Section B: Fees for Non-Admitted Patients

1. Fees and Charges for Non-Admitted Patients

Public hospitals in Victoria are permitted to raise fees for the following non-admitted patient services; but are not permitted to raise fees for the following services provided to admitted patients upon discharge:

• dental services;
• spectacles and hearing aids;
• surgical supplies;
• prostheses - however, this does not include the following classes of prostheses, which must be provided free of charge:

1. artificial limbs
2. prostheses which are surgically implanted, either permanently or temporarily or are directly related to a clinically necessary surgical procedure;

• external breast prostheses funded by the National External Breast Prostheses Reimbursement Program;
• pharmaceuticals at a level consistent with the Pharmaceutical Benefits Scheme statutory co-payments;
  (if the hospital is participating in the Australian Health Care Agreement-Pharmaceutical Reforms, charges can be levied for non-admitted patients and admitted patients upon discharge
  Reference: Circular No. 24/2007 );
  
• aids, appliances and home modifications; and
• other services as agreed between the Commonwealth and Victoria.

National Healthcare Agreement
Date of effect: 1 July 2009
Circular 18/2009

MBS arrangements for funding of MRI apply to public and private non-admitted patients (eligibility conditions apply).

Date of effect 1 September 1998
Reference: Circular No.20/1998 Issued 10 December 1998

2. Dental Fees

Public dental services are available to eligible Victorians through community dental clinics located in community health centres, hospitals and in some instances mobile vans.

Fees for public dental services apply to:

• Victorians with a Pensioner Concession Card or Health Care Card, and their dependants, aged 18 and over.
• Victorian preschoolers and children aged 5 to 13, who are not dependants of a health care cardholder.

For details see: Dentistry in Victoria - Public Dental Fees Policy

3. Pharmaceutical Fees

The following charges apply to all pharmaceutical items (other than those items dispensed after reaching the safety net threshold) dispensed to eligible patients, including nursing home and hostel residents.

Date of effect: 1 January 2011
Reference: Circular No. 23/2010

Patient Contribution per Prescription Item

For hospitals not participating in the Australian Health Care Agreement-Pharmaceutical Reforms

General Patients $27.40
Concessional Beneficiaries $5.60

For hospitals participating in the Australian Health Care Agreement-Pharmaceutical Reforms charges can be levied for non-admitted and admitted patients upon discharge.

General patients - up to $34.20 for PBS listed items and up to cost price for non-PBS listed items.
Concessional Beneficiaries - up to $5.60 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.

Date of effect: 1 January 2011
Reference: Circular No. 23/2010

3.1 Pharmaceutical Benefits Safety Net Scheme

The Pharmaceutical Benefits Safety Net Scheme exists to help protect financially individuals or families who need a lot of medicines in a calendar year. Once an individual or family reach the Safety Net threshold you can apply for a Safety Net Card and your PBS medicines will be cheaper or free for the remainder of that calendar year.

Safety Net Threshold

The Scheme requires a patient to record the purchase of PBS items on a Prescription Record Form (PRF). When a certain monetary value is reached (the safety net threshold), the patient qualifies for further PBS items at either a concessional price (for general patients) or for free (if you were a concessional patient originally). The safety net threshold may be reached by the accumulation of prescriptions purchased through pharmacies in the community, acute geriatric hospital services and public hospitals. Consequently, it is important that public hospital and acute geriatric hospital services pharmacies count patient payments for pharmaceuticals purchased from community pharmacies when applying the safety net thresholds.

Public hospitals may record, on the PRF, any item ( PBS or non-PBS) that is supplied to a patient, for which a patient contribution is levied.

For hospitals not participating in the Australian Health Care Agreement-Pharmaceutical Reforms the charges that may be recorded are:

General Patients - $27.40
Concessional Patients - $5.60

For hospitals participating in the Australian Health Care Agreement-Pharmaceutical Reforms the charges that may be recorded are as follows:

General patients - up to the "Maximum Recordable Value for Safety Net", as listed in the Schedule of Pharmaceutical Benefits for PBS listed items and up to $34.20 for non-PBS listed items.

Concessional Patients - up to $5.60 for PBS and non-PBS listed items.

Patients qualify for the safety net after their expenditure has reached the following levels within the calendar year:

General patients: $1317.20. Expenditure to this level entitles the family to further PBS items at the concessional rate of $5.60 per item
(issue of blue Concession Card).

Date of effect: 1 January 2011
Reference: Circular No. 23/2010

Concessional Beneficiaries: $336.00 per calendar year after which all PBS items are free (issue of pink Entitlement Card)

Date of effect: 1 January 2011
Reference: Circular No. 23/2010

A family can include the following:

• a spouse or defacto spouse
• children under the age of 16 in your care
• full-time dependent students under 25
  

Concessional Beneficiaries

Centrelink has several types of concession cards, which provide a range of benefits, including help with the cost of medicines.

• Commonwealth Seniors Health Card - you may be eligible if you have reached Age Pension age and you do not qualify for a pension from Centrelink or the Department of Veterans’ Affairs.
• Health Care Card - you may be eligible if you receive certain payments from Centrelink or if you have a low income or if you have a foster child in your care or you are an ex-Carer Allowance child.
• Pensioner Concession Card - if you receive a pension or certain other payment from Centrelink.

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