Franks

Hi Prehoney. Sorry to hear your news re the health waiver being rejected. In answer to your question - my application was to live in Australia permanently (on a spouse visa). The quote you included is exactly the same as the one I had on my initial visa application - "Granting a visa for the above applicant would prejudice the access ..."etc. I think that you could be right when you mention that because you have no family connections in Australia, that it could be one of the issues that has prevented you from having the health waiver granted. In my case I 1) Am married to an Australian Citizen ..2)Provided supporting documents from my wife's relatives that basically said that they would financially support me should my transplant fail and I needed expensive care 3) Provided evidence of my own financial situation - namely a house that I own in the UK, that I stated would be sold to cover medical expenses if it came to that. Having been fortunate enough to not get to this stage, I'm not sure of your best course of action, but you could certainly talk to some agents and pick their brains/get a feel about if they know of a course of action for you to take. We found that most agents will give you some time for free as an initial consultation. Sometimes by email, sometimes on the phone. However if you are looking at engaging one, be sat down when they tell you their fees. I sincerely wish you the best of luck wherever your path takes you. Just remember, sometimes you don't get what you want but you might just get what you need. Good luck!:smile:

Hi Pampa Like I said, I'm not an expert, but I think it's correct to assume that you will be paying the full costs without expecting any of it back. The renal consultation visit was (struggling to recall as it was 2012) approximately $150 (Australian dollars). That included blood and urine check. I never needed any follow up tests as all my results were fine, of course, extra tests mean extra costs. In terms of the PBS site - it gives you the FULL COST of items as well as the subsidised costs, so should give you an idea of what you might have to pay for your meds. Hope this helps, good luck. Franks

Pampla, To be clear, the health waiver has nothing to do with costs for medication or care. It simply means that failing the health requirement for a visa can be ignored and the visa can be granted (should the decision go in your favour). See a previous post I made regarding the types of information you will need to provide. I will have to pay for all clinic appointments/ nephrologist appointments, blood tests/urine tests as well as all prescribed meds that I need. In my case, some of the cost will be subsidised (for appointments AND prescriptions) but there will still be a fair amount to be paid. You can try this: http://www.pbs.gov.au/pbs/home as a place to look for your particular meds and see how much yours may be. I don't think the USA has a subsidy agreement, so you may be looking at the full price for your meds, but don't take my word for it as I am NOT an expert in this matter. Good luck, hope it all turns out well for you and your partner. Franks

Hi Pampa, To find a nephrologist I booked an initial appointment with a local GP and he then referred me onto one. The nephrologist I went to had to phone for permission to prescribe the anti-rejection meds as they are very expensive and need government approval to be prescribed - it took quite a long and difficult phone call for this to happen as there is concern about people having them prescribed and then selling them on the side. The nephrologist monitored my blood tests and kidney function without the need to visit a hospital. In terms of costs, I'm sorry but I can't remember the exact figures. I was also on a medicare card (possibly due to a reciprocal arrangement between the Australian govt and the UK govt), which meant that part of the cost of my consultations and prescriptions was subsidised. You pay the full amount for consultant visits, blood tests etc up front and then get part of it reimbursed, or some clinics may just ask you to pay the difference (i.e. the amount that the reimbursement won't cover), it's dependent on the clinic and consultant. I'm not going to Australia with a job offer, the visa I am on is a Spouse Visa. The fact that my wife is Australian is crucial to this as she has had to be my sponsor, also having Australian family members who have written letters of support (including financial support if it's needed to cover my medical costs) has been influential in the outcome. There is a very limited list for the visas where a health waiver can be implemented, I agree with Quinkla that you should use any available free consultations with experts to see what your chances are. We spoke with about 4 visa agencies before starting the process but our path was far more clearly defined as the Spouse Visa is one where the health waiver can be implemented. Unless things have changed, you will very likely fail the health requirement (as I did) simply for the fact that your medication will cost so much that it will take you over the threshold for an acceptable level (in the eyes of the immigration dept). I was previously granted a visa for a 6 month stay but this was as a tourist and did not allow me to work. It will depend completely on the type of visa you are applying for and IF there is a possibility of the health waiver being applied to that visa. I don't want to sound like I'm saying that there is no chance for you, just to be fully prepared for what's likely. Best wishes for the future and good luck! Franks

Many thanks

Hi again Quinkla, Thank you very much. And thanks again for the good advice and pointers you gave us earlier in the process. In terms of what the waiver means - you were completely right - the visa has been granted with no conditions etc, just the health requirement is waived and the visa granted as normal. Can't wait to get packing now!

