Sets the acceptable standard of health for visa applicants, including medical assessments and cost thresholds.

Status: active
Updated: 2026-04-30
Also known as: medical
Sources: A4A4.1A4.5A4.10A4.15A4.20A4.25A4.30A4.40A4.45A4.55A4.60A4.65A4.70A4.74A4.75A-appendix-1-list-of-countries-using-panel-physiciansE7.50R5.96

Health Requirements

At a glance

Applicants for most visa categories must meet the health requirements set out in Section A4. [A4]
Exceptions apply: applicants entering New Zealand for specific medical treatment or consultation with a visa under V3.40, and those applying for a further residence class visa under RV2 or RV4, are not required to have an acceptable standard of health. [A4.5][A4.75]
An acceptable standard of health means the applicant is unlikely to be a danger to public health, unlikely to impose significant costs or demands on New Zealand's health or special education services, and able to undertake the work or study required. [A4.5]
Immigration New Zealand assesses whether an applicant is unlikely to impose significant costs or demands on New Zealand's health services or special education services. [A4]
A medical certificate (completed by an INZ panel physician) and a chest x‑ray are generally required, with specific triggers based on visa type and length of stay. [A4] [A4.5]
Medical waivers may be considered for some applicants who do not meet the health standard. [A4.5]
For temporary entry class visas, medical certificate requirements follow A4.25: a Medical Certificate and Chest X-ray Certificate are required for stays over 12 months, with numerous exceptions; Chest X-ray for 6–12 month stays with TB risk factors; and tailored rules for specific visa types like the Global Workforce Seasonal Visa. [A4.25]
For residence class visa applicants specifically, the acceptable standard of health is assessed under A4.10, which sets out a list of deemed high-cost conditions (A4.10.1), a NZ$81,000 cost threshold (A4.10.2), an Ongoing Resourcing Scheme (ORS) test for special education (A4.10.5), and a demand-based assessment for health services (A4.10.10). [A4.10]
For residence class visa applications, a Medical Certificate and Chest X-ray Certificate (INZ 1096) must be lodged at the time the application is made for every person included. A General Medical Certificate (INZ 1007) is required for most applicants; a Limited Medical Certificate (INZ 1201) may be provided by partners and dependent children of New Zealand citizens or residence class visa holders, recognised refugees and protected persons, Refugee Quota Family Reunification applicants, mandated refugees selected under the Refugee Quota Programme, and Ukraine Resident Visa applicants. Applicants under the Community Organisation Refugee Sponsorship category must provide a General Medical Certificate. [A4.20]
Mandated refugees and Refugee Quota Family Reunification Category applicants are exempt from the health standard unless they have conditions listed at A4.74. [A4.10]
Partners and dependent children of New Zealand citizens or residence class visa holders, and applicants for a 2021 Resident Visa or a Ukraine Resident Visa, are not automatically referred to a medical assessor unless specific waiver grounds apply. [A4.10]
For temporary entry class visa applicants, the acceptable standard of health is assessed under A4.15 using a four-part test: the applicant must be unlikely to be a danger to public health, unlikely to impose significant costs or demands on New Zealand's health services during their period of intended stay, unlikely to qualify for Ongoing Resourcing Schemes (ORS) funding (if under 21 and applying for a student visa), and able to undertake the work or study required. [A4.15]
Applicants under 21 applying for a student or visitor visa as dependents of a work, student, or military visa holder face an additional assessment for severe developmental disorders or cognitive impairments requiring significant support — including physical disability, intellectual disability, autistic spectrum disorders, and brain injury. The ability to pay for or provide support has no bearing on this assessment. [A4.15]
For temporary entry class visas, an immigration officer must not decline an application on health grounds without first referring the applicant's Medical Certificate and Chest X-ray Certificate to an INZ medical assessor or the Ministry of Education. [A4.15]

Definition

The health requirements are the criteria for determining an acceptable standard of health. The objectives of the Health instructions are to: protect public health in New Zealand; ensure that people entering New Zealand do not impose excessive costs and demands on New Zealand's health and special education services; and where applicable, ensure that applicants for entry to New Zealand are able to undertake the functions for which they have been granted entry. [A4.1]

Under A4.5, a person has an acceptable standard of health if they are:

unlikely to be a danger to public health; and
unlikely to impose significant costs or demands on New Zealand's health services or special education services; and
able to undertake the work or study on the basis of which they are applying for a visa, or which is a requirement for the grant of the visa. [A4.5]

"Health services" includes all health and disability support services funded through Vote Health. [A4.5]

The threshold for costs is based on whether an applicant's medical condition is likely to impose significant costs on New Zealand's health system or special education services, or would place a burden on services that are already overstretched. [A4] The manual sets out specific conditions that are deemed to impose significant costs, as well as a monetary threshold. [A4]

