PIC 4005 and PIC 4007 set the same substantive health requirement for Australian visa applicants, but PIC 4005 offers no waiver if you fail it, while PIC 4007 allows the Department to consider a discretionary health waiver. Both criteria use the same Significant Cost Threshold, currently AUD $86,000 (as at July 2024), to assess whether an applicant’s projected health and community service costs are too high.
PIC 4005 vs PIC 4007
Feature | PIC 4005 | PIC 4007 |
Waiver available? | No | Yes (discretionary) |
Typical visas | Skilled independent (189/190), 186 Direct Entry | Partner, Child, NIV (858), 482, 186 TRT |
Significant Cost Threshold | AUD $86,000 | AUD $86,000 |
Outcome if cost threshold exceeded | Refusal (no waiver path) | Health waiver may be considered |
3 Steps to Understanding Which Criterion Applies
- Check Schedule 2 for Your Visa Subclass: Each visa subclass specifies which health criterion applies.
- Understand the Stakes Before You Apply: If PIC 4005 applies and a known health condition is likely to exceed the threshold, there is no waiver safety net.
- Plan Early If PIC 4007 Applies: Strong financial and medical evidence prepared ahead of a “does not meet” assessment puts you in the best position for a waiver.
Overview
Every applicant for an Australian visa must meet a health requirement. What many people do not realise is that there are two distinct legal frameworks under which that assessment is made – Public Interest Criterion 4005 and Public Interest Criterion 4007 – and the difference between them is the difference between an absolute bar and a potential pathway.
What Both Criteria Have in Common
Both PIC 4005 and PIC 4007 set the same substantive health requirement. A visa applicant must be free from:
Tuberculosis (TB) – active TB is an absolute bar under both criteria.
Any disease or condition that poses a threat to public health or would prejudice the safety of the Australian community.
Any condition that would be likely to result in significant health care or community service costs, assessed against the Significant Cost Threshold (SCT).
Any condition that would prejudice access by Australian citizens or permanent residents to health care or community services that are in short supply.
The Significant Cost Threshold is currently set at AUD 86,000 (as at July 2024). This is the estimated benchmark against which a Medical Officer of the Commonwealth (MOC) assesses whether an applicant’s likely costs are “significant.” For permanent visa applicants, the assessment period is 10 years; for temporary visa applicants, it aligns with the intended period of stay.
The Critical Difference: Waiver Availability
This is where the two criteria diverge fundamentally.
PIC 4005 – No Waiver Available
PIC 4005 applies to most visa subclasses, including many permanent skilled and employer-sponsored categories such as the Subclass 189 (Skilled Independent), Subclass 190 (Skilled Nominated) and Subclass 186 (Employer Nomination Scheme) Direct Entry stream.
If a Medical Officer of the Commonwealth assesses that an applicant subject to PIC 4005 does not meet the health requirement, the visa must be refused. There is no mechanism for a waiver. There is no discretion. The application cannot proceed.
PIC 4007 – Waiver Available
PIC 4007 applies to a specific list of visa subclasses, including Partner Visas (820/801 and 309/100), Child Visas, certain Protection Visas, Humanitarian Visas, and some temporary skilled visas such as the Subclass 482 (Temporary Skill Shortage).
Under PIC 4007, if an applicant fails the health requirement, a health waiver may still be exercised by the delegate – provided the costs or impact on services would not be “undue” in the applicant’s specific circumstances. This gives the decision-maker discretion, and it means a failed health assessment is not necessarily the end of the road.
How the Medical Assessment Works
All visa applicants must complete their immigration health examination through the Health Assessment Portal (HAP) using panel-approved doctors. The Medical Officer of the Commonwealth reviews the results and issues either a health clearance or a “does not meet” assessment.
For applicants who do not meet the health requirement, the MOC provides an assessment of the likely costs or impacts. This information feeds into the waiver consideration process where PIC 4007 applies.
Practical Implications by Visa Type
Understanding which criterion applies to your visa can fundamentally change how you approach an application if you or a family member have a health condition:
Skilled independent or nominated visa (189/190) – PIC 4005 applies. A significant health condition may result in refusal with no recourse other than an Administrative Review Tribunal (ART) review and, if unsuccessful, Ministerial Intervention.
Partner visa (820/801, 309/100) – PIC 4007 applies. A failed health assessment opens the door to a waiver application.
Employer Nomination Scheme via Direct Entry (Subclass 186 DE) – PIC 4005 applies. Via Temporary Residence Transition (186 TRT) – PIC 4007 applies. This has led to a common strategy of applying for a 482 first and transitioning via 186 TRT to access waiver provisions.
National Innovation Visa (Subclass 858) – PIC 4007 applies.
Temporary Skill Shortage (Subclass 482) – PIC 4007 applies.
The distinction matters enormously in practice. Applicants or families who know of a health condition should seek professional advice before lodging to understand the applicable framework and the realistic outlook.
What Counts Towards the AUD 86,000 Threshold?
The Department uses the Significant Cost Threshold (SCT) to decide whether an applicant’s projected health and community service costs are too high. This is currently set at AUD $86,000 (increased from $51,000 on 1 July 2024), and the figure has stood as the largest single increase since the threshold was introduced in 1995.
The Medical Officer of the Commonwealth (MOC) builds this projection by comparing the applicant against a hypothetical Australian of the same age, sex, and health condition – then estimates what that person’s likely healthcare costs would be over the relevant assessment period. The costs counted in include public hospital treatment, specialist care, pharmaceuticals, disability support, and certain community services.
Holding private health insurance doesn’t change this assessment – the MOC still runs the same projection regardless of what cover you have. Where private health insurance does matter is at the waiver stage: if the threshold is exceeded, well-documented evidence of your ability to fund treatment privately can meaningfully strengthen a waiver application under PIC 4007.
Frequently Asked Questions
How do I find out which health criterion applies to my visa?
Each visa subclass has specified criteria listed in Schedule 2 of the Migration Regulations. A registered migration agent or immigration lawyer can confirm which criterion applies and what that means for your specific circumstances.
My spouse has been assessed as "does not meet" health. Does that affect my own application??
If your spouse is included in your application as a secondary applicant, their health assessment directly affects your application. The health requirement applies to all applicants included, including non-migrating family members in some circumstances. This is one of the most important reasons to seek professional advice before lodging where any health condition is known.
Can I appeal a health-based visa refusal?
In most cases, there is a right to seek merits review at the ART. However, the scope of review under PIC 4005 is limited. Under PIC 4007, the ART can assess whether a waiver should have been exercised.
Does holding private health insurance help my application?
It does not change the MOC assessment, but for PIC 4007 cases, strong evidence of private health coverage and the financial ability to manage medical costs privately is a significant factor in a health waiver submission.
What medical conditions are most likely to trigger the threshold?
Conditions with high ongoing treatment costs tend to attract the most scrutiny. These include diabetes requiring insulin, hepatitis B, HIV, cancers requiring ongoing treatment, and certain disability-related conditions requiring specialist or community support services. Each case is assessed individually.
My child has autism. Can we still migrate to Australia?
This depends on which visa you are applying for and the projected costs of support services. Under PIC 4007 visas (such as partner or certain employer-sponsored visas), a waiver submission with strong private support evidence has succeeded in many cases. Under PIC 4005 visas, the options are more limited.