Such a relief and such exciting plans to make. Official notice of the visa being granted today! We hope that this post might just give someone some hope if they are facing the health requirement in a similar situation to myself. I have a 6 year old, well established kidney transplant. It is healthy and has never shown any sign of rejection. I failed the health requirement due to expected financial costs and with the support of my in-laws in Australia, my family here in the UK and of course, the ever present support of my fantastic wife - we have had the spouse visa granted (health waiver applied in our case). We did this on our own using common sense, honesty and lots of information from specialists, no immigration agents were used. To end this I'd just like to wish anyone hoping to move to Australia all the very best of luck, especially if you are facing a medical battle. Keep positive (it will be hard) and just put your case forward as strongly as you can. Best wishes and best of luck to all of you out there. Franks and wife :biggrin:

Hello all. Time for a long overdue update. We were informed in March 2014 that I have failed the health requirement as expected. In more detail - to quote the decision: "Likely cost to the Australian Community In my opinion, the estimated cost to the Australian community of the services identified in the 884 is likely to be: Medical services $15,086 Pharmaceuticals $199,690 Total Cost $214,776 Likely Prejudice to Access In my opinion, granting a visa to the above applicant for the assessed period of stay would not be likely to prejudice the access of an Australian citizen or permanent resident to health care or community services." I took from this the good news that no prejudice to access has been identified. I think that this would be a lot harder to fight and would take far more time for the application for the health waiver to be processed. The costs are projected over the next 19 years (I requested and was provided with a breakdown of how the costs figure was arrived at). We have applied for the health waiver. To do this, you have to respond to the following points: "You are invited to provide further information in order to consider a health waiver. It is important that you supply as much relevant information as possible. Please provide written comment, and/or evidence where possible on the following where appropriate:  The English language skills of all applicants;  Qualifications and work history of you, your sponsoring spouse and any other relevant adults;  Current employment or employment prospects for all relevant adults (including the sponsor). Any claims should be supported by documents such as most recent annual income advice or payslips where possible;  Assets and other income of all relevant adults (including home ownership; other property, investments, social security payments from overseas government, private superannuation etc);  Any skills or contributions you may contribute to the community;  Whether there are Australian children who would be adversely affected by a decision not to waive the need to meet the health requirement;  The location and circumstance of your family members and your sponsor’s family members;  The willingness and ability of a sponsor, family member or other person or body to provide care and support;  What care arrangements are in place or what are the proposed care arrangements;  Information regarding non-migrating applicants, including what arrangements have been put in place for their care, and what is the likelihood of them ultimately applying to migrate to Australia;  Any factors preventing your sponsor from joining you in your own country, or in another country;  Any other compassionate and compelling circumstances which you consider relevant;  Where prejudice to access has been identified, how this can be mitigated. For example if it relates to: o An organ transplant: o Fresh blood or products o Radiotherapy for malignancy  is there a donor identified and what are the details? Is a potential donor on any donor exchange programmes? Is the applicant transplant list eligible?  Are there registered organ donors in the family with a history of donation? Are there members who have an uncommon blood group that donate? What is the history of the applicant’s requirement for these products?  Is there a shortage at the location where radiotherapy is intended? Are there any private arrangements available that mitigate this?" Word of advice here, we responded to all these points via email, attaching several letters and documents. We waited and didn't hear anything for 2 weeks. Normally our CO has been very good at replying to emails and confirming receipt of information quickly. I contacted the CO and she said that she had not received the email. DIAC can only accept emails up to 5mb in size and our application was larger with the attachments. Resending the information in several emails, the application has now been made for the waiver. We have been advised that it will take a couple of weeks to hear back. Again, I think that this time has been drastically reduced as there has been no prejudice to access identified and apparently, my projected costs are relatively low for a 19 year forecast. Here is some further information that was very useful in the waiver application preparation process. I found this information on another forum. I claim no authorship, ownership to the following information. I also do not claim to have any idea as to it's accuracy. Here's what we found: "Health waiver applications are complicated and the processing time is lengthy. The length of time for the DIAC to consider your waiver request depends on how and why you failed the health requirements, as per the Medical Officer of the Commonwealth's opinion. We need to understand the basis of their refusal. Essentially there are two limbs to the health test (two main ways you can fail, aside from infectious diseases like TB or public health risks): 1. Significant cost (i.e. the estimated cost of treating your health condition is $35,000+. Examples include HIV/AIDS, disability); or 2. Prejudice to access (i.e. if you were to access treatment for your medical condition it would prejudice the access to the treatment of Australian citizens/permanent residents. Example includes kidney/dialysis). There are health waivers available for the employer sponsored visas, humanitarian visas and partner visas only. All other visas have the strict health requirement - if you fail, there is no waiver. As I mentioned, health waiver applications are complex and require lots of work. You are trying to prove that despite failing the health requirements, you are nevertheless a benefit to Australia and the country/people here would be detrimentally impacted should you be required to leave. This is broad discretion for the DIAC to consider how you might benefit Australia so the health waiver response should be a detailed response, with supporting evidence, on a number of topics. Regarding processing times, these must be understood in the context of how the DIAC process health waiver applications and the internal steps involved, particularly consideration by a number of stakeholders and levels of hierarchy within DIAC: 1. Case officer considers health waiver and makes recommendation; 2. If costing is $500,000+ or prejudice to access issues are involved, the case is referred to Health Policy (aka Global Health) in Sydney for a recommendation. If it is a skilled visa, the view of the State/Territory government will also be sought. 