The Health Requirement: PIC 4005, PIC 4007 and the $86,000 Threshold

The health requirement refuses more well-prepared applications than almost any other criterion, and it refuses them for a reason that surprises people: not whether you are sick, but what your care would cost — whether or not you would ever use it. Here is how the test actually works, what the current threshold is, and which visas allow a waiver. Verified against the Migration Regulations 1994 (compilation in force 1 July 2026) and the Department of Home Affairs, 20 August 2026.

Every visa carries one of two public interest criteria from Schedule 4. Their requirements are worded almost identically. The difference is one subclause — and it decides whether a refusal is the end of the road.

The cost limb is the one that catches families, and its wording is unforgiving: the condition is assessed "regardless of whether the health care or community services will actually be used". Private insurance, a promise not to claim Medicare, and family capacity to pay do not answer the test — the assessment is of a notional cost to the community, not your actual spending.

The Significant Cost Threshold: $86,000

The Department applies a Significant Cost Threshold (SCT) of $86,000, last updated on 1 July 2024 and reviewed every two years. The figure is derived from the average health and welfare spend an Australian would require over a five-year period, drawn from AIHW expenditure reporting.

The period your costs are assessed over — this is where most published summaries are wrong:

• Temporary visas — costs are assessed for the period of stay in Australia
• Provisional and permanent visas — generally 5 years, or 3 years if you are aged 75 or older
• Permanent or ongoing conditions with a reasonably predictable course — assessed over your remaining life expectancy, capped at 10 years

You will often see "$86,000 over 10 years" quoted as though it were the general rule. It is not. Ten years is the cap for permanent or ongoing conditions; the default is five. Getting this wrong changes the maths on whether a condition breaches the threshold at all.

Note also what does not change: there is no separate dollar threshold for temporary versus permanent visas. The same $86,000 is applied — only the costing period differs.

The Medical Officer of the Commonwealth

A Medical Officer of the Commonwealth (MOC) is a medical practitioner appointed by the Minister under regulation 1.16AA. Two regulations decide how much weight their view carries:

• Regulation 2.25A(1) — the Minister must seek the MOC's opinion on the health criteria
• Regulation 2.25A(3) — "The Minister is to take the opinion of the Medical Officer of the Commonwealth… to be correct for the purposes of deciding whether a person meets a requirement or satisfies a criterion"

That is the practical heart of the health requirement: the case officer does not second-guess the MOC on cost. Arguing that the estimate is too high is not a submission to the decision-maker — it is a matter for the material the MOC assesses. Which is why what you put in front of the MOC, through your treating specialists, is the part of a health case you can actually influence.

The waiver — PIC 4007(2)

Where the visa carries 4007, the Minister may waive the cost limb if:

• the applicant satisfies all other criteria for the visa; and
• the Minister is satisfied that granting the visa would be unlikely to result in undue cost to the Australian community, or undue prejudice to an Australian's access to health care or community services

Note the shift in language: 4005 and 4007(1) speak of significant cost; the waiver asks about undue cost. That is a different question, and it is decided by the visa decision-maker, not the MOC. The MOC prices the condition; the delegate decides whether that cost is undue in the whole circumstances — the family's contribution, the applicant's role in an Australian family, compassionate factors, offsetting benefits.

Which visas allow a waiver

PIC 4007 (waiver available) — verified from Schedule 2: subclasses 100, 101, 102, 191, 192, 200, 201, 202, 203, 204, 300, 309, 449, 461, 801, 802, 820, 826, 852, 858, 887 and 888. In broad terms: partner, child, adoption, humanitarian and refugee visas.

PIC 4005 (no waiver) — subclasses 103, 114, 115, 116, 117, 173, 190, 400, 403, 405, 407, 408, 417, 462, 476, 485, 491, 590, 600, 601, 602, 651, 771, 800 and 835–838. In broad terms: skilled, most temporary, visitor and student-adjacent visas.

The stream-level trap. Some subclasses carry different criteria in different streams, and stating "the 186 requires 4007" would be wrong:

• Subclass 186 — the Temporary Residence Transition stream requires 4007; the Direct Entry and Labour Agreement streams require 4005
• Subclass 189 — the Points Tested stream requires 4005; the Hong Kong stream requires 4007

Similar splits run through the 143, 151, 187, 188, 482, 494, 500, 804, 864 and 870 — often between primary and secondary applicants. Never assume from the subclass number alone: check the stream, and check whether you are the primary or secondary applicant.

Where health cases go wrong

1. Assuming private insurance answers the cost limb. It does not — the test runs regardless of whether services are used

2. Believing "$86,000 over 10 years" is the rule. For most applicants the costing period is five years

3. Sending thin specialist evidence. The MOC prices what is in front of them; incomplete prognosis material invites a worst-case estimate

4. Applying for a 4005 visa when a 4007 pathway exists. Where a family has a real health issue, the choice of visa can decide whether a waiver is even legally possible

5. Treating the waiver as automatic. It requires all other criteria to be met first, and then a discretionary judgement about undue cost

6. Leaving it to the end. A health issue is a strategy question before lodgement, not a problem to solve after a request arrives

Health requirement advice — Australia-wide

Migration Vision advises on health-requirement strategy for clients across Australia and overseas — reading which criterion your visa and stream actually carries, preparing the specialist evidence the MOC will price, and building 4007 waiver submissions where the pathway allows one. Related reading: complex cases hub · Ministerial Intervention.

Reviewed by Dr Asad Muhammad Khan, Registered Migration Agent, MARN 2619525. Updated 20 August 2026 — PIC 4005 and 4007, regulations 1.16AA and 2.25A and the Schedule 2 criteria verified against the Migration Regulations 1994 (compilation in force 1 July 2026) on legislation.gov.au; the $86,000 Significant Cost Threshold and the costing periods verified against the Department of Home Affairs health requirement pages on that date. This article is general information, not migration advice for your circumstances.