Meeting the Acceptable Standard of Health (ASH) 

If you receive a potentially prejudicial information (PPI) letter from your case officer stating that you may not meet the acceptable standard of health (ASH), do not accept this at face value and seek professional opinion.  
 
It is because the initial opinion from the Immigration New Zealand medical assessor may not be correct or in some cases, the assessor may not have applied the medical-related visa policy correctly. In this case, our firm engages with a consultant physician and/or specialist who will assess your case and may come up with a different assessment. We will present the case to your CO to identify the areas wherein the medical assessor has not applied the standard and policy correctly. With this justification, we will argue that the medical issues are not serious enough for your case officer to decline your visa application.

In some cases, your case officer will say “relatively high probability” to raise their concern with your medical situation. It means the possibility to pressure to the New Zealand hospital system with the costs and treatments to be more than 50% but below 100%. Therefore, our firm will engage with you to justify your case and not that it will not be in the range.

When you apply for a temporary visa, you must meet the acceptable standard of health (ASH).  But if the duration of the visa you’re seeking is short, your ASH will not be scrutinized as your case officer would usually do with your resident visa application.

For your temporary visa to be declined due to failing ASH, your case must require hospitalization, residential care, high-cost pharmaceuticals, and/or high-cost disability services during the term of the visa requested.  
When you are not meeting ASH for your residence visa application, you will need to apply for a medical waiver. Our firm can engage with you to prepare your medical waiver for you to meet ASH.

The list of health conditions not meeting ASH.

• HIV infection;
• Hepatitis B-surface antigen positive and meeting criteria for anti-viral treatment in New Zealand;
• Hepatitis C-RNA positive and meeting criteria for anti-viral treatment in New Zealand;
• Malignancies of organs, skin (such as melanoma) and hematopoietic tissue, including past history of, or currently under treatment.

Exceptions are:

• Treated minor skin malignancies;
• Malignancies where the interval since treatment is such that the probability of recurrence is greater than 10 percent.
• Requirement for organ transplants (with the exclusion of corneal grafts), or following organ transplant when immune suppression is required (with the exclusion of corneal grafts);
• Severe, chronic or progressive renal or hepatic disorders;
• Musculoskeletal diseases or disorders such as osteoarthritis with a high probability of surgery in the next five years;
• Severe, chronic or progressive neurological disorders, including but not exclusive to:
• Any dementia including Alzheimer’s disease;
• Poorly controlled epilepsy;
• Complex seizure disorder;
• Cerebrovascular disease;
• Cerebral palsy;
• Paraplegia, quadriplegia;
• Poliomyelitis;
• Parkinson’s disease;
• Motor neuron disease, Huntington’s disease, muscular dystrophy;
• Prion disease;
• Relapsing and/or progressive multiple sclerosis.
• Cardiac diseases, including but not exclusive to:
• Severe ischemic heart disease;
• Cardiomyopathy;
• Valve disease with a high probability of surgical and/or other procedural intervention in the next five years;
• An aortic aneurysm with a high probability of surgical and/or other procedural intervention in the next five years;
• Chronic respiratory disease, including but not exclusive to:
• Severe and/or progressive restrictive (including interstitial) lung disease;
• Severe and/or progressive obstructive lung disease;
• Cystic fibrosis;
• Significant or disabling hereditary disorders, including but not exclusive to:
• Hereditary anemias and coagulation disorders;
• Primary immune-deficiencies
• Gaucher’s disease
• Severe autoimmune disease which may require treatment in New Zealand with immune-suppressant medications other than Prednisone, Methotrexate, Azathioprine or Salazopyrine;
• Severe hearing loss or profound bilateral sensorineural hearing loss (71-90 decibels) after the best possible correction from country of origin, where significant support is required, including cochlear implants;
• Severe vision impairment with visual acuity of 6/36 or beyond after best possible correction at country of origin, or a loss restricting the field of vision to 15-20 degrees where significant support is required;
• Severe developmental disorders or severe cognitive impairments where significant support is required, including but not exclusive to:
• Physical disability;
• Intellectual disability;
• Autistic spectrum disorders;
• Brain injury;
• Major psychiatric illness and/or addiction including any psychiatric condition that has required hospitalization and/or where significant support is required;
• Those with a history, diagnostic findings or treatment for MDR-TB or XDR-TB, unless they have been cleared by a New Zealand Respiratory or Infectious Diseases specialist upon review of their file or review of the applicant according to the New Zealand Guidelines for Tuberculosis Treatment.
• If these medical conditions are evident (in most instances further reports from specialists are required to confirm this), then the applicant’s condition will be deemed to impose a significant cost and/or demand on the provision of New Zealand’s health services and therefore the individual will fail the requirement to demonstrate a satisfactory standard of health.

Other case with failed ASH:

• In the case of acute medical conditions, there is a relatively high probability that the condition or group of conditions will require health services costing more than NZD 41,000.00 within five years from the date the assessment is made; or
• In the case of chronic recurring medical conditions, over the predicted course of the condition or group of conditions, there is a relatively high probability that the condition or group of conditions will require health services costing more than NZD 41,000.00; or
• The Ministry of Education has determined that there is a relatively high probability that the applicant’s physical, intellectual, sensory, or behavioral condition or group of conditions would entitle them to Ongoing and Reviewable Resourcing Schemes (ORRS) funding; or
• There is a relatively high probability that the applicant’s medical condition or group of conditions will require health services for which the current demand in New Zealand is not being met (irrespective of actual service costs).

 
In most instances where an individual doesn’t meet the ASH, this does not necessarily mean the individual will not qualify for the grant of a residence visa.

Medical Waivers – Residence Class Visas
Your case officer (CO) will not decline your application without providing you with an opportunity to respond to their request for further information. Your CO may take into account in their decision to grant a medical waiver, including (but are not limited to) the following:
The objectives of health requirements policy and the objectives of the policy or category under which the application has been made;

• The degree to which the applicant would impose significant costs and/or demands on New Zealand’s health or education services;
• Whether the applicant has immediate family lawfully and permanently resident in New Zealand and the circumstances and duration of that residence;
• Whether the applicant’s potential contribution to New Zealand will be significant;
• the length of intended stay (including whether a person proposes to enter New zealand permanently or temporarily).

Our firm can engage with you to apply for a medical waiver for your case engaging with you, a medical consultant and your CO.

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Examples of medical waiver cases Immigration Trust dealt with

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