For residence class visa applicants, A4.10 applies the same three-part test and adds further specificity. Applicants for residence class visas must have an acceptable standard of health unless granted a medical waiver under A4.60 or covered by an exemption. An application must be declined if any person included in it is assessed as not having an acceptable standard of health and a medical waiver is not granted. [A4.10]

Where an immigration officer is not satisfied that a residence applicant meets the health standard, the matter must be referred to an INZ medical assessor (or the Ministry of Education, as appropriate). However, referral is not required for the partner or dependent child of a New Zealand citizen or residence class visa holder, or for 2021 Resident Visa or Ukraine Resident Visa applicants, unless the provisions of A4.60(a) or A4.60(b) apply. [A4.10]

The conditions listed in A4.10.1 are deemed to impose significant costs and/or demands on New Zealand's health and/or special education services. Where a medical assessor confirms an applicant has one of those conditions, the applicant will be assessed as not having an acceptable standard of health. The A4.10.1 list is not exhaustive — other conditions may also indicate that an applicant does not meet the standard. [A4.10]

For temporary entry class visa applicants, A4.15 adapts the health framework to the temporary nature of the stay. Under A4.15, an applicant has an acceptable standard of health if they are: [A4.15]

unlikely to be a danger to public health; and
unlikely to impose significant costs or demands on New Zealand's health services during their period of intended stay in New Zealand; and
(if under 21 years of age and applying for a student visa) unlikely to qualify for Ongoing Resourcing Schemes (ORS) funding during their period of intended stay in New Zealand; and
able to undertake the work or study on the basis of which they are applying for a visa, or which is a requirement for the grant of the visa. [A4.15]

In addition, applicants under 21 years of age who apply for a student or visitor visa as the dependent of a work, student, or military visa holder are not considered to have an acceptable standard of health if they have severe developmental disorders or severe cognitive impairments where significant support is required. This includes, but is not limited to, physical disability, intellectual disability, autistic spectrum disorders, and brain injury. [A4.15]

Applicants for temporary entry class visas who have been granted a visitor visa for the purpose of obtaining medical treatment, or who have been granted a medical waiver, are exempt from the requirement to have an acceptable standard of health under A4.15. [A4.15]

Application in decisions

Immigration officers rely on INZ medical assessors to determine whether an applicant satisfies the health requirements. The medical assessor's opinion is treated as determinative unless compelling reasons exist to overturn it. [A4]

Applicants for residence class visas and applicants for temporary entry class visas are assessed using separate sets of criteria. The assessment for temporary entry class applicants takes into account the length of intended stay in New Zealand. [A4.5]

Applicants may be required to provide further tests or specialist reports at their own expense. [A4]

For residence class visa applicants, the cost-assessment threshold is NZ$81,000. The requirement to be unlikely to impose significant costs is not met if a medical assessor determines there is a relatively high probability that the applicant's condition or group of conditions will require health services costing more than that amount. Assessment is in current costs with no inflation adjustment. [A4.10]

For acute medical conditions, the medical assessor evaluates whether there is a relatively high probability of exceeding NZ$81,000 within five years from the date of assessment. [A4.10]
For chronic recurring medical conditions, the medical assessor evaluates whether there is a relatively high probability of exceeding NZ$81,000 over the predicted course of the condition. [A4.10]

The following factors have no bearing on the cost assessment: ability of any person or organisation to pay for health services, pharmaceuticals, or residential care; ability to access the private health system; possession of health insurance; and capacity of family, friends, or charitable organisations to provide care. [A4.10]

For special education services, the requirement is assessed by the Ministry of Education (MoE). The threshold is not met if the MoE determines there is a relatively high probability that the applicant's physical, intellectual, or sensory condition (or use of language and social communication) would entitle them to Ongoing Resourcing Scheme (ORS) funding. Neither the ability to pay for education services nor the ability to provide in-home education affects this assessment. [A4.10]

For health service demands, the requirement is not met if a medical assessor determines there is a relatively high probability the applicant will require health services for which current demand in New Zealand is not being met. The ability to access private health services and the capacity of family, friends, or charitable organisations to provide care have no bearing on the demands assessment. [A4.10]

For temporary entry class visa applicants, the assessment of whether an applicant is unlikely to impose significant costs or demands on New Zealand's health services takes into account whether there is a relatively high probability that the applicant will need publicly funded health services during their period of stay, including but not limited to hospitalisation, residential care, high-cost pharmaceuticals, and high-cost disability services. Residential care is defined as long-term care provided in a live-in facility such as an aged-person's facility or a facility for people with a physical, sensory, intellectual, or psychiatric disability. [A4.15]

The following factors have no bearing on whether a temporary entry class visa applicant is unlikely to impose significant costs or demands on health services: [A4.15]

The ability of any person or organisation to pay for health services, pharmaceuticals, or residential care which may be required.
The ability of the applicant to gain access to the private health system.
The applicant's possession of health insurance.
The capacity of family, friends, or a charitable organisation to provide care for the applicant. [A4.15]

