Updated · NextMigrate Team
Medical Inadmissibility: When a Family Member's Condition Blocks the Visa
Imagine you are a project manager in São Paulo. You have the points, the English, the experience and the savings. You want a safer street for your children and a school that has time for them. Your youngest is four. Last year he was diagnosed with autism. He is funny and stubborn, and he loves trains.
Then you read a forum post that says your son could be the reason the whole family is refused. Your chest goes tight. You wonder if it is even fair to ask.
It is a hard thing to read. It is also something you can plan around, if you know how the rules work before you spend money. Many families in your position do move abroad. They usually succeed by choosing the right country and the right visa, not by hoping.
The short answer: Canada, Australia and New Zealand assess the health of every family member in the application. If one person is expected to cost the public system more than a published threshold, the whole family can be refused. The UK, Germany, Ireland and most of the EU do not run this kind of cost test for skilled routes. Some Australian and New Zealand visas allow a health waiver, and Canada lets you answer with a mitigation plan. For most families, choosing the destination is the strongest move you can make.
This is general information. A licensed adviser in the destination country should confirm your case before you spend money.
Who this affects
Read this carefully if any of these describe your household:
- A child with a diagnosis that means ongoing therapy, special education support or lifelong help.
- A spouse or child who needs recurring high-cost treatment, such as dialysis, biologic drugs, transplant follow-up or long-term specialist care.
- A dependent parent or grandparent in the application, where age plus a chronic condition raises the projected cost.
- A family member staying behind, if you apply to Canada. Non-accompanying family members generally still need a medical exam.
- Anyone in the household with a communicable disease that a destination screens for.
If nobody has a significant condition, see our guide to migrating with a pre-existing health condition instead.
Why the whole family is assessed
Skilled visas are granted to a household. Each person you list sits the medical exam with an approved panel physician, and each one can trigger a refusal.
Think of the application as one boat. Everyone gets in together. If one person is not allowed on board, the boat does not leave.
Canada goes further. IRCC generally requires family members who are not coming with you to be examined too, because they could be sponsored later. There are exclusions, so read IRCC's current guidance.
So you can have a strong score, a valid registration and a job offer, and still be refused because of a four-year-old's diagnosis. It is not a judgement on your child's worth. It is an accounting rule.
What the cost test measures
Canada calls it excessive demand. Australia calls it the significant cost threshold. A panel physician examines each person and sends the results to a medical officer at the immigration authority, who forms the opinion. The officer estimates the likely publicly funded health costs, and in some systems social service costs such as special education, over a set period. Then they compare it with a published threshold. If the estimate is higher, the application heads towards refusal unless you answer it.
Four features matter for planning:
- It looks forward. The officer estimates future cost. A condition that has been stable and cheap for ten years can still project high if the standard care in the destination is expensive.
- It counts public cost. Treatment you would pay for privately is often still counted, if that service is normally publicly funded there.
- The period is fixed. Systems run the estimate over a set number of years, longer where care will be needed for life. Canada and Australia publish their periods. The period changes the total a lot, so read it with the threshold.
- The threshold is reindexed. A number from a forum post two years old is very likely wrong.
Treat every figure below as a planning range. Confirm it on the authority's page before you decide you are over or under the line.
