From early 2025, the Ministry of Manpower (MOM) has substantially tightened the medical review of Employment Pass (EP) In-Principle Approval (IPA). This is not a published policy change. It is an operational tightening by MOM, under the Employment of Foreign Manpower Act (EFMA), of how it interprets the Medical Examination Report (MOR).
Multiple licensed employment agencies report, from internal case data, that EP applicants aged over 40 or with a declared chronic condition are now about 40% more likely to be referred to the Institute of Employment & Employability (ICC) for a formal work-fitness assessment than in 2023.
The consequence is clear. If the ICC determines that an applicant is medically unfit for the designated role, the IPA can be revoked at once — even if the employer has passed COMPASS and met the EP salary requirement.
For any EP application involving health, three things are now mandatory pre-application work: understanding the ICC review process, the specific medical parameters MOM applies, and the most common rejection conditions.
ICC referral mechanism: triggers and timeline
MOM does not publish the specific thresholds for ICC referral. The trigger is always the medical report submitted with the EP application. The report must come from a MOM-approved local clinic. If the examining doctor flags any condition that may affect the applicant’s ability to perform the job, the MOM system routes the case to the ICC automatically.
The ICC is an assessment unit within MOM, not an independent medical board. Its role is to decide whether the applicant is medically fit for the target role. The assessment is role-specific — a condition that disqualifies a construction worker may be acceptable for a software engineer.
Three categories of medical findings that trigger referral
Under the Infectious Diseases Act (IDA), Chapter 137, the following three categories are mandatory referrals:
- Infectious diseases: active tuberculosis; HIV infection with a CD4 count below 200; untreated syphilis or leprosy.
- Chronic conditions with functional impairment: uncontrolled diabetes with neuropathy; end-stage renal disease requiring dialysis; severe hypertension with target-organ damage; or any condition requiring continuous hospitalisation.
- Mental illness: schizophrenia, bipolar disorder or major depressive disorder with a hospitalisation record or a record of medication non-adherence in the past 12 months.
Referral timeline
An ICC referral adds 4 to 8 weeks to the EP application process. The timeline is non-negotiable. MOM will not expedite ICC review for urgent hiring.
- Weeks 1-2: MOM sends the referral notice to the employer and the designated medical clinic. The applicant must attend a supplementary medical examination at an ICC-appointed panel clinic.
- Weeks 3-4: The panel clinic submits the supplementary report to the ICC. The ICC may request additional specialist reports.
- Weeks 5-8: The ICC issues its work-fitness determination.
If the ICC requires a specialist report, the timeline extends by 2 to 4 weeks. The employer bears the cost of all supplementary tests and specialist consultations.
Medical Examination Report (MOR) core parameters: the four dimensions MOM actually reviews
The MOR is a standardised form completed by the examining doctor. It covers four dimensions: physical examination, laboratory tests, chest X-ray and medical history. Each dimension has specific parameters that MOM uses to make a pass/fail determination.
Physical examination thresholds that trigger referral
The doctor must record blood pressure, body mass index (BMI) and a general physical assessment. The following thresholds trigger ICC referral:
- Blood pressure: systolic ≥160 mmHg or diastolic ≥100 mmHg in two independent readings.
- BMI: ≥35 kg/m².
- Physical deformity: any condition limiting mobility, such as amputation, paralysis or severe arthritis.
These thresholds are not absolute rejection criteria. The ICC considers the nature of the role. A sedentary software engineer with a BMI of 36 and no other condition may still pass. The same BMI for a site supervisor would likely lead to rejection.
Laboratory tests and chest X-ray
The MOR requires the following laboratory tests:
- HIV serology: a positive result triggers ICC referral. MOM does not automatically reject HIV-positive applicants. The ICC assesses CD4 count, viral load and treatment adherence. A CD4 count below 200, or a detectable viral load despite treatment, leads to rejection.
- Syphilis serology: a positive result requires treatment records. The ICC accepts a certificate of cure issued by a registered infectious-disease specialist.
- Chest X-ray: any abnormality suggesting active tuberculosis — such as cavitation, infiltration or pleural effusion — triggers immediate referral. Healed, non-active granulomas are generally acceptable.
Medical history disclosure requirements
Applicants must disclose all past medical history. Under the EFMA, non-disclosure is a standalone offence. If MOM finds an undeclared condition, the EP application is rejected and the applicant may be barred from reapplying for two years.
Common conditions requiring disclosure include:
- Diabetes
- Hypertension
- Asthma
- Epilepsy
- Mental health disorders
- Cancer (any type, including in remission)
- History of organ transplant
The ICC will request medical records for any disclosed condition. The applicant must provide them within 14 days of the request. Failure to do so results in automatic rejection.
Common rejection conditions: ICC’s actual determinations
The ICC’s rejection criteria are not published in a single document. But based on MOM’s published appeal data and decisions of the Employment Claims Tribunal, the following are the most common grounds for rejection.
Active tuberculosis
Under the IDA, active tuberculosis is an absolute ground for rejection. The applicant must complete a full course of directly observed therapy (DOT) and obtain a certificate of treatment completion from the Tuberculosis Control Unit (TBCU) at Tan Tock Seng Hospital. The certificate must state clearly that the applicant is no longer infectious and is fit for work.
The treatment period is at least six months. During this period, the EP application is effectively suspended. The employer cannot proceed with the IPA until the certificate is submitted.
Uncontrolled diabetes with complications
Diabetes alone is not a ground for rejection. The ICC focuses on complications that affect work capacity, including:
- Diabetic retinopathy with visual impairment
- Diabetic nephropathy with chronic kidney disease stage 3 or above
- Diabetic neuropathy affecting mobility
- Diabetic foot ulcers or history of amputation
The ICC will require a recent HbA1c level. A reading above 10% is a strong signal of poor glycaemic control and will likely lead to rejection.
End-stage renal disease
Applicants requiring dialysis are typically rejected. The ICC holds that dialysis makes the applicant unable to perform full-time work. There is no exception for remote or sedentary roles. The only possible route is a kidney transplant, requiring at least two years of post-transplant follow-up and stable renal function.
Severe mental illness
Schizophrenia, bipolar disorder or major depressive disorder with a hospitalisation record in the past 12 months are grounds for rejection. The ICC requires a psychiatrist’s report confirming medication adherence and at least six months of functional stability.
The report must include:
- Diagnosis and disease course
- Medication regimen and adherence record
- Hospitalisation record (if any)
- Current functional status assessment
If the applicant has a history of suicide attempt or self-harm, the ICC will reject outright.
Active cancer
Active cancer is a ground for rejection. Cancer in remission requires an oncologist’s report confirming no signs of recurrence and a stable follow-up plan. The ICC typically requires proof of at least two years of disease-free survival.
Practical advice: 2025 EP medical screening strategy
For applicants from mainland China, Hong Kong, Taiwan and Malaysia, the following three steps directly reduce the risk of ICC referral:
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Complete a pre-screening before applying: choose a MOM-approved clinic and proactively test blood pressure, BMI, HbA1c and HIV. If any indicator is abnormal, bring it under control locally before submitting the MOR. This can lower the ICC referral probability by about 60%.
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When disclosing history, follow the “disclose more rather than less” principle: an undisclosed chronic condition, once found by MOM, triggers a two-year application ban. A disclosed chronic condition, provided it is supported by complete specialist reports proving stability, has a far higher approval rate than concealment.
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Allow an 8-week buffer for ICC review: from 2025, the ICC referral timeline has lengthened from 4-6 weeks to 4-8 weeks. Employers should inform recruitment teams of this potential delay at the point of application, to avoid an offer being withdrawn over medical issues.