You are financially responsible for any health debts you incur in Australia. The Department of Home Affairs (Immigration) might consider any outstanding health debts you have if you apply for a visa in future.
If you are not eligible for Medicare, any treatment you have in a hospital or emergency room will be as a private patient. Most temporary visa holders are not eligible for Medicare.
For routine medical treatment in Australia, out-of-hospital treatment from a general practitioner is normally the most cost-effective solution.
Immigration offer a guide to the minimum level of health cover that will mitigate your financial risk but your healthcare costs are unlikely to be covered completely. You will still be liable for the balance of your healthcare costs.
Consider whether a higher level of cover than Immigration specify here might be more suitable for you.
You can be charged a patient contribution, excess or co-payment for treatment by either or both:
- your insurance fund
- any hospital you are treated at
You should get cover that provides benefits at least equivalent to the following:
For admitted patient treatment, a benefit equal to the state and territory health authority gazetted rates for ineligible patients for:
- overnight and day only hospital accommodation (all costs including: all theatre, intensive care, labour wards, ward drugs)
- emergency department fees that lead to an admission
- admitted patient care and postoperative services that are a continuation of care associated with an early discharge from hospital
This includes all admitted treatments covered by the Medicare Benefit Schedule (MBS).
Surgically Implanted Prostheses
For no-gap prostheses and gap-permitted prostheses as listed in the Private Health Insurance (Prostheses) Rules 2007, a benefit at least equal to 100 per cent of the minimum benefit amount listed.
For all PBS-listed drugs, prescribed according to PBS-approved indications, that are administered during and form part of an admitted episode of care, a benefit equal to the PBS-listed price in excess of the patient contribution.
This includes the cost of PBS-listed drugs administered post-discharge if they form part of the admitted episode of care.
For admitted medical services with an MBS item number, 100 per cent of the Medical Benefits Schedule fee or less if the patient is charged less.
100 per cent of the charge not otherwise covered by third-party arrangements for transport by ambulance provided by, or under an arrangement with, a government-approved ambulance service when medically necessary for admission to hospital, emergency treatment onsite, or inter-hospital transfer for emergency treatment.
This includes inter-hospital transfers that are necessary because the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences.
Informed Financial Consent
The insurer will allow hospitals to check members’ eligibility so members are able to give informed financial consent when they are admitted.
To comply with the minimum level, the only waiting periods that can be applied are:
- 12 months for pregnancy related conditions
- 12 months for pre-existing conditions applied in a way that is consistent with Section 75-15 of the Private Health Insurance Act 2007
- 2 months for psychiatric, rehabilitation and palliative care, whether or not the condition is pre-existing
To comply with the minimum level of health insurance, the only admitted patient treatments that may be excluded are:
- assisted reproductive treatments
- elective cosmetic treatments
- stem cells, bone marrow and organ transplant
Insurance Policies May Also Exclude:
- treatment provided outside Australia, including necessary treatment en route to or from Australia
- treatment arranged in advance of the insured’s arrival in Australia
- services and treatment which are covered by compensation or damages provisions of any kind
Insurers don’t have to exclude these treatments. They can choose to cover them or not.
Global Annual Benefit Limits
To comply with the minimum level of health insurance, the per-person, per-annum benefit must not be less than AUD1,000,000.
For treatment that relates to medical services with an MBS item number, cover up to the Medical Benefits Schedule fee.
Except where otherwise stated, the insurer can decide whether to provide cover for out-of-hospital treatment. The insured person can choose to purchase this additional cover or not.
Excess, Co-Payment or Patient Contribution
The insurer can decide to charge an excess, co-payment or patient contribution. Excess, co-payment and patient contributions can be charged on either an annual or per-separation basis.
When determining waiting periods, insurers must recognise previous length of membership on a policy held with another Australian insurer that meets the minimum standards.
- when transferring between Australia-based insurers where the customer has been a member of the previous fund for more than 12 months, waiting periods of no longer than 12 months will apply to the higher level of benefits
- when transferring between Australia-based insurers where the customer has been a member of the previous fund for less than 12 months, any unserved waiting periods must be completed with the new fund. If increasing the level of cover or benefits, further waiting periods of no longer than 12 months will apply to the higher level of benefits. These waiting periods are to be served concurrently
To comply with the minimum level of health insurance, the insurer must agree to:
- grant a member who transfers between Australia-based insurers continuity of cover for up to 30 days from the date they leave their previous insurer
- provide members who terminate their policy with a clearance certificate, approved by the Department of Home Affairs, within 14 days of the termination date or the date they were notified of the termination, whichever is later
To comply with the minimum level of health insurance, a policy must not contain a buy-out clause that would have the effect of terminating the insurer’s liabilities in exchange for a predetermined lump sum payment.
The insurer will allow the insured person 60 days from the last financial date of membership to pay a premium without terminating the membership.
Insurers do not have to pay for treatment received during any arrears period until and unless the arrears are paid for the relevant period.
Evidence of Adequate Health Insurance
Some visas require you to provide evidence of adequate health insurance before Immigration grant the visa and where applicable (seek advice).
Please Contact Nevett Ford Lawyers Melbourne for Advice and Assistance:
Telephone: +61 3 9614 7111