Last month, Ms. Zhang, who held a Skilled Worker visa, gave birth in a NHS hospital in London. She had paid IHS (Immigration Health Surcharge) for three years, totaling £3,105, but received a bill of £1,800 when she was discharged from the hospital. The reason was that "some postpartum care services are not covered by IHS."
This is not an isolated case. In 2026, although visa holders who pay IHS can "access NHS services within the validity period of the visa and use them on the same basis as ordinary residents," many Chinese people encounter unexpected charges when seeking medical treatment because they do not understand the details of the rules, which even affects subsequent visa applications. Today we break it down from a legal perspective: Who has the right to use NHS for free in ? Which services still require payment? What are the consequences of non-payment?
💷 IHS is not a master key: which services you still need to pay for yourself
In 2026, the standard rate for IHS is £1,035 per year, with a reduced rate of £776 per year for students and applicants under 18 years of age. However, many people mistakenly believe that paying this money can provide "free medical treatment" - . In fact, IHS only covers part of NHS services, and the following three types of expenses still need to be paid out of pocket:
1. Prescription Charges
£9.90 per prescription in England (frozen from 2026 to 2027), free in Scotland/Wales/Northern Ireland. Patients with chronic diseases can save money by purchasing a Prescription Prepayment Certificate.
2. Dental Treatment
NHS dental services are charged on a tiered basis in England, for example, examination £26.80, filling £73.50, tooth extraction/root canal treatment up to £319.10. IHS does not waive these fees.
3. Eye examination and optical services (Optical Services)
Optometry may be free (for certain groups of people), but glasses and contact lenses are usually at your own expense, and those who qualify can apply for the NHS subsidy voucher.
💡 Practical advice: If you have long-term medication needs (such as high blood pressure, asthma medications), it is recommended to purchase an annual or quarterly prescription prepayment certificate (£32.05 for 3 months, £111.60 for 12 months), which is much more cost-effective than a single payment.
🩺 Short-term visitors and "overseas residents": the trap of 150% rate
Not everyone in the UK has access to NHS's free service. According to the charging regulations, an "overseas visitor" refers to a person who is not "ordinarily resident" in the UK. The following groups may be charged:
❌ Coming to the UK on a short-term visitor visa (less than 6 months):
Visitor visa holders are not required to pay IHS but are not entitled to free NHS. If medical attention is required, you will be charged 150% of the standard NHS rate - an emergency hospital stay can easily exceed £10,000.
❌ Former UK residents who have been outside the UK for more than 2 years:
British citizens who return to the UK with settled status will immediately be deemed to be ordinarily resident and eligible for free NHS care, but those who return briefly to visit relatives after living abroad for a long time may be recognized as "overseas visitors".
✅ But these services are always free:
Treatment in A&E (Emergency Department) and GP surgeries is free to everyone, regardless of visa status. COVID-19 testing and treatment (when requested by a medical professional) are also free. But note: A&E is free only for diagnosis and treatment in the emergency department, and subsequent hospitalization will still be charged (unless you meet the exemption conditions).
🔍 Case: Mr. Wang, who holds a tourist visa, suddenly suffered from appendicitis in London. A&E diagnosis was free, but surgery and 3 days of hospitalization were charged £8,500 (150% rate). Later, due to unpaid debts, future applications for British visas may be affected.
⚠️ The consequences of non-payment are serious: the £500 threshold will be reported to Home Office
Many people think that "see the doctor first and pay later" can delay the payment, but NHS takes debt collection very seriously. Debts over £500 that are more than 2 months overdue will be reported to Home Office by the hospital and the Home Office will prevent you from returning to the UK until the debt is paid.
Impact of on permanent residence application:
Although the NHS debt itself will not directly lead to the rejection of permanent residence, the Ministry of Home Affairs will examine the applicant's "Good Character" requirement when processing the ILR application. Large medical debts can be seen as evidence of financial irresponsibility, especially if you know you have the ability to pay but deliberately default on it.
💡 How to avoid the risk of arrears?
• Before seeking medical treatment, proactively ask whether there are any charges and the estimated cost
• Keep all payment vouchers and IHS payment records
• If you are truly unable to pay, contact the hospital’s financial department as soon as possible to negotiate an installment plan
• Use "永居计算器 APP" to record your visa validity period and IHS coverage period to avoid charge disputes caused by visa expiration
🛡️ Immunity for special groups: You may qualify but don’t know it
Even if IHS is not paid, the following groups can still use some or all NHS services for free:
1. Asylum seekers and refugees:
People during a formal asylum application (including appeals), people receiving Home Office Article 95 support, identified or suspected victims of modern slavery – these groups are fully exempt from NHS charges.
2. Domestic violence victim:
Overseas visitors who have suffered certain types of violence (including domestic violence and sexual violence) will receive free treatment for any physical or mental illness resulting from that violence, provided they have not traveled specifically to the UK to seek such treatment.
3. Health and Care Worker visa holder:
All Health and Care Visa holders are exempt from paying IHS, and their dependents are also exempt.
4. European Economic Area visitors with EHIC card:
Emergency treatment during your visit is covered with a valid European Health Insurance Card (EHIC), but planned treatment is not covered.
📋 4 documents you must bring with you when seeking medical treatment
To avoid being mistakenly charged as an "overseas visitor", it is recommended to bring the following documents proving your right to reside in the UK:
✅ BRP card or digital visa status screenshot (to prove visa validity)
✅ IHS payment confirmation email (including IHS reference number)
✅ recent water, electricity and gas bill (proof of address, mobile phone bills are not accepted)
✅ employer letter or payslip (proof that you are working/study in the UK)
💡 Tips: uses a mobile phone to take pictures and save electronic versions of these files, which are stored in the cloud and can be retrieved at any time. If the hospital insists on charging but you think it is unreasonable, you can request a written explanation of the basis for the charge on the spot and file an appeal with the hospital's Overseas Visitor Manager within 48 hours.
🤔Interactive topic: Have you ever been "unexpectedly charged" by NHS?
Chat in the comment area:
• Have you ever encountered any disputes over charges when seeking medical treatment in the UK?
• Do you know your NHS rights for your visa type?
• If your parents come to the UK to visit relatives on a tourist visa, will you buy private medical insurance for them?
⚖️ Disclaimer: This article is for reference only and does not constitute legal advice. NHS fee rules vary depending on the circumstances of each case. Please consult a licensed immigration attorney or contact the hospital's Overseas Visitor Manager for specific questions.
📌 Data source:
• GOV.UK: Charging overseas visitors in England: guidance for providers of NHS services (updated to December 2025)
• GOV.UK: NHS visitor and migrant cost recovery program
• NHS England: Visitors who do not need to pay for NHS treatment
📚 Data source
·https://iasservices.org.uk/immigration-health-surcharge/
·https://www.davidsonmorris.com/immigration-health-surcharge/