Guidance

Immigration health surcharge: guidance for health and care reimbursements

Updated 1 October 2021

Introduction

The immigration health surcharge

The immigration health surcharge (IHS) was set up in 2015 and has raised almost £2 billion since its introduction. Foreign nationals who are subject to immigration control and not subject to an exemption to the IHS and applying for temporary leave to enter the UK for longer than 6 months or leave to remain in the UK for any period, must pay an IHS to the Home Office at the point of visa application.

Income raised from the IHS goes to general UK government funds and is then distributed to devolved health administrations (including England) under the Barnett formula.

The Prime Minister’s announcement

On 21 May 2020, the Prime Minister announced plans to exempt health and care workers from the IHS “as soon as possible” and that eligible health and care staff would be reimbursed depending on their individual circumstances.

In August 2020, the Home Office launched the health and care worker visa, exempting individuals at the point of application from having to pay the IHS. On 1 October 2020 the Department of Health and Social Care (DHSC) launched the Health and Care Reimbursement scheme for eligible staff outside these visas.

1. Purpose of guidance

This guidance is public facing and intended to support potential applicants within the health and social care sector determine if they are eligible for reimbursements. It sets out the review process where an applicant disagrees with the reimbursement decision.

This guidance covers the eligibility criteria and process for applying for health and care reimbursements of the IHS for people who do not have a grant of leave through the health and care worker visa (formerly a sub-category of the current Tier 2 (General) immigration route) and whose reimbursement will be administered by the NHS Business Services Authority (NHSBSA).

This process (the scheme) is operated on a UK-wide basis by NHSBSA on behalf of DHSC. DHSC is responsible for setting the policy and eligibility criteria for this scheme and the Home Office retains responsibility for overall immigration policy and the IHS.

Until 30 September

NHSBSA is responsible for validating applications for reimbursement from the IHS and referring these applications to UK Visas and Immigration (UKVI), which will process repayments to applicants.

From 1 October

NHSBSA is responsible for validating applications, and for requesting repayments for validated applications which are eligible for reimbursement via the IHS portal.

Those working in health and care but on a visa that allows them to work in a place of their choosing, that is their visa is not linked to their employment. For example, an applicant who has a skilled worker visa can apply to be reimbursed any IHS they have already paid in respect of any 6-month period from 31 March 2020 where they were working in a relevant health or social care context. The scheme also extends to eligible dependants.

Applicants who hold a Tier 2 (General) Visa and work in an eligible role

If the applicant is in the UK on a Tier 2 (General) visa, working in an eligible occupation, or a health and care visa, they should not claim a reimbursement through this scheme. Instead they should go to getting an IHS refund if you work in health and care for details on refunds and eligibility.

2. Summary of eligibility criteria

Anyone holding a relevant visa, who has worked in health and social care continuously for at least 6 months commencing on or after 31 March 2020 and has paid the IHS, may be eligible for a reimbursement.

Their dependants may also be eligible for a reimbursement if they have paid the IHS or the IHS has been paid for them.

Applicants must have paid the IHS for the period covered by their claim. 

For example, they must hold visas, for which they have paid the IHS, covering the period between 1 April and 30 September 2020, if they claim on 1 October 2020.

Dependants of UK nationals, or an individual who has indefinite leave to remain or enter and where the dependant has paid the IHS for a period on or after 31 March 2021, will need to be eligible in their own right to receive a reimbursement.

For example, an applicant who is of Korean nationality, and paid the IHS who works as a NHS administrator, and is the partner of a UK national who works as a team member in a supermarket would be eligible to apply for reimbursement.

An applicant who is of Chinese nationality, and paid the IHS and who works as a teacher, and is the partner of a UK national who works as a care assistant in an Adult Care Home, would not be eligible to apply for reimbursement.

Dependants of other temporary migrants may be eligible for reimbursement based on the eligibility of the main applicant.

Applicants will need to apply for reimbursements on a 6-monthly basis, when they have worked for an average of at least 16 hours per week over the full 6 months. These reimbursements will be processed in 6-month instalments in arrears. 

Example

If an applicant paid the IHS in 2019, for a period of 3 years, they will be able to claim 6 months’ worth of IHS reimbursement on 1 October 2020.

This can be repeated on 31 March 2021 and for any additional 6-month periods, as long as they have met the eligibility criteria for each period.

Any period of time or work an applicant has completed before 31 March 2020 cannot be claimed for. 

