Health and Character Test
Within Australia’s migration law framework, the health test and the character test are two distinct but equally important gatekeeping criteria that derail thousands of visa applications every year.
The legal basis for the health test is Public Interest Criterion (PIC) 4005 and PIC 4007; the legal basis for the character test is s 501 of the Migration Act 1958 (Cth). Although these two tests differ in their legal nature, they are often considered together in practice for three reasons:
In practice, health- and character-related issues commonly include:
When the NS Legal migration team assists in health and character matters, the focus is on assessing the legal strength of the case, gathering the evidence the decision-maker actually values, and lodging a logically tight, well-documented response within the strict time limits.
almost every substantive visa requires the applicant to satisfy both the health and the character criteria;
both allow the Department of Home Affairs to initiate assessment at application stage or at any point during the visa hold;
once either standard is failed, the remedy pathway involves strict statutory time limits and a highly evidence-intensive response process.
whether the visa can still be granted after a significant condition is identified at health examination;
whether prior criminal records, family-violence orders or links to criminal organisations may trigger s 501;
how to prepare a response within the 28-day window following receipt of a s 501 notice;
how to persuade the decision-maker to grant a health waiver, or to exercise the character discretion favourably.
PIC 4005 and PIC 4007 Health Criteria
Australia’s health criteria are implemented primarily through two Public Interest Criteria: PIC 4005 (no waiver available) and PIC 4007 (waiver available). The two apply to different visa classes.
- PIC 4005: applies to most visa classes (including the Subclass 482 Employer-Sponsored, 189/190 skilled migration, 500 Student visa and 600 Visitor visa, amongst others). If the applicant cannot satisfy PIC 4005, no waiver option is available and the visa will be refused.
- PIC 4007: applies to selected visa classes (including the Subclass 186 Employer Nomination Scheme, 491 Skilled Work Regional, Protection visas and certain family-stream visas). If the applicant cannot satisfy PIC 4007, the decision-maker may exercise a discretion to grant a health waiver.
The core assessment standard is the Significant Cost Threshold (SCT), that is, whether the applicant’s health condition is expected, during the period of stay in Australia, to generate medical and social-service costs to the community that exceed the statutory threshold.
The threshold was raised after the 2024 reform from the previous level of around AUD 51,000 to a higher current figure (with the specific amount updated from time to time), but for many conditions requiring ongoing treatment the threshold remains relatively easy to cross.
In addition to the SCT, PIC 4005/4007 also requires that the applicant’s condition will not place undue demand on Australia’s existing health services (in particular scarce resources such as organ transplantation and dialysis).
This factor is especially critical in matters involving kidney failure, severe cardiac disease or certain rare conditions.
Common Health Refusal Triggers
While each matter must be assessed individually, in practice the following categories of condition most commonly trigger refusal under PIC 4005/4007:
- HIV/AIDS: particularly where long-term antiretroviral treatment is required, with anticipated medical costs typically crossing the SCT;
- Kidney disease requiring dialysis: dialysis services constitute a significant draw on Australia’s public health resources;
- Certain cancers: in particular advanced or recurrent cancers requiring long-term chemotherapy, radiotherapy or immunotherapy;
- Severe cardiac disease: including cases requiring cardiac transplantation, pacemakers or long-term cardiovascular intervention;
- Serious mental health conditions: such as severe depression, schizophrenia or bipolar affective disorder requiring long-term medication and inpatient support;
- Intellectual and developmental disability: matters involving long-term special education, care or community support;
- Certain autoimmune conditions: such as those requiring expensive biologic therapies;
- Chronic liver disease and significant inherited disorders: matters requiring ongoing monitoring and intervention.
It is important to emphasise that a diagnosis of one of the above conditions does not automatically lead to refusal.
What the decision-maker considers is the anticipated cost to the community’s medical and social services during the visa period, not the clinical severity of the condition itself.
Detailed medical assessment and cost modelling are therefore central to any response to a health notice.
The Role of the MOC
The Medical Officer of the Commonwealth (MOC) plays a central role in the health assessment process.
The MOC is a medical officer authorised by the Department of Home Affairs and is responsible for assessing whether the applicant’s health condition satisfies the requirements of PIC 4005/4007.
The MOC’s assessment process typically involves:
- reviewing health examination reports issued by Bupa Medical Visa Services (or the equivalent authorised overseas panel provider);
- assessing the anticipated medical and social-service costs of the applicant’s existing condition during the visa period;
- considering whether the applicant’s condition will place undue demand on scarce health resources in Australia;
- providing a written health opinion to the visa decision-maker.
It should be understood that, in law, the MOC’s opinion carries strong weight with the visa decision-maker — absent compelling reasons, the decision-maker will generally accept the MOC’s health assessment.
