Medical exam requirements and working abroad: What to expect

15 February 2023
Preparing employees for an assignment abroad is essential for their success. In addition to providing cultural training and information about visas, taxes and housing, your company’s global mobility policy should warn them about another matter: medical exams.

Not all countries require a medical exam for a work visa. In the US, for example, an exam is rarely necessary unless the employee is also applying for permanent residency. But many countries screen foreign workers for contagious diseases such as tuberculosis, and others require a full medical exam, which may be undertaken in the home country or the target country, depending on target-country rules.

Countries can change their rules quickly in response to health conditions within their own borders or abroad. For example, in December 2022, Japan introduced a mandatory Covid test for all visitors travelling from China, including foreign workers. While this rule is still in effect, many other countries have eliminated their Covid-related restrictions.

Best practices

Depending on the host country, target country and other factors, understanding and following medical exam requirements is not always a straightforward task. In addition to the employee, spouses and children may also need exams. Information may be hard to find or unclear, and government websites may link to vital details that aren’t published in the employer’s home-country language.

Many companies consider it best practice to have employees and their families obtain an exam before they go on assignment, regardless of whether the host country requires one. It’s a good idea to be aware of any conditions that may require special treatment or medications. That said, it’s important to realize that most home country exams are not accepted in target countries — unless they are performed by an approved clinician with the right paperwork.

Employers should provide an explanation of medical tests and covered expenses in their global mobility policies. Because rules are shifting and complicated, the safest course is to obtain information from a third-party company familiar with target-country requirements.

Medical exam requirements around the world are another instance of what is sometimes called regulatory divergence, or how individual jurisdictions have regulations that are unique, consistently changing and often very different from those even in neighbouring countries. It is therefore all but impossible to collect and maintain an up-to-date list of major countries’ exam requirements in a brief article. It is, however, useful to look at some country-specific requirements; they provide real-life examples of the kinds of issues and situations an employer should be aware of when conducting due diligence prior to sending an expat on assignment. As in virtually all facets of cross-border expansion and global operations, it’s best to conduct due diligence as far in advance of planned activities as possible to lower risk. Let’s now take a look at those country-specific examples.

China: Try to arrange a target-country test

China requires foreign workers to obtain a medical exam performed either by an approved doctor in the home country or in China as soon as possible after arrival. The exam includes blood tests, X-rays, an electrocardiogram, and an abdominal ultrasound scan, as well as standard check-up procedures such as height and weight measurements, and a blood pressure test.

Arranging for an exam in the home country can be difficult. Tests are expensive, and some employees report having to go to appointments at multiple locations.

The easier path may be to have employees arrange an exam in China at a hospital or clinic approved for testing foreign workers. Large cities have many such facilities, but employees stationed in rural areas may need to travel.

Japan: Country of origin matters

In Japan, employees must complete a Certificate of Eligibility to obtain a work visa. While the form is mostly standard, medical requirements vary by country of origin. For many jurisdictions, including the US, no medical tests are required, but workers from countries with a high incidence of tuberculosis are required to undergo screening for the disease.

As mentioned above, at the time of publication, travellers from China need Covid testing. They must submit results of a negative test taken within 72 hours before departure, then pass another Covid test on arrival.

The UK: Screening for serious and communicable diseases

Workers and their family members who plan to stay in the UK for more than six months need a medical exam from an approved provider, either in the home country or in the UK.

The UK government publishes an online application form detailing exam requirements. It tests for transmissible diseases such as tuberculosis, venereal disease and other conditions “which might endanger the health of persons in the United Kingdom or require major medical treatment,” as well as conditions that could interfere with applicants’ ability to support themselves and any dependents. The form also asks providers to note the presence of mental illness or other abnormalities discovered during the exam.

As with Japan, tuberculosis screening is required for visa applicants from countries where the disease is prevalent. At the time of publication, UK officials are expanding this screening, which will eventually apply to 82 countries. Workers should carry their original medical certificate and chest X-rays in their carry-on luggage and present it to an immigration officer on arrival.

Canada: Location and job profile

Workers planning to stay in Canada for more than six months may need a medical exam, depending on where they’re coming from and the nature of their job. Exams are required for workers who have lived in specified jurisdictions for six consecutive months within the past year, or for those who work in settings that require close contact with the public.

The exam is a standard physical, but depending on their age, workers may also be asked to undergo a chest X-Ray and laboratory tests.

Some countries with fewer requirements

Many European countries have comparatively lax requirements, though it’s important to check the particulars. For example, the Netherlands requires a tuberculosis test, while Germany and Ireland require no medical tests but workers must provide proof of insurance.

India also has no medical requirements. In the US, workers who are not seeking emigration generally are not required to obtain a medical exam; however, customs and border protection officials can require one on the spot if they suspect there may be a public health concern.

Keeping up

For employers arranging expat assignments, medical exams are just one small piece in the large, complex puzzle of cross-border regulatory compliance. But neglecting that piece could mean delaying operations or working without key employees. Before sending staff abroad, it pays to learn the requirements of the target country and document them. To lower risk, work with a third-party provider with proven in-country expertise.

This is an updated version of a previously published article.