Immigration Health Surcharge and ILR — Do You Pay It Again?

Most ILR applicants do not pay the Immigration Health Surcharge again when they apply for ILR. The surcharge was paid upfront with your original visa. Once you have ILR, you have full NHS access with no further IHS payments required.

Key Facts at a Glance

Detail	Information
Do ILR applicants pay new IHS?	No — for most applicants
When was IHS paid?	Upfront with the original visa application
NHS access after ILR	Full NHS access, same as UK citizens
Further IHS payments after ILR?	No — ILR holders are not subject to IHS
Current IHS rate (for visas)	£1,035 per year (most visas); £776 per year (students, Youth Mobility, under-18s)
Does IHS refund apply if visa refused?	Yes — full automatic refund within 6 weeks to original payment method
Family members applying simultaneously	Fully exempt — neither main applicant nor dependants pay IHS when applying for ILR

Quick Overview

✅ The vast majority of ILR applicants do NOT pay new IHS at the ILR stage
✅ After ILR is granted, you have full NHS access with no ongoing surcharge
⚠️ IHS was a one-time upfront payment made when you first got your visa — it covered your period of leave
⚠️ If any dependants are applying for temporary leave at the same time, different rules may apply to them
📌 ILR is permanent status — you are treated the same as British citizens for NHS purposes
📌 The IHS payment you already made was the full cost for your temporary leave period
💡 You do not need to budget for IHS when calculating your ILR application cost
💡 After ILR, focus your budget on the £3,226 application fee and any test-related costs

What Is the Immigration Health Surcharge?

The Immigration Health Surcharge (IHS) is a fee that most non-EEA visa applicants pay when they come to the UK. It is paid upfront as part of the visa application, and it covers their access to the NHS for the duration of their leave.

The IHS is a significant amount — it is calculated per year of leave at a rate set by the Home Office. The current rate is £1,035 per year for most visa categories (Skilled Worker, family routes, etc.), calculated in 6-month blocks and rounded up. The rate is £776 per year for students, student dependants, Youth Mobility Scheme applicants, and under-18s.

For example, a person granted a 5-year Skilled Worker visa would have paid IHS covering all 5 years upfront, at the point of the original visa application. They do not pay monthly or annually — they pay the full amount in advance.

Why ILR Applicants Generally Do Not Pay IHS Again

When you apply for ILR, you are moving from temporary leave to permanent status. ILR holders are not on a visa. They are permanent residents.

The Immigration Health Surcharge only applies to people applying for temporary leave — visas that have an end date. ILR does not have an end date. Once granted, it does not expire (unless you spend 2 continuous years outside the UK and it lapses).

Because ILR holders are not on a time-limited visa, there is no IHS to pay at the ILR stage. The surcharge system simply does not apply to them.

NHS Access After ILR

Once you have ILR, your access to the NHS is the same as a British citizen. You can access NHS services without any additional payment or surcharge.

There is no annual fee to maintain NHS access. There are no IHS renewals. You use the NHS on the same basis as someone who was born in the UK.

This is one of the significant practical benefits of ILR. After years of paying the IHS upfront with visa renewals, the NHS access continues without further cost.

What Happened With IHS and Your Original Visa

When you first applied for your visa — whether that was a Skilled Worker visa, a family visa, or another qualifying category — you paid the Immigration Health Surcharge as part of that application.

You paid for the full period of your leave upfront. If you were granted a 3-year visa and later extended for a further 2 years, you would have paid IHS on each application.

By the time you apply for ILR after 5 years, you have already paid IHS for 5 years of residence. The ILR application itself does not generate a new IHS payment because you are leaving the temporary visa system entirely.

IHS Refunds If a Visa Application Is Refused

If a visa application is refused and the IHS was paid as part of that application, the IHS is fully refunded automatically within 6 weeks, returned to the original payment method. You do not need to take any action to claim this refund.

The visa application fee itself may not be refunded. The IHS and the visa application fee are separate charges with separate refund rules.

Family Members Applying at the Same Time

If you are applying for ILR and some of your family members are also applying — but for temporary leave rather than ILR — their situation may be different.

When all family members are applying for ILR at the same time, all are fully exempt from IHS — neither the main applicant nor their dependants pay new IHS when applying for ILR. If a dependant is not yet eligible for ILR and is instead applying to extend temporary leave, their situation is different and may attract IHS payments for that temporary visa extension.

If your family's immigration situation is complex — with different members at different stages — get advice from an OISC-regulated immigration adviser.

How IHS Compares to Other ILR Costs

The IHS is not a cost you face at ILR stage. The costs you do face are:

ILR application fee: £3,226 per person from 8 April 2026
Life in the UK test: £50 per person
B1 English test: £150 to £215 depending on provider and location

Use our ILR eligibility calculator to see your exact eligibility date and a full cost breakdown for your family.

