Health requirements

Last reviewed: April 2020

Authored by Sasko Markovski, Partner, Fragomen.

Public Interest Criterion (PIC) 4005 — General health requirement

Public Interest Criterion (PIC) 4005 (Sch 4, cl 4005 of the Migration Regulations 1994 (Cth) (the Regulations)
outlines the standard health requirement for applicants seeking to enter Australia either on a temporary or
permanent basis. The level of health assessment required by a particular applicant will depend on several factors
including:
References: Sch 4, cl 4005, Migration Regulations 1994 (Cth)

• the applicant’s proposed length of stay in Australia;

• the passport country's level of risk in terms of incidence of Tuberculosis (TB);
• the applicant’s intended activities in Australia; and
• the applicant's medical history.

The purpose of this health requirement is to protect the Australian community from public health and safety risks (in
particular, active TB), while containing public expenditure on health and community services (including social
security benefits and allowances and pensions) and to safeguard the access of Australian citizens and permanent
residents to health care and community services in short supply.

Important definitions
• “Prejudice to access” — refers to the situation where the nature of the foreign applicant's condition is likely
to limit access of Australian citizens or permanent residents to health care and community services.
Currently, health services in short supply include organ transplants and dialysis.
• “Threats to public health” — refers to the applicant being free from a disease or condition considered to be
a threat to the public health in the Australian community. These conditions include TB, HIV, hepatitis and
yellow fever.

Practice Tip: The Department of Health advises that all persons over 12 months old who have, within the 6 days
prior to their arrival in Australia, stayed overnight or longer in a declared yellow fever infected country in Africa, the
Caribbean, Central or South America, must hold an international yellow fever vaccination certificate.

“Significant costs” — refers to the scenario where a significant medical condition is identified which may result in
significant health care and community service costs if the visa is granted.

The term “community services” is defined under reg 1.03 to include the provision of an Australian social security
benefit, allowance or pension. Under policy , it is also taken to include services such as supported accommodation,
special education, home and community care.
References: reg 1.03, Migration Regulations 1994 (Cth)

Practice Tip: For temporary visas, under 4005(3), 4006A(1B) and 4007(1B), certain health care and community
services are excluded from the cost assessment) under the provisions of the current legislative instrument (see
Legislative Instrument IMMI 15/144 ).

The financial threshold for the level of costs regarded as “significant” is currently set at $49,000 under policy which
notes that the calculation of this figure incorporates data on health and welfare service costs per capita rounded to
the nearest $5000 in favour of the applicant .

For temporary visa applicants (other than applicants for two stage provisional to permanent visas under the Partner,
Business Investment and Innovation and General Skilled Migration programs), the estimated costs for their
 Health requirements

proposed stay in Australia is assessed over the period of stay that the departmental officer intends to grant the visa
for.

For permanent visa applicants (including applicants for two stage provisional to permanent visas), the costs will be
assessed as follows:

Visa type Medical Officer of the Commonwealth cost assessment period

Permanent and Provisional • applicants over 75 years of age 3 years

• applicants with reasonably predictable a maximum of 10 years

(beyond a 5-year period) permanent condition

• applicants with reasonably predictable (>65% a maximum of 10 years if greater than 5

likelihood) reduced life expectancy years

• all other permanent and provisional applicants 5 years

Here, when assessing “lifelong” costs, the Medical Officer of the Commonwealth will include estimated costs over
the applicant's remaining life expectancy where the applicant has an inevitable or reasonably predictable (more
than 65% likelihood) reduced life expectancy due to their health condition or disease. In this case, the applicant will
be assessed on the reduced life expectancy to meet the health criteria, applicants are required to do at least one of
the following:

• complete the health declaration in the visa application form;

• undertake a medical examination;
• obtain a medical certificate from their doctor;
• in certain cases, have a human immunodeficiency virus (HIV) test, hepatitis B and/or C test or other
specific test;
• have a chest x-ray (radiological) examination, if 11 years or older;
• have a medical examination and/or tuberculosis screening test instead of a chest x-ray, if under 11 years
(or a chest x-ray, if appropriate on clinical grounds); or
• have other tests as may be requested by a Medical Officer of the Commonwealth (MOC).

