Visas & Medicals

There are several parts of the visa process that create both a lot of questions and also a lot of confusion - and medical assessments (the way INZ assesses your health for a visa) is certainly one of them. It is confusing because there are various forms of assessment that take place and what is being considered or assessed will vary depending on the visa you are applying for. There are different assessments for temporary visas, as compared to residence and different again for partners (of NZ citizens or residents), than to anyone else. Some visas allow for medical waivers and some don’t and then there are all the thresholds to consider, in terms of cost, risk and burden to the NZ health system.

For the vast majority of applicants, who are medically fit and well, there will be no real cause for concern, however for anyone with a blip on the medical radar, the process can be very different. Applications can be delayed due to the assessment process, requests for more information and then securing follow up appointments (particularly with specialists).

So this week, in what might be a bit of a lengthy article, we are going to break this all down and demystify the medical process for New Zealand visas, explain how the different medicals are assessed, the process for a medical waiver and how to prepare for your medical, to avoid the potential lengthy delays that the medical assessment process can bring.

Temporary Vs. Residence

Something that many migrants don’t appreciate is the fact that the assessment of your medicals will differ depending largely on the type of visa you are applying for. If you are applying for a temporary visa (Work, Student and Visitor) and intend to stay for more than 12 months, you will require a medical and that medical will be assessed under one specific set of rules. If you then apply for Residence, the same medical (or a new one, if you need it) will be assessed against a very different set of criteria.

The main difference between these two thresholds is the period of time you intend to be here. The temporary visa medical assessment is looking at your potential to create a cost or burden on the NZ health system over the life of your visa - whereas for residence, we are looking at a permanent stay. So in essence the assessment for residence is more stringent than that imposed for temporary visas. This can be problematic because the same condition that passes for a work visa, may not pass for residence. It therefore pays to be very cautious in terms of any acute or chronic conditions and how they might stack up against both sets of rules.

Different Levels

Health assessments differ depending on whether you are applying for a temporary visa or for residence.

I would need an entire article to explain the technical differences that sit within these rules, but the easiest way to understand it, is that time factor. Both sets of rules are looking at the likelihood of an applicant incurring a cost, burden or risk on the health system, but both assess these risks against the potential time you want to stay here. For temporary visas, the assessment is focused more on whether that risk is near to medium term, however for residence, the assessment is considering whether that risk will appear over either five years (for acute conditions) or your lifetime (for chronic conditions). For residence, INZ also brings in a dollar value of NZD$81,000.00 over either of those two timeframes. Temporary visa rules dont have a dollar value attached, but instead consider whether there is a high probability of needing treatment (hospitalisation, residential care, high-cost medications or disability services) during the time of your visa.

For residence, INZ also has a list of specific conditions that it believes are high risk, so if you have one of these, you are already in for a bumpy ride. This doesn’t however mean you will automatically be declined, instead it means that INZ will determine you to fail the medical standard, which then means you are having to consider a medical waiver (more on this below).

For temporary visas there is no specific list, instead INZ is looking more generally at your medical situation to determine whether you might require treatment over the term of your visa - however if you are on the above list, then inevitably this will be a factor in terms of your temporary visa situation.

Importantly however, just being on the list doesn’t necessarily mean you wont qualify, and that is because medical conditions are not a black and white assessment. Individuals can have specific conditions that INZ do not like, but may still qualify depending on the severity of them. What is key is understanding that if you have a medical condition, how it will be viewed against the different visas you may need to go through, to get to the end, will also differ. So assessing this at the beginning will help you to avoid potential medical assessment issues throughout the journey.

ASH or not ASH

The medical assessment process itself can also be quite confusing, particularly because it all happens behind closed doors. Immigration officers don’t assess the medicals directly and this process is actually conducted through a separate part of INZ called the Health Assessment Team (the HAT). When a medical exam is completed, the INZ approved Panel Doctor will mark the medical and x-ray with a rating - A for all good and B for an abnormality (almost anything can create that B grade).

When the medical is submitted electronically by the Panel Doctor and if it has an A grade, it will end up being automatically declared by the HAT as acceptable or in INZ terms ASH (acceptable standard of health). If the medical is a B grade, it will end up with the HAT and be assessed by that team to determine if further investigations are required. The HAT will look at the issue and might determine that the medical can be deemed ASH, in which case the visa officer is alerted and the visa process continues.

Health Assessments

Health assessments end up with three outcomes, ASH, not ASH or ASH with conditions.

If the HAT determines that the medical needs closer inspection, the medical details are referred to a medical assessor, who is a qualified medical professional appointed by INZ to review these medicals.

The medical assessor will then decide on whether to clear the medical and confirm it as ASH or to request more information. If more information is required, the request will come back through the Panel Doctor (or directly from the visa officer). The further information is then sent back to the HAT and back to the medical assessor for further review. That review will then determine whether the applicant is considered to be ASH, not ASH or ASH with conditions (temporary only). If the medical is deemed to be ASH with conditions, this means that your medical is cleared for this visa, but further investigations will be required for any future applications.

If your medical is deemed not ASH then the next steps will vary, depending on the visa you are applying for. In the case of temporary visas, this could ultimately lead to your application being declined, largely because there is no medical waiver process for most temporary visas - there are some exceptions for partnership based applications or the old work to residence visas, however for most temporary visas, if you are medically declined, your visa is very likely to be declined. There are options to potentially argue an exception to instructions, but this can be very complex and risky.

If you have applied for residence, and your medical is deemed not to be ASH, then a very different process unfolds, one that includes a second medical assessment (second opinion) and potentially a medical waiver. Medical waivers are an entirely different layer of complexity and usually require specialist assistance from someone able to prepare the right response (and not all waivers are approved obviously).

Medical Waivers

Medical waivers are often discussed in the various migrant chat groups, and can be a fairly complex process to understand. Essentially if you have applied for residence, and your medical is deemed to be unacceptable, then you have the potential to argue for a medical waiver. There are some exceptions to this, which mean a waiver is not possible:

• If you have a specific condition, including dialysis treatment, severe haemophilia, a significant cognitive or physical impairment, current TB.

• Applying under the family category and were eligible to be included in a previous application, but were not declared, not included or were withdrawn from that application.

The medical waiver process is essentially your opportunity to argue why, despite your medical not being acceptable, you should still be granted a resident visa. However before INZ offers that, there is another process they will follow. If your medical is deemed to be not ASH, INZ will contact you to allow you to dispute that finding through further medical information.

Not ASH - Waivers

If your medical is deemed to be not-ASH, you can (potentially) request a medical waiver (for residence only).

If you are able to provide a further medical opinion that disputes the first decision, that opinion is sent to a different medical assessor for a second opinion. You dont have to do this, however and you might not be able to provide any further medical arguments.

Either way, if the end result is still an unacceptable medical, then INZ considers whether a waiver can be applied for. Assuming you dont meet the exceptions mentioned earlier, INZ will then invite you to present a waiver response.

If you are eligible to be considered for a waiver, it is really important that you seek out some professional guidance, because the waiver process is complicated and you have to present your argument against very clear criteria that INZ needs to consider. It is tempting to simply plead your case, but unless that plea addresses the factors INZ need to look at, it might fall on deaf ears.

During the course of a waiver assessment, INZ officers are looking at five key factors:

• The objective of health instructions and the objectives of the category you have applied under (e.g. skilled or family or business).

• The degree of cost, risk or burden your medical situation might impose on New Zealand.

• Whether you have any immediate family present in New Zealand.

• Whether your contribution to New Zealand will be significant.

• The length of intended stay, which is really only relevant if comparing the waiver against temporary or resident visa instructions.

In reality you are looking at the first four factors to argue your case. What is really important in preparing a response and using the factors, is that whether you can pay for your healthcare independently, is not something INZ can consider - in fact it is specifically excluded from that assessment. Even if you have insurance or money to cover the potential cost of treatment, INZ cannot take that in to account.

For some applicants, specifically those applying on the basis of being in a relationship to a New Zealand citizen or resident, a waiver is almost guaranteed and the rule book says, that unless the applicant has one of the conditions listed at the beginning of this section or could have been included in an earlier application, they will be granted a waiver.

The short answers here is that waivers are complex, not only in terms of whether you will be able to apply for one or not, but then if you can, the actual request for one and how to present it, is just as much of a minefield.

Need Some Help?

In an ideal world, every potential migrant would know, from the very start whether or not they qualify, medically, for residence and I have often advocated for a system that allows migrants to chose, which threshold they are assessed under, at the very start. If you are applying for a work visa and don’t intend to live here forever, then you can be assessed under temporary entry, however if you have a plan to secure residence in the future, then you could opt to be assessed against that higher threshold at the very start.

That process would give potential migrants at least some comfort that they are on the right track, before they end up here on one visa, but can’t progress to the next, given their medical situation might not meet both sets of criteria. Of course medical situations change over time and no one can ever be guaranteed that their medical situation will be the same when they start as opposed to when they might finish the process, but knowing upfront what hurdles might exist would be handy.

In the absence of this option, the next best thing an applicant can do, where they know they have a medical condition that might need to be reviewed is to try and establish the risks upfront and an assessment with an experienced adviser will definitely help. Whilst we are not doctors, we have seen our fair share of medical assessments and have built up an excellent body of knowledge in terms of what will work and what won’t. More importantly we can assist applicants to prepare for that medical assessment by securing the right reports and medical opinions upfront, thereby reducing the overall assessment time.

Keen to know more, then get in touch with the team today.

Until next week…