Health requirement · PIC 4005 / 4007
Health Waiver for Australian Visas — PIC 4005 vs 4007 and How Waivers Are Decided
A medical condition or disability does not automatically bar a visa, but the health requirement is strict, and whether it can be waived depends entirely on which visa you applied for. This page explains the two health criteria, the cost test the Medical Officer applies, the “one fails, all fail” rule, and what a successful waiver submission contains.
By Keshab Chapagain, registered migration agent (MARN 1576536) since 2015 · WIDEN, Sydney · Reviewed October 2026
Keshab Chapagain · MARN 1576536 · Registered since 2015 - PIC 4005
- No waiver available
- PIC 4007
- Waiver available on compelling grounds
- One fails, all fail
- Applies to the family unit
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A health waiver is decided on the submission. Get it planned before the Medical Officer’s opinion arrives.
In the extended consultation I identify which health criterion your visa carries, what the likely assessment is, whether a waiver is available and on what grounds, and the evidence (medical, financial, family, employment) that has to be assembled. If the opinion has already issued, I read it and set the response.
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Check which criterion your visa carries before anything else. If it is PIC 4005 there is no waiver, whatever the circumstances, and the strategy is a different visa, not a submission. If it is PIC 4007, a waiver exists and the case is winnable with the right evidence.
How the health requirement works
Most applicants undergo a medical examination with a panel physician. The results go to a Medical Officer of the Commonwealth, who gives an opinion on whether the applicant has a condition that is a threat to public health, would be likely to result in significant cost to the Australian community in health care or community services, or would prejudice access of Australians to such services. The delegate deciding the visa is bound by the Medical Officer’s opinion on the medical facts. What the delegate can do, for some visas, is decide not to refuse despite the opinion: the waiver.
PIC 4005 vs PIC 4007
The visa regulations attach one of two health criteria to each visa. Public Interest Criterion 4005 has no waiver: if the Medical Officer’s opinion is adverse, the visa must be refused. It applies to the points-tested skilled visas (189, 190, 491), visitor visas, most student visas and several others. Public Interest Criterion 4007 contains a waiver: the Minister may decide not to apply the cost and services limbs if satisfied that granting the visa would be unlikely to result in undue cost or undue prejudice to access. It applies to most partner and child visas, the employer-sponsored 482, 186 and 494, protection and some others.
This single difference decides strategy. A family refused under PIC 4005 on a skilled visa may have an employer-sponsored or partner route under PIC 4007 where the same condition can be waived.
The significant cost test
The Medical Officer estimates the cost of the condition to Australian health and community services over the period of stay (for temporary visas) or over a capped period for permanent visas, against the significant cost threshold the Department publishes (currently AUD86,000). The estimate uses standard costings for the condition, not the applicant’s own insurance or means, and assumes services will be used whether or not the applicant intends to. Conditions commonly caught include intellectual disability, autism spectrum conditions requiring support, chronic kidney disease, HIV, some cancers and significant cardiac conditions. The opinion is about cost, not about the person.
One fails, all fail
Every member of the family unit included in the application must meet the health requirement, and for most visas, members of the family unit who are not included must meet it too. If one child does not meet it and no waiver is available, the whole family is refused. Where a waiver is available it is considered for the family as a whole, and the contribution the family will make is part of what is weighed.
What a waiver submission contains
- Mitigation of cost: specialist evidence of the actual prognosis and likely service use, private health insurance, employer-funded care, family capacity to provide care, and whether the estimate assumes services that would not in fact be accessed.
- Compelling and compassionate circumstances: Australian citizen or permanent resident family members, children settled in Australia, hardship if refused.
- Economic contribution: the applicant’s and family’s employment, skills in demand, tax contribution, regional location.
- Community ties and support networks: evidence that care is in place and will not fall on public services.
- Submissions organised against the waiver test and the Department’s policy guidance, with the medical evidence indexed.
Timing and strategy
The waiver stage usually begins with a letter from the Department giving the Medical Officer’s opinion and inviting a response within a set period. The evidence takes time to assemble: specialist reports, insurance quotes, employer letters, statements. Families who know a condition is likely to be caught should prepare before lodging and, where possible, choose the visa with the waiver. If a visa with no waiver has already been refused on health grounds, the realistic path is a different visa, and the Tribunal cannot substitute its own medical view for the Medical Officer’s.
General information only, current at October 2026; not advice on your own case. 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.
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Which Australian visas allow a health waiver?
Those that carry Public Interest Criterion 4007: most partner and child visas, the employer-sponsored 482, 186 and 494, protection visas and some others. Visas carrying PIC 4005, including the points-tested 189, 190 and 491, visitor visas and most student visas, have no waiver.
What is the significant cost threshold?
The Department’s figure above which a condition is assessed as likely to result in significant cost to the community, currently AUD86,000, estimated over the period of stay for temporary visas and a capped period for permanent visas, using standard costings rather than the applicant’s own insurance or means.
My child has autism. Will our visa be refused?
It depends on the assessed support needs and cost, and on which criterion the visa carries. Under PIC 4007 a waiver is regularly obtained where the family shows mitigation, contribution and compelling circumstances. Under PIC 4005 there is no waiver and the strategy is a different visa.
Does private health insurance avoid the cost finding?
No. The Medical Officer’s estimate is made on standard public costings regardless of insurance. Insurance is relevant to the waiver, as mitigation, not to the opinion.
Can the Tribunal overturn a health refusal?
The Tribunal is bound by the Medical Officer’s opinion on the medical facts. It can review whether the opinion was properly obtained and, for PIC 4007 visas, whether the waiver should have been exercised. It cannot waive PIC 4005.
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