For student visa applicants under 21 where it has been determined they may qualify for ORS funding during the period of intended stay, neither the ability of a person or organisation to pay for education services nor the ability to provide in-home education services has any bearing on whether the applicant is unlikely to impose significant costs on New Zealand's special education services. [A4.15]

Where an immigration officer is not satisfied that a temporary entry class visa applicant has an acceptable standard of health, they must refer the Medical Certificate and Chest X-ray Certificate to an INZ medical assessor (or the Ministry of Education where appropriate). An immigration officer must not decline an application on the basis that an applicant does not have an acceptable standard of health without first making this referral. [A4.15]

In all cases, an immigration officer must not decline an application on the basis that an applicant does not have an acceptable standard of health, without first seeking comment from the applicant on the report provided by the INZ medical assessor or the Ministry of Education (MoE) advising that the applicant does not meet the requirements of A4.10(b) or A4.15(b). [A4.40]

Where a further medical opinion on the medical condition or disability of the applicant, or a further opinion from a suitably qualified professional concerning an applicant's disability or eligibility for Ongoing Resourcing Scheme (ORS) funding is provided and this disputes the original medical or ORS assessment, officers must refer this to the INZ medical assessor (or MoE as appropriate) before deciding whether or not to decline the application. [A4.40]

Having regard to the opinion that disputes the assessment of the INZ medical assessor or the MoE, the INZ medical assessor or MoE assessor may either amend their original assessment or confirm their original assessment. [A4.40]

For residence class visa applications, where the original assessment of an INZ medical assessor is confirmed by that medical assessor and a further medical opinion that disputes the original assessment has been provided, the original assessment and the further opinion must be referred to a different INZ medical assessor for a second opinion. The second medical assessor, acting as a medical referee, then assesses whether the applicant is unlikely to be a danger to public health, unlikely to impose significant costs or demands on New Zealand's health services or education services, and able to undertake the work required. The recommendation arising from the second medical assessor's assessment is final. [A4.45]