Practice Tip: While the PIC 4005 health requirement applies to most visa subclasses, there are differences in the
regulations and under policy as to how the applicant is required to demonstrate that they meet PIC 4005 and this
will typically depend on the applicant’s nationality (and where they have resided in the last 5 years), their proposed
activities and the proposed period of stay. These factors must be established before requesting your client to
undertake a health examination. For example, for most Visitor visas where the proposed stay is less than 12
months, a personal declaration on the application form is accepted as evidence that a person has met the health
criteria, whereas permanent visa applicants need to undertake a medical examination as a minimum, and
depending on age, a chest x-ray and HIV test.
References: Sch 4, cl 4005, Migration Regulations 1994 (Cth)

The required health assessments for the purposes of Sch 4, cll 4005 and 4007 of the Regulations are specified in
Legislative Instrument IMMI 15/144 . This is often referred to as the “health matrix” and identifies the health
assessments required based on the following factors:
References: Sch 4, cl 4005, Migration Regulations 1994 (Cth)
Sch 4, cl 4007, Migration Regulations 1994 (Cth)

• country of citizenship or country where the applicant has spent 3 or more consecutive months in the last 5
years;
• proposed period of stay: temporary stay up to and including 6 months, temporary stay of more than 6
months, permanent or provisional visa applicants;
 Health requirements

• proposed activities: likely to work or be a trainee at an Australian childcare centre (including preschool and
crèche), intending to work as (or study to be) a doctor, dentist, nurse or paramedic, hospital or other
healthcare environment or likely to enter a health care facility and from a higher risk country;
• pregnancy (where intending to have the baby in Australia); and
• age (for Visitor visas only).

Practice Tip: Any visa applicants who has spent a period of 28 days or longer on or after 5 May 2014 in any of the
following countries, or in any combination of these countries, will be required to provide a certificate of vaccination
against polio:

• Angola;
• Afghanistan;
• Cameroon;
• China;
• Democratic Republic of the Congo;
• Ethiopia;
• Indonesia;
• Mozambique;
• Myanmar;
• Nigeria;
• Pakistan;
• Papua New Guinea;
• Somalia; and
• Syria.

Practice Tip: The policy requirement for valid certificate of vaccination is based upon direction from the Global Polio
Eradication Initiative regarding countries classified under the “endemic” and “outbreak” categories. For a current list
of countries, see Where we work tab found in the Global Polio Eradication Initiative website.

Practice Tip: On 20 November 2015, a number of health systems and policy changes came into effect. These
included:

• moving all health functionality from the department’s visa processing systems to the Health Assessment
Portal (HAP);
• enhanced arrangements in re-use of health examinations and health clearances;
• a revised health matrix with only two risk levels (namely “safe countries” and “all other countries”) and
tuberculosis (TB) screening for children aged between 2 and 10 who:
◦ are applying for an offshore humanitarian or onshore protection visa;
◦ are “higher risk” and applying for a provisional or a permanent visa; or
◦ are applying for a temporary visa and declare close family contact with TB in their visa application or
My Health Declarations form;
• an updated prejudice to access list removing blood/plasma products and radiotherapy; and
• an automated referral of clients on health undertakings to state and territory health clinics.

As a result of these amendments, no examinations will be required for temporary visa applicants unless:
 Health requirements

• they are from a country where health examinations are required and their visa will provide for a stay period
of 6 months or more (in which case both an x-ray and medical examination will be required); or
• special significance applies — typically, where applicant is likely to work or be a trainee at an Australian
childcare centre (including preschool and crèche), intending to work as (or study to be) a doctor, dentist,
nurse or paramedic, hospital or other healthcare environment, or likely to enter a health care facility and
from a higher risk country.

Practice Tip: Applicants can also use the Department’s “My Health Declarations ” service (accessed via
ImmiAccount ) to determine which health examinations they will be required to undertake if they have not yet
made a visa application. The applicant must first establish an ImmiAccount before they can access the service.

Practice Tip: Following the outbreak of the Ebola Virus Disease (EVD), at the end of 2014 the Minister announced
the following new visa and border measures (Threats to public health ) for all travellers from EVD-affected
countries in Africa:

• a temporary suspension of processing of visa applications for permanent visas and some provisional visas
from EVD affected countries;
• in some circumstances, cancelling visas that have been granted to persons currently outside of Australia
when those persons have been in an EVD affected country in the last 21 days; and
• refusing some visa applications for temporary visas unless applicants are assessed as posing no risk of
EVD.

