spacer State Government Victoria Australia Department of Health header
Victorian Government Health Information header		 Victorian Government Website (Victoria the place to be)
spacer
spacer Health Home
Main A to Z Index | Site Map | About Health | Links  
Commonwealth/State Highly Specialised Drugs Program banner
>>contact
Contents Program Information Appendix 1 - AHMAC Appendix 2 - Drugs Covered by the Program Appendix 3 - Agreed Prices
Appendix 4 - Patient Eligibility Criteria Appendix 5 - Certification Appendix 6 - Community prescribers of AIDs & Hep C medications Appendix 7 - Auditing Requirements Appendix 8 - Claiming Procedures

Appendix 4: Patient Eligibility Criteria

Eligibility

Persons eligible for Commonwealth subsidy through this program must be patients in the community or attending day services (ie. not in-patients), and be an "eligible person" satisfying the following criteria from the Health Insurance Act 1973.

Eligible person means Australian resident, a person covered by a Reciprocal Health Care Agreement, or an "eligible overseas representative".

Australian resident means a person who resides permanently in Australia and is:

(a) an Australian citizen; or
(b) a person who holds a permanent visa; or
(c) a New Zealand citizen; or
(d) an applicant for permanent residence in certain circumstances (see Interim card below).

An eligible person is entitled to have one of the following Medicare cards:

  1. Medicare card (green in colour), issued to Australian permanent residents.
  2. Medicare card (blue in colour), with the words "INTERIM CARD", issued in
    certain circumstances to persons who have applied for permanent resident status.
    Note: Interim cards will have an expiry date beyond which the card-holder is no longer eligible for PBS subsidy, including Highly Specialised Drugs.
  3. Medicare card (green in colour) with the words " VISITOR RHCA", issued to visitors from six of the eight countries with which Australia has Reciprocal Health Care Agreements - the UK, Malta, Italy, Sweden, Finland, Norway and the Netherlands.

Note:
(a) Australia also has Reciprocal Health Care Agreements with New Zealand and Ireland, however visitors from these countries are not issued with cards. They are eligible for PBS on presentation of their passports.
(b) Supply of drugs to persons from these eight RCHA countries is limited to the original prescription only. Repeat prescriptions are not permitted.

An eligible person who has enrolled recently in Medicare, but has not yet received a card, will have been given a receipt with a Medicare number. This receipt is evidence of eligibility.

Eligible overseas representative means:

  1. The head of a diplomatic mission or consular post, established in Australia, of those countries with which Australia has a Reciprocal Health Care Agreement except for New Zealand; or
  2. Staff of those diplomatic missions or consular posts referred to in paragraph (a); or
  3. Family members of persons referred to in paragraph (a) or (b).

Eligible overseas representatives will have a Medicare card (green in colour).

Note: As a condition of funding hospitals must ensure that patients are eligible for treatment in accordance with the above criteria.

Return to Top

Contact: Michael Furey Tel (03) 9096 2506 Fax (03) 9096 9205

Last updated: 30 April, 2008
This web site is managed and authorised by the Ambulance & Acute Programs Section of the Metropolitan Health and Aged Care Services Division of the Victorian State Government, Department of Health, Australia

Copyright | Disclaimer | Privacy Statement | State Government of Victoria Home | Download Help

For general enquiries to the Department of Health telephone 61 3 90960000