Interpretation & edge cases

The manual outlines situations in which a medical waiver may be considered for residence class visa applicants and temporary entry class visa applicants. [A4.5]
Applicants who are pregnant or have serious communicable diseases face additional requirements and may be subject to deferred processing. [A4]
Residence class visa applications may be deferred in two main circumstances:
- Tuberculosis (TB): For active TB (pulmonary or non-pulmonary), the decision must be deferred for up to six months from the start of anti-TB treatment. Approval requires adequate treatment according to the New Zealand Guidelines for TB Treatment and meeting all other requirements. For a history, diagnostic findings, or treatment of Multidrug-Resistant TB (MDR-TB) or Extensively Drug-Resistant TB (XDR-TB), a six‑month deferral applies, and approval is conditional on clearance by a New Zealand Respiratory or Infectious Diseases specialist based on the Guidelines and laboratory evidence of culture conversion. [A4.55]
- Other treatable conditions: A decision may be deferred for up to three months if an INZ medical assessor advises that the medical condition, if not successfully treated, would result in an assessment that the applicant is likely to be a danger to public health, impose significant costs or demands, or be unable to undertake the required work, and the condition is treatable within that three‑month period. Approval then requires a further medical report, a favourable reassessment by the medical assessor, and the applicant continuing to meet all other requirements. [A4.55]
- These deferral provisions do not apply to further residence class visa applications under RV2 or RV4. [A4.55]
Evidence of health status is required as follows: [A4.5]
- Temporary entry class visa applicants intending a stay of more than six months who have risk factors for tuberculosis must provide a Chest X-ray Certificate.
- Residence class visa applicants (other than those excepted) and temporary entry class visa applicants intending a stay of more than 12 months must provide a Medical Certificate and a Chest X-ray Certificate, unless an exception applies.
- Applicants for a permanent resident visa under the Afghan Emergency Resettlement Category must provide a Chest X-ray Certificate.
- Applicants for a Global Workforce Seasonal Visa must provide a Medical Certificate and a Chest X-ray Certificate, regardless of the intended length of stay.
Pregnant women and children under 11 years of age are not required to have an X-ray examination. [A4.5]
An immigration officer may request a Chest X-ray Certificate or a Medical Certificate regardless of the period of intended stay if they consider it necessary to establish an acceptable standard of health. [A4.5]
Generally, a Chest X-ray Certificate or Medical Certificate remains valid for any subsequent visa application made within 36 months of the certificate being completed by the radiologist or physician. [A4.5]
While the health chapter sets a standard list of conditions likely to impose significant costs, individual circumstances are assessed on their merits. [A4]
If any person included in an application fails to meet health requirements and does not qualify for a medical waiver, the application may be declined. [A4.5]
Before declining an application on health grounds, an immigration officer must first seek comment from the applicant on the medical assessor's or MoE's adverse report. If the applicant provides a further medical or ORS opinion that disputes the original assessment, the officer must refer that opinion back to the medical assessor or MoE for reconsideration before making a final decision. The medical assessor or MoE may then amend or confirm their original assessment. [A4.40]
The A4.10.1 list of conditions deemed to impose significant costs and/or demands includes (but is not limited to): [A4.10]
- Hepatitis B (surface antigen positive, meeting anti-viral treatment criteria) and Hepatitis C (RNA positive, meeting treatment criteria)
- Malignancies of organs, skin (e.g. melanoma), and haematopoietic tissue, including past history or current treatment (with limited exceptions for treated minor skin malignancies and malignancies with <10% recurrence probability)
- Organ transplants requiring immune suppression (excluding corneal grafts)
- Severe, chronic, or progressive renal, hepatic, neurological, cardiac, or respiratory disorders
- Musculoskeletal disorders with high probability of surgery within five years
- Significant or disabling hereditary disorders (e.g. hereditary anaemias, coagulation disorders, primary immuno-deficiencies, Gaucher's disease)
- Severe autoimmune disease potentially requiring immune-suppressants beyond Prednisone, Methotrexate, Azathioprine, or Salazopyrin
- Severe hearing loss (71–90 decibels) or profound bilateral sensori-neural hearing loss requiring significant support including cochlear implants
- Severe vision impairment (acuity 6/36 or beyond, or field restriction to 15–20 degrees) requiring significant support
- Severe developmental disorders or cognitive impairments requiring significant support (including physical/intellectual disability, autistic spectrum disorders, brain injury)
- Major psychiatric illness and/or addiction, including conditions requiring hospitalisation or significant support
- History, diagnostic findings, or treatment for MDR-TB or XDR-TB, unless cleared by a NZ Respiratory or Infectious Diseases specialist
Mandated refugees (under S3.5(a)(i)) and Refugee Quota Family Reunification Category applicants are exempt from the health standard unless they have conditions listed at A4.74. This exemption does not apply to Community Organisation Refugee Sponsorship category applicants. [A4.10]
Under A4.74, mandated refugees and RQFR applicants are ineligible for a residence class visa if they: [A4.74]
- require dialysis treatment, or an INZ medical assessor indicates they will require such treatment within five years from the date of the medical assessment; or
- have severe haemophilia; or
- have a physical, intellectual, cognitive and/or sensory incapacity that requires full time care, including care in the community; or