Public Interest Criterion (PIC) 4007

If the applicant does not meet the PIC 4007(1) general health requirement, a health waiver can be exercised under
PIC 4007(2) if it is determined that an applicant has a condition which will result in “significant health care and
community service costs” or “prejudice the access of Australian citizens or permanent residents to such services”.
To be eligible, the visa applicant must satisfy all other criteria for the grant of the visa, and the delegate of the
Minister must be satisfied that granting the visa would unlikely result in “undue cost” to the Australian community or
“undue prejudice” to the access to health care or community services of an Australian citizen or permanent resident.
References: Sch 4, cl 4007, Migration Regulations 1994 (Cth)

“Undue” is not defined in migration law, but falls within the discretion of the case officer to determine whether the
costs or degree of prejudice will be considered too great or excessive.

If a waiver is available, it must be considered by the assessing Department of Home Affairs (Department) officer
and in such instances, notification will be sent to the applicant to put forward additional claims and information to
support the waiver. Once the response is received, an assessment is made based on a number of factors, including
the employment history of the applicant/s, ability of supporters/sponsors to reduce the potential costs and use of the
health care and community services, and any compassionate and compelling circumstances that would support a
health waiver being exercised for the case. It is not sufficient to waive the need to meet the health requirement
simply because the applicant satisfies all other criteria for the grant of the visa.

Practice Tip: No health waiver is available if the applicant fails to meet the health requirement on TB, danger to the
community, or other public health risk grounds (see PIC 4007(1)(a) and (b)). Accordingly, it is important for
practitioners and migration agents to make enquiries as to an applicant’s medical history and/or conditions prior to
any visa application being submitted. See the definition of “threat to public health” under PIC 4005.
References: Sch 4, cl 4005, Migration Regulations 1994 (Cth)
Sch 4, cl 4007, Migration Regulations 1994 (Cth)

The below table identifies the subclasses of visas where health waivers under PIC 4007 may be applied for.

Visa category Subclass of visa where applicant may apply for health
waiver

Humanitarian visas 200, 201, 202, 203, 204 and 449.

 Health requirements

Certain Skilled visas 186 Temporary Residence Transition Stream (TRTS), 187
(TRTS), 189 (NZ stream only), 482, 494 (Employer Sponsored
Stream), 846, 855, 856, 857, 887 and 191.

Family and non-Humanitarian visas (if compassionate and 100, 101, 102, 110, 188 (provisional), 300, 309 (provisional),
compelling circumstances exist) 310 (provisional), 445 (provisional), 447, 449, 451, 461, 787,
801, 801, 802, 814, 820 (provisional), 826 (provisional), 850,
851, 852, 883 and 888

Family and non-Humanitarian visas (if dependent on 151, 137, 143, 487, 884, 804, 883, 864, 887, 891, 892, 893
applicant's circumstances) and 890.

Student visa where student Foreign or Defence sponsored 500

student

Eligible New Zealand citizen sponsors (must hold a 444 visa) 300, 309/100 and 820/801

Public Interest Criterion (PIC) 4007 waivers for Humanitarian visas

Most Humanitarian visa applicants have a strong set of compelling and compassionate circumstances, but cannot
reduce the level of undue prejudice to access (particularly to community services and extra care) given their
circumstances, vulnerability and more often than not, language barrier in facilitating effective communication on a
daily basis.

Given the nature of these visa types, the approach taken by the Department is to focus on the compelling and
compassionate circumstances of the individuals (beyond those that make the applicant eligible for a Humanitarian
visa). If the humanitarian applicant fails to meet the health requirement on prejudice to access grounds, it is
possible that the health waiver is not granted. However, in humanitarian cases, cost factors are always considered
as not undue/too excessive and are not a factor for consideration. Even in cases where both cost and prejudice
elements are present, the cost factor would automatically be discarded.

It can be very difficult to look beyond the circumstances of a Humanitarian visa applicant for even deeper
compelling and compassionate circumstances, however common traits which can assist include:

• the applicant’s strong family links to Australia;

• the family’s ability/welfare to assist in reducing the prejudice to access;
• whether the case has been referred by the United Nations High Commissioner for Refugees (UNHCR);
or
• whether denying the visa will result in a “split family” situation.