The reimbursement scheme is designed for applicants who are in the UK on time-limited visas that give them a generic right to work. Examples of this may include:

• a dependant of a UK national or another migrant
• someone on a Tier 4 student visa who can undertake up to 20 hours of work a week during term time
• someone on a Tier 5 government authorised exchange visa
• someone on a Tier 5 youth mobility scheme

Eligibility criteria

An applicant is entitled to claim reimbursement of the IHS where they do not hold or are not eligible for the health and care worker visa (including applicants who hold a valid Tier 2 (General) visa and work in an eligible role), and if they have provided the required evidence to demonstrate they have completed the eligible hours of eligible work. ‘Eligible hours’ and ‘eligible work’ is defined below.

Eligible hours

Eligible hours must total at least an average of 16 hours per week calculated over a 6-month period which began on or after 31 March 2020. Applicants will be asked to demonstrate this by submitting pay slips as part of their application.

The calculation of hours can include periods of statutory leave from ongoing employment (including contracted hours during jury service, maternity leave, and sickness leave). It may also include eligible work for one or more employers and can include up to 4 weeks (28 days) unpaid leave with justification, such as changing employers or personal circumstances. Applicants may be asked to explain any unpaid leave or breaks of service as part of their application.

If an applicant has changed jobs in the 6-month period, they will remain eligible so long as breaks within the relevant 6-month period do not total longer than 4 weeks (28 days) in any 6-month period. Each job must meet the criteria specified under eligible work. Applicants may be asked to provide evidence or explanation for any gaps or breaks in their employment.

Example

If an applicant started working in a care home on 1 May 2020, leaving that role on 14 June and starting in a new, eligible post on 1 July, they would be able to claim a reimbursement from 1 November.

Eligible work

Work is ‘eligible’ if it is of a type and for an employer as described in Annex A.

For example, this will mean work is eligible if it is:

1. providing a service which is related to the delivery of health or social care
2. the applicant is employed or engaged to do the work by:

• a recognised health or care provider (for example, NHS trusts, national NHS bodies)
• an employer which is registered with an appropriate health or social care services regulator to provide health or care services. For instance, this includes care homes or independent sector healthcare providers, which would be registered with the Care Quality Commission (CQC) in England, or a pharmacy, which would be regulated by the General Pharmaceutical Council
• an employer delivering services that directly support health and social care services, such as facilities management services within a hospital, as long as this work is undertaken within a health and care setting

An applicant could be providing direct patient care (such as a healthcare assistant or social care worker), providing administrative support or leadership (such as a care home manager or hospital receptionist), or support facilities management (such as a hospital cleaner, catering, or courier services).

If the applicant works for a private sector provider or company which is providing services related to the delivery of health or social care then this work would also be eligible, as long as the employer is registered with the appropriate regulator (such as CQC in England).  

Some applicants will work for employers that provide a wide range of services which includes some health- and care-related work. An example of this would be a supermarket that has a pharmacy. In this instance, applicants will be asked to specify their job role. This should also be included in the evidence supplied by the applicant, for example, ensuring the job role is quoted on the pay slip.

The full list of criteria for employers is in Annex A.

The applicant should provide evidence of hours worked, ideally in the form of payslips (these can be scanned photocopies or photographs). These can be uploaded online as part of the claim process.

Applicants will be eligible if they have had any statutory breaks in work, such as sickness, maternity leave or jury duty, but they should have remained employed during this time. This should be evidenced as part of the claim, ideally in the form of payslips.

If an applicant has changed jobs in the 6-month period, but remained in eligible work, they will remain eligible. Applicants may have had a short break in employment between jobs. They would remain eligible if the break in employment totals no longer than 4 weeks (28 days) in any 6-month period.

Applicants who are self-employed, but working in the health or care sector, should provide evidence that they are engaged in an appropriate role in an appropriate setting, as set out in Annex A. Unpaid volunteers are not eligible for reimbursement.

Dependants

If the applicant has dependants who have also paid the IHS, they will be able to claim a reimbursement for each of their dependants. 

A dependant for the purpose of this scheme is an individual who has paid the IHS (or had it paid for them) and is reliant on another individual to be granted a temporary right to remain or enter the UK.

A dependant may be any of the following:

• a husband, wife or partner
• a child under 18 years of age
• a child over 18 years of age, if they are currently in the UK as a dependant

3.23 Dependants of UK nationals, or an individual who has indefinite leave to remain or enter and where the dependant is a temporary migrant and has paid the IHS for a period on or after 31 March 2021, will need to be eligible in their own right to receive a reimbursement.