The IHS was a past cost — one that funded your NHS access throughout your years in the UK. At ILR stage, the major financial concern is the £3,226 application fee, not any new surcharge.

What Changed With EU Citizens

EU citizens who obtained Settled Status through the EU Settlement Scheme by the deadline did not pay IHS in the same way that non-EU visa holders did. The EU Settlement Scheme had different cost rules. Most EU citizens did not pay IHS as part of obtaining Settled Status.

For more on the difference between ILR and Settled Status, see ILR vs Settled Status.

Common Mistakes

❌ Budgeting for IHS as part of the ILR application cost Most ILR applicants do not pay new IHS. The £3,226 ILR fee is the main cost. Do not set aside additional funds for IHS unless you have a specific reason to believe it applies to you.

❌ Thinking NHS access ends if you do not pay IHS Once you have ILR, your NHS access is permanent and does not depend on any ongoing IHS payment. There is no expiry or renewal. Your access continues indefinitely.

❌ Assuming IHS paid previously can be reclaimed The IHS paid with your original visa covered your access to the NHS for the period of that leave. It is not refundable at ILR stage. It was the cost of your temporary residency.

❌ Not checking whether dependants applying simultaneously face IHS If any family members are applying for temporary leave at the same time as your ILR application, check whether IHS applies to their applications. Their situation is different from yours.

❌ Confusing the ILR application fee with the IHS These are two entirely different charges. The ILR application fee (£3,226) is paid to the Home Office for processing your settlement application. The IHS was a healthcare-related charge paid with your visa. They serve different purposes and apply at different stages.

Expert Tips

Confirm in writing that IHS does not apply to your specific application. If you are applying through a route other than the standard Skilled Worker or family visa, check GOV.UK for your category. Most applicants do not pay IHS for ILR, but there may be exceptions in specific circumstances.
Understand what you have already paid. Look back at your original visa application. The IHS amount you paid upfront is on your original payment receipt. Understanding this helps you explain the cost to your family and confirms that you have already funded NHS access throughout your stay.
Do not confuse IHS with the NHS access rules for ILR holders. After ILR, you access the NHS as a permanent resident. This is a right of your status, not something that needs annual payment. The NHS charges system for visitors and temporary residents does not apply to you.
Factor in the total ILR journey cost. The IHS is not a new cost. The ILR application fee is. Make sure your financial planning focuses on the fee that actually applies.
After ILR, consider the next step. Once you have ILR and full NHS access, the next potential milestone is British citizenship — which opens the right to a British passport and removes any risk of ILR lapsing due to absence from the UK.

Frequently Asked Questions

Do I have to pay the Immigration Health Surcharge when I apply for ILR?

In most cases, no. The IHS was paid upfront when you applied for your original visa. ILR is permanent status and does not attract a new IHS payment for most applicants.

Will I still have access to the NHS after ILR?

Yes. ILR holders have full NHS access on the same basis as British citizens. There is no surcharge, no annual fee, and no renewal required.

What was the Immigration Health Surcharge I paid with my visa?

It was a fee paid upfront to fund your access to the NHS for the duration of your temporary leave. It was paid per year of leave, as a lump sum, at the time of your visa application. It does not need to be paid again at ILR stage.

Can I get the IHS refunded when I get ILR?

The IHS paid with your visa funded your NHS access for the period of that leave. It is not refunded when you get ILR. GOV.UK explicitly states that applying for indefinite leave to remain is a reason you will not receive an IHS refund on previously paid IHS.

My visa still has time remaining when I apply for ILR. Do I get a partial IHS refund?

No. GOV.UK explicitly states that applying for indefinite leave to remain is a reason you will not receive a refund on previously paid IHS. There is no pro-rata refund for unused IHS when ILR is granted before the visa expiry date.

Does the IHS apply to my children's ILR applications?

Children applying for ILR alongside a parent are fully exempt from IHS at ILR stage — the same as adults applying for ILR. No new IHS payment is required.

How This Aligns With Official Guidance

The Immigration Health Surcharge rules are set out in the Immigration (Health Charge) Order 2015 and subsequent amendments. GOV.UK guidance confirms that ILR holders are not subject to the IHS because they hold permanent status rather than temporary leave. The NHS rules for ILR holders treat them in the same category as British citizens for healthcare access purposes.

Official Resources

Our Free Tools

While you prepare your ILR application, use these free tools to prepare for the Life in the UK test:

570 practice questions — full question bank, free
Mock exam — 24 questions, 45 minutes, timed
Cheat sheet — key facts, dates and people
Study guide — fastest route to a first-time pass

Focus on What You Do Need to Pay

The IHS is not a cost you face at ILR stage. The costs that do apply are the £3,226 application fee, the £50 Life in the UK test, and the B1 English test. Start your Life in the UK test preparation here — it is the part of the cost you can control by getting it right first time.

Last reviewed: April 2026 — figures correct at time of publication. Always check GOV.UK for the latest fees and requirements.