Applicants in particularly vulnerable situations, such as woman at risk and survivors of torture or trauma, are more
likely to satisfy the notion of possessing compelling or compassionate circumstances beyond that of an ordinary
Humanitarian visa applicant.

While the focus is on compelling and compassionate grounds, all individual circumstances need to be taken into
account. The applicant’s English skills, educational background, qualifications, employment history and proposed
care/support in Australia will still add weight to a decision to exercise a health waiver. The more work experience or
qualifications that an applicant has, the stronger their ability will be to mitigate prejudice to access and to obtain the
health waiver.

Public Interest Criterion (PIC) 4007 waivers for certain Skilled visas
Two notable changes were made to processing arrangements for Skilled visa health waiver cases in February
2013. First, there was an increase in the referral threshold to $500,000 (for referrals to both state/territory
governments and to the Health Policy section of the Department) and second, the centralisation of the Health Policy
 Health requirements

section. The Health Policy section of the Department is the section that deals with all cases requiring state/territory
consultation.

When making a determination on whether or not to exercise a PIC 4007(2) health waiver for a Skilled visa (subclass
186, 187, 189 (NZ stream only), 482, 855, 856 and 857 only), the process is firstly dependent on the cost. If it is
assessed that the applicant's condition is likely to cost $500,000 or more, then prejudice to assess is likely to be
present and the view of the participating state/territory can be sought. If the state/territory puts forward the view that
the health waiver should not be exercised, the Departmental officer will forward the case to the Department Director
of Health Policy for consideration. Upon receiving a recommendation from the Director of Health Policy, a decision
is then made by the Departmental officer as to whether or not to grant a health waiver.
References: Sch 4, cl 4007, Migration Regulations 1994 (Cth)

The view of the participating state/territory (if sought) plays a significant factor in determining undue cost or undue
prejudice and generally, case officers will adhere to the these views given that the relevant state holds a key
interest in whether or not to sponsor the applicant for the Skilled visa. However, other factors that will be considered
include the individual applicant's skills and qualifications, employment experience, the level of demand of the
nominated occupation (here the Department refers to the Medium and Long-Term Strategic Skills List (MLTSSL),
ability of the family to reduce potential costs/prejudice to access, any compelling and/or compassionate
circumstances (eg close family ties, difficulty of returning to home country) and arrangements for the person's care
and welfare, as well as likelihood of their future migration.

The Department’s Skilled Health Waiver Fact Sheet provides information about Skilled health waivers.

Practice Tip: If your applicant is looking to apply for a visa under the 186 Skilled visa category, it will be worthwhile
to consider the Regional 187 Skilled visa, if available as an option, since settlement in a remote/rural area will
provide added weight as a factor to be considered for a health waiver.

Practice Tip: A 4007 health waiver is also available to the Special Eligibility (Class CB) Former Resident (subclass
151) visa in circumstances where the primary applicant has applied in Australia as a “long residence applicant” or
as a “defence service applicant”, both of which are defined under cl 151.111.

Public Interest Criterion (PIC) 4007 waivers for other non-Humanitarian

visas
PIC 4007 also applies to a few other non-Humanitarian visa subclasses. Most of these subclasses are Family visas
such as Partner or Child visas, hence the health waiver reflects the fact that visa applicants are likely to have family
or close ties to Australia. The key notion underpinning the non-Humanitarian category is that refusal of exercising a
health waiver should not negatively impact on Australian citizen children (particularly those children of the
relationship if a Partner visa has been applied for, or those children who are already residing in Australia), or result
in immediate family members living apart.
References: Sch 4, cl 4007, Migration Regulations 1994 (Cth)

Practice Tip: A 4007 health waiver is also available to Parent visa subcll 143, 864, 884 and 804 in circumstances
where the applicant holds a visa obtained by Ministerial Intervention such as a substituted 600 or 676 visa.

Factors for granting a health waiver (non-Humanitarian visas)

A Departmental officer will take into account a range of factors and allocate them differing weight when considering
whether a medical condition will result in undue cost or undue prejudice to access.