3.203.24 Dependants of other temporary migrants may be eligible for a reimbursement in their own right, for instance if they work in a health or social care setting for an average of at least 16 hours per week. If they are the dependant of a person who is in the UK on a work or study visa but who does not work in health or social care, they would only be able to claim a reimbursement for themselves and any further dependants (such as children). 

Example:

An engineer is in the UK working in the energy sector on a General Work Visa (Tier 2) and has brought a partner as a dependant, who works as a care home manager. They have brought one dependant child.

In this instance, the dependant and their child would qualify for a reimbursement, but the engineer would not.

3. Reimbursement process

Until 30 September 2021

The NHSBSA works with the UKVI, which is part of the Home Office, to process reimbursement applications.

Applications are made via the GOV.UK website. The applications are then processed by the NHSBSA, which will ensure the claims fall within the rules outlined in this guidance before passing the approved claims to UKVI to process the reimbursement.

Where help is needed, applicants should call the NHSBSA helpline on 0300 330 7693. Call +44 191 283 8937 if you’re outside the UK. 

This helpline is available Monday to Friday 8am to 6pm.

Card details will not be stored and NHSBSA does not have access to payment information. Reimbursement payments are made through the Immigration Health Surcharge Portal, operated by UKVI, which processes any reimbursements through WorldPay.

A reimbursement will be paid to the original payment method that made the payment. If the original payment method is no longer valid, the applicant will need to contact NHSBSA in the first instance.

From 1 October 2021

The NHS Business Services Authority (NHSBSA) will process reimbursement applications and request payments via the Immigration Health Surcharge Portal, which processes payments through WorldPay. Card details will not be requested or stored by NHSBSA.

Apply for your immigration health surcharge reimbursement

The applications are then processed by the NHSBSA which will ensure the claims fall within the rules outlined in this guidance, before passing the approved claims to UKVI to process the reimbursement.

Where help is needed, applicants should call the NHSBSA helpline on 0300 330 7693. Call +44 191 283 8937 if you’re outside the UK.This helpline is available Monday to Friday, 8am to 6pm.

A reimbursement will be paid to the original payment method that made the payment. If the original payment method is no longer valid, the applicant will need to contact NHSBSA in the first instance.

Required evidence: hours worked and claims for dependants (if applicable)

Applicants should ensure they have all relevant documentation to hand before beginning their application, including:

• the applicant’s IHS number, and that of any dependants who are also being claimed for
• payslips covering the 6-month period of the reimbursement claim. The applicant should ensure that this includes the:
  • name of the employer
  • applicant’s job role
  • number of hours worked throughout the period
• details of any dependants that the applicant is also claiming for and relevant evidence (where applicable) such as:
  • payslips (where applicable)
  • supporting letter from the employer outlining the sector of work and applicant’s role

This is not an exhaustive list, and other evidence may be requested to demonstrate eligibility of the applicant, their partners or dependants.

By submitting this information onto the portal the applicant is declaring it to be complete and accurate to the best of their knowledge.

Applicants are reminded that:

• if they submit false or misleading information, they may not receive their payment and could be liable to criminal prosecution and/or civil proceedings
• information given may be shared with other departments for the purposes of fraud prevention, detection and investigations
• information applicants give may be shared as part of the Cabinet Office National Fraud Initiative (NFI) exercise to prevent and detect fraud
• NHSBSA provides data to the NHS Counter Fraud Authority when referrals of alleged fraud, bribery and corruption are received

Personal data

Information in relation to how we will use your data, who it may be shared with and how long it will be retained for can be found in the NHSBSA privacy notice.

Timing

Applicants should receive a decision via email and payment to the bank account associated with paying the immigration health surcharge within 6 weeks from submission to NHSBSA of all evidence information required. Please be aware that in some instances NHSBSA will need to contact the applicant for more information or to conduct a more thorough check. In these cases, it may take longer to process. Where further evidence is requested or required, the 6-week period will be paused until receipt of the required evidence.

The applicant may make another claim for reimbursement when they have worked a further 6 months in an eligible role.

Complaints

See details on how to make a complaint regarding the scheme on the ‘contact us’ page of the NHSBSA website.

Requesting a review of a decision

Applicants who are unhappy with decisions in their cases may request an internal review. If they remain unhappy with the outcome of an internal review, they can request an external review.

NHSBSA are responsible for conducting an internal review, and DHSC are responsible for conducting an external review, at the request of an applicant where there are relevant grounds for review (see below ‘grounds for internal or external review’ section). The Home Office has no role in making decisions in relation to internal or external reviews as part of the health and care reimbursement scheme.

Due to COVID-19 office restrictions, it may take longer to process any correspondence that is sent by post.