- currently have tuberculosis (TB) (any form including pulmonary and non-pulmonary TB, Multidrug-Resistant (MDR)-TB and Extensively Drug-Resistant (XDR)-TB) and have not completed full treatment for TB as outlined in the New Zealand Guidelines for TB Treatment; or
- have had 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. [A4.74]
For mandated refugees and RQFR applicants, medical certificates typically consist of a Limited Medical Certificate (INZ 1201) and a Chest X-ray Certificate (INZ 1096); however, the Chest X-ray Certificate need not be provided until requested by INZ. An immigration officer may also request a further medical certificate, chest X-ray certificate, or other medical information if considered necessary to determine eligibility under A4.74. [A4.74]
The instructions in A4.10 do not apply to residents and former residents applying for a permanent resident visa or a second or subsequent resident visa (see RV2 and RV4). [A4.10]
Unlike the residence class visa assessment under A4.10, the temporary entry health assessment under A4.15 does not use a fixed monetary threshold. Instead, it considers whether there is a relatively high probability the applicant will need publicly funded health services during their specific period of intended stay in New Zealand. [A4.15]
For temporary entry class visa applicants, the factors excluded from consideration — ability to pay for services, access to private health care, possession of health insurance, and capacity of family or others to provide care — apply uniformly across all limbs of the health assessment, including the cost/demand assessment, the ORS funding assessment, and the severe developmental or cognitive impairment assessment for under-21 dependents. [A4.15]
For residence class visa applicants, two types of Medical Certificate are prescribed under A4.20: [A4.20]
- General Medical Certificate (INZ 1007): Required for all applicants except those who qualify for the Limited Medical Certificate. This includes applicants under the Community Organisation Refugee Sponsorship category (S4.25). [A4.20]
- Limited Medical Certificate (INZ 1201): Applies to partners and dependent children of New Zealand citizens or residence class visa holders meeting Partnership or Dependent Child Category requirements (unless R5.96 applies); applicants recognised as having refugee or protection status in New Zealand and their partner and dependent children; Refugee Quota Family Reunification (RQFR) Category applicants; mandated refugees selected under the Refugee Quota Programme; and Ukraine Resident Visa applicants. [A4.20]
- Under R5.96, an applicant under a Family Category who was eligible for inclusion in an earlier residence class visa application made by their partner or parent but was not included, or was withdrawn, must provide a General Medical Certificate (INZ 1007) rather than a Limited Medical Certificate. If the applicant does not have an acceptable standard of health, they will not be granted a medical waiver (see A4.60(b)). [R5.96]
All Medical and Chest X-ray Certificates for residence class visa applications must have been issued less than three months before the date the application is made, unless the 36-month exception applies. [A4.20]
Residence class visa applicants may provide a Medical Certificate and Chest X-ray Certificate issued more than three months before the application date only if: [A4.20]
- they provided a Medical Certificate and Chest X-ray Certificate with an earlier visa application; and
- they were assessed as having an acceptable standard of health based on those certificates; and
- those certificates were issued less than 36 months prior to the current application. [A4.20]
Despite the 36-month exception, a new Chest X-ray Certificate (less than three months old) is required if the applicant has spent six consecutive months in any country not listed in A4.25.10 since their previous Chest X-ray Certificate was issued. [A4.20]
Applicants who previously provided a Limited Medical Certificate (INZ 1201) but no longer qualify for it must provide a new General Medical Certificate (INZ 1007) less than three months old. [A4.20]
Applicants who did not provide a Chest X-ray Certificate or specified tests in the past 36 months because of age (under 11) or pregnancy must now provide them if their age would now require them or they are no longer pregnant. [A4.20]
An immigration officer may require a Medical Certificate and Chest X-ray Certificate less than three months old at their discretion if considered necessary to establish an acceptable standard of health. [A4.20]
Evidence of completion of a Medical Certificate and Chest X-ray Certificate for residence class visa applications includes: a completed certificate, an eMedical reference code (NZER), or confirmation in the visa application form that a physician is directly submitting the certificates to INZ. [A4.20]
Applicants for a permanent resident visa under the Afghan Emergency Resettlement Category are not required to provide a medical certificate but must provide a Chest X-ray Certificate. [A4.20]
Where a residence class visa application is made through an online system that does not require a Medical Certificate or Chest X-ray to complete the application, an immigration officer may request one if needed to determine acceptable standard of health. [A4.20]
The instructions in A4.20 do not apply to people applying for a further residence class visa under RV2 or RV4. [A4.20]
Medical certificate requirements for temporary entry class visas (A4.25): [A4.25]
- The prescribed forms are the General Medical Certificate (INZ 1007), Chest X-ray Certificate (INZ 1096), and Limited Medical Certificate (INZ 1201). Unless specified otherwise, the default combination is the General Medical Certificate and Chest X-ray Certificate. [A4.25]
- Applicants intending to stay more than 12 months must provide a Medical Certificate and Chest X-ray Certificate issued less than three months before the date of application, subject to the exceptions below. [A4.25]
- 36-month exception: A new certificate is not required if the applicant previously provided a certificate that was assessed as acceptable and was issued less than 36 months before the current application. However, the Parent Boost visitor visa has its own requirements (see V4.5 and V4.5.1). [A4.25(c)]
