The role of health assessments in New Zealand visa applications.
Just this week, INZ updated it’s health assessment criteria, in two rather important places - Hepatitis B and C is now no longer automatically considered a high-cost condition that could lead an applicant to failing the health assessment and a small but very useful change was made to the assessment of mental health conditions as well.
I will expand on these a bit later on, but these changes prompted me to revisit how health impacts on the visa process, because it is an area that many potential migrants are concerned about and is something we are asked to explain very often. How INZ assesses your health is pretty complicated and I have written about it before, but with these changes, it is also useful to consider how our medical assessment process often lags behind advances in medical treatment.
Understanding how health is assessed against different visas is also really important, because you might pass through the medical criteria for a temporary visa, but then fall short at the residence stage. What happens if your medical raises issues and what avenues you have to argue those issues, are all things that some migrants might need to contend with at various stages throughout the process
So, this weeks article hopes to clarify some of those things, in terms of how health is assessed, the different criteria for different visas, and what options exist when the results aren’t quite as positive as you would have liked.
Different Assessment Thresholds
The first point to understand is that there is no single health test that applies neatly across every visa category. All applicants must generally demonstrate an acceptable standard of health, but what that means depends on the type of visa being applied for and, particularly for temporary visas, how long the person intends to remain in New Zealand.
For a temporary visa (work, study or sometimes even to visit), INZ is largely concerned with what is likely to happen during the period of your proposed stay. It will consider whether you might be a risk to public health, whether you are likely to create significant costs or demands on publicly funded health services during that period, and whether your health might prevent you from undertaking the work or study on which the visa is based. There are also separate considerations for younger applicants who may require significant educational support (still bundled in to the overall health assessment process).
Not All Medicals Are Equal
How your medical is assessed is determined by the type of application you are making - with different assessments for temporary versus residence.
That time-limited assessment can make the temporary visa threshold appear more forgiving, because INZ isn’t looking over your lifetime but just over the period that the visa will be granted. Someone with a stable condition might present very little risk over the next two or three years, particularly if they are working, receiving appropriate treatment and are unlikely to require hospital care in the near term.
However, residence is assessed differently because INZ is no longer considering a defined stay. It is assessing the potential long-term impact of allowing someone to settle permanently, based on either an acute or chronic condition. For residence applications, INZ considers whether a medical condition is likely to impose significant costs or demands on New Zealand’s health or special education services. The current significant-cost threshold is NZD $81,000 over five years, or over the likely course of the condition where that period is shorter.
That figure is important, but it is not the entire test. A condition can create an issue because of demand on limited services, the need for substantial disability support, access to high-cost medication or eligibility for significant educational assistance. Immigration health assessments are not simply an accounting exercise, although cost does form a key part of the assessment process.
This is why someone may successfully obtain a work visa and then encounter a very different result when applying for residence - and we have seen the media stories on this before. The temporary visa was assessed against the likely impact during a limited period. The residence application asks what the condition may mean over a much longer time horizon.
A temporary visa approval is therefore not a promise that residence will follow and it is why it is really important that applicants with a medical condition understand how INZ will look at that against differing criteria. Nor does the fact that INZ has previously reviewed and accepted a medical certificate mean the same conclusion must be reached later on. Different visa, different test and occasionally a significant disappointment.
The recently published changes involving hepatitis B, hepatitis C and mental health conditions demonstrate why these assessments must continue to evolve.
For residence applications submitted on or after 3 August 2026, hepatitis B and hepatitis C are no longer automatically treated as high-cost conditions. INZ will instead assess the applicant’s individual medical circumstances. The wording relating to major psychiatric illness and addiction has also been narrowed so that it applies where significant support is required and doesn’t automatically kick in to gear, if you have ever been hospitalised. These two changes are actually really important because a lot of people were being caught out by the wording of these criteria, despite being completely fit and health in all other respects.
These changes recognise that diagnosis alone does not always tell us very much about future cost or demand. Treatments improve, medication becomes cheaper and conditions that once created substantial pressure on the health system can become manageable.