3. The case is sent back to an Executive Level officer within the DIAC (usually a Manager) for a recommendation 4. The case officer makes a decision to grant or refuse the visa. These steps can take excess of 6-12 months and there is no published processing time. I deal with a number of complex health cases mainly involving HIV positive clients with very high costings, and some examples of processing times: 1. Subclass 820 Partner visa lodged March 2011, health waiver submissions/supporting docs provided Feb 2013, visa granted Oct 2013. 2. Subclass 856 ENS lodged Sep 2011 health waiver submissions/supporting docs provided 4 May 2012 , visa granted 2 May 2013 3. Subclass 820 Partner visa lodged December 2010, health waiver sent April 2012 - visa granted late July 2012 I recently discussed health waivers with one of my favourite case officers at ENS in Melbourne and she advised that "applicants should expect their case to be referred for a recommendation generally within 6 months of their health waiver submission being received." Generally, you will not know what stage the health waiver submission is at - i.e. the case officer cannot expedite the matter after it has left their hands. Health Policy and the State governments can take many months to make their recommendation and there is nothing the case officer can do, so don't bug them repetitively. In addition, the case officer will not make a separate decision on health - you will likely just receive the visa grant (or refusal). If other people reading this are required to go through the health waiver process, be ready for a long fight. You will need to prepare lots of detailed documentation for the health waiver - my applications involve even more documentation than a typical first stage partner visa, supporting statements, and a submission. Like complex character matters, health is a legally and factually interesting area of the law which may be reformed in the next couple of years... so in the future the approach may change. However if you are going through the process now - good luck. Hang in there, it will be a long and time consuming process." A lot of this was not relevant to my application but my wife and I found it interesting to have the process explained so thoroughly. Also of interest was the following post regarding how the waiver application might be considered: " Quote: Factors afforded weight under policy Under policy, s65 delegates should put substantial weight on the fact that a failure to exercise the PIC 4007(2) waiver would: • negatively impact on Australian citizen children (particularly those children of the relationship if a Partner visa has been applied for or those children who are already residing in Australia) or • result in immediate family members living apart. Significant weight should also be given to the following factors: • if an Australian citizen sponsor were forced to relocate it would negatively impact on their health • the applicant and/or other working family members have occupational skills in high demand • the applicant and/or other family members have substantial assets or an ability to mitigate the costs/prejudice to access involved (for example, due to private care arrangements and/or support being available*) • an Australia citizen sponsor would not be able to migrate to the applicant’s home country (for example, because same sex migration is not available) or • the applicant has significant family links in Australia. * Any available private care cannot, however, be at a level that the Australian community would find unacceptable. No person requiring care in Australia should be expected to accept a lesser standard of food, accommodation, work environment or social interaction than that which would be expected to be available to Australian residents. Other factors to be taken into account Section 65 delegates must consider all relevant circumstances. In the case of waivers for non-humanitarian visas, such circumstances are likely to vary widely and may include: • significant support from family or community groups • the potential contribution of the visa applicant and their family to Australia including skills, qualifications, English language capacity and employment prospects that may assist the applicant and any dependants once in Australia • any other compelling or compassionate factors including the location and circumstances of the applicant and/or sponsor’s family members • the immigration history of the applicant (and sponsor/proposer where applicable), including, for example, compliance to date with immigration requirements and any undertakings and • any other relevant factors. In the alternative, factors that would add weight to a waiver not being exercised include: • the applicant, sponsor and their immediate family can reside in a 3rd country with no particular hardship (for example, they have another citizenship or they have been residing in another country for a significant period) • a lack of family links to Australia or • a lack of ties to Australia more generally (for example, if the applicant and sponsor have been absent from Australia for a significant period of time/majority of their life, and there is no reason why they cannot continue to reside in their current location)." We went through the list, ticked off which parts we felt apply to us and are optimistic about the outcome. I will update this post when we have a final decision. In the meantime I've started to get estimates for shipping costs, flights etc without letting my excitement carry me away. Our fingers are crossed hard and we hope to get some good news soon. Best wishes to everyone and thank you for reading. We hope that this post will be of help to anyone else in our position. - See more at: http://www.pomsinoz.com/forum/newreply.php?do=postreply&t=191111#sthash.iSGyj8RD.dpuf