This means that the most effective way to challenge a health refusal is not simply to submit the applicant’s own medical reports, but to provide expert evidence that directly engages with the MOC’s assessment framework, in particular evidence rebutting the cost modelling.
Health Waiver under PIC 4007
For visa classes to which PIC 4007 applies, the decision-maker may exercise a discretion to grant a waiver where the applicant has not satisfied the health criterion.
This is one of the most important remedy pathways in health-related matters.
At the core of a PIC 4007 health waiver lies the cost-benefit analysis: the applicant must demonstrate that the overall benefits to Australia of granting the visa are sufficient to outweigh the impact of the health-related costs on the community’s medical resources.
In practice, key evidence supporting a health waiver typically includes:
- Evidence of economic contribution: the applicant’s earning capacity, salary level, anticipated tax contribution and contribution to their industry;
- Family reunion factors: dependency relationships of immediate family members in Australia (in particular Australian citizen spouses or children);
- Evidence of community involvement: the applicant’s record of service in their local community, church or other organisations;
- Private health insurance arrangements: whether the applicant has obtained, or has committed to obtain, sufficient private health cover to share the cost;
- Alternative cost modelling: rebuttal opinions from independent medical experts indicating that the MOC’s cost estimates may be overstated;
- Humanitarian factors: evidence that the applicant cannot obtain appropriate treatment in their country of origin.
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What Does a VACCU Review Mean?
Many applicants, on finding that their visa application has made no progress for a long time, or on being told that the case is undergoing a character review, mistakenly assume the visa is “basically hopeless”. That understanding is not accurate. VACCU’s role is to further assess cases that may involve a character risk, assisting Home Affairs in determining whether an applicant meets the character requirement under Australian migration law. It is not itself a court, nor an independent review body, but a specialist review unit within Home Affairs responsible for assessing character risk.
A VACCU review usually extends the processing time of a case considerably, because the review may involve criminal records, police material, court outcomes, overseas background records, family violence risk, fraud or false information, a history of past deportation or removal, and other matters that may affect the safety of the Australian community or the integrity of the migration system.
Which Situations May Be Referred to VACCU?
Not every visa application goes to VACCU. Most applications are processed by the relevant visa team through the normal channel, but if a case officer identifies a character issue requiring further assessment during processing, the case may be referred to VACCU.
Common situations include a more serious criminal record, violent or sexual offences, drug-related offending, family violence, human trafficking, fraudulent conduct, false documents, a history of overseas deportation or removal, and associations with criminal individuals or high-risk organisations.
In some cases the applicant has no record of lengthy imprisonment yet may still be asked to explain relevant events. For example, an Apprehended Violence Order (AVO), police charges, criminal charges that were later withdrawn, incidents with no final conviction but an adverse police record, or inconsistent information in previous visa applications may all attract the attention of Home Affairs.
Whether a risk exists cannot be judged simply by “whether the person has been to prison”; rather, it depends on whether the relevant information may affect Home Affairs’ overall assessment of the applicant’s character, risk, and integrity.
What Does VACCU Focus On?
Whether the Applicant May Fail the Section 501 Character Test
A VACCU review is usually closely connected with the section 501 character test. Under the Migration Act, if an applicant fails the character test, the visa application may be refused; and for a person who already holds a visa, there may, in certain circumstances, be a risk of visa cancellation.
The character test is not limited to whether there has been a lengthy sentence of imprisonment. Home Affairs generally weighs together the applicant’s criminal record, whether serious unlawful conduct exists, and whether the case involves violence, family violence, sexual offences, drugs, people smuggling, human trafficking, associations with criminal organisations, and whether the applicant may pose a risk to the Australian community in future.
Accordingly, even if the relevant events occurred many years ago, or the applicant regards them as merely an isolated incident, that does not mean they will not affect the visa; equally, however, it does not mean that having a past record makes the visa hopeless. Home Affairs usually does not mechanically look only at whether there is “a prior record”, but considers together the seriousness of the conduct itself, whether it was a single event or repeated behaviour, how much time has passed since it occurred, whether similar problems have recurred since, and whether the applicant still presents an actual risk now.
Australian Community Safety and Risk Assessment
Whether the applicant may pose a risk to the Australian community is one of the central focuses of a VACCU review.
In cases involving violence, family violence, sexual offences, drugs, weapons, child safety, or repeated offending, simply submitting a few character references is usually far from enough. What Home Affairs is really concerned with is often not whether the people around the applicant think they are “a good person”, but whether the relevant risk still exists now.
What matters more is to set out specifically the background to the events and the actual situation since they occurred. For example, whether no similar problems have arisen for a long time, whether the applicant has maintained stable employment, whether they carry ongoing family responsibilities, whether they have completed treatment, alcohol-cessation, behaviour-management programs, or other rehabilitation measures, and whether those changes are supported by objective material.
