What Is a Health Waiver in Australia? (PIC 4007 Explained)

When migrating to Australia, every visa applicant must meet the health requirements as specified under their visa subclass. This is a mandatory criterion, as it allows the Department of Home Affairs to maintain fair access to the Australian healthcare system and avoid risks to public health.

However, where an applicant does not meet the health requirements due to the severity of their medical condition, a health waiver may be considered, subject to eligibility. The following is a detailed guide on health waivers and their application.

What Is a Health Waiver?

Health waivers are formal exemptions that can be exercised under two conditions:

• Whether a waiver is available for the specific visa subclass
• Whether the visa applicant meets the criteria for waiver consideration

Public Interest Criteria (PIC) 4005, 4006A, and 4007

Every applicant is assessed against the Public Interest Criteria (PIC) outlined in the Australian Migration Regulations. Simply put, the PIC determines whether it is in the public interest to approve a visa applicant and let them live in Australia. Three health-related PICs are applicable to visas, and these include:

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• PIC 4005: This is the PIC 4005 health requirement standard, applicable to certain subclasses, most commonly points-tested skilled visas, and does not grant a health waiver.
• PIC 4006A: Applicable only to the temporary visa (skilled) subclass 457 and includes a 'nominator undertaking' to sponsor potential costs, instead of granting a health waiver.
• PIC 4007: Applicable to most of the visa subclasses, and includes granting a health waiver if available.

Health Waiver: Partner Visa vs Skilled Visa

This is where the PIC 4005 vs PIC 4007 split matters most in practice. Most points-tested skilled visas, like the Skilled Independent (189), Skilled Nominated (190), and Skilled Work Regional (491), fall under PIC 4005, which has no waiver. If you or a family member doesn't meet the health requirement on one of these, there's generally no waiver path. Partner visas (820/801, 309/100), by contrast, fall under PIC 4007, so a waiver may be available. If you're weighing a skilled pathway against a partner visa pathway and health is a concern, this difference can be decisive.

What Happens If a Visa Applicant Fails the Health Requirement?

When a visa applicant meets the health requirements of their visa, no waivers are needed. However, when they do not meet health clearance, they cannot be granted a visa unless the health waiver process is available and exercised.

The process starts with the Medical Officer of the Commonwealth (MOC) assessment, examining the applicant's health condition (through health examinations and medical reports). As an applicant, you must first meet your visa's other eligibility criteria. Then, if the MOC's assessment shows that you cannot get the health clearance, the Department of Home Affairs may exercise a health waiver for you.

It's also worth knowing that the health requirement is often a "one fails, all fail" test. If any member of your family unit, including a non-migrating family member not included in the application, doesn't meet the health requirement, it can affect the whole visa application, not just that person's place in it. There are limited exceptions to this, so it's worth getting advice early if you think this might apply to you.

Which Australian Visas Allow a Health Waiver?

Obtaining a health waiver depends on whether it is available for your visa in the first place. Here is a breakdown of the visas that allow health waivers under PIC 4007, for applicants or their non-migrating family members, and when they are not available.

Visas Covered Under PIC 4007

• All Refugee and Humanitarian visas
• Temporary Skill Shortage (TSS) visas (SC482)
• Foreign Affairs and Defence Sector student visa (SC500)
• Partner visas
• Certain employer-sponsored, skilled, and non-humanitarian migration visas

Visas Where Health Waivers Are Not Available

Health waivers are not available when applicants are seeking visas with PIC 4005 or 4006A. If they fail to meet the health requirement for a visa subclass where these PICs apply, they cannot get a waiver.

When Can a Health Waiver Be Exercised?

If a health waiver is available for a visa, it can only be exercised when the applicant:

• Has met all the other eligibility criteria of their visa.
• Has demonstrated that they do not have active tuberculosis or any other medical condition that can be a public health risk
• Has failed to meet the health requirement, as the MOC's assessment has determined that their disease or health issues can involve medical treatment that potentially results in:
  • Significant healthcare and community services costs, or
  • Prejudice to access to health care or community services for an Australian citizen or permanent resident
• The Department of Home Affairs must also be satisfied that granting the visa will not result in high costs or limit access to health or community services for the Australian community.

