Medical waivers and the acceptable standard of health for NZ visas

What the acceptable standard of health is

The requirement comes from immigration instructions made under the Immigration Act 2009 — chapter A4 of INZ's operational manual, with A4.10 governing residence and A4.15 temporary entry. For residence, an applicant has an acceptable standard of health if they are unlikely to be a danger to public health, unlikely to impose significant costs or demands on health services or special education services, and able to undertake the work the visa is based on. If any person included in the application fails the standard, the application must be declined unless a waiver is granted — the instruction leaves no discretion in between.

Three points surprise people. The special education limb is real: a child with a relatively high probability of qualifying for Ongoing Resourcing Scheme funding fails the standard on demands alone. "Significant demands" also covers scarce services regardless of cost — needing health services for which New Zealand demand is already unmet. And the instruction expressly excludes the mitigations people assume will help: ability to pay for treatment, private healthcare, medical insurance, and the capacity of family or charity to provide care are all irrelevant to the assessment. The health instructions do not apply to permanent resident visa or second resident visa applications.

The $81,000 threshold — and how it is actually counted

Significant cost means a relatively high probability that the applicant's condition or group of conditions will require health services costing more than NZ$81,000 — a figure in force since 4 September 2022, when it doubled from $41,000. The counting window is the detail that gets misstated everywhere: for acute conditions the $81,000 is measured over five years from assessment, but for chronic or recurring conditions it is measured over the predicted course of the condition — the whole course, not five years. A manageable chronic condition with modest annual costs can therefore fail the threshold over a long predicted course, which is exactly how conditions people consider minor end up in waiver territory. Costs are assessed at current prices, with no inflation adjustment.

The high-cost conditions list — and what changed in August 2026

Instruction A4.10.1 deems anyone with a listed condition not to meet the standard, and the list is expressly non-exhaustive. It includes malignancies (with limited skin-cancer exceptions), organ transplant need or post-transplant immunosuppression, severe chronic renal or hepatic disorders, severe or progressive neurological disorders, cardiac and respiratory disease with a high probability of intervention within five years, significant hereditary disorders, severe autoimmune disease needing the stronger immunosuppressants, severe bilateral hearing loss or vision impairment where significant support is required, severe developmental disorders or cognitive impairments where significant support is required, major psychiatric illness that has required hospitalisation, and drug-resistant tuberculosis without New Zealand specialist clearance.

Two removals matter. HIV came off the list in late 2021 — HIV-positive applicants are now assessed individually against the cost threshold, not automatically failed. And for resident visa applications made on or after 3 August 2026, hepatitis B and C are off the list too: INZ announced the change on 5 August 2026, noting modern treatment costs sit well below the $81,000 threshold. The operational manual page can lag certified changes — at the time of writing it still showed the older list — so for a listed condition, check the INZ news centre as well as the manual before assuming the worst.

Medical waivers for residence — who can be considered, who cannot

A residence applicant who fails the health standard but meets every other requirement of their category may be considered for a medical waiver — except where the instructions shut the door entirely. No waiver can be considered for a person who requires dialysis (or is assessed as likely to within five years), has severe haemophilia, needs full-time care including care in the community, has untreated tuberculosis, or has a history of multi-drug-resistant tuberculosis without New Zealand specialist clearance. Family Category applicants who could have been included in an earlier residence application as a partner or dependent child, but were not declared, are also excluded.

At the other end, some groups must be granted a waiver unless one of those absolute exclusions applies — recognised refugees and protected persons, and partners and dependent children of New Zealand citizens and residents applying under the Partnership or Dependent Child categories among them. Everyone else gets the discretionary assessment: an officer with the required delegation weighs whether your circumstances are compelling enough, considering the objectives of the health instructions and your visa category, the degree of cost or demand you would impose, whether you have immediate family lawfully and permanently in New Zealand, whether your potential contribution will be significant, and how long you intend to stay — with the medical assessor's advice on prognosis in front of them and full reasons recorded. Before declining on health grounds at all, INZ must seek your comment on the medical assessment — in practice a PPI letter, and the waiver submission you send back is where these factors get argued.

Temporary visas — screening thresholds and a much narrower door

Temporary entry runs on the same standard assessed against the intended stay — hospitalisation, residential care or high-cost treatment during the visa period — with no dollar threshold. Screening scales with time: medical certificates are generally required for stays over 12 months, and a chest X-ray for stays over six months where the applicant has spent time in countries off INZ's low-TB-risk list.

The waiver door, though, is nearly closed for temporary applicants. Only five classes can be considered at all: seconded business personnel whose employer guarantees all medical costs, refugee and protection claimants, recognised refugees and protected persons, partners and dependent children of New Zealand citizens or residents staying to be with them, and under-21 dependants of work or student visa holders caught only by the severe developmental disorder limb. Parent Boost visitor visa applicants cannot be granted a medical waiver at all — and a temporary waiver, where granted, implies nothing about meeting the standard for residence later.

Certificates, forms and the 36-month rule

Residence applications need a General Medical Certificate (INZ 1007) and a Chest X-ray Certificate (INZ 1096) for every person included; partners and dependent children of New Zealanders under the Partnership and Dependent Child categories, and several refugee and special categories, use the Limited Medical Certificate (INZ 1201) instead. Certificates are normally submitted electronically through an eMedical-linked physician or as paper forms, and must be less than three months old at lodgement — unless a certificate less than 36 months old was already assessed as meeting the standard in an earlier application, in which case it can generally be reused. Pregnant women and children under 11 are exempt from the X-ray. If a medical assessor's opinion is heading the wrong way, that is the moment to take advice — the waiver argument is built from the same evidence the assessment runs on.