15.5.6 Purpose
15.5.7 Medical costs
15.5.7A Minimum thresholds
15.5.8 Hospital costs
15.5.9 Pharmaceutical costs
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.
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.
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.
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
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.
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
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.
| 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
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
The cost of dentures and orthodontic appliances cannot