Since 6 April 2015, nationals from outside the European Economic Area (EEA) now have to pay a “health surcharge” when making a UK immigration application. This surcharge is also payable by those applying for extensions to their immigration permission to remain in the UK.

Set out below is a summary of the main issues this health surcharge poses for migrants, as well as its likely impact upon employers of non-EEA workers.

When the surcharge applies

Upon application to enter

Non-EEA nationals applying to enter the UK for more than six months are required to pay the health surcharge when making their online application.  The surcharge must be paid before the application is submitted and, if the application is being made by appointment at a Premium Service Centre, the surcharge must be paid before attending this appointment.

Upon renewal of existing immigration permission

Those renewing an existing entitlement to stay in the UK are also caught by the surcharge. This is the case even though payment of a health surcharge was not one of the conditions imposed when the person’s initial application to enter the UK was made.

Failure to pay

Failing to pay the surcharge will not simply delay an application; it may also lead to a refusal. If an entry clearance officer requests payment, it must be made within seven working days of that request (10 working days for renewal of existing immigration permission).

Amount of the surcharge

It is charged at a rate of £200 (£150 for students) per year, and is the same amount for dependants as for main applicants. Importantly, the surcharge is payable up-front for the “entire period” of the immigration permission being applied for. This can mean either:

  1. the maximum period of immigration permission that could be granted under the relevant application route; or
  2. if the applicant is entering on the basis of a Certificate of Sponsorship or Confirmation of Acceptance for Studies, the period of time stated on that document.

Paying up-front for the entire period, and having to pay the same charge for dependants and main applicants, can make the health surcharge higher than the fees individuals are required to pay for the actual applications.


For a family of four applying to stay in the UK for three years under Tier 2 (General), the amount payable would be:

  • £514 application fee per person, at a total of £2,056; and
  • £600 per person for the health surcharge (i.e. £200 per year), at a total of £2,400.

The applicant would be required to pay £4,456 overall, with the health surcharge accounting for more than half of the total amount.

Partial years

Payment is complicated if the maximum period of stay in the UK includes part of a year. If this part of a year is six months or less, half of the surcharge will apply for this period, but otherwise, the full year will be charged for.

For example, if a person is entitled to stay for one and a half years, they will pay: £200 for the first year, and £100 for the half year. However, if they stay for one year and seven months, they will be charged for two full years at £200 each.

Important exceptions

  • Visitor visa holders are exempt from the surcharge, but may still have to pay for any National Health Service (NHS) care received in the UK.
  • Australian and New Zealand nationals do not have to pay as there is a reciprocal healthcare agreement in place with those nations. However, they will still have to complete the online surcharge process in order to obtain the “surcharge reference number” necessary for their main immigration application.
  • Those transferring within a company (known as “Tier 2 – Intra-Company Transfer” (ICT)) are also exempt, but must complete the surcharge process to be given their reference number.
  • Note that a child born in the UK to a person who has an exemption, is also exempt until they reach the age of three months.  However, if they leave and return to the UK, this exemption will no longer apply.

Impact on entitlement to healthcare services

Before the surcharge was introduced, non-EEA nationals receiving non-emergency NHS healthcare in the UK would be charged for these services at point of use if they were “not ordinarily resident” in the UK. This is a complex test, and remains relevant for those entering for six months or less, or without permission.

Paying the surcharge means a person is entitled to treatment by the NHS as if they were a permanent resident of the UK. However, this does not mean that all NHS healthcare services will be free of charge. Dental treatment and obtaining prescription medicine will still give rise to their own charges at point of use.

Those who have paid the surcharge or are exempt from it will be pre-registered onto an electronic NHS database. A “green banner” will appear on the file of each patient who has paid or is exempt, and this is meant to be visible to the NHS staff treating them. Those granted indefinite leave to remain will have this green banner removed from the date of the grant.

Avoiding the surcharge

Unless a person falls under an exempt visa category, there is no way of avoiding paying the surcharge. Having private healthcare insurance may mean that a migrant will have a reduced need to use NHS services, but this does not mean they can avoid paying the health surcharge. Part of the reasoning behind this appears to be that emergency treatment is provided by the NHS even if an individual has private healthcare insurance.

Note that the surcharge will not be refunded if a person decides not to enter the UK after being granted immigration permission to enter. Similarly, partial refunds are not available  if an individual leaves the UK (for whatever reason) before their immigration permission expires.

Considerations for employers

Employers seeking to bring an employee into the UK from an overseas office should consider whether it is worth applying for this employee under a Tier 2 (ICT) visa in order to avoid paying the health surcharge.


A worker with three dependants coming into the UK to work for four years under Tier 2 (ICT) Long-Term Staff would pay:

  • £1,028 per person for the application fee, at a total of £4,112; and
  • no health surcharge.

By contrast, this same worker applying to stay for four years under Tier 2 (General) would pay:

  • £1,028 per person for the application fee, at a total of £4,112; and
  • £800 per person for the health surcharge (i.e. £200 a year), at a total of £3,200.

If the worker is going to be earning a salary of £41,500 or more (thereby satisfying the salary requirements for both Tier 2 (General) and Tier 2 (ICT) Long-Term Staff), and has worked for the company for at least 12 months, there is a saving of £3,200 by applying under Tier 2 (ICT).

The Home Office do not believe that processing times for applications will increase as a result of the surcharge, but care should be taken with the payment process, as payment of the incorrect amount is expected to delay an application. Special attention should be given when partial years are involved (see above).


Migrants and employers of migrants should be aware that the health surcharge will appreciably increase the cost of UK immigration applications and renewals. Although the surcharge promises to simplify access to NHS healthcare, it remains to be seen whether the electronic “green banner” system will work effectively in practice.