The health surcharge

The Immigration Health Surcharge (IHS) is the extra contribution that migrant workers and their families have to make to the NHS, in addition to paying their taxes.

The surcharge was introduced in 2015 at £200 a year for each person. In 2018 it was doubled to £400 and in 2020 it increased to £624. In 2023, the Government announced a rise to £1035 per adult.

Health and social care staff

UNISON has campaigned for years against the unfairness of the IHS. As the COVID-19 pandemic took hold we highlighted the huge financial and administrative pressures on health and social care staff to politicians, civil servants and the public.

Under pressure from the public, the Government announced that health and social care staff would be exempt from paying the IHS. We welcomed the change of heart from the Government.

However, the implementation of this exemption is deeply unfair and places the lowest paid health and care staff under great financial pressure.

While migrant workers on Tier 2 visas working in the healthcare sector will be exempted, wider healthcare staff and nearly all social care staff will have to pay upfront and then be reimbursed over time.

UNISON will continue campaigning to exempt all health and social care staff from the surcharge as the first step to scrapping the charge altogether.

The exemption scheme: how it works

Tier 2 visa holders working in Healthcare

A new Health and Social Care Visa (Tier 2) was launched by the government in July 2020. Those eligible for this visa pay a reduced visa application fee and are exempt from the IHS for themselves and their dependents.

If you are a Tier 2 visa holder/NHS and Social Care visa holder and you’ve paid it already – you can claim a refund for the months after 31 March 2020. This is different from the reimbursement scheme. Find out how to claim your refund by visiting the website.

All other health and social care staff

These workers will need to continue to pay the IHS for themselves and their dependents but may be able to claim the fee back in 6 month blocks

To be eligible to claim the IHS fee back, the applicant must be working or have previously worked in a health and social care sector job:

  • for 6 months or more
  • for an average of 16 hours per week
  • on or after 31 March 2020
  • have payslip evidence of their employment for the period covered.

Gaps for maternity, paternity and sick leave are allowed for in this calculation.

Reimbursements are not paid as a single payment. They’re paid in 6-month instalments, in arrears, covering the period from 31 March 2020. The reimbursement amount will be 6-months’ worth of what the applicant has paid for their immigration health surcharge.

The applicant will need to reapply after every 6 months to continue getting reimbursed. A reimbursement claim cannot be made for any period before 31 March 2020.

Useful links

Applying for reimbursement

Government guidance about the scheme

Our concerns

It’s unfair

We are campaigning for the surcharge to be dropped for all migrant workers. Exempting healthcare workers on Tier 2 visas only leaves some of the lowest paid health and social care staff under a terrible financial burden.

All healthcare staff were applauded and recognised during the peak of the pandemic, all should be exempt from paying the health surcharge.

It’s unaffordable

If someone comes to work in the UK on a three-year-visa, with a partner and two children, they will have to find an extra £6,564 (£624 x two adults plus £470 x two children for three years) on top of their visa fees.

One healthcare assistant nurse recently told us that she and her care worker husband work all hours possible to provide for their three children, aged 13, nine and three.

Owing to their immigration status and having no recourse to public funds, the family is not eligible for any state aid, or child benefit.

It contributes to staff shortages

Workers from other countries play an important role in helping to deliver healthcare in the UK.

NHS staff shortages are a real problem and international recruitment remains vital to achieving the overall staffing numbers needed. It’s now harder to recruit staff from abroad for many reasons, including the immigration health surcharge.

What you can do

UNISON branches/reps

There are several things branches could be doing to help UNISON campaign to end the immigration health surcharge for all migrant workers:

  • publicise details of the reimbursement scheme to members who might be able to claim their money back.
  • find out how many of your members are affected by the immigration health surcharge and the impact it has on them.
  • meet your employer and ask them to help support staff who still have to pay the IHS upfront.
  • let us know if members experience any difficulty in getting their reimbursements.
  • ask your members to speak to UNISON about how paying the surcharge has affected them. They can email us, in confidence, at

Help for UNISON members

We work with the Joint Council for the Welfare of Immigrants (JCWI) to provide immigration advice to members who have come to work in the UK. If you would like to get some advice please call us on 0800 0 857 857 and we’ll arrange an appointment for you.