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UNITED KINGDOM: Further Details of NHS Health Surcharge Announced

Following publication of the United Kingdom Department of Health's response to the 2013 public consultation on migrant access and financial contribution to National Health Service (NHS) provision in England, the Department of Health has now published an implementation plan to cover the phased roll-out of an NHS cost recovery scheme for some migrants, including European Union (EU) nationals.  This follows the introduction of the Immigration Act 2014 in May this year, which contains provisions for NHS cost recovery.  Secondary legislation is expected to be passed later this year to pave the way for the anticipated roll-out beginning in April 2015 of the "immigration health surcharge."  With the exception of Tier 2 intra-company transfer applicants, all other migrants applying for a visa of more than six months' duration will be required to pay the surcharge with their visa application fee.

How Much Will Migrants Need To Pay?

The surcharge is expected to be £200 per year for all affected migrants except students, who will be subject to a lesser annual charge of £150.  What is new and very significant is the proposal for the surcharge to be fully payable upfront at the visa application stage to cover the duration of the visa.  This will be a hefty sum for many migrants.  For example, a Tier 2 General migrant applying for the maximum five-year visa will need to pay £1,000 for the surcharge.  Following the consultation, the fee was widely expected to be payable annually rather than in one upfront lump sum for the duration of the visa.  For migrants with a number of dependents, this will represent a substantial financial outlay, in addition to all the visa fees.  There are plans for lobbying to have this requirement removed.

There will be NHS pre-registration arrangements for migrants who have paid the surcharge, which will be aligned with those the Home Office is putting in place for the issue of entry documents and distribution of Biometric Residence Permits (BRPs) to migrants at their local Post Office.  When accessing NHS treatment, migrants who have paid the surcharge will be required to produce their BRP but no further charges will be levied, other than prescription charges and other charges payable by those ordinarily resident in the UK.


As stated above, Tier 2 intra-company transfer migrants will be exempt from the surcharge and will continue to enjoy free NHS care.  Other exempt categories include those seeking asylum, refugees, and victims of human trafficking.  Furthermore, GP services will remain free of charge for all.

EU Migrants

All EU migrants and visitors will be required to produce their European Health Insurance Card (EHIC) to avoid being charged.

Migrant Visitors and Other Non-EU Migrants

All visitors and non-EU migrants who have not paid the surcharge will be expected to pay upfront to access NHS services.  However, emergency or urgent treatment will be provided without an upfront payment, subject to the proviso that the costs will be payable.  Since 2011, NHS providers are able to share with the Home Office non-clinical information on individuals subject to immigration controls who hold £1,000 or more of debt to the NHS.  Those who owe a substantial debt to the NHS could be refused permission to re-enter or remain in the UK until they clear that debt, subject to human rights obligations.

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