A4.10 Acceptable standard of health (applicants for residence) (15/12/2017)

1. Applicants for residence class visas must have an acceptable standard of health unless they have been granted a medical waiver or (f), below, applies. An application for a residence class visa must be declined if any person included in that application is assessed as not having an acceptable standard of health and a medical waiver is not granted (see A4.60).
2. Applicants for residence class visas are considered to have an acceptable standard of health if they are:
   1. unlikely to be a danger to public health; and
   2. unlikely to impose significant costs or demands on New Zealand's health services or special education services; and
   3. able to undertake the work on the basis of which they are applying for a visa, or which is a requirement for the grant of the visa.
3. The conditions listed in A4.10.1 are considered to impose significant costs and/or demands on New Zealand's health and/or special education services. Where an immigration officer is satisfied (as a result of advice from an Immigration New Zealand medical assessor) that an applicant has one of the listed conditions, that applicant will be assessed as not having an acceptable standard of health.
4. If an immigration officer is not satisfied that an applicant for a residence class visa has an acceptable standard of health, they must refer the matter for assessment to an Immigration New Zealand medical assessor (or the Ministry of Education as appropriate).
5. Despite (d) above, referral to an Immigration New Zealand medical assessor (or the Ministry of Education) is not required where the applicant is the partner or dependent child of a New Zealand citizen or residence class visa holder, unless the provisions of A4.60(a) or A4.60(b) apply.
6. Mandated refugees (see S3.5(a)(i)) and Refugee Quota Family Reunification Category applicants (see S4.20) are exempt from the requirement to have an acceptable standard of health, except where they have any of the conditions set out at A4.74.
7. The exemption at (f) above does not apply to those invited to apply under the Community Organisation Refugee Sponsorship category (see S4.25).

   Note: These instructions do not apply to residents and former residents applying for a permanent resident visa or a second or a subsequent resident visa.

A4.10.1 Medical conditions deemed to impose significant costs and/or demands on New Zealand's health and/or education services

• HIV infection
• Hepatitis B-surface antigen positive and meeting criteria for anti-viral treatment in New Zealand
• Hepatitis C-RNA positive and meeting criteria for anti-viral treatment in New Zealand
• Malignancies of organs, skin (such as melanoma) and haematopoietic tissue, including past history of, or currently under treatment. Exceptions are:
  • treated minor skin malignancies
  • malignancies where the interval since treatment is such that the probability of recurrence is <10 percent
• Requirement for organ transplants (with the exclusion of corneal grafts), or following organ transplant when immune suppression is required (with the exclusion of corneal grafts)
• Severe, chronic or progressive renal or hepatic disorders
• Musculoskeletal diseases or disorders such as osteoarthritis with a high probability of surgery in the next five years
• Severe, chronic or progressive neurological disorders, including but not exclusive to:
  • any dementia including Alzheimer's disease
  • poorly controlled epilepsy
  • complex seizure disorder
  • cerebrovascular disease
  • cerebral palsy
  • paraplegia, quadriplegia
  • poliomyelitis
  • Parkinson’s disease
  • motor neurone disease, Huntington’s disease, muscular dystrophy
  • prion disease
  • relapsing and/or progressive multiple sclerosis
• Cardiac diseases, including but not exclusive to:
  • severe ischaemic heart disease
  • cardiomyopathy
  • valve disease with a high probability of surgical and/or other procedural intervention in the next five years
  • aortic aneurysm with a high probability of surgical and/or other procedural intervention in the next five years
• Chronic respiratory disease, including but not exclusive to:
  • severe and/or progressive restrictive (including interstitial) lung disease
  • severe and/or progressive obstructive lung disease
  • cystic fibrosis
• Significant or disabling hereditary disorders, including but not exclusive to:
  • hereditary anaemias and coagulation disorders
  • primary immuno-deficiencies
  • Gaucher’s disease
• Severe autoimmune disease which may require treatment in New Zealand with immune-suppressant medications other than Prednisone, Methotrexate, Azathioprine or Salazopyrin
• Severe (71-90 decibels) hearing loss or profound bilateral sensori-neural hearing loss after best possible correction at country of origin, where significant support is required, including cochlear implants
• Severe vision impairment with visual acuity of 6/36 or beyond after best possible correction at country of origin, or a loss restricting the field of vision to 15-20 degrees where significant support is required
• Severe developmental disorders or severe cognitive impairments where significant support is required, including but not exclusive to:
  • physical disability
  • intellectual disability
  • autistic spectrum disorders
  • brain injury
• Major psychiatric illness and/or addiction including any psychiatric condition that has required hospitalisation and/or where significant support is required
• Those with a history, diagnostic findings or treatment for MDR-TB or XDR-TB, unless they have been cleared by a New Zealand Respiratory or Infectious Diseases specialist upon review of their file or review of the applicant according to the New Zealand Guidelines for Tuberculosis Treatment

