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Immigration Health Surcharge: common casework questions

Published Tuesday, January 22, 2019

Most non-EEA nationals applying for temporary leave to remain in the UK must pay an 'Immigration Health Surcharge' to the Home Office, in addition to the immigration application fee.

The ‘Immigration Health Surcharge’ came into effect on 6 April 2015, under powers in the Immigration Act 2014. The charge is paid as part of an immigration application depending on the type of visa or status. It is intended to “ensure that migrants make a proper financial contribution to the cost of their NHS care.” The Immigration (Health Charge) Amendment Order 2018 came into effect from 8 January 2019 and doubled the previous amount in each category.

Official information about the immigration health surcharge is available from the GOV.UK website. This includes details of which application categories are affected, and online tools to enable applicants to calculate how much they will have to pay.

Home Office news release briefly sets out the policy rationale for the charge. The Explanatory Memorandum to the Statutory Instrument implementing the charge gives a more detailed explanation.

1.1       Who must pay the charge?

As a general rule, non-European Economic Area (EEA) nationals must pay the charge if they are applying to come to or stay in the UK for longer than six months. Once they have paid the charge, they are entitled to free NHS treatment on the same basis as permanent residents, for the duration of their visa.

Visa applicants’ dependant family members must also pay the charge if they are coming to live in the UK.

Certain categories of applicant are exempt from paying the surcharge but still have access to free NHS treatment. The GOV.UK page ‘Pay for UK healthcare as part of your immigration application’ outlines those who are exempt.   

Visitors can only stay in the UK for six months or less. They do not have to pay the charge. Instead, they must pay for any NHS treatment they receive whilst in the UK at the point of access.

EEA nationals living in the UK prior to Brexit do not have to pay the charge. After Brexit the Government intends to implement a new, unified immigration system for all those who come to the UK, including EEA nationals. The proposals for the immigration system are set out in ‘The UK’s future skills-based immigration system’, which indicates that EEA nationals applying for a Tier 2 visa will have to pay the charge. It is not clear in which other visa categories the charge may apply to EEA nationals.

1.2       How much is the charge?

Parliament approved a motion for the health surcharge to be increased and the changes have been in effect since the 8 January 2019. The new charges are:

  • £300 per year for international students and their dependants
  • £300 per year for Tier 5 (Youth Mobility Scheme) Temporary Migrants
  • £400 per year for all other applicants

The health surcharge prior to 8 January 2019 was:

  • £150 per year for international students and their dependants
  • £150 per year for Tier 5 (Youth Mobility Scheme) holders
  • £200 per year for other applicants

This means that the immigration health surcharge has doubled in each visa category it applies to.

The actual amount that applicants must pay will depend on the duration of the visa they (and any dependants) are applying for. The charge must be paid for at the point of applying for a visa.

The charge amounts are intended to reflect the range of health services available to migrants in the UK, as well as the need to ensure that the UK remains an attractive destination for the “brightest and best” migrants. The charge is lower than the average per capita cost of treating temporary migrants (the Department of Health and Social Care estimates an average of £470 per person) and is lower than the cost of basic private medical insurance, which some other countries require.

The regulations give the Home Secretary discretion to reduce, waive or refund all or part of a charge. Home Office policy is that refunds will be given if an application is refused or rejected as invalid. Partial refunds will be given if a visa is granted for a shorter length of time than was paid for. Reductions or waivers of the charge are only expected to be made in other circumstances for exceptional cases.

1.3       Why was the charge introduced?

The previous arrangements allowed temporary non-EEA migrants to have access to free NHS care soon after arrival in the UK. The Coalition Government considered that this was overly generous, and inconsistent with restrictions on temporary migrants’ eligibility for welfare benefits and social housing (these are generally only available to permanent migrants).

The charge is intended to “ensure that migrants make a proper financial contribution to the cost of their NHS care.” In response to a parliamentary Question, the Parliamentary Under-Secretary for the Department of Health and Social Care stated “…between 2012/13 and 2016/17, NHS cost recovery income identified for chargeable overseas visitors and migrants has more than quadrupled from £89 million to £352 million. All income recovered is directed straight back to the NHS frontline.”

The charge is one of several reforms to the NHS charging regime which are being introduced further to a 2012 review of migrant access to the NHS. This is discussed in a separate Library briefing: NHS Charges for Overseas Visitors (England).

1.4   Why was the charge doubled?

In a written statement on 11 October 2018, Minister of State for Immigration Caroline Nokes explained:

In February, the Government announced its intention to double the IHS. This followed a review by the Department of Health and Social Care of the evidence regarding the average cost to the NHS of treating surcharge payers. That review found that the average annual cost of NHS usage by those paying the surcharge is around £470 and that doubling the IHS could generate an additional £220 million a year for the NHS across the UK.

The proposed amount is still below full average cost recovery level and remains a good deal for those seeking to live in the UK temporarily. These changes do not affect permanent residents, who are not required to pay the IHS. Certain vulnerable groups such as asylum seekers and modern slavery victims are exempt from paying the IHS. Short-term migrants (including those on visitor visas) and those without permission to be in the UK are generally charged for secondary care treatment by the NHS at the point of access.

In a joint briefing in response to the announced increase, the Immigration Law Practitioners’ Association (ILPA) and the Joint Council for the Welfare of Immigrants (JCWI) criticised the increase. ILPA and JCWI argued that the increase:

…ignores the fact that most migrants are also taxpayers and are thus paying double to the NHS. Furthermore, migrants access the NHS less frequently than the general population. A Department of Health and Social Care analysis of the cost to the NHS of treating surcharge payers suggests an average cost of £480/year per surcharge-paying migrant.

ILPA and JCWI also claimed that the increase will ‘discourage nurses and doctors from moving to the UK’.

This information is provided to Members of Parliament in support of their parliamentary duties. It is a general briefing only and should not be relied on as a substitute for specific advice. The House of Commons or the author shall not be liable for any errors or omissions, or for any loss or damage of any kind arising from its use, and may remove, vary or amend any information at any time without prior notice

Commons Briefing papers CBP-7274

Authors: Melanie Gower; Hannah Wilkins

Topics: Health finance, Health services, Immigration

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