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Fees and Charges for Acute Health Services in Victoria
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Section A: Admitted Patients
Section B: Non-Admitted Patients
Section C: Other Services
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Section A: Fees for Admitted Patients

8. Eligible (including Reciprocal Health Care) 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.

Fees for Medicare ineligible patients will vary between hospitals. Individual health services determine the level of fees to be charged, and publish this information.

In setting fees, hospitals should be aware that some overseas patients are entitled to financial assistance, and others may be eligible for medically necessary treatment under reciprocal healthcare agreements.

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

  • • the Department's Victorian Admitted Episodes Data Set Manual (as may be amended from time to time), which can be accessed at the Health data standards and systems section on VAED, and refer to the following patient categories defined in Section 2: Concepts and Derived Items:
    • Medicare Eligibility Status - Eligible Person
      • Australian Resident
      • Eligible Overseas Representative
      • Reciprocal Health Care Agreements
      • Persons Declared Eligible by the Minister
    • Medicare Eligibility Status - Ineligible Person
      • Exempt Patient
      • Non-Exempt Patient

Reciprocal Health Care Agreements (RHCA)

Circular No. 23/2009 - Reciprocal Health Care Agreements

Asylum seekers

For State arrangements for public hospitals with respect to Asylum seekers refer Circular 27/2005 and Circular 29/2008.

9. Nursing Home Type Patients

Public Hospital Charges - Changes to Nursing Home Type Patient (NHTP) Fees - Effective from September 2016

NHTP contribution

The Department has been advised of a pension increase that becomes effective from 20 September 2016. Pensioners and beneficiaries will see increases from their first payday after that date. As a consequence the Commonwealth Department of Health and Ageing has revised the minimum statutory NHTP contribution.

The current contribution for nursing home type patients in public hospitals will be increased to $58.05 per day under the Health Insurance Act 1973. This represents 87.5% of the standard rate of the pension.

NHTP accommodation

The NHTP accommodation fee for privately insured nursing home type patients in public hospitals will be increased to $130.00.

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 $36.10 for PBS listed items and up to cost price for non-PBS listed items.

Concessional Beneficiaries - up to $5.90 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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Last updated: 28 September, 2016

For information relating to this site, contact: Peter Lewis Ph: (03) 9096 9050

This website is managed and authorised by the Finance, Policy and Operations Unit, Chief Finance Officer Branch of the Finance and Corporate Services Division of the Department of Health, Victorian State Government, Australia

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