- Full exemptions – the following applicants are not required to provide Medical or Chest X-ray Certificates: [A4.25(d)]
  - Fee paying foreign students (except those on a NZ MFAT scholarship or where A4.25(f) or A4.25.1 apply);
  - Working Holidaymaker Extension visa applicants;
  - Applicants recognised as having refugee or protection status in New Zealand who are eligible for a permanent resident visa, including their partner and dependent children;
  - Migrant Exploitation Protection work visa applicants, including partner and dependent children;
  - Essential Skills work visa applicants who previously provided these certificates and are in New Zealand at the time of application;
  - 2022 Special Ukraine Visa applicants.
- Limited exemptions for specific groups: [A4.25(f)]
  - Partners of NZ citizens/residents who meet the Partnership Category criteria must provide a Limited Medical Certificate (INZ 1201) and Chest X-ray Certificate if staying >12 months. However, if they were eligible for inclusion in an earlier residence class visa application made by their partner but were not included, or were withdrawn from that earlier application, they must provide a General Medical Certificate (INZ 1007) instead. [E7.50]
  - Dependent children of NZ citizens/residents meeting the Dependent Child Category criteria must provide a Limited Medical Certificate and Chest X-ray Certificate if staying >12 months. However, if they were eligible for inclusion in an earlier residence class visa application made by their parent but were not included, or were withdrawn from that earlier application, they must provide a General Medical Certificate (INZ 1007) instead. [E7.50]
  - Recognised Seasonal Employer (RSE) limited visa applicants must provide a Chest X-ray Certificate where TB screening is triggered (A4.25.1(b)), but are never required to provide a General Medical Certificate regardless of stay length.
- Refugee/protection claimants: Applicants with a claim under consideration (and their partner/dependent children) do not ordinarily need a Medical Certificate, but must provide a Chest X-ray Certificate. [A4.25(e)]
- Officer discretion: An immigration officer may still require a Medical Certificate and/or Chest X-ray Certificate even if the applicant would otherwise be exempt. Risk factors that may trigger such a request include: [A4.25(g), (h), (i)]
  - The applicant declaring a medical condition;
  - INZ having knowledge of a medical condition;
  - A recommendation from an INZ medical assessor that a future application be accompanied by an updated certificate;
  - Where A4.25.1(e) applies (TB risk-factor applicants who have spent time in a non-low TB country).
- Change of circumstances (age/pregnancy): If an applicant did not provide a Chest X-ray or specified tests in the past 36 months because of age (under 11) or pregnancy, and they are now older than 11 or no longer pregnant, they must now provide the required certificate/tests. [A4.25(j)]
- Defining "intending to stay more than 12 months": Includes applicants who: [A4.25(k)]
  - Are already in New Zealand for up to 12 months and seek a further visa to stay longer than 12 months;
  - Indicate an intention to remain longer than 12 months;
  - Are applying for a student visa and are defined as domestic students, or are MFAT scholarship students, for courses totalling more than 12 months;
  - Are applying for a Parent Boost visitor visa.
- Global Workforce Seasonal Visa: Applicants must provide both a Medical Certificate and Chest X-ray Certificate issued within three months, regardless of intended stay length, unless the 36-month exception applies. [A4.25(l)]
- Parent Boost visitor visa condition: Holders must provide a Medical Certificate and Chest X-ray Certificate less than three months old when submitting a compliance with conditions form (V4.35.5). [A4.25(l) – note: (l) in the text is split; this refers to the Parent Boost condition]
- Acceptable evidence: A completed certificate, an eMedical reference code (NZER), or confirmation in the application that the physician is submitting the certificates directly to INZ. [A4.25(n)]
Tuberculosis (TB) screening for stays of 6–12 months (A4.25.1): [A4.25]
- Applicants intending to stay more than 6 months but not more than 12 months who have risk factors for TB must undergo TB screening, unless they are pregnant or under 11 years of age. [A4.25.1(a)]
- All Recognised Seasonal Employer limited visa applicants (even those intending to stay less than 6 months) who have TB risk factors must be screened, unless pregnant. [A4.25.1(b)]
- TB screening requires a completed Chest X-ray Certificate (INZ 1096) and the associated radiologist report, issued less than three months before application. [A4.25.1(c), (d)]
- 36-month re-use: The 36-month exception applies (i.e. a previous chest X-ray accepted within 36 months can be re-used), unless the applicant has spent six consecutive months in any country not listed in A4.25.10 since that certificate was issued. [A4.25.1(d), (e)]
- An immigration officer may still require a Chest X-ray if considered necessary to establish an acceptable standard of health. [A4.25.1(f)]
- Active TB in New Zealand: If an applicant in New Zealand is assessed as having active TB (not latent), any further temporary entry class visa application must be declined. A limited visa may be granted for one month for the express purpose of immediate treatment and departure from New Zealand. [A4.25.1(h)]
- Pregnant TB-risk applicants who otherwise meet instructions may be granted a visa within the limitations of E3.10.1. [A4.25.1(i)]
Risk factors for TB (A4.25.5): [A4.25]
- A person has risk factors if they: [A4.25.5(a)]
  - Hold a passport from a country not listed in the low TB incidence list (A4.25.10); or
  - Have spent a combined total of three or more months in any country not listed in A4.25.10 in the five years before the application.
- An applicant who holds a passport from a non-listed country may rebut the risk-factor presumption if they can prove they have never lived or spent time in that country, and the time-spent criterion does not apply. [A4.25.5(b)]
Low TB incidence countries (A4.25.10): A large list of countries, territories and areas is deemed to have a low incidence of TB. The full list is in the Immigration Operational Manual (A4.25.10). [A4.25]

