly. Before 2012, most children and young people who had grown up in the UK could expect to acquire indefinite leave to remain after six years and two applications or in some cases after two years and one application. Now, if able to make an application for leave to remain, these children are on very long routes to settlement: they will only be granted 2.5 years' leave at a time and will have to make four applications over the course of 10 years, costing £6,521 in application fees (at 2018 rates) and an additional £2,000 in IHS before they will have been granted settled status (indefinite leave to remain). With the charge doubled they will have to pay another £2,000, bringing the total bill to £10,521 over 10 years.

Exemptions and fee waivers

Asylum seekers, those applying for humanitarian protection and those applying for discretionary leave to remain in the UK as a potential victim of trafficking (or their dependants) do not need to pay the IHS. Neither do children under 18 who are looked after by a local authority, who are exempt. Immigration application fee waivers are also available on specified human rights routes and where this fee is waived, the requirement to pay the surcharge is also waived. However, concerns have been raised about the effectiveness of the current fee waivers system and the low grants of fee waivers to children - less than eight per cent of children in 2016.


  • Payment of the IHS must be made at the same time as an immigration application is made. It is not possible to pay by instalments. Payment must cover the total cost up-front for the duration of the leave applied for, and for all the people named on the application. Non-payment may lead to an application being deemed invalid.
  • Fee waivers are available for most immigration applications made on the basis of Article 8 of the European Convention on Human Rights. Applicants will qualify for a fee waiver only where they can demonstrate that:
  • They are destitute; or
  • They would be rendered destitute by payment of the fee; or
  • There are exceptional circumstances relating to their financial circumstances and ability to pay the fees such that the fee should be waived in their case.
  • Where this fee is waived, the requirement to pay the surcharge is also waived.

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