Good luck, I hope it all comes through for you without having to apply for a waiver. In any event, please feel free to come back and let us know how it's going. And as for the last part of what I quoted - that's exactly how i feel (although I can take off the 'if i fail' part)! Stay positive, she'll be right :smile:

The previous 2 posts (By CollegeGirl and Quinkla) only go to reinforce the confusion and mystery surrounding this whole area. CollegeGirl says '$35,000 over 5 years', Quinkla says 'I understood (a few years ago) that waivers started to get difficult once the expected cost of treatment over a five year period exceeded $100,000.' Maybe belts have been tightened recently, has the threshold moved? We just can't know. Please don't get me wrong. I'm very happy to have people contributing to this discussion. Indeed Quinkla has already given me good advice about the specialist report and areas to make sure that it covers. It only goes to show though, that it's a very difficult area to be certain (or at least, feel well informed) about. Because each case applying for the health waiver will be judged individually I suppose that there's no hard and fast rules for any of us. When I have time I will sit down with my list of meds and work out what the cost will be for 5 years. I will need to add onto that some checkups (currently I'm seen on the NHS once every 3 months). Then I suppose there's the possibility of an expensive procedure, which I may have to try and work out based on the specialist report. Hmmmm,, time to get my geek on :GEEK: Will be back with some figures, I just can't say when! Franks

For sure Quinkla. All aspects of 'I'm not going to be a burden' will need to be covered. I've been wondering if they could stipulate that I wouldn't be eligible to go on a waiting list should I need a future transplant. Or that I would have to cover the cost of any dialysis in the event of transplant failure. Perhaps the waiver may simply say that I have to have insurance to cover the eventuality of problems with my transplant. I really don't know. Which is kind of the point of keeping this post on the forum. So that should someone be in the same situation as me, at least there's a record of what my experience has been. Hopefully it will end up giving someone else with a transplant reason to be optimistic (as well as realistic) about moving to Australia. :ssign19:

Totally right CollegeGirl. B rating just is a flagging system for the DIAC to be aware that there is a medical condition to check. It doesn't mean you will fail your health requirement. In most cases, you won't. No need to correct you This is what the migration booklet tells you about what might cause you to fail the Health Requirement: "Health conditions that may lead to your application being refused include: • tuberculosis; • other conditions where you are assessed by Australian authorities as requiring treatment, support or assistance that are considered to be in short supply, or that have a high cost." The last part seems pretty self explanatory. The grey area is where 'high cost' is calculated. Someone advised me that it was in the area of $25,000 to $30,000 for the first 3 years. This is the kind of money I'd be costing for all my meds (at non subsidised price).

Indeed that's exactly the case. Unfortunately simply the cost of my meds could be enough for them to consider me 'too expensive' without even considering the chance of any future treatment needed. My anti-rejection tablets are hugely expensive, add to that the cocktail of other tablets I have to take to combat side-effects and other complications, not least of which is (Chemically induced) Diabetes brought on by the anti-rejection medication (and steroids) being toxic to the pancreas. This is probably why renal conditions are specifically listed, although of course, my entire medication regime is far cheaper than dialysis (which I had to be on for 4 1/2 years). But this puts me into a very expensive category in the eyes of the DIAC. My hope is that they grant the health waiver and don't attach too many unreasonable conditions to it. My transplant is very healthy and has never shown signs of rejection - this will work in my favour as will the fact that I'm able to work and currently working (and paying tax) - I just hope that there are enough reasons for them to grant the waiver when they come to weigh everything up.

Thanks Snifter, good advice. I think the thing that concerns me most is that Renal Conditions are specifically listed in the health requirements literature (as conditions that will definitely lead you to fail) so unless there are others out there who have emigrated after a kidney transplant, I'm not sure how relevant their experiences will be to me, apart from in the very general sense of negotiating the waiver process. I'll trawl the forums when I have more time and see what there is to be learned - plenty I'm sure!. Thanks for taking the time to post and I'm glad that everything ended up positively for yourself.

Hi Quinkla, Yes indeed, I've gone into this whole process with that piece of information at the forefront of my mind. What you have said about how the decision is made is very useful as I can now ask my Renal Consultant to prepare her report from a viewpoint of the likelihood of needing any costly procedures over the next 5 years. Very useful, thank you very much!