Spouse visa migration with a kidney transplant.

[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:

[CollegeGirl]

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).

 

It's $35,000 over the first five years. I don't have your same medical condition, but I do have some, and we're concerned we're going to have to go through the waiver process as well. So I've read everything I can get my hands on here and on other forums. The problem is there seems to be precious little information out there on exactly why some "A" graded medicals get referred, on how they determine who will be offered a waiver and who won't (man, if I fail AND we don't get offered a waiver or the waiver isn't granted, I have no idea what we'll do), how exactly they calculate risk and costs, etc. It's all very shrouded in mystery. Sigh.

Edited August 3, 2013 by CollegeGirl

[Quinkla]

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 think (but happy to be corrected) that the waiver comes without conditions. You fail the health requirement, your CO applies for a waiver, and if granted, the CO is allowed to disregard the fact that you failed the health requirement in assessing your visa - hence you just get the same visa as anyone else. You can make promises that you would get private health cover or pay costs of treatment or live a super-virtuous life but there is no way to enforce these kinds of promises. 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. This may be out of date now. And, of course, that figure represents the average cost for someone in your position.

[Franks]

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

[Franks]

I don't have your same medical condition, but I do have some, and we're concerned we're going to have to go through the waiver process as well. ... (man, if I fail AND we don't get offered a waiver or the waiver isn't granted, I have no idea what we'll do).

 

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:

[CollegeGirl]

I'm sure I'm right in this particular instance. I've followed this very closely. It was just last year that the Significant Cost Threshold was raised from $21,000 over 5 years to $35,000 over five years. Google "significant cost threshold" and Australia (and make sure you're only looking at articles from the last year since it changed on 1 July 2012) and you'll see many more. Here's an example.

[CollegeGirl]

I have to say - I really, really wish Quinkla was right. It'd be much easier to meet the criteria.

[CollegeGirl]

And here we go - always better to see it on a government site. Here we go: the 2012-13 Budget Measures Report.

 

Relevant section of that page:

 

 

The Government will reform the health criteria that applicants must meet to obtain an Australian visa, at a cost of $4.6 million over four years.Under current arrangements, visa applicants are refused entry to Australia where the estimated costs of treating a pre‑existing health condition are above the Significant Cost Threshold set at $21,000.

 

The reform will increase the Significant Cost Threshold from $21,000 to $35,000 to better reflect current health costs, and remove the requirement for offshore Humanitaritan Visa applicants to meet the Significant Cost Threshold criteria. This reform will commence on 1 July 2012.

 

These reforms are in response to the report of the Joint Standing Committee on Migration on the Migration Treatment of Disability: Enabling Australia.

 

 

[Quinkla]

I have to say - I really, really wish Quinkla was right. It'd be much easier to meet the criteria.

 

The figure I put forward was not the figure for meeting the health requirement - it was the figure at which I had understood (perhaps incorrectly) that it became tricky even to get a waiver of the health requirement.

[CollegeGirl]

The figure I put forward was not the figure for meeting the health requirement - it was the figure at which I had understood (perhaps incorrectly) that it became tricky even to get a waiver of the health requirement.

 

Oh, I see. That makes more sense. Man. My kingdom for a magical calculator to show me what DIAC is going to come back with for me.

[Quinkla]

Here's some material on health waivers from a third party website - hence cannot vouch for its veracity: http://www.hwimmigrationlawyers.com/health-waiver/

 

Looking at this, I wonder whether I might have had a waiver applied in my case and just not known it.

[Franks]

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

Edited May 15, 2014 by Franks
I was tired when I wrote it.

[Franks]

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:

[Gbye grey sky]

Congratulations on this and all the best for your new life in Oz. Excellent thread.

[Rupert]

Congratulations to you.

[Quinkla]

Very pleased to hear this - and well done for keeping a cool head and seeing it through.

[Franks]

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!

[Franks]

Many thanks

[Pampa]

Hello Franks!