Internal review

If an applicant is unhappy with the NHSBSA’s decision on eligibility for, or amount of, a reimbursement (the reimbursement decision) they can make a request for NHSBSA to review this decision via an internal review. This will be handled by the processor team, which is independent of the team handling reimbursement decision.

To do this, they must, within 90 calendar days of the date of the reimbursement decision, contact the NHSBSA helpline on 0300 330 7693 (or +44 191 283 8937 if outside the UK).  This helpline is available Monday to Friday 8am to 6pm.

The processor team will review the decision with reference to this policy guidance, the evidence submitted, and to the facts they have found based on the information provided to them at the point of application.

NHSBSA may contact the applicant to request further evidence or explanations, which should be provided within 20 working days of the date of the request. The Processor Team reserve the right to make a decision in the absence of a response after 20 working days.

NHSBSA will attempt to communicate their internal review decision within 25 working days of receipt of all the information they have requested. An internal review decision will be communicated by email, or as otherwise agreed with the applicant.

External review

If the applicant is unhappy with the internal review decision, they can seek an external review, which will be conducted by DHSC. The external review will be completed by a Senior Civil Servant who is independent of NHS and NHSBSA sponsorship. The review will interpret eligibility in accordance with this guidance, its annexes and the evidence in making the previous decisions.

To request an external review, the applicant should, within 28 calendar days of the date of the internal review decision inform NHSBSA that they wish for DHSC to review the decision.

NHSBSA will supply the original application, the evidence provided and the grounds for the internal review decision to DHSC within 5 working days of the request for external review.

DHSC will review the decision made by NHSBSA using the same evidence. If DHSC requires more information to make its decision it will contact the applicant directly, providing detail of the information required, how to return the requested evidence and deadline for return. Where a response isn’t received by the deadline outlined, and no extension has been agreed to that deadline, then DHSC reserves the right to make a decision on the external review based on all the available evidence.

The reviewer will consider if the reimbursement decision was reasonable, based on this guidance, the grounds for review and the evidence that the applicant provided. If the applicant provided new evidence that NHSBSA was not able to consider in respect of their original application for a reimbursement, the review will determine if the original decision was reasonable, based on the evidence available at the point of application, and if the new evidence when considered in the round with this guidance and the applicant’s original evidence would make them eligible to receive a reimbursement.

DHSC will aim to review the original decision within 28 calendar days and report this back to NHSBSA, who will report it back to the applicant. If new evidence is requested that period is paused until the evidence is received, or the timeframe has been exceeded.

If the appeal is upheld, DHSC will inform NHSBSA who will process the reimbursement and inform the applicant of the outcome. If the appeal is not upheld the applicant will be notified in writing and is free to make a new application using additional evidence.

Evidence required

In making a request for internal review the applicant will be asked for the rationale (grounds, see below) behind requesting an internal review and any further evidence they wish to supply to supplement the review.

Grounds for internal or external review

The only ground for an internal or external review is where the applicant believes it was:

• incorrect to decide that they were ineligible for a payment under the scheme criteria, as set out in this guidance document
• the amount of reimbursement is incorrect
• they do not agree with decision of the internal review (where applicable)

The applicant must also note that the reviewer may need further information to reach a final decision. If this is the case, the reviewer will write to the applicant and make them aware of this. The reviewer will attempt to communicate a response to the applicant within 20 working days of receipt of all evidence requested. In the case of external review, the reviewer will also inform the NHSBSA of the external review outcome including, where deemed applicable, approving a reimbursement for the period for which an external review has been sought.

The reviewer will also write to the applicant if there is a delay in processing their review.

The outcome of the applicant’s review will be communicated to them in writing and the matter will be considered closed. The applicant will still be able to make a claim for subsequent eligible work if the applicant meets the eligibility criteria.

If the applicant remains dissatisfied with the outcome, they can refer the matter to the Parliamentary and Health Service Ombudsman.

Annex A: eligibility criteria

These criteria are designed to support the NHSBSA in determining whether an applicant is eligible. 