Medicine moves quickly, where immigration instructions follow behind rather more slowly.
Medical Waivers
Failing the acceptable standard of health assessment does not always mean the visa application is dead and buried. In some cases, INZ can consider granting a medical waiver. A waiver allows an application to be approved despite the applicant not meeting the normal health requirements and requires an applicant to put forward a compelling argument as to why that concession should be granted.
However, a medical waiver is not something an applicant files as a separate application. INZ considers it as part of the visa assessment, usually after concluding that the applicant does not have an acceptable standard of health and confirming that the other visa requirements have been met.
Not Acceptable?
If your medical fails, there are options to apply for and be granted a medical waiver, however these are not available under every visa category.
A waiver is not an opportunity to rerun the medical assessment because the applicant dislikes the result. The health assessment asks whether the applicant meets the required standard. The waiver assessment accepts that they do not and asks whether their wider circumstances are strong enough to justify granting the visa anyway.
When considering a waiver, INZ may look at the seriousness and likely progression of the condition, the level of cost or demand involved, the applicant’s family connections in New Zealand, their potential contribution to the country and the length of time they intend to remain here. The medical assessor provides advice about the condition and prognosis, but the final waiver decision is made by an immigration officer.
Medical waivers are also far more widely available for residence applications than they are for temporary visas. Most residence applicants who meet the remaining visa criteria can potentially be considered for a waiver, although there are important exceptions. A waiver cannot generally overcome conditions involving dialysis, or likely dialysis within five years, severe haemophilia, the need for full-time care, or untreated tuberculosis. There are also specific restrictions involving multidrug-resistant tuberculosis and some family applications where an applicant was not declared or was withdrawn from an earlier residence application.
Partners and dependent children of New Zealand citizens or residents are in a stronger position. Where they otherwise meet the requirements of the relevant residence category, a waiver will usually be granted unless one of the mandatory restrictions applies. That reflects the importance given to maintaining close family relationships, although even family connections cannot override every health concern.
Temporary visa waivers are considerably narrower. They are generally limited to particular groups, including some partners and dependent children of New Zealand citizens or residents, certain refugee or protection applicants, seconded businesspeople and some dependent children with serious developmental or cognitive conditions. An ordinary work, student or visitor visa applicant cannot assume that a waiver will be available simply because their circumstances are sympathetic. Where a waiver is available, the quality of the evidence to support your health assessment becomes really important.
A specialist letter saying that someone is “currently well” may be reassuring to the patient, but it does not necessarily answer INZ’s questions. The more useful evidence will explain the diagnosis, prognosis, treatment plan, medication, likelihood of hospitalisation, expected future support and probable use of publicly funded services.
The waiver submission then needs to connect that medical evidence to the applicant’s wider circumstances. Family relationships, employment, skills, contribution to New Zealand and the practical consequences of decline may all be relevant.
A successful waiver case is therefore not simply a large bundle of medical records delivered with high-hopes, instead it requires a clear explanation of why, despite the identified health issue, granting the visa is justified.
Your Situation - Plan Ahead
Health concerns do not always prevent someone from moving to New Zealand. They can, however, affect which visa pathway is realistic, what medical evidence will be required and whether a temporary route is likely to lead to residence later.
That is why health should be considered at the beginning of the process, not after a job has been accepted, or a house has been sold. Identifying these issues early on, help to identify whether the overall move is possible, or whether there are risks involved, that need to (hopefully) be overcome with good solid medical information and evidence.
If you or a family member has an existing medical condition, previous surgery, ongoing treatment, a mental health history, a disability or a condition that may require future support, obtain clear and practical advice before committing to the move.
Our team routinely assess how a clients condition may be treated under the relevant immigration instructions, identify potential problems between the temporary and residence stages and helping to prepare the medical and waiver evidence where required. We have done these before, so we understand what it is that INZ wants to see, in order to consider whether a waiver is justified.
The earlier the issue is understood, the more options there are. Discovering it when INZ raises a concern is still manageable in some cases, but it is rarely the preferred opening move.
Until next week.
