Diabetes, hypertension, obesity, hepatitis, HIV and the health requirement: how an adult’s condition is costed, and when it needs a waiver

MARN 1576536

How the costing works

The health requirement's cost limb asks whether the applicant has a disease or condition that would be likely to result in significant cost to the Australian community in health care or community services. The Medical Officer of the Commonwealth takes the condition as the panel examination and the specialist reports describe it, identifies the health care and community services a hypothetical person with that condition at that severity would be expected to use, costs them at standard public rates over the assessment period, and compares the total with the significant cost threshold, which is AUD86,000 at the date of this page and is revised by the Department. The applicant's own circumstances, their insurance, their wealth, their stated intention to pay privately, the fact that a temporary visa holder has no Medicare, are not part of the estimate. It is a standardised costing of a condition, which is why two applicants with the same diagnosis and the same severity get the same answer. The health waiver guide sets out the criterion and the waiver.

The period: temporary against permanent

The period over which the cost is estimated is the length of the proposed stay for a temporary visa, so two or four years for a 482, the course length for a student, the stay for a visitor; and for a permanent visa it is capped at ten years, or set at the applicant's life expectancy or at the expected duration of the condition where that is shorter. The threshold is the same. A condition costing six thousand dollars a year is twelve thousand over a two-year 482, far under; sixty thousand over ten years, under; a condition costing nine thousand a year is ninety thousand over ten years, over. The same applicant passes the 482 and, with no change in health, fails the 186 four years later, because the arithmetic changed. Applicants on a temporary route who know they have a condition estimate the permanent arithmetic before they start, and the consultation does it with the figures. The 186 pathway guide covers the visa where the period changes.

Diabetes

Type 2 diabetes controlled by diet or by oral medication, with no complications, is costed on the medication, the monitoring and the routine reviews, and comes in under the threshold for temporary and usually for permanent visas. Type 2 diabetes on insulin is costed higher, and the costing rises steeply with complications: diabetic kidney disease, retinopathy requiring treatment, neuropathy, cardiovascular disease, each of which adds specialist care and, in the case of kidney disease, the prospect of dialysis within the period. Type 1 diabetes is costed on lifelong insulin and monitoring and often comes close to the threshold for a permanent visa, with complications taking it over. The panel doctor's blood tests, the HbA1c in particular, and the urine test for protein are what the Medical Officer reads first, and an applicant whose control has improved sends the current results and the specialist's report rather than letting the file rest on an old picture.

Hypertension, heart disease and weight

Treated hypertension without organ damage is costed on medication and monitoring and passes. Hypertension with heart, kidney or eye damage is costed on the damage. Established heart disease, a previous heart attack, stents, heart failure, is costed on the ongoing care and the likely interventions in the period, and can exceed the threshold for a permanent visa depending on severity. Obesity is not a disease the requirement costs on its own, but a body mass index above the panel doctor's threshold prompts the tests for the conditions it accompanies, and those are costed where found; an applicant with a high body mass index and normal glucose, blood pressure and lipids passes. Sleep apnoea treated with a device is costed on the device and the review and usually passes.

Hepatitis and HIV

Every permanent applicant and many temporary applicants are tested for HIV and hepatitis B and C. Chronic hepatitis B that is inactive is a health undertaking for monitoring and not a cost problem; active hepatitis B requiring antiviral treatment is costed on the treatment over the period and can approach the threshold for a permanent visa. Hepatitis C is now cured with a short course of direct-acting antivirals, and is costed on that course, which is under the threshold. HIV on antiretroviral treatment is costed on the medication and the specialist care, and for a permanent visa the cost over the period usually exceeds the threshold, so a permanent application by a person living with HIV is a waiver application on the visas that have one and is refused on the visas that do not; for a temporary visa of two or four years the cost is often under. None of the three is a public health threat for the requirement's first limb, and none affects a visitor visa of a few months. The health undertaking guide covers the monitoring undertaking.

Kidney disease, cancer and the conditions that usually exceed

Chronic kidney disease at a stage where dialysis is likely within the period exceeds the threshold for any visa longer than a short visit, because dialysis is costed at tens of thousands a year; a transplant recipient on immunosuppression is costed on the medication and the monitoring and usually exceeds it for a permanent visa. Cancer is costed on the prognosis: a cancer in remission with a good prognosis and a surveillance plan is costed on the surveillance and often passes; a cancer under active treatment is costed on the treatment and the likely course and usually exceeds; a cancer with a poor prognosis may be assessed on life expectancy. Multiple sclerosis, rheumatoid arthritis on biologic therapy, severe chronic lung disease, and any condition that needs ongoing high-cost medication or specialist care in hospital are the other conditions that regularly exceed the threshold for a permanent visa, and each is examined on its specialist report.

Mental health

Depression, anxiety and similar conditions treated with medication and periodic review are costed on those and pass for most visas. Conditions involving psychiatric hospital admissions, intensive community support, or a prognosis of ongoing high-level care, including some presentations of schizophrenia and bipolar disorder, are costed on the services and can exceed the threshold for a permanent visa. The panel doctor asks about mental health history and the applicant answers honestly; a treated condition disclosed and reported on by the treating doctor is read for what it is, and an undisclosed history that appears in the medical records the Department later obtains is a different problem. There is no public health limb for mental health; it is cost only.

The tests and the specialist report

The panel examination includes the history, the examination, urine and blood tests whose scope depends on the visa and the applicant's age, and the chest x-ray; where a condition is found or declared, the Medical Officer requests further information, usually a report from the treating specialist on the diagnosis, the current status, the treatment, the complications and the prognosis, and sometimes further tests. The specialist report is the document the costing is built on, and an applicant commissions it with that in mind: current, specific, stating the control achieved and the absence of complications where that is so, and describing the actual treatment rather than the textbook course. A report that says a condition is stable, controlled on a named medication, with normal organ function and no complications, is costed on that; a report that says only the diagnosis is costed on the standard course for the diagnosis, which is usually worse. The medical examination guide covers the examination.

The undertaking and the waiver

A condition that needs monitoring rather than costly treatment, inactive hepatitis B, past tuberculosis, some others, is met by a health undertaking to attend follow-up in Australia, and the visa is granted. A condition costed over the threshold fails the requirement, and what follows depends on the visa: on the visas subject to PIC 4007, the employer-sponsored 482, 186 and 494, the partner visas, the child visas and most student visas, the Department may waive the cost limb if the cost would not be undue in the applicant's circumstances, weighing the applicant's contribution, their family, their capacity to meet the costs privately, and the consequences of refusal; on the visas subject to PIC 4005, the points-tested 189, 190 and 491, the parent visas and the visitor visas, there is no waiver and the application is refused. An applicant with a condition near the threshold chooses the visa with the waiver where one is open to them, and the waiver submission is prepared before the Department's letter rather than inside the 28 days after it. The child disability guide sets out the waiver evidence in detail; the same evidence serves an adult.

Disclosing the condition

The application and the panel examination ask about the applicant's health history, and the answers are declarations. A condition disclosed is costed on its merits, with the specialist report shaping the picture, and most disclosed conditions pass. A condition not disclosed is found anyway, through the blood tests, the examination, or the medical records the Department can obtain, and is then costed on the worst reading of the evidence and treated as false information under PIC 4020, which refuses the application and bars others for three years whatever the condition would have cost. An applicant who stops medication before the examination to improve the results has produced a test result that does not match the history, and the Medical Officer reads both. The condition is disclosed, the control is evidenced, and the arithmetic is done in advance; that is the whole of the strategy, and it is enough for most people.

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General information only, current at October 2026; not advice on your own case. Public Interest Criteria 4005 and 4007 in Schedule 4 to the Migration Regulations 1994 and the Department’s published significant cost threshold and health examination arrangements, as at the date above; the threshold, the assessment periods and the costing methodology are the Department’s and are revised, and the examples of conditions above are general orientation and not a prediction for any applicant, whose assessment turns on the Medical Officer’s reading of their own reports. Medical questions are for the treating doctor. Outcomes depend on the Department’s assessment of each application; no registered migration agent can guarantee a result (Code of Conduct, Migration Agents Regulations). Keshab Chapagain, MARN 1576536.