The applicant will be employed or engaged by:

• an NHS foundation trust in England
• an NHS trust in England
• Care Quality Commission
• Health Education England
• Health Research Authority
• Human Fertilization and Embryology Authority
• Human Tissue Authority
• Medicines and Healthcare products Regulatory Agency
• National Institute for Health and Care Excellence
• NHS Blood and Transplant, NHS Business Services Authority
• NHS Digital (the Health and Social Care Information Centre)
• NHS England (the NHS Commissioning Board)
• NHS Improvement (Monitor and the NHS Trust Development Authority)
• NHS Resolution (the NHS Litigation Authority)
• Public Health England
• a local authority
• a clinical commissioning group
• a local Health Board in Wales
• Health Education & Improvement Wales
• Public Health Wales
• The Welsh Ambulance Service
• Velindre NHS Trust
• a Health Board or Special Health Board constituted under section 2 of the National Health Service (Scotland) Act 1978
• Common Services Agency for the Scottish Health Service (established under section 10 of that Act)
• Social Care and Social Work Improvement Scotland (known as the Care Inspectorate) established under section 44 of the Public Services (reform) (Scotland) Act 2010
• Scottish Social Services Council established under section 43 of the Regulation of Care (Scotland) Act 2001
• a Health and Social Care Trust in Northern Ireland
• Northern Ireland Blood Transfusion Service
• Northern Ireland Guardian Ad Litem Agency
• Northern Ireland Medical and Dental Training Agency
• Northern Ireland Practice and Education Committee
• Northern Ireland Social care Council
• Patient and Client Council
• Regional Agency for Public Health and Social Well-Being (the Public Health Agency)
• Regional Business Services Organisation
• Regional Health and Social Care Board or Regulation and Quality Improvement Authority, or

The applicant will be employed:

• to provide or to support the provision of, regulated activities as prescribed in Schedule 1 (read with Schedule 2) to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (S.I. 2014/2936), and who is also employed or engaged by an institution or organisation registered with the Care Quality Commission
• for the purposes of an establishment or agency in Wales regulated under Part 2 of the Care Standards Act 2000
• for the purposes of a service regulated under Part 1 of the Regulation and Inspection of Social Care (Wales) Act 2016
• the applicant will be employed or engaged by a party to:
  • a general medical services contract to provide primary medical services, or an agreement for the provision of primary medical services under section 50 of the NHS (Wales) Act 2006
  • a general dental services contract to provide primary dental services, or an agreement for the provision of primary dental services under section 64 of the NHS (Wales) Act 2006, or

The applicant:

• is providing care services as defined in section 47(1) of the Public Services Reform (Scotland) Act 2010 and registered under that Act
• is employed or engaged by an organisation registered with Social Care and Social Work Improvement Scotland
• is, or who is employed or engaged in connection with the provision of services under the National Health Service (Scotland) Act 1978 by, a party (other than a Health Board) to:
  • an arrangement to provide services under section 2C of that Act
  • an agreement to provide services under section 17C of that Act
  • a contract to provide services under section 17J of that Act
  • an arrangement to provide services under section 25, 26 or 27 of that Act, or

The applicant is employed or engaged by a General Practitioner Federation or by any entity with which the Northern Ireland Regional Health and Social Care Board has a contract or an arrangement under the Health and Personal Social Services (Northern Ireland) Order 1972 to provide Family Practitioner Services, or

The applicant is employed or engaged by a body registered with, or monitored or inspected by, the Regulation and Quality Improvement Authority, and who, if that body were in England and they were employed or engaged by it, would be registered with the Care Quality Commission or General Pharmaceutical Council, or

The applicant is employed or engaged by, or registered with, one of the following organisations:

• General Chiropractic Council
• General Dental Council
• General Medical Council
• General Optical Council
• General Osteopathic Council
• General Pharmaceutical Council
• Health and Care Professions Council
• Northern Ireland Social Care Council
• Nursing and Midwifery Council
• Pharmaceutical Society of Northern Ireland
• Scottish Social Services Council (under the Regulation of Care (Scotland) Act 2001) or Social Care Wales, or

The applicant is employed by an organisation commissioned or engaged by the NHS to provide services in an NHS setting, such as facilities management.

The applicant is employed by an organisation providing adult social care services. Adult social care services means any services which an English local authority must or may provide or arrange to be provided under:

• section 117 of the Mental Health Act 1983 (Aftercare)
• part 1 of the Care Act 2014 (Care and Support)

The applicant is working in testing services for an average of at least 16 hours a week for 6 months, starting on or after 31 March 2020 and falls into any of the following categories:

• directly contracted to a Facilities Management Company for the purpose of COVID-19 testing, and is working at a recognised test site (including, RTS, LTS and MTU)
• directly contracted to a laboratory for the purpose of COVID-19 testing and spends at least 50% of their overall contracted hours for this purpose, as long as this totals an average of at least 16 hours over the course of 6 months
• administers tests on behalf of contracted testing supplier, either as a test site supervisor or operative

In addition to the above, the applicant will be undertaking a role related to the delivery of healthcare or social care.