If a response simply states “I have changed” or “these events were many years ago”, it is usually very difficult to truly address Home Affairs’ concerns. What matters more is whether the applicant can show, through actual material, that the relevant risk has clearly diminished, and whether the overall situation since the past events is sufficient to support that conclusion.
Family, Work, and Ties to Australia
A character review does not look only at adverse records. Home Affairs may also consider an applicant’s genuine ties to Australia, such as the length of residence in Australia, family members, the interests of any minor children, work and business contributions, community support, health, the practical hardship that departure may cause, and the impact on family members.
These favourable factors cannot be dealt with in general terms; it must be made clear what those ties actually mean in practice. If the applicant has a spouse, minor children, or long-term caring responsibilities, what matters more is to set out specifically the relationships of dependency, the family arrangements, and the real impact a refusal may have; and if the applicant has been in stable employment for a long time, it is also necessary to explain whether this reflects a settled and stable life, and what practical consequences would follow for the employer, the family, or other affected people.
Has Your Case Entered the Character Review Stage? Prepare a Targeted Response Early
Common Risks in a VACCU Review
Lengthy Processing Delays
One of the most common problems in VACCU cases is a marked increase in processing time.
Cases of this kind often involve background checks, verification of police records, review of court material, cross-agency information checks, and more complex risk assessment, so the processing cycle is usually far longer than for an ordinary visa application.
For the applicant, prolonged delay can itself create real pressure — for example, work arrangements being affected, family plans unable to proceed, an unstable visa status, or prolonged uncertainty over whether they can remain in Australia.
At this stage, simply chasing the case repeatedly usually achieves little. The more practical questions are whether the case already has a request for further information, whether court outcomes or police clearances need to be proactively updated, whether there are unaddressed risk points, and whether the case needs to be actively advanced through a legal strategy.
Responding in the Wrong Direction
For example, what Home Affairs really wants to understand is the specific sequence of an event, the applicant’s explanation of the conduct involved, and whether those circumstances still reflect a current risk — yet what the applicant submits may simply emphasise that they are “not a bad person”. In some cases Home Affairs is concerned with the police record, court outcomes, or the adverse material itself, but the applicant submits extensive character references without directly responding to these core issues. Some applicants try to minimise the significance of past events without realising that inconsistent statements, the omission of key facts, or evasion of the risk issues can themselves attract further scrutiny.
If the case already involves a section 501 character issue, the response usually cannot be merely a personal plea; it should correspond directly to the risk points the law genuinely requires to be addressed — including the background to the events, acceptance of responsibility, behavioural change, risk of reoffending, family impact, community ties, and why, on the whole, the visa should still be granted.
Inconsistent or Withheld Information
Consistency of information is very important in a VACCU review. If the information an applicant has provided in the visa application form, character declarations, police clearances, court documents, police material, or previous visa applications is inconsistent, Home Affairs will often look more closely at the question of integrity.
In some circumstances this is not merely a character issue but may also involve a risk of false or misleading information, which broadens the complexity of the case.
Before responding to VACCU or a request for further information, it is therefore usually necessary first to systematically check what material the applicant has previously submitted, which records have already been disclosed, whether there are inconsistencies between records from different countries, and whether court outcomes have been accurately explained. Rushing to submit unverified explanatory material can sometimes create new risks instead.
What Should You Do If You Receive a VACCU-Related Notice?
If Home Affairs asks you to provide further information, or the case has clearly entered a delayed-review stage because of a character issue, the first step is usually not to immediately submit a short explanatory letter, but first to identify the legal nature of what Home Affairs is asking for. Different documents may represent entirely different risks. For example, an ordinary request for further information, a section 57 natural justice letter, and a request for submissions in relation to section 501 each carry different legal significance and call for a different focus in response.
Preparing a response usually requires dealing with three levels at once — fact, evidence, and law. At the level of fact, the sequence of events must be set out accurately, without glossing over the difficult parts; at the level of evidence, this may include court outcomes, police material, police clearances, treatment or rehabilitation records, employment evidence, and family and community support material; and at the level of law, it is necessary to explain why, within the framework of the relevant character test, the applicant should still be granted the visa.
If the case involves serious crime, family violence, prolonged delay, previously undisclosed records, or a clear potential to trigger section 501 risk, obtaining legal advice early is usually very important. The quality of the response at the VACCU stage often has a direct bearing on whether a refusal decision follows, and on whether the case record has been properly established should the matter later proceed to merits review or court.
What Are the Possible Outcomes of a VACCU Review?