The following factors are likely to add weight to a decision to grant a health waiver:

• if an Australian citizen sponsor were forced to relocate, it would negatively impact on their health;
• occupational skills in high demand (for applicants or family);
• the immigration history of the applicant (if danger will befall applicant should he/she return to their home
country);
 Health requirements

• the applicant and/or other family members have substantial assets or an ability to mitigate the
costs/prejudice to access involved (eg running a successful business/investment in Australia or due to
private care arrangements and/or support being available);
• an Australia citizen sponsor would not be able to migrate, eg because same-sex migration is not available;
• the applicant has significant family links in Australia or significant support from family or community groups;
• an Australia citizen sponsor would not be able to migrate to the applicant’s home country;
• potential contribution to Australia's interest by the applicant and their family; and
• any other compelling or compassionate factors, including the location and circumstances of the applicant
and/or sponsor’s family members.

Factors against granting a health waiver (non-Humanitarian visas)

The following factors are likely to contribute to a decision not to grant a health waiver:

• the applicant, sponsor and their immediate family can reside in a third country with no particular hardship
or danger;
• there are no family links to Australia;
• the applicant lacks substantial ties to Australia generally (eg if the applicant and sponsor have been absent
from Australia for a significant period of time/majority of their life);
• there is no reason why the applicant cannot continue to reside in their current location;
• the applicant and/or other working family members have few or no occupational skills; and
• if there have been any adverse findings or if the applicant has a history of fraud or non-compliance with
immigration requirements.

Certain second-stage Skilled and Business Skills visas also provide for a health waiver, reflecting the fact that these
applicants are likely to already have resided in Australia for a significant period on a provisional visa. See Business
Innovation and Investment (Business Skills) visas.

Practice Tip: Where the applicant applying for the waiver has a child in Australia, evidence of the child’s schooling
and the child’s general circumstances should also be provided and emphasised, together with submissions
addressing any difficulty the child will experience in adapting to life in another country, or to live without one of the
parents.

Public Interest Criterion (PIC) 4007 waivers for the Foreign Affairs or
Defence sponsored Student (TU-500) visa.
PIC 4007 applies to a Student (TU-500) visa if the applicant is a Foreign Affairs AusAID or Defence sponsored
student.

Applicants for this visa (including secondary applicants) must be considered for a waiver of the health requirement if
they fail to meet the health requirement on health cost or prejudice to access grounds. The Department of Foreign
Affairs or the Department of Defence will mitigate any health costs.
References: Sch 2, cl 500.217(5), Migration Regulations 1994 (Cth)
Sch 2, cl 500.317(5), Migration Regulations 1994 (Cth)
Sch 4, cl 4007, Migration Regulations 1994 (Cth)

The higher the level of support received from the student’s home government, an Australian university and/or family
or community groups, the more likely it will be deemed that the student can reduce costs or prejudice to access,
and the greater the likelihood of obtaining a health waiver. If the student's community or family will suffer a
significant detriment upon the refusal of a health waiver, then this will be a benefiting factor to the granting of a
health waiver.
 Health requirements

Public Interest Criterion (PIC) 4007 — eligible New Zealand citizen

sponsors
Certain New Zealand citizens seeking to sponsor another person to Australia must be classified as an “eligible New
Zealand citizen” in order to do so. “Eligible New Zealand citizen” is defined in reg 1.03 of the Regulations. See
Children and New Zealand citizens.
References: Sch 4, cl 4007, Migration Regulations 1994 (Cth)
reg 1.03, Migration Regulations 1994 (Cth)

If an applicant who has failed to meet PIC 4007(1)(c) is being assessed as an “eligible New Zealand citizen” as part
of the health waiver consideration process, the case will be referred to the Health Policy section of the Department
for a recommendation, irrespective of the level of their health condition, the related costs, or whether there would be
prejudice to access to services in short supply. Once a recommendation is received from the Director of Health
Policy, a decision is then made by the Departmental officer as to whether or not to grant a health waiver.

Further Reading - you will need a LexisNexis© subscription

Australian Immigration Law > Australian Immigration System > Australian Immigration System Commentary >
Health criteria > [20,810] Undue cost

Australian Immigration Law > Australian Immigration System > Australian Immigration System Commentary >
Health criteria > [20,820] Operation of the waiver

End of Document