 

Congratulations for your success. It was a really hard road!

 

I am writing to tell you (and anyone that could help) my current situation:

 

I am a 28 year old american citizen (US), Bachelor of Environmental Sciences. My girlfriend is also 28 years old, she is italian and a Chemist (Bachelor also).

We are both planning to move to Australia with a work and holiday visa to start.

 

I have a kidney transplant, got it 3 years ago, never been rejected nor had any problems. The cause of my kidney failure was Lupic Nephritis (my Lupus is in remission since my kidneys failed = 5 years ago), and I have been almost two years in dialisys.

 

Today, and so since I had received my kidney, I am really healthy, just attending a nephrologist consultation and having blood and urine tests once every two months. In addition, I am taking anti-rejection medication.

 

Firstly I'd like to ask you, how do you manage your medication supplies and costs? Are you still being supplied from the UK or does your waiver covers medication costs and you get supplied in OZ? Do you have information on costs (I'll have to pay for everything without coverage)?

 

Regarding medical post-transplant follow up, I am having a hard time finding a recommended nephrologist...so the second question to ask you is how are you going to manage you regular medical control (Consult and blood/urine tests)? Do you have a recommended nephorologist and hospital in OZ? if positive, in which city?

 

Finally, I want to tell that our idea is to stay in OZ after our WHVs are over. After reading your whole story about the health waiver, I didn't understand if you are going with a job contract and therefore your waiver is soponsored by a company or if the waiver is sponsored by Australian Government. If the last one is the case, is the fact that your wife is Australian important to this matter?

 

I am not going to apply to a visa to stay longer yet, but I know that if I did, I would most likely not pass health requirements and would have to go for the waiver. I really do not to know where to begin with this.

 

I hope you can give me some advice (or anyone reading), any comment will help.

The resolution of your situation gives us a lot of hope!

 

With kind regards,

 

P

[Quinkla]

Franks is on a partner visa - therefore the health waiver comes with no conditions and he has full access to medical facilities in Australia just like citizens and permanent residents.

 

If you are looking for a non-family visa, you are only going to get a health waiver if you are looking at temporary skilled visas and the employer undertakes to cover all medical costs. Here's the list of visas for which health waivers are available: https://www.immi.gov.au/allforms/health-requirements/health-waiver-provision.htm

 

The work and holiday visa is not on the list and also has a health requirement. You might want to seek out a free initial assessment from a migration agent to see whether you have a realistic chance of success.

[Pampa]

Franks is on a partner visa - therefore the health waiver comes with no conditions and he has full access to medical facilities in Australia just like citizens and permanent residents.

 

If you are looking for a non-family visa, you are only going to get a health waiver if you are looking at temporary skilled visas and the employer undertakes to cover all medical costs. Here's the list of visas for which health waivers are available: https://www.immi.gov.au/allforms/health-requirements/health-waiver-provision.htm

 

The work and holiday visa is not on the list and also has a health requirement. You might want to seek out a free initial assessment from a migration agent to see whether you have a realistic chance of success.

 

Hi Quinkla,

 

Thank you very much for your response.

I am already up to date with the information you are providing me.

 

I know that work and holidays visa has a health requirement and that it has no medical benefits and so I'll have to cover full expenses by myself.

Because of this, I was wondering if Franks or anybody else could provide me information about anti-rejection meds, medical consultation and lab tests (urine/blood) costs beyond Medicare.

 

Regarding waiver, so I understand that the only way is having a work contract and, at the time to apply for the temporary skilled visa and the waiver, discuss with the employer the chances of "sponsoring" it.

 

Regards!

[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

[wrussell]

If, and only if, the waiver is rejected would it be worth considering engaging a medical lawyer for an appeal.

 

How many adverse health assessments have you handled and what were the outcomes?

[Pumpkin]

How many adverse health assessments have you handled and what were the outcomes?

 

Who are you quoting?

[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