The thresholds, as published
| Destination | Whose health is assessed | What the test measures | Waiver or mitigation route | Where to verify |
|---|---|---|---|---|
| Canada | Principal applicant, accompanying dependants, and generally non-accompanying family members | Excessive demand on health and social services, measured against an annually reindexed cost threshold per year over a defined period, plus public health and public safety grounds | Procedural fairness response with a mitigation plan; certain categories are exempt from the excessive demand ground, including refugees and protected persons and, as published by IRCC, sponsored spouses, partners and dependent children; confirm the current exempt list with IRCC, since sponsored parents and grandparents are treated differently | IRCC medical inadmissibility and immigration medical examination pages |
| Australia | Principal applicant and all dependants, including non-migrating family members in some cases | The health requirement, including a significant cost threshold assessed over the relevant period, plus prejudice to access to services in short supply and public health risk | A health waiver exists for some visa subclasses and is absent from others; the subclass you applied under sets availability, independently of the condition | Department of Home Affairs health requirement and panel physician pages |
| New Zealand | Principal applicant and dependants | Acceptable standard of health, with conditions deemed to impose significant cost or demand on health or education services | Medical waiver available for some visa categories, considered against defined factors | Immigration New Zealand acceptable standard of health instructions |
| United Kingdom | Applicant and dependants | No general excessive demand cost test; tuberculosis screening required for applicants from listed countries | Not applicable; cost is handled through the Immigration Health Surcharge instead | UKVI tuberculosis test and health surcharge pages |
| Germany | Applicant and dependants | No general excessive demand assessment for skilled work routes; health insurance coverage is the operative requirement | Not applicable | Federal Foreign Office and BAMF visa requirement pages |
| Ireland | Applicant and dependants | No general excessive demand cost test for employment permit routes; private medical insurance normally required | Not applicable | Irish immigration service permission conditions |
| Gulf states, for example the UAE and Qatar | Applicant and sponsored dependants | Medical fitness screening focused on specified communicable diseases, applied at residence permit stage and repeated at renewal | Very limited; a failed fitness test generally means no residence permit | The destination's health authority and residency portal |
Canada. IRCC publishes an annual excessive demand threshold, per year over the assessment period, and reindexes it. In 2018 a policy change tripled the threshold and removed most special education and social service costs from the sum. Since then the figure has sat in the region of the mid to high CA$20,000s per year and has risen at each reindexation. Do not plan against this sentence. Open IRCC's medical inadmissibility page and use the dated figure there today.
Australia. Home Affairs applies a significant cost threshold, published as a total over the assessment period. It has been in the AU$80,000s in recent years and is reviewed regularly. Confirm the figure and the period on the health requirement page.
New Zealand. Immigration New Zealand describes conditions likely to impose significant costs or demands on health or special education services. Its operational manual lists the conditions and the approach. Read the current instructions directly.
Public health and public safety grounds
These are separate from the cost test and work differently.
Public health mainly means active tuberculosis. Screening is standard. This ground can usually be cleared: finish treatment, produce clear results, and it falls away. It typically delays an application by months. The UK's tuberculosis certificate for applicants from listed countries is this kind of screening step. It has nothing to do with cost.
Public safety is narrow and based on individual behaviour. A psychiatric diagnosis alone does not fall into it.
HIV. Much online advice is a decade out of date. Canada, Australia, New Zealand, the UK and the EU do not refuse residence because of HIV status itself. In a cost-testing country, treatment cost can still be assessed under the excessive demand rules. Several Gulf states do screen for HIV and hepatitis at the residence permit stage and refuse on that basis, including for sponsored dependants. If a Gulf move is on your list, check with that country's health authority before you accept an offer. A failed medical there ends the residence permit, whatever your contract says.
Answering an adverse opinion
Most systems let you respond before they refuse. How much that response can do differs.
Canada: the procedural fairness letter. If an officer thinks a family member would cause excessive demand, IRCC generally sends a letter with the assessment, the projected costs and the reasoning. You get a set period to respond. A strong response tackles two things. The medical facts: specialist evidence that the assumed care is wrong, or the condition is better controlled than the file suggests. And the cost: showing items would not really be publicly funded, or were counted twice. Some families also show they can and will privately fund what can lawfully be privately funded, with proof the money exists. That only works for services you can lawfully opt out of.
Australia: the health waiver. The waiver depends on the visa subclass. Some allow it. Some do not. That is fixed by the visa you apply for. Where it exists, the decision weighs cost against factors such as compassionate circumstances and your contribution. Two similar skilled routes can differ on this one point. Check the subclass page on the Home Affairs site, and have a registered migration agent confirm it.
