The health assessment process

Last reviewed: April 2021

Introduction
Visa applicants who are required to complete health examinations can generally do so electronically or via paper
application. The Department of Home Affairs (the Department) Health Assessment Portal (HAP) is used to
determine whether health examinations are required.

Where health examinations are completed manually (via paper), the applicant’s health results will be referred to the
Department for manual processing. Manual processing takes longer than electronic processing, which involves the
applicant’s health results being automatically submitted to the Department and either “auto-cleared”, or referred to a
Departmental officer for manual processing. If an issue is identified, the results will be referred to Medical Officers of
the Commonwealth (MOC).

Practice Tip: If the Department case officer has requested additional health checks to be completed by the
applicant, it will likely mean that the initial results were referred to Medical Officer of the Commonwealth (MOC)
for processing. However, it does not mean that the applicant failed to satisfy the health requirement. It is often the
case that the first x-ray examination will have yielded inaccurate results.

The Health Assessment Portal (HAP)

The Health Assessment Portal (HAP) was developed with several different “views” for both the Department
internal and external users. This was done to improve the Department's risk management of health examinations
through better management of client records and data collection, as well as improved monitoring and reporting
arrangements.

The HAP tabs are separated into the management, administration, examination, assessment and undertakings tab,
which outlines the applicant's health-check process from start to finish.

eMedical — My Health Declarations

The Department eMedical system (rolled out from July 2013) is an online system used to process visa
applicant's health examination results electronically. It is based on the Department My Health Declarations ,
developed to allow clients to determine whether health checks are needed before they have lodged the visa
application. After inputting passport details, the applicants are prompted to answer a series of questions regarding
their health. The system then generates a response as to which (if any) health examinations are required for the
visa application they intend to lodge, and it will also generate a health identifier (HAP ID) to facilitate them
undertaking eMedical health examinations prior to lodging a visa application.

Practice Tip: Applicants must first establish an ImmiAccount before they can access the My Health Declarations
service.

Health examinations outside Australia

If an applicant is applying for a visa from outside of Australia, they must arrange their health examinations with a
panel physician at an approved panel clinic. A panel physician is a doctor or a radiologist who has been appointed
and given approval by the Australian government to perform medical examinations for applicants applying from
overseas for an Australian visa.

Traditionally, only examinations via paper forms were available, whereby the sealed results were physically posted
to Global Health in Australia for manual processing. Panel physicians in many countries are now able to process
health examinations online using the Department eMedical system. This is a much more efficient process which
means that health results can be processed online within minutes, instead of weeks.
 The health assessment process

For a list of countries and applicable panel doctors, see the Department of Home Affairs website.

Health examinations in Australia

Applicants in Australia will need to arrange their health examinations with BUPA Medical Visa Services (prior to
July 2014, the approved migration medical services provider was Medibank Health Solutions (MHS). Details of
their services (including costs, locations, and access to and use of interpreters during medical appointments) can
be found on the BUPA Medical Visa Services website.

When attending MHS, an applicant needs to bring:

• the completed forms;

• passport and ID documents;
• any previously completed health check results; and
• payment for the examination.

Practice Tip: X-ray reports and medical examinations are generally only valid for 12 months (6 months where a
health undertaking has been provided) and must remain valid at the time the visa is ready to be granted. This
means that applicants should estimate the processing time of the visa to ensure that medicals are not completed
too early. In some cases, Department case officers may have discretion to extend the validity period of medical
results for up to 3 months.

The role of Medical Officers of the Commonwealth (MOC)

Referral to MOC

Applicants are generally required to satisfy health assessments according to the “health matrix” (see Legislative
Instrument IMMI 15/144 ). The health assessments are completed by panel physicians (outside Australia) and by
BUPA Medical Visa Services (in Australia). If no health concerns or risks are raised and the applicant is from a
local clearance eligible country, then the health examination report can be cleared by the Department case officer.
This process is called “local clearance”.

When a case officer is unable to clear a health examination report locally, reg 2.25A of the Migration Regulations
1994 (Cth) (the Regulations) requires case officers to seek the opinion of an MOC. MOCs are medical practitioners
appointed by the Minister for Immigration, Citizenship, Migrant Services and Multicultural Affairs (the Minister)
under reg 1.16AA of the Regulations. Department case officers must accept the opinion of an MOC as being
“correct” and cannot dispute or review the MOC’s opinion.
References: reg 1.16AA, Migration Regulations 1994 (Cth)
reg 2.25A, Migration Regulations 1994 (Cth)

Practice Tip: If there is information available that an applicant may not satisfy the health requirement, then the case
must be referred to an MOC. Examples of information that may warrant referral to an MOC include (among others):

• previous refusals on health grounds;

• where the panel physician/MHS indicates a serious health condition;
• previous health undertaking not satisfied; and
• applications in relation to refugee, humanitarian or adoption visa etc.