Completion of medical certificates

The Medical Certificate and Chest X-ray Certificate must be completed by an INZ-appointed panel physician and radiologist where required; otherwise by a registered medical practitioner and radiologist in countries without an INZ panel, and in English if possible. [A4.30]
If completion in English is not possible, the certificates and any accompanying laboratory or specialist reports must be submitted with a certified translation. [A4.30]
The cost of medical and X-ray examinations is generally the applicant's responsibility. The New Zealand Government pays for medical examinations of certain approved refugee and protection applicants, some Christchurch Response (2019) Category visa applicants, and for Chest X-Ray Certificates of some refugee and protection claimants and Afghan Emergency Resettlement Category applicants. [A4.30]
In most countries, INZ selects and requires the use of a panel of reputable registered physicians and radiologists. All applicants resident in those countries must use a panel physician or radiologist. The list of panel countries is in Appendix 1 of the Operations Manual. [A4.30]
The countries where INZ panel physicians and radiologists must be used are listed below (effective 19/02/2018). For the current detailed list of panel physicians and radiologists in each country, see www.immigration.govt.nz/paneldoctors. [A-appendix-1-list-of-countries-using-panel-physicians]
- Afghanistan
- Albania
- Algeria
- Argentina
- Armenia
- Australia
- Austria
- Azerbaijan
- Bahrain
- Bangladesh
- Belarus
- Belgium
- Bermuda
- Bhutan
- Bolivia
- Bosnia & Herzegovina
- Botswana
- Brazil
- Brunei Darussalam
- Bulgaria
- Burkina Faso
- Burundi
- Cambodia
- Cameroon
- Canada
- Chile
- China
- Colombia
- Congo (Democratic Republic of)
- Congo (Republic of the)
- Costa Rica
- Croatia
- Cyprus
- Czech Republic
- Denmark
- Djibouti
- Dominican Republic
- Ecuador
- Egypt
- El Salvador
- Eritrea
- Estonia
- Ethiopia
- Federated States of Micronesia
- Fiji
- Finland
- France
- French Polynesia (FR)
- Gambia
- Georgia
- Germany
- Ghana
- Greece
- Guam
- Guatemala
- Guinea
- Guyana
- Haiti
- Honduras
- Hong Kong (SAR China)
- Hungary
- Iceland
- India
- Indonesia
- Iran
- Iraq
- Ireland
- Israel
- Italy
- Ivory Coast
- Jamaica
- Japan
- Jordan
- Kazakhstan
- Kenya
- Kiribati
- Korea (South)
- Kosovo
- Kuwait
- Laos
- Latvia
- Lebanon
- Lesotho
- Liberia
- Libya
- Lithuania
- Macedonia
- Madagascar
- Malawi
- Malaysia
- Maldives
- Malta
- Mauritania
- Mauritius
- Mexico
- Moldova
- Mongolia
- Morocco
- Mozambique
- Myanmar (Burma)
- Namibia
- Nauru
- Nepal
- Netherlands
- New Caledonia
- New Zealand
- Nicaragua
- Nigeria
- Norway
- Oman
- Pakistan
- Palau (Republic of)
- Palestinian Territories
- Panama
- Papua New Guinea
- Paraguay
- Peru
- Philippines
- Poland
- Portugal
- Qatar
- Reunion Island (FR)
- Romania
- Russia
- Rwanda
- Samoa
- Saudi Arabia
- Senegal
- Serbia
- Seychelles
- Sierra Leone
- Singapore
- Slovakia
- Slovenia
- Solomon Islands
- South Africa
- Spain
- Sri Lanka
- Sudan
- Swaziland
- Sweden
- Switzerland
- Syria
- Tahiti
- Taiwan
- Tanzania
- Thailand
- Timor Leste
- Togo
- Tonga
- Trinidad and Tobago
- Tunisia
- Turkey
- Turkmenistan
- Tuvalu
- Uganda
- Ukraine
- United Arab Emirates (UAE)
- United Kingdom (UK)
- United States of America (USA)
- Uruguay
- Uzbekistan
- Vanuatu
- Venezuela
- Vietnam
- Yemen
- Zambia
- Zimbabwe
INZ medical assessors are appointed to examine medical and chest X-ray certificates referred to them. They assess an applicant's health against government requirements and the INZ Guidelines for Medical Assessors, and may seek advice from the Ministry of Health or Ministry of Education (MoE). Medical assessors also advise on medical waiver factors. [A4.30]
The MoE assesses whether an applicant would be eligible for Ongoing Resourcing Scheme (ORS) funding when requested by an immigration officer or medical assessor, based on the applicant's certificates and associated reports. [A4.30]

Medical waivers for residence class visa applicants

Residence applicants who do not meet the health standard but satisfy all other requirements may be considered for a medical waiver unless they: [A4.60]
- require dialysis treatment, or an INZ medical assessor indicates they will require dialysis within five years; [A4.60]
- have severe haemophilia; [A4.60]
- have a physical, intellectual, cognitive and/or sensory incapacity requiring full-time care, including care in the community; [A4.60]
- currently have tuberculosis (TB) in any form and have not completed full treatment as outlined in the New Zealand Guidelines for TB Treatment; or [A4.60]
- have a history, diagnostic findings or treatment for multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB), unless cleared by a New Zealand Respiratory or Infectious Diseases specialist. [A4.60]
Medical waivers will also not be granted to a person who: [A4.60]
- applies under a Family Category; and
- was eligible to be included in an earlier residence application as the partner or dependent child of the principal applicant (or their partner); and
- was not declared, not included, or was withdrawn from that earlier application. [A4.60]
Applicants with recognised refugee or protection status (except those invited under the Community Organisation Refugee Sponsorship category) will be granted medical waivers, unless the mandatory dialysis, haemophilia, full-time care, or TB exclusions in (a) apply. [A4.60]
The partner or dependent child of a New Zealand citizen or residence class visa holder who meets the Partnership or Dependent Child criteria will be granted a medical waiver unless the (a) or (b) exclusions apply. [A4.60]
Specific residence categories receive automatic medical waivers subject to certain exclusions:
- Christchurch Response (2019) Category: medical waiver unless (a) applies. Even if (a) applies, a waiver will still be granted if the condition was caused by injuries or trauma suffered in the 15 March 2019 mosque attacks in Christchurch. [A4.60]
- Afghan Emergency Resettlement Category: medical waiver unless (a)(iv) (active TB not completed treatment) or (a)(v) (MDR/XDR-TB) applies. [A4.60]
- 2021 Resident Visa Category: medical waiver unless (a) applies. [A4.60]
- Ukraine Resident Visa: medical waiver unless (a) applies. [A4.60]
These medical waiver instructions do not apply to applicants for a permanent resident visa who already hold resident visas. [A4.60]