What Is the Significant Cost Threshold (SCT)?

During the MOC's assessment, they also provide an opinion to the Department of Home Affairs about the applicant's condition and whether it can result in “significant costs”. This refers to potential costs “higher than the average health and community services cost for an Australian,” including social security benefits, community care services, pensions, and allowances. Generally, applicants are assessed for significant costs for the following:

• The duration for which the s65 delegate or Minister grants the visa (for temporary visa applicants)
• A permanent stay in Australia (for provisional or permanent visa applicants)

Current Health Cost Threshold Explained

Currently, the SCT value set by the Department of Home Affairs is $86,000. Depending on your medical condition, its severity, and your required period of stay in Australia, the MOC will assess the estimated health and community expenses. If the estimated costs exceed the SCT, the applicant is generally considered not to have met the health requirement. In such cases, the health waiver process may be available, depending on the visa subclass.

What Costs Are Considered?

Under the SCT rules, the costs considered are broken down between health expenses and welfare spending. Here is what they include:

• Health Spending:
  • Hospital bills
  • Primary health care
  • Public health research and communication programs
  • Referred or unreferred medical services
  • Prescribed pharmaceuticals (therapies and drug treatments) under the Pharmaceutical Benefits Scheme
• Welfare Spending:
  • Aged care
  • Disability support services
  • Welfare payments
  • Specialised education support

What Does “Prejudice to Access” Mean?

The health requirements for Australian visas are established to ensure that the Australian community has steady access to the healthcare system and its services. When an applicant's health issues or medical conditions are too severe, they may prevent residents or citizens from accessing health services with limited supply (organ transplants and dialysis). This is formally known as “prejudice to access” and can be a reason for waiver refusal.

What Do “Undue” and “Mitigate” Mean in Health Waiver Decisions?

“Undue” and “mitigate” are key terms for health waiver cases. While they are not defined under Australian migration law, this is what they mean:

• Undue: This refers to when an applicant's health condition is complex or too severe, which is likely to result in undue costs for the Australian healthcare system. This is the core of the undue burden health services test applied at waiver stage.
• Mitigate: For health waiver cases, 'mitigate' refers to mitigating, or lessening, the potential costs of the applicant's condition. If the applicant is deemed to not meet the health requirement, the Department of Home Affairs assesses whether they have family support to help reduce the costs before deciding if a waiver should be granted.

This policy, and the significant cost threshold in particular, has drawn criticism from some legal academics and disability advocates, who argue it can disadvantage people with disabilities or chronic conditions in ways that raise non-discrimination concerns. The Department maintains the policy is about managing costs to the public health system, not about disability itself. This is an ongoing area of public debate rather than a settled question.

How Are Health Waiver Decisions Made?

The Department of Home Affairs decides on waivers on a case-by-case basis. Meaning, they consider various factors to determine if a waiver can be exercised, including:

• Whether a waiver is available
• The MOC assessment
• Whether you have met the other criteria for the visa
• Whether you or your family members can mitigate the potential costs of your condition
• Whether you have sufficient evidence demonstrating minimal costs (access to private health insurance, overseas treatment options, family members supporting the costs, etc.)
• Other compelling and compassionate circumstances

Compassionate and Compelling Circumstances

Compassionate and compelling circumstances that may support a health waiver include:

• The applicant has a severe medical condition and cannot get adequate treatment if forced to move overseas.
• There is no permanent migration option to the applicant's home country (for couples wanting to legally reside), for example, if same-sex migration is illegal in that country.
• The applicant previously held or currently holds a ‘Refugee’, ‘Protection’, or ‘Humanitarian’ visa, and without the waiver, they may face family separation for not returning safely to their home country.
• The applicant would experience significant financial difficulties if they do not get a health waiver and, hence, are forced to live in their home country.
• The applicant has significant family links to Australia, demonstrating financial obligations and care towards them.
• There is enough reason that not granting the waiver would mean Australia misses out on a significant benefit of the applicant contributing to its social, economic, and cultural development or offering valuable community service (for example, volunteer work).
• There is sufficient evidence that a waiver refusal can adversely affect Australian citizen minor children.
• The applicant or their working family members have occupational skills that are in high demand, as per the Skilled Occupation List or Medium and Long-Term Strategic Skills List (MLTSSL). This only applies to applicants for non-skilled visa applications.
• The applicant or their working family members have occupational skills listed on the Department of Jobs and Small Business Skilled Shortage List. This only applies to skilled visa applicants.
• The applicant or their family members are already living in a rural, remote, or regional area.
• The applicant may not have occupational skills as per the Department of Jobs and Small Business Skilled Shortage List or MLTSSL, but has unique skills vital for their employer, or presents evidence that the employer will be adversely affected if a waiver is not granted.
• There are other compassionate and compelling circumstances to grant the health waiver.

Whatever the ground, the strength of your health waiver compelling circumstances evidence is what carries the case. General statements aren't enough. The Department expects specific, documented evidence for each circumstance you raise.

Health Waivers and ART Reviews

If your health waiver application is refused, you can still apply for an Administrative Review Tribunal (ART) review to make your case. This is the main health waiver refusal review option available.

The ART will approve health waivers based on whether the applicant meets the (PIC) 4007 requirements, which look at whether their medical condition is unlikely to cause extra costs or problems with access. Additional health assessments may be required as part of the review process.

Common Mistakes That Lead to Health Waiver Refusals

Australian visa applications are already complex, and when a health waiver is required, applicants must complete additional steps as stipulated by the Department of Home Affairs. Even the smallest mistakes or inaccurate evidence can result in a waiver being refused. Here are some common mistakes that lead to a refusal:

• Not taking the required health assessments
• Not providing sufficient evidence, especially for compassionate and compelling circumstances
• Not disclosing health conditions truthfully
• Not submitting the health waiver application accurately
• Not acting promptly upon the Department of Home Affairs's notification to start your health waiver process
• Submitting the waiver application without checking if you have met all the other criteria for your specific visa subclass

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How Migration Agents Can Help With Health Waivers

If you or your non-migrating family member has a severe medical condition, you may need a health waiver to proceed with your visa application. And as you may already understand, navigating a health waiver submission can be quite challenging. From undertaking health tests to presenting sufficient evidence for compassionate circumstances, you must navigate every step accurately to be eligible for the waiver.

Australian Migration Agents can assist with health waiver applications by providing guidance on document preparation, liaising with the Department of Home Affairs, and assisting with reviews where required. Our migration agents aim to support you through each stage of the process with clear, practical advice.

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FAQ

What Is a Health Waiver Under PIC 4007?

Under PIC 4007, a health waiver is a formal exemption that can be exercised if it is available for an applicant's visa subclass, allowing them to remain eligible for the visa after failing to meet its health requirements.

Which Australian Visas Allow a Health Waiver?

Visas where PIC 4007 is applicable allow health waivers. These generally include all ‘Refugee’ and ‘Humanitarian visas’, SC482 visas, SC500 student visas, partner visas, and certain skilled, business, and non-humanitarian migration visas.

What Is the Current Significant Cost Threshold for Health Waivers?

The current SCT for health waivers is $86,000.

Can a Visa Be Granted If a Family Member Fails the Health Requirement?

Yes. If a non-migrating family member fails to get the health clearance, the visa can still be granted if a waiver is available and can be exercised.

Does Failing a Health Check Always Lead to Visa Refusal?

This depends on your visa subclass. If you are applying for a visa under PIC 4005, failing the health check will lead to a refusal. However, if your visa does have a waiver consideration, you can still get the visa upon meeting its eligibility requirements and getting the waiver granted.