Visa health cost assessment periods: temporary stay, 5 years or up to 10 years

The Department of Home Affairs says the Medical Officer of the Commonwealth (MOC) assesses estimated health and community costs for a temporary visa over the applicant’s intended period of stay in Australia; provisional or permanent applications are generally assessed over 5 years, or 3 years for an applicant aged 75 years or older. A permanent or ongoing condition with a reasonably predictable course is assessed over remaining life expectancy, up to 10 years. The current $86,000 Significant Cost Threshold (SCT) applies across these assessment pathways (information checked 1 October 2026).

Which assessment period applies?

The Department of Home Affairs sets different cost-estimation periods depending on the visa application and the condition being assessed.

Application or condition	Period used by the MOC
Temporary visa	The applicant’s period of stay in Australia, taking the intended stay into account
Provisional or permanent visa—general rule	5 years
Provisional or permanent applicant aged 75 years or older	3 years
Permanent or ongoing condition with a reasonably predictable course	Remaining life expectancy, up to a maximum of 10 years

The intended period of stay matters because having a particular condition does not automatically mean its estimated costs will exceed the SCT. The Department says costs depend on the type of condition, its severity and how long the applicant intends to stay in Australia.

The Department presents the age-75 rule and the rule for permanent or ongoing conditions as separate parts of its explanation. Its published wording does not explain how those two rules interact if both descriptions apply to the same applicant, so a visa holder should check the Home Affairs information for that visa.

These are visa health cost-assessment periods, not the duration or benefit period stated in an OVHC policy.

How does the $86,000 Significant Cost Threshold work?

A significant cost is described by the Department as a cost higher than the average health and community services cost for an Australian. The current SCT used for that comparison is $86,000.

The Department calculates the Australian average using average spending on health and welfare services over a 5-year period. It draws on two published Australian Institute of Health and Welfare reports covering health expenditure and welfare expenditure, then projects the historical data into the current year to set the SCT.

The Department says the threshold:

• forms part of the policy for containing public expenditure on health care and community services under the Migration Regulations 1994;
• is reviewed every 2 years;
• was last updated on 1 July 2024; and
• is compared with the MOC’s estimated costs, regardless of whether the applicant is applying for a temporary or provisional/permanent visa.

Having a diagnosed condition does not by itself exceed the threshold. The MOC considers the condition’s type, severity and the applicant’s intended stay when estimating costs.

What costs does the threshold framework cover?

The Department’s explanation includes several categories of health and community services.

Category	Examples listed by the Department
Unreferred or referred medical services	Medical specialists and pathology or laboratory testing
Disability services	Support funded through the National Disability Insurance Scheme, Employment Support, Youth Support, Social Services and Protection Support
Research and public health	Public-health research and communication programs supporting health awareness in the Australian community
Specialised education support	Early-intervention support for children with disability
Cash welfare payments	Carers Payment, Disability Support Pension and Child disability Assistance Payment, among others
Pharmaceuticals	Prescribed drug treatments and therapies under the Pharmaceutical Benefits Scheme

These categories help explain what may enter the estimate. They do not mean that every person with a condition will have the same costs or will exceed the SCT.

What happens if estimated costs are above $86,000?

If the MOC assesses estimated costs as above the SCT of $86,000, the applicant exceeds the threshold and does not meet the health requirement on the significant-cost ground. The Department says a visa will not be granted when the health requirement is not met because the condition is likely to be a significant cost.

There are stated exceptions to this ground:

• An eligible child born and ordinarily resident in Australia may be covered by a specific exception.
• If a health waiver is available for the visa subclass, the costs may be waived following a decision.

For a child born in Australia who does not meet the temporary or permanent visa health requirement, the Department says an application for special consideration is not needed. A visa processing officer considers the child’s eligibility for the child born and ordinarily resident assessment.

Is short-supply access assessed separately?

Yes. The MOC also considers whether a condition is likely to prevent Australian citizens or permanent residents from accessing health care or community services that are in short supply. The Department calls this “prejudicing access”.

If the health requirement is not met because a condition is likely to prejudice access to short-supply services, the Department says the visa will not be granted. This is additional to the SCT cost assessment.

When can a health waiver matter?

A health waiver allows the decision maker to consider the applicant’s personal circumstances to mitigate costs so that those costs can be waived. If a waiver is available for the applied-for visa subclass, the visa processing officer must consider it and may request further information.

For some visas, the Department may consider exercising a health waiver if granting the visa is unlikely to:

• result in significant cost to the Australian community; or
• prejudice Australian citizens or permanent residents’ access to short-supply health care or community services.

A waiver is therefore a possible route, but its availability for the visa subclass and the decision to waive costs must be confirmed through the visa process.

What should you check before making a decision?

Check both your OVHC policy documents and the Home Affairs information for your visa:

• Visa subclass: Confirm whether the application is temporary, provisional or permanent and whether a health waiver is available.
• Intended stay: The duration affects both the visa cost assessment and the estimated costs associated with a condition.
• Policy terms: An OVCC policy sets the insurance contract’s benefits and conditions; it does not replace the MOC’s visa health assessment.
• Current Home Affairs information: The SCT is reviewed periodically, so confirm the current threshold and the wording that applies to the visa.

This is general information rather than an assessment of an individual condition or application.

Sources

• Department of Home Affairs — Protecting health care and community services

FAQ

Does a temporary visa always use a 5-year assessment period?

No. For a temporary visa, estimated health and community costs are assessed for the applicant’s period of stay in Australia, taking the intended stay into account.

Is a provisional or permanent application always assessed over 5 years?

Five years is the general rule. The Department states a period of 3 years for applicants aged 75 years or older. A permanent or ongoing condition with a reasonably predictable course may instead be assessed over remaining life expectancy, up to 10 years.

Does having a medical condition automatically exceed the SCT?

No. The estimated costs depend on the type and severity of the condition and the applicant’s intended period of stay. The MOC compares the resulting estimate with the current $86,000 threshold.

Can a health waiver help when estimated costs are high?

It can if a waiver is available for the visa subclass and the decision maker decides to waive the relevant costs. The visa processing officer must consider an available waiver and may request further information; approval is not automatic.

Does the SCT test cover anything besides estimated costs?

The MOC also considers whether a condition is likely to prevent Australian citizens or permanent residents from accessing health care or community services in short supply. The Department refers to this as prejudicing access.