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15.5.6 Purpose

15.5.7 Medical costs

Guidance

Example: If the member is only eligible for six months, the minimum threshold is AUD 34.50.

Guidance

Example: During a visit to Australia, a consultation with a doctor costs AUD 50. The Medicare benefit is AUD 25.20. The AUD 24.80 difference reduces the threshold amount from AUD 69 to AUD 44.20.

15.5.8 Hospital costs

15.5.9 Pharmaceutical costs

Guidance

Example: A member and dependant are posted to the UK. The dependant is an eligible person and suffers from asthma. The asthma medications cost AUD 35.50 each. The member is reimbursed AUD 4.20 for each item.

Guidance

Example: A member paid AUD 35 on a weekly basis for pharmaceutical products in this calendar year for an eligible person. After 37 weeks, they had paid the AUD 31.30 threshold enough times to total AUD 1,158.10. The weekly products now have a threshold of AUD 5 per item and the member is reimbursed AUD 30 to make up the difference to AUD 35.

Guidance

Example: A member only performed duty at the posting location for six months in the calendar year. The total threshold in subsection 2 is halved to AUD 570.90.

Guidance

Example: During a visit to Australia, a member pays AUD 31.30 for a pharmaceutical product. The total threshold of AUD 1,141.80 is reduced to AUD 1,110.50.

15.5.10 Pharmaceutical costs – health care card

Guidance

Example: A member was only accompanied by their dependant at the posting location for six months in the calendar year. The total threshold in subsection 2 is halved to AUD 145.

Guidance

Example: During a visit to Australia, a member pays AUD 25 for five pharmaceutical products. The total threshold of AUD 290 is reduced to AUD 265.

15.5.11 Ancillary services

Guidance

Note: As all dependants of members are required to obtain certificates of fitness before departure, the principle for recognising an ancillary service for reimbursement under this Part is that there is a clearly identified medical or dental need for it.

Examples of ancillary services
An ancillary service includes services like these... dental treatment that is medically necessary
optical services
physiotherapy, speech pathology, occupational therapy
ambulance transport
and excludes services like these... cosmetic dental treatment
cosmetic optical treatment

Example of an ancillary service - optical: An eligible person requires a change of prescription lenses. The member would be eligible for the reimbursement of the costs incurred under subsection 3. 

Example of excluded service - cosmetic dental treatment: An eligible person wishes to have their teeth capped and existing amalgam fillings replaced with a synthetic type. This work would be for cosmetic reasons only. The member would not be eligible for the reimbursement of the costs incurred under subsection 3.

Example of excluded service - cosmetic optical treatment: coloured contact lenses with no corrective property

Guidance

Example: An eligible person had dental work overseas, totalling AUD 400. The Australian private health insurance fund estimates AUD 300 as the cost of the same treatment in Australia. The member is reimbursed AUD 100 for the eligible person's dental work.

15.5.12 Dental costs for young children

Guidance

Example of orthodontic appliances: Braces

Guidance

Example: A member's first child has AUD 200 of dental treatment, and qualifies for reimbursement.The member's second child has AUD 35 of dental treatment at the same time, and does not, as the threshold has not been met.

Guidance

Example: A child might start secondary education part way through a financial year. The child will no longer be an eligible child. The threshold that applies to that child will be reduced.

Guidance

Example: In September a member spends AUD 80 on necessary dental treatment for an eligible child in Australia. There is a AUD 55 Medicare benefit. The threshold in respect of that child is reduced by AUD 25 for the rest of that financial year.

15.5.13 Ambulance costs

15.5.14 Routine medical checks

Pay and conditions manual

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