After a VACCU review concludes, the case may continue into the normal visa-processing stream, or the applicant may be asked to provide further information.
If Home Affairs is satisfied that the character concerns have been adequately addressed, the case may return to normal processing and ultimately be granted. But if Home Affairs considers that the applicant has not adequately responded to the character risk, or finds that the applicant does not meet the relevant character requirement, the visa application may be refused. For a person who already holds a visa, this may, in certain circumstances, further give rise to a risk of visa cancellation.
The consequences of a decision related to section 501 are usually very serious, potentially affecting the current visa, future visa applications, the ability to remain in Australia, and in some circumstances even leading to immigration detention or a requirement to depart.
How We Can Help
The complexity of health and character matters lies in this combination: the legal standard is clear, but the evidence requirements are highly individualised; the time limits are strict, but the preparatory work is dense.
When the NS Legal migration team assists in these matters, the emphasis is on targeted evidence, precise legal argument and direct engagement with the decision-making framework.
We will generally begin by assessing the stage of the matter (during visa application, having received a health/character notice, having received a cancellation notice, already cancelled, etc.), and then identify the critical time limits, viable remedy pathways and order of priority.
In practice, we are typically able to assist clients to:
- analyse the application of PIC 4005/4007 and s 501 to the matter and define the legal-argument framework;
- coordinate independent medical experts to provide rebuttal opinions targeted at the MOC’s cost modelling;
- draft PIC 4007 health waiver applications and structure the cost-benefit argument and supporting evidence;
- draft and lodge s 501CA revocation requests within the 28-day window;
- systematically organise evidence around the Direction 110 factors, in particular the best-interests-of-children analysis;
- coordinate psychologists, social workers, religious leaders and employers to provide targeted expert evidence;
- represent the client on ART merits review or judicial review, challenging adverse health opinions or character decisions;
- prepare ministerial intervention applications once ordinary remedies are exhausted.
Our goal is, within the strict statutory time limits, to lodge a logically tight, well-evidenced health or character response that engages directly with the decision-making framework, so as to maximise the client’s chances of remaining in Australia.
Frequently Asked Questions
If a health examination identifies a condition, will the visa always be refused?
Not necessarily. What the decision-maker assesses is whether the anticipated medical and social-service costs of the condition during the visa period exceed the Significant Cost Threshold (SCT), not the clinical severity of the condition itself. For visa classes to which PIC 4007 applies, a health waiver may still be sought even where the cost crosses the SCT. The key is rebuttal evidence directed at the MOC’s cost estimate and a cost-benefit argument.
Will a prior criminal record always trigger s 501?
Not necessarily. The principal criterion under s 501 is a “substantial criminal record” (a sentence of 12 months or more, whether or not aggregated). Minor offending (such as traffic infringements or non-custodial misdemeanours) generally will not trigger s 501. However, s 501 also incorporates the broader “past or present conduct” and “reasonable suspicion” standards, and some serious allegations may trigger an assessment even where no conviction has been recorded.
How long do I have to respond after receiving a s 501 cancellation notice?
Under s 501CA, the revocation request must be lodged within 28 days of receipt of the notice. The time limit is strict and generally runs from the date of service. Missing the time limit will result in the revocation request not being entertained, and the person will face removal and a possible permanent re-entry ban. We recommend contacting a migration legal team on the very day the notice is received.
Are health waivers often successful?
A health waiver is a discretionary decision and no publicly published success rate is available, but our practical experience indicates that the quality of the evidence preparation drives outcome. A strong waiver application typically includes: a rebuttal from an independent specialist directed at the MOC’s cost estimate, detailed projection of economic contribution, concrete evidence of family reunion factors and a private-health-insurance commitment. Generic support letters very rarely secure a waiver.
How important is the best-interests-of-children factor in Direction 110?
It is one of the most important favourable factors in Direction 110, but in practice it is often the most under-utilised. Simply stating “I have children in Australia” is far from sufficient — the decision-maker needs to see concrete evidence of the parent-child relationship (records of joint activities, school drop-offs and pick-ups, descriptions of the emotional bond), an opinion from an independent psychologist on the impact of separation and, where appropriate to age, a statement from the child. Systematically organising this evidence is often the most powerful argument in a discretionary s 501 matter.
What is the difference between a health/character notice and a Section 57 procedural notice?
Section 57 is the statutory basis on which the visa decision-maker provides a procedural notice to the applicant, advising of adverse information (which may include health or character matters) and offering an opportunity to respond. The specific legal standards for health and character are set out separately in PIC 4005/4007 and s 501. In simple terms, s 57 is the “notification mechanism” while PIC 4005/4007 and s 501 are the “substantive standards”. A response to a s 57 notice should therefore engage directly with the specific requirements of the relevant PIC or of s 501.
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