  Note: The list above at A4.10.1 is not an exhaustive list of conditions which may indicate that an applicant does not have an acceptable standard of health.

A4.10.2 Assessment of whether an applicant for a residence class visa is unlikely to impose significant costs on New Zealand's health services

1. The requirement that an applicant for a residence class visa must be unlikely to impose significant costs on New Zealand's health services is not met if, in the opinion of an Immigration New Zealand medical assessor, there is a relatively high probability that the applicant's medical condition or group of conditions will require health services costing in excess of NZ$41,000.

   Note: Assessment will be in terms of current costs with no inflation adjustment.

2. In the case of acute medical conditions, the medical assessor will provide an opinion on whether there is a relatively high probability that the condition or group of conditions will require health services costing in excess of NZ$41,000 within a period of five years from the date the assessment against health requirements is made.
3. In the case of chronic recurring medical conditions, the medical assessor will provide an opinion on whether, over the predicted course of the condition or group of conditions, there is a relatively high probability that the condition or group of conditions will require health services costing in excess of NZ$41,000.
4. The following factors have no bearing on whether an applicant is unlikely to impose significant costs on health services:
   1. The ability of a person or organisation to pay for health services, pharmaceuticals, or residential care which may be required.
   2. The ability of an applicant to gain access to the private health system.
   3. The applicant’s possession of health insurance.
   4. The capacity of family, friends, or a charitable organisation to provide care for an applicant.

A4.10.5 Assessment of whether an applicant for a residence class visa is unlikely to impose significant costs on New Zealand's special education services

1. The requirement that an applicant for a residence class visa must be unlikely to impose significant costs on New Zealand's special education services is not met if the Ministry of Education (MoE) has determined that there is a relatively high probability that the applicant's physical, intellectual, or sensory condition or their use of language and social communication would entitle them to Ongoing Resourcing Scheme (ORS) funding.
2. Where it has been determined that there is a relatively high probability that an applicant would be entitled to ORS funding, the following factors have no bearing on whether an applicant is unlikely to impose significant costs on New Zealand’s special education services:
   1. The ability of a person or organisation to pay for education services.
   2. The ability of a person to provide in-home education services.

A4.10.10 Assessment of whether an applicant for a residence class visa is unlikely to impose significant demands on New Zealand's health services

1. The requirement that an applicant must be unlikely to impose significant demands on New Zealand's health services is not met if, in the opinion of an Immigration New Zealand medical assessor, there is a relatively high probability that the applicant's medical condition or group of conditions will require health services for which the current demand in New Zealand is not being met.
2. Where it has been determined that there is a relatively high probability that an applicant may require health services for which the demand in New Zealand is not being met, the following factors have no bearing on whether the applicant is unlikely to impose significant demands on New Zealand’s health services:
   1. The ability of a person to gain access to the private health system.
   2. The capacity of family, friends, or a charitable organisation to provide care for an applicant.

      Note: These instructions do not apply to people applying for a further residence class visa under RV2 or RV4.

Effective 15/12/2017