Medical waivers for temporary entry class visa applicants

Temporary entry class visa applicants are only eligible for consideration of a medical waiver if they fall into one of the following categories: [A4.65]
- seconded business personnel meeting the requirements of A4.65.1;
- claimants for refugee or protection status, or recognised refugees/protected persons;
- partners or dependent children of a New Zealand citizen or residence class visa holder, where the purpose of stay is to be with that individual and, if they applied for a residence class visa, they would meet the criteria under Partnership (F2.5(a)) or Dependent Child (F5.1(a)) instructions;
- applicants under 21 applying for a student or visitor visa as a dependent of a work, student, or military visa holder, where it has been determined they do not have an acceptable standard of health as set out in [A4.15(c)]. [A4.65]
The medical waiver is only available in respect of [A4.15(c)] — there is no ability to consider a medical waiver if a person is assessed as not having an acceptable standard of health under [A4.15(b)]. [A4.65]
Despite the partner/dependent child pathway, medical waivers will not be granted to applicants who were eligible for inclusion in an earlier residence application but were not included or were withdrawn. [A4.65][E7.50]
The grant of a medical waiver for temporary entry does not confirm that the applicant has an acceptable standard of health for residence purposes or that a medical waiver would be granted for a residence application; an immigration officer may still consider whether an applicant would be likely to be granted a medical waiver for residence. [A4.65]
Parent Boost Visitor Visa applicants are not eligible for a medical waiver. [A4.65]

Seconded business people

Seconded business people applying for work visas may be granted a medical waiver if the officer is satisfied that: [A4.65]
- the intended secondment will be of real benefit to New Zealand;
- the applicant is unlikely to be a danger to public health during the secondment; and
- the employer has guaranteed to pay all medical expenses of the applicant during the secondment, including any significant costs to health services identified by an immigration officer or medical assessor (despite [A4.15.1(b)]). [A4.65]
At the time the work visa is granted, the principal applicant must be advised in writing that the visa has been granted even though the applicant does not have an acceptable standard of health. [A4.65]
These instructions facilitate New Zealand's international trade commitments. [A4.65]

Determination of medical waiver (A4.70)

The decision to grant a medical waiver must be made by an immigration officer with Schedule 1-3 delegations. [A4.70]
When determining whether to grant a medical waiver, the officer must consider the applicant's circumstances to decide if they are compelling enough to justify entry and/or stay in New Zealand. [A4.70]
Factors the officer may consider include (but are not limited to):
- the objectives of Health instructions (A4.1) and the objectives of the specific visa category; [A4.70]
- the degree to which the applicant would impose significant costs and/or demands on New Zealand's health or education services; [A4.70]
- whether the applicant has immediate family lawfully and permanently resident in New Zealand, and the circumstances and duration of that residence; [A4.70]
- whether the applicant's potential contribution to New Zealand will be significant; [A4.70]
- the length of intended stay (permanent or temporary). [A4.70]
For applicants applying for a student or visitor visa as a dependent of a work, student, or military visa holder, the officer may also take into account the parent's potential contribution to New Zealand. [A4.70]
An applicant who is the partner or dependent child of a New Zealand citizen or residence class visa holder, meeting the criteria under Partnership (F2.5(a)) or Dependent Child (F5.1(a)), will be granted a medical waiver unless the exclusions at A4.60(a) apply. [A4.70]
An applicant recognised as a refugee or protected person (except those invited under the Community Organisation Refugee Sponsorship category) will be granted a medical waiver, unless the A4.60(a) exclusion applies. [A4.70]
The officer should consider any advice from an INZ medical assessor on medical matters relating to the waiver, such as prognosis. [A4.70]
All decisions to approve or decline a medical waiver must be recorded, with full reasons for the decision. [A4.70]
The exception for medical treatment visitors is specifically provided for in A4.75, which references the temporary entry instructions for medical treatment or consultation (V3.40). This separate section confirms that such applicants are exempt from the health requirement for the purpose of the visa applied for under V3.40. [A4.75]

Health Requirements

Health Requirements

At a glance

Definition

Application in decisions

Interpretation & edge cases

Completion of medical certificates

Medical waivers for residence class visa applicants

Medical waivers for temporary entry class visa applicants

Seconded business people

Determination of medical waiver (A4.70)

Citations

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