Does anyone know how this works when you are employed in the UK and national insurance contributions are coming directly out of your paycheck? This seems like double taxation, but before I started chasing home office for an explanation, I wanted to check if anyone knows if there's good reason for those on a visa to have to pay regardless of their working situation?
Unfortunately, you have to pay both the IHS surcharge AND your tax/NI contributions.
It's a deliberate decision made by UKVI to generate more money. They don't care that you are already contributing to your healthcare... they are making visa holders pay even more than everyone else.
Personally, I don't think it's fair on those who are already paying into the system, but unfortunately, there's nothing you can do about it. You have to pay your taxes, and you also have to pay the IHS surcharge... your visa will be refused if you don't pay it.
This article from the UKVI website talks about the reason for the IHS surcharge, though it doesn't really mention the fact that visa holders who work will also be paying towards healthcare anyway:
https://www.gov.uk/government/news/migrant-health-surcharge-to-raise-200-million-a-year