Immigration Health Surcharge for Dependants: What It Really Costs an African Family of Four
Numbers in the abstract rarely land the way a concrete example does. So here's a detailed, worked-through example of exactly what the Immigration Health Surcharge costs a real African family of four moving to the UK together — and a few places where genuine savings are available if your circumstances allow.
Meet our example family
Let's say a Nigerian father is sponsored on a 3-year Skilled Worker visa by a UK engineering firm. He's bringing his wife and their two children, aged 10 and 14, as dependants on the same visa. All four family members apply together, for the same 3-year visa length.
Calculating the total, person by person
On the standard Skilled Worker route (not Health and Care Worker, which would be exempt), all four family members — including the children — generally pay IHS at the standard rate for this route, since the discounted rate is specifically tied to the Student visa category, not to age alone on a work-based route. At £1,035 per year for 3 years, that's £3,105 per person. For all four family members: £3,105 × 4 = £12,420 in IHS alone, paid as a single upfront sum as part of the family's combined visa applications.
Adding the application fees
On top of the IHS, each family member also pays their own application fee — £819 each (for a 3-year visa, applying from outside the UK) × 4 = £3,276. Combined with the IHS total, this family's application fees and IHS together come to £15,696 before a single flight is booked or a biometric appointment attended.
Where the real savings opportunity lies
If this same family's sponsoring employer were a healthcare or social care provider offering a Health and Care Worker visa instead of a general Skilled Worker visa, the entire family would be exempt from the IHS altogether — saving the full £12,420. This is exactly why it's worth understanding which specific visa sub-category applies to your job offer, not just the broad category ("Skilled Worker" can include or exclude Health and Care Worker depending on the specific occupation and employer type) — a difference of over £12,000 for a family this size is not a detail worth glossing over.
Planning the payment
Because this entire sum is due upfront, at the point of application, for all family members together, it's worth having the full amount available and confirmed well before you start the application process — a family application can be delayed or complicated if the payment fails partway through, or if the family realises mid-application that they haven't budgeted the full amount for every member.
Comparing our example family to a smaller household
It's worth seeing how dramatically family size changes the total. A single applicant on the same 3-year Skilled Worker visa pays £3,105 in IHS alone. A couple with no children pays £6,210. Add the two children from our example family, and the total climbs to £12,420 — meaning each additional family member adds a full extra £3,105 to the bill, with no reduction for additional dependants. Families considering whether to bring all children at once, or whether older children might have other options (staying with extended family in Nigeria to finish a specific school term, for instance), sometimes weigh this cost directly against the practical and emotional considerations of keeping the family together immediately versus in stages.
A note on children's healthcare specifically
While the IHS cost for children on a work-sponsored family visa is substantial, it's worth remembering what it actually buys: full NHS access for your children exactly as a permanent resident's children would receive, including GP registration, health visitor services, and hospital care if needed, without the additional charging that can apply to non-IHS-covered overseas visitors. For families moving with young children, this access is genuinely valuable, even though the upfront cost of securing it is significant.
If your family's route qualifies for exemption
It's worth restating clearly, given how much this changes the picture: if your sponsoring visa is a Health and Care Worker visa rather than a general Skilled Worker visa, your entire family — main applicant and all dependants — is exempt from the IHS. For our example family of four, that's the full £12,420 saved, a difference significant enough that it's worth double-checking with your employer or a regulated adviser exactly which specific visa sub-category your job offer falls under, rather than assuming "healthcare-adjacent work" automatically qualifies. Not every role in a care setting necessarily falls under the exempt category, so verify your specific position rather than assuming either way.
Reviewing your family's total picture together
IHS is just one part of your family's total visa cost — application fees for all four family members, any professional advice fees, translation costs, and travel to a visa application centre all sit alongside it. Rather than looking at the IHS figure in isolation, it's worth pulling together every cost line for your specific family size and route into one complete picture before you commit to an application date, so there are no surprises partway through the process.
Talking to your children about the move
While this is fundamentally a financial planning article, it's worth acknowledging the human side of a family relocation this significant. Bringing children into a new country is a major life change for them too, and the financial planning discussed here — while necessary — is only one part of preparing a family for a successful move. Many families find it helpful to involve older children in age-appropriate parts of the planning process, including understanding why the move is happening and what to expect, which can make the practical logistics (like a lengthy visa application process) feel less abstract and stressful for everyone involved.
Reviewing your figures one final time before applying
Given how much money is involved for a family this size, it's worth doing a final, careful review of your calculated IHS and application fee totals against the current official gov.uk figures immediately before you submit — not weeks or months earlier when you first started planning. Fee changes, an error in a family member's date of birth affecting a discount, or a change in visa route between initial planning and final application are all things that could shift your total, and catching any discrepancy before you pay is far easier, faster, and less stressful than trying to resolve it afterward once the application is already submitted.
Work out your own family's figure
Every family's number will differ based on visa route, length, and family size. Use our IHS Calculator to get your family's specific total, and our Dependants Visa Cost & Eligibility Calculator to check the full picture including application fees for everyone joining you.
Frequently asked questions
Do all four family members need to apply at exactly the same time?
Not necessarily, though applying together is common and can simplify the process — dependants can sometimes join later with their own separate applications, each incurring their own fees and IHS at that later point.
Is there a family cap on total IHS, similar to some insurance products?
No — there's no discount or cap for multiple family members; the cost is strictly per person, per year of visa length.
If our circumstances change and we no longer qualify for Health and Care Worker exemption, do we owe backdated IHS?
This would depend on the specific circumstances of any change — if you're unsure whether your exemption remains valid, it's worth checking with a regulated adviser rather than assuming your original exemption continues indefinitely regardless of circumstances.
Does the IHS cost differ between a spouse dependant and a child dependant on the same visa?
Not on the standard Skilled Worker route — both generally pay the exact same standard annual rate, regardless of whether they're an adult spouse or a young child, unless a specific route-based discount happens to apply in your case.