Section A: Fees for Admitted Patients

8. Eligible and Ineligible Patients

Hospitals may set fees for patients who are not covered by Medicare including overseas patients. Fees for ineligible patients should be set to achieve full cost recovery. In setting fees, hospitals should be aware that some overseas patients are entitled to financial assistance (eg because of reciprocal health care agreements).

To help determine eligibility status, and level (if any) of financial assistance, see:

• the Department's PRS/2 Manual (as may be amended from time to time), which can be accessed though:Internet website: www.health.vic.gov.au/hdss/vaed/ and refer: Part A, Definitions Related to Patients (- see also specification changes at www.health.vic.gov.au/hdss/vaed/ )
• Patient Categories
• Eligible Person
• Australian Resident
• Eligible Overseas Representative
• Reciprocal Health Care Agreements
• Persons Declared Eligible by the Minister
• Ineligible Person
• Types of Ineligible Patient
• Exempt Patient
• Non-Exempt Patient.

• Department Hospital Circulars (as may be amended from time to time), located at Internet website: www.health.vic.gov.au/hospitalcircular/ and refer to:

• Circular No. 23/2004 Reciprocal Health Care Agreement - with the Kingdom of Norway
• Circular No. 2/2000 (Item No.4) new reciprocal health agreement with New Zealand
• Circular No. 10/1998 (Item No. 3) RHCA - Malta update
• Circular No. 7/1998 (Item No. 1) Republic of Ireland
• Circular No. 8/1997 (Item No. 4) correction regarding diplomatic staff and their families from New Zealand
• Circular No. 46/1993 Britain (England, Wales, Scotland, Northern Ireland and the Channel Islands), New Zealand, Malta, Italy, Sweden, Netherlands and Finland, with which Australia has RHCAs

• Circular No. 46/1993
• Circular No. 3/1999 (Item 6)
• Circular No. 12/2000

Contacts for urgent advice not apparent from the above include:

1. Departmental Regional Offices; and
2. Health Insurance Commission (whose responsibilities under Medicare include enrolment of eligible persons). The HIC's Medicare Information Service is ph:132011.

Reference: Circular No.3/1999 Issued 6 April 1999

9. Nursing Home Type Patients

The following fees are charged daily for nursing home type patients in public hospitals:

Standard Fees

Benefit (private patients) $99.15
Patient Contribution (public & private patients) $41.35

(See section on Compensable Patients re: compensable nursing home patients)

Date of effect: 20 March 2009
Reference: Circular No. 8/2009

10. Pharmaceutical Fees

Public hospitals in Victoria that are participating in the Australian Health Care Agreement-Pharmaceutical Reforms are permitted to raise fees for admitted patients upon discharge, non participating hospitals are not permitted to raise fees for admitted patients upon discharge.

Patient Contribution per Prescription Item

General patients - up to $32.90 for PBS listed items and up to cost price for non-PBS listed items.

Concessional Beneficiaries - up to $5.30 for PBS listed items and up to cost price for non-PBS listed items.

Brand and Therapeutic Group premiums may also be applied by participating hospitals.

Information regarding the Pharmaceutical Benefits Safety Net Scheme and Concessional Beneficiaries can be found in Section B: Fees for Non-Admitted Patients

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