Immigration Health Surcharge UK: What It Costs and How to Pay in 2026

The Immigration Health Surcharge is not a minor administrative fee. For a Pakistani professional applying for a five-year UK Skilled Worker visa, the IHS alone costs £5,175 — roughly 1.8 million PKR at current exchange rates. Add the visa application fee and you are looking at approximately 2.35 million PKR before you have paid for a single document, test, or flight. Most guides mention the IHS in passing. This one explains what it actually costs, why it exists, how to pay it safely from Pakistan, and what happens to your money if the application goes wrong.

What the Immigration Health Surcharge Is

The Immigration Health Surcharge is a mandatory fee paid by overseas nationals coming to the UK on a visa of more than six months. It is charged per year of the visa, per person, and it covers the applicant's access to the National Health Service (NHS) during their stay.

Paying the IHS does not give you private healthcare. It gives you the same access to the NHS as a UK citizen — GP registration, hospital treatment, and prescriptions at the standard subsidised rate. If you have already paid the IHS and you fall ill in the UK, you do not pay NHS fees on top.

For 2026, the IHS rate is £1,035 per adult per year and £776 per child under 18 per year. These rates apply to the full duration of the visa, not just the time you expect to use NHS services.

How Much You Will Pay as a Pakistani Applicant

The IHS is calculated automatically when you complete your online visa application on GOV.UK. You cannot skip it or pay it later. The payment is collected before your application is submitted — it is a condition of submission.

Here is what typical scenarios look like at current rates:

For context: a Pakistani IT professional earning 200,000 PKR per month would spend the equivalent of three years of gross income on IHS alone for a family of four on a five-year visa.

The total upfront cost — IHS plus visa application fee — for a single professional on a five-year visa is approximately £6,694. For a family of four, it approaches £24,000 (over 8 million PKR). These numbers are not a reason not to apply; the earning potential in the UK typically recovers these costs within the first year. But they are numbers you need to face before you start the application, not after.

How to Pay the IHS Safely from Pakistan

The IHS is paid during the online visa application on GOV.UK using a debit or credit card. This is where Pakistani applicants encounter a specific trap.

Many Pakistani applicants use a third-party agent or a friend or relative abroad to pay their visa fees, either because their Pakistani bank card does not process the GOV.UK payment or because the agent is "handling" the application for them. This is dangerous for one specific reason: if the visa is refused, the IHS is refunded — but it is refunded to the original payment card, not to the applicant's bank account.

If a consultant paid the IHS on your behalf using their card, the refund of several million rupees goes to the consultant's account. Recovering it from an unscrupulous agent is a separate legal problem on top of an already failed visa application. The Home Office cannot redirect refunds to a different card or account.

If your Pakistani bank card is not accepted on GOV.UK, open a Wise account or ask a trusted family member already in the UK to make the payment, then transfer the equivalent amount to them. The refund will then go to someone you trust unconditionally.

What Happens to the IHS If Your Visa Is Refused

If your Skilled Worker visa is refused, the IHS is refunded in full to the payment card. The visa application fee (£1,519 for a visa over three years) is not refunded.

The refund takes approximately six to eight weeks from the date of the refusal decision. It is returned automatically — you do not need to apply for it separately, provided the application was refused and not withdrawn. If you withdraw your application before a decision is made, different rules apply and a partial refund may apply.

This distinction matters significantly for Pakistani applicants, because Pakistani applications have an approval rate of approximately 66% — meaning roughly one in three applications is refused. The non-refundable visa fee represents real money lost, but the IHS refund does come back.

The IHS and Dependent Applications

Each dependant — spouse and children — must pay a separate IHS at the full annual rate for their own application. The dependant IHS is calculated independently and paid during the dependant's own online application, not the main applicant's.

There is no family discount. A couple with two children on a five-year visa pays four separate IHS amounts totaling over £18,000.

One strategic note: if you apply with dependants and the main application succeeds but a dependant application is refused, the IHS for the refused dependant is refunded. If you are uncertain whether your spouse's documentation is complete — particularly the Nikah Nama, NADRA FRC, and relationship evidence — it may be worth completing and checking those documents before including dependants in the initial application.

For a step-by-step payment walkthrough and a full breakdown of every cost involved in a Skilled Worker visa application from Pakistan, including HEC attestation fees, TB test costs, and VFS service charges, see the Pakistan to UK Skilled Worker Guide.

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