Departmental policy outlines the conditions that should be referred to an MOC for further opinion. Matters which
cannot be locally cleared will generally experience longer processing times. See Procedures Advice Manual and
Immigration Legislation > PAM3: Regulations — Schedule 4 > Schedule 4 > [P Sch4.4005-4007] Sch 4/4005–4007
 The health assessment process

— The Health Requirement.

The MOC assessment

MOCs provide expert opinion in respect of an applicant’s ability to meet the health requirements set out in Sch 4, cll
4005 and 4007 of the Regulations in relation to:
References: Sch 4, cl 4005, Migration Regulations 1994 (Cth)
Sch 4, cl 4007, Migration Regulations 1994 (Cth)

• public health and safety;

• likely cost of health care and community services; and
• likely prejudice to access of Australians to health care and community services.

Tuberculosis (TB) and threats to public health

To satisfy the above Sch 4 requirements, MOCs must be satisfied that applicants are free from TB.
References: Sch 4, Migration Regulations 1994 (Cth)

Significant Costs

Where an applicant is found to have a health condition or disease, one of the roles of the MOC is to determine
whether the grant of visa is likely result in a “significant” cost to Australia’s health care and community services.
Community services include:

• provision of an Australian social security benefit;

• allowance or pension;
• supported accommodation;
• special education; and
• home and community care.

Policy sets a threshold for the level of costs considered to amount to a “significant cost” and this is currently set at
AU$49,000. This “significant cost” figure changes over time and incorporates data on the health and welfare
services cost per capita. See Procedures Advice Manual and Immigration Legislation > PAM3: Regulations —
Schedule 4 > Schedule 4 > [P Sch4.4005-4007] Sch 4/4005–4007 — The Health Requirement.

For temporary visa applicants, the estimated cost of their proposed stay in Australia is assessed over the period of
time that the visa processing officer intends to grant the applicant’s visa.

Practice Tip: As the estimated cost is assessed over the intended visa duration, a maximum term visa may not be
ideal for certain applicants where a health condition has been disclosed. Consideration should be given to reducing
the period of stay.

For permanent or provisional visa applicants, the estimated cost is capped at a maximum 10-year period, assessed
as follows:

Visa applicant characteristics Cost assessment period

Applicants aged 75 years and over 3 years

Applicants with reasonably predictable (beyond a 5-year A maximum of 10 years

period) permanent condition

Applicants with reasonably predictable (>65% likelihood) A maximum of 10 years if expectancy is greater than 5 years
 The health assessment process

reduced life expectancy

All other permanent and provisional visa applicants 5 years

Prejudice to access

Another role of the MOC is to assess whether an applicant’s condition or disease would likely prejudice the access
of Australians to health care and community services due to a shortage in supply, should the visa be granted.

Services can be considered to be in short supply where they are in high demand, where the choice of persons for
treatment may be exercised, and where the consequences of failure to obtain treatment may seriously
disadvantage an individual by causing premature death, unnecessary pain or suffering, or loss of quality of life. The
following services (among others) are considered to be in short supply:

• organ transplants (including bone marrow transplants);

• blood/plasma products, including coagulations factors and immunoglobulin (incudes intravenous
immunoglobulin products);
• fresh blood or blood components for people with rare blood groups; and
• radiotherapy for malignancy.

Practice Tip: Current policy provides that if the MOC has identified the applicant is likely to require organ
transplantation, consideration should be given by the assessing officer as to whether the organ could be provided
through live donation (eg kidney, liver and bone marrow), preferably by a family member such that it would be
unlikely that the applicant would be placed on a transplant list or if the donation would need to be from a deceased
donor (eg heart and lungs).

Actual use of services is irrelevant

When assessing whether an applicant’s condition will result in significant costs or prejudice to access, MOCs
cannot take into account whether the applicant will actually use the identified health care or community service.
MOCs are to make assessments based on a hypothetical person with a disease or condition of the same form and
level as the applicant’s.

Review Medical Officers of the Commonwealth (RMOC)

If an applicant is advised by the Department that the visa application has been refused on health grounds, they can
choose to review the decision via an application for review by the Migration and Refugee Division of the
Administrative Appeals Tribunal (AAT). Once deemed eligible for review, the AAT will notify the review applicant
that there will be an additional fee for a Review Medical Officers of the Commonwealth (RMOC) to review the
medical assessment.

The fee for RMOC is prescribed in reg 5.41(2) of the Regulations. The review applicant will be also liable for the
expenses of any additional testing or repeat examinations. These costs are non-refundable.
References: reg 5.41(2), Migration Regulations 1994 (Cth)

Further Reading - you will need a LexisNexis© subscription

Australian Immigration Law > Public Interest Criteria & Special Return Criteria > Public Interest Criteria & Special
Return Criteria > [28,055] Adverse MOC opinion.

End of Document