New Zealand: the medical waiver. Available for some visa categories, assessed against published factors. As in Australia, the category decides whether the door exists.
A good response takes time and money, and the outcome is never certain. Families who succeed usually gathered evidence before the medical exam. Families who fail often sent arguments without new medical evidence. If you have already been refused, see what to do if your visa is refused.
What to gather before you start
Build this file before you pay for a skills assessment, a language test or any application fee. It may change which country you apply to.
- A written diagnosis and clinical summary from the treating specialist, in English or professionally translated, with dates.
- The actual care plan: medicines and doses, therapy frequency, specialist reviews, equipment and any planned surgery.
- A prognosis for the next five to ten years, because the test looks forward.
- What care has really cost over the last two or three years, with receipts or insurer statements.
- School support records for a child: any individual education plan, aide hours and therapy funded through school.
- Proof of funds, if you plan to argue private funding.
- A shortlist of destinations, with each one's health rule noted.
With this file, an adviser can tell you if you are near a threshold. A diagnosis name alone brings false panic and false comfort.
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Your child's condition is fixed. Your points move slowly. The threshold is set by a government. The country is the one thing you control.
Think of it like a door with a weight limit. If your bag is too heavy for one door, you do not repack forever. You walk to a door that has no scale.
Cost-testing versus non-cost-testing countries. Canada, Australia and New Zealand can refuse on projected public cost. The UK, Germany, Ireland and most of the EU do not run an equivalent test for skilled work routes. For a family with a high-cost condition, that difference matters more than any points strategy. The trade-off: UK, German and Irish routes usually need a job offer and a salary. Our guides to the UK Skilled Worker visa and to skilled visa routes without a job offer set out what each needs.
Waiver versus no-waiver subclasses. In Australia, your choice of subclass decides whether you get a second chance at all. If your family is borderline, treat waiver availability as a first-order choice, next to occupation eligibility and state nomination.
Temporary versus permanent. Health rules bite hardest at permanent residence, where a country takes on lifetime cost. Some families move first on a temporary employer-sponsored visa, build a work and treatment record, then apply for PR later. This can work, but it carries real risk. The later application faces the same test with the same family member. Go that way only with a plan for a PR refusal in year four.
One hard truth. The countries with the most generous public care for a high-needs child are often the most careful about who enters that care. A country that admits you easily may offer weaker care for your child's condition. Weigh both before you choose.
What it costs
Planning ranges. Confirm current fees with the issuing body.
| Item | Typical planning range | Notes |
|---|---|---|
| Immigration medical examination, per person | US$100 to US$500 | Set by the panel physician under their own schedule of charges; varies widely by country and by whether extra tests are ordered |
| Additional specialist reports and tests | US$200 to US$2,000 | Ordered when the examination flags something; paid by you |
| Specialist reports for a mitigation response | US$500 to US$3,000 | Detailed prognosis and cost-of-care letters from treating consultants |
| Immigration lawyer or registered adviser for a fairness response | US$1,500 to US$6,000 | Medical inadmissibility responses are specialist work and sit at the upper end of adviser fees |
| Reapplication or appeal fees | Varies by country | Confirm with IRCC, the Department of Home Affairs, Immigration New Zealand or the relevant tribunal |
The exam is cheap. The response is expensive, and it arrives after you have paid for everything else. That is why you check your exposure first.
How long it takes
The exam usually takes days, and for most applicants nothing more happens. A fuller review by a medical officer adds weeks or months. A procedural fairness letter usually gives you a few weeks to respond, and consultants rarely write letters on demand. If you know a condition is significant, ask for the letters now. An appeal or judicial review adds many months to more than a year.
When this does not work
Some cases have no good route on a given path. Knowing early saves years and money.
- A high-cost, lifelong, publicly funded condition, in a cost-testing country, on a subclass with no waiver. If the projected cost is well above the threshold, that route is closed. A better letter will not open it. A different country or subclass might.
- A Gulf move with a screened communicable disease in the household. Fitness screening there is largely yes or no. A job contract does not override it.
- A borderline case where you cannot afford a proper response. A weak response is close to none. Spend that money on a destination without the test instead.
- Hiding a diagnosis. This is the worst option. Medicals are designed to find significant conditions. A misrepresentation finding carries a multi-year bar in Canada and Australia. Disclose, then argue.
For some families, Canada and Australia are closed. Pushing at a closed door is the expensive mistake. A UK or Irish employer-sponsored route, a German skilled worker route, or a longer stay on temporary status may serve you far better.
Common mistakes
- Thinking the diagnosis decides it. Two people with the same diagnosis can land on opposite sides.
- Taking a threshold from a forum. Use the authority's dated page.
- Picking a subclass before checking waiver availability. In Australia this can remove your only second chance.
- Forgetting family members staying behind. Canada's exam rule can reach them.
- Answering a fairness letter with argument but no evidence. Sympathy alone does not move cases.
- Not disclosing. Misrepresentation is worse than inadmissibility.
- Ignoring care after arrival. Getting good treatment there is a separate question. See our family checklist for moving abroad.
- Paying an unregistered agent who promises a waiver.
Agents, promises and how to check
Frightened families attract bad actors. Nobody can guarantee a waiver or any outcome. Never pay into a personal bank account, and never pay to be introduced to a job offer.
Check registration first. Canadian consultants are regulated by the College of Immigration and Citizenship Consultants, and lawyers by their provincial law society. Australian agents are on the Office of the Migration Agents Registration Authority register. UK advisers are regulated by the Immigration Advice Authority or the legal regulators. New Zealand advisers are licensed by the Immigration Advisers Authority. Search the person's name on the regulator's own register.
Be wary of anyone offering medical reports from a doctor you have never met. A bought report turns a hard case into a misrepresentation case. Our guide to avoiding immigration scams covers the wider pattern.
Frequently asked questions
Can one family member's health really cause the whole family to be refused?
Yes. In Canada, Australia and New Zealand, every person in the application is assessed. An adverse finding on one dependant generally means refusal for all. A strong principal applicant does not offset it.
What is the current excessive demand threshold in Canada?
IRCC publishes it as a yearly figure over the assessment period and reindexes it. Since the 2018 change it has been in the region of the mid to high CA$20,000s per year. Use the dated figure on IRCC's medical inadmissibility page, not any article.
Does Australia allow a health waiver for skilled visas?
For some subclasses, not others. The subclass decides, not the condition. Check the Home Affairs subclass page before you commit, and have a registered migration agent confirm it.
Are children with autism automatically refused?
No. No diagnosis means automatic refusal. What counts is the projected cost of support over the assessment period, so support needs, therapy intensity and school help drive the outcome. Canada's 2018 change removed most special education costs from the calculation. Confirm current rules with IRCC.
Which countries do not run an excessive demand test?
The UK, Germany, Ireland and most of the EU do not apply this kind of cost test to skilled work routes. The UK requires a tuberculosis certificate from listed countries and charges the Immigration Health Surcharge. Germany and Ireland focus on health insurance. These routes usually need a job offer. Verify with UKVI, the German missions and the Irish immigration service.
Does private health insurance solve the problem?
Not on its own in a cost-testing country. Some public costs cannot be opted out of by buying insurance. Proof of private funding can help for certain cost items in a mitigation response. In Germany and Ireland, insurance is the actual requirement, so there it does solve it.
What to do next
You are not doing anything wrong by wanting a better life for your whole family, including the child who needs more. The goal is to find the door that opens for all of you.
Do three things in order. Build the medical file above, including prognosis and real cost history. Work out which destinations run a cost test and which do not. Then ask a licensed adviser in the one or two countries that pass that filter to read your actual file, before you spend on assessments, tests and fees.
Take the free eligibility check for a quick read on your options. If the honest answer is that Canada or Australia is closed on your current subclass and diagnosis, it is far better to learn that before the application fee than after the fairness letter.
