UK Immigration Health Surcharge: How Much South Africans Pay (2026)
Last updated:
Quick answer
The Immigration Health Surcharge (IHS) costs £1,035 (about R22,690) per adult for each year of a UK visa, and £776 (about R17,010) a year for children, students and Youth Mobility visas. You pay it upfront for the whole visa when you apply. Visitors and Health and Care Worker visa holders don't pay it.
The Immigration Health Surcharge (IHS) is what you pay for NHS access when you move to the UK on a visa. For most South Africans moving over, it's the biggest single cost of the visa, often several times the visa fee itself.
All rand figures use R21.92/£ (Oct 2026).
How much is the Immigration Health Surcharge?
| Who | Per year | Approx. ZAR |
|---|---|---|
| Adults (most visas) | £1,035 | R22,690 |
| Children under 18 | £776 | R17,010 |
| Students and their dependants | £776 | R17,010 |
| Youth Mobility Scheme | £776 | R17,010 |
You pay for every year of your visa, upfront, when you apply. Adult dependants (such as your partner) usually pay the same rate as you.
How much will you pay for your visa?
| Visa | Length | IHS per adult | Approx. ZAR |
|---|---|---|---|
| Skilled Worker | 3 years | £3,105 | R68,060 |
| Skilled Worker | 5 years | £5,175 | R113,440 |
| UK Ancestry | 5 years | £5,175 | R113,440 |
| Spouse / Partner (first visa) | 2 years 9 months | £3,105 | R68,060 |
| Graduate | 2 years | £2,070 | R45,370 |
For children, a 5-year visa costs £3,880 (R85,050) in surcharge.
For a family it adds up fast. Two adults and two children on a 5-year Ancestry visa pay £18,110 (about R396,970) in health surcharge alone, before visa fees.
How are part years charged?
| Visa length | What you pay |
|---|---|
| 6 months or less, applied for from outside the UK | Nothing |
| More than 6 months, less than 1 year | A full year |
| Over 1 year, up to 18 months | 1½ years |
| More than 18 months, less than 2 years | 2 full years |
| Each extra part-year over 6 months | A full extra year |
That's why a 2-year-9-month spouse visa costs the same as 3 full years: the extra 9 months count as a whole year.
Who doesn't pay the surcharge?
- Visitors, on any Standard Visitor visa (including 2, 5 and 10-year visas).
- Anyone applying from outside the UK for 6 months or less.
- Health and Care Worker visa holders and their dependants.
- People applying for indefinite leave to remain (settlement).
Having private medical insurance doesn't exempt you. You still pay.
Visitors don't pay the surcharge, but they're not covered either. If you visit and need hospital treatment, you're charged 150% of the NHS rate. That's why travel insurance matters for visits.
Do you get it back if your visa is refused?
| Situation | Refund? |
|---|---|
| Visa refused | Yes, in full |
| You withdraw before a decision | Yes, in full |
| Granted a shorter visa than you asked for | Partly |
| Approved, but you don't come to the UK | No |
| You leave the UK before your visa ends | No |
Refunds go back automatically to the card or account you paid with, usually within 6 weeks of the decision. You don't need to apply.
What does the surcharge cover?
Once your visa starts, you can use the NHS much like a UK resident, including GP visits and hospital treatment. You still pay the same charges as residents for things like prescriptions, dental care and eye tests in England.
Common questions
How much is the UK health surcharge in rands?
£1,035 a year per adult (about R22,690) and £776 a year (about R17,010) for under-18s, students and Youth Mobility visas, at R21.92/£ (Oct 2026). You pay it for every year of your visa upfront.
Do I pay the health surcharge for a UK visitor visa?
No. Visitors don't pay it, and nor does anyone applying from outside the UK for a visa of 6 months or less. But visitors are charged for most NHS hospital care if they need it.
Do I get the health surcharge back if my visa is refused?
Yes. It's refunded in full if your visa is refused or you withdraw before a decision, usually within 6 weeks, to the card or account you paid with.
Is the health surcharge refunded if I leave the UK early?
No. You don't get money back if you leave before your visa ends, or if you're approved but don't come to the UK.
Does private medical insurance mean I don't pay the surcharge?
No. You still have to pay it, even if you have private medical insurance.
Sources
General information, not legal or financial advice. Costs change; check official sources.