Most visa applicants will require a visa medical at some point in their Australian migration journey. Only those who will ever hold temporary visas and are from a low-risk country can avoid it.

This is because public interest criteria (PIC) 4005 and 4007 require that if a visa applicant is in a class specified, then unless a Medical Officer of the Commonwealth, who is a medical practitioner appointed by the Commonwealth, decides otherwise, must undertake any medical assessment specified in a legal instrument and must be assessed.

PICs 4005 or 4007 are commonly known as the health requirement. They are listed as a criterion for visa grants for almost all Australian visas. Resident return visas (subclass 155 – Five Year Resident Return visa and subclass 157 – Three Month Resident Return visa), subclass 988 – Maritime Crew visa, subclass 995 – Diplomatic Temporary visa, subclass 444 – Special Category visa, and the subclass 403 – Temporary Work International Relations visa in the Privileges and Immunities stream applicants only do not have a health requirement.

For permanent and provisional visa applications, the health requirement can even apply to non-migrating members of the family unit, meaning even if a partner or a dependent child is not a visa applicant, they must still undertake a visa medical.

There are three primary reasons for the health requirement. They are to minimise threats to public health, including from tuberculosis and emerging communicable diseases, to control public expenditure on healthcare and community services, and to safeguard access to medical services that are in short supply.

The second and third reasons are particularly critical because where a visa applicant has a health concern, their visa may be refused for incurring a significant cost to the Australian community in the areas of health care and community services, or for prejudicing the access of an Australian citizen or permanent resident to health care or community services. This is regardless of whether the visa applicant will use such services.

What occurs is that any condition or disease is assessed as to whether that condition or disease would be likely to result in health care and community service costs if a visa were to be granted. For temporary visas, the costs are assessed for their proposed stay in Australia. For permanent and provisional visas, the costs are assessed for a maximum of 10 years only if there is a reasonable chance the disease is permanent or it is reasonably predictable that it would extend beyond five years. Otherwise, costs are assessed for five years if the applicant is less than 75 years old, or three years if at least 75 years old.

If those costs are above a certain threshold, currently $51,000, then they will not meet the health requirement. The major difference between PIC 4005 and 4007 is that PIC 4007 has access to a health waiver. Therefore, those who fail PIC 4005 cannot be granted a visa. As visa medicals are one-fail-all-fail criteria, with combined visa applications, all applicants are refused a visa if one person fails the visa medical including the non-migrating member of the family unit.

Interestingly, those with active tuberculosis can be approved a visa provided they undergo treatment. Those with latent tuberculosis can also be approved a visa, however, if it is a permanent visa, they must provide an undertaking for further monitoring as it may return.

The way to determine whether a visa medical is required is to use the health matrix. This lists countries where citizens may be exempt from undertaking certain tests. It also lists special situations where tests are required, such as being at least 75 years old, pregnant and intending to give birth in Australia, or intending to work or train in a medical or childcare setting.

In this matrix, all permanent and provisional visa applicants must undertake visa medicals, without exception.

The amending instrument will effectively do two things:

1. Provides a term and list of countries that are known as a high hepatitis B risk jurisdiction. These are all countries that are not listed in Schedule 5, which are low hepatitis B risk countries and jurisdictions. Those born in a high hepatitis B risk jurisdiction must undertake a hepatitis B test if they are over 15 years old and are applying for a permanent or provisional visa.

2. Add a list of provisional visas, for which applicants must undertake visa medicals. Provisional visas are not defined in the Migration Act 1958 (Cth) or Migration Regulations 1994 (Cth) but are temporary visas that are part of a two-stage application process where applicants have a pathway to a permanent visa.

It has, however, always been policy that any provisional visa applicants must undergo permanent visa medicals. This is because the health assessment is generally not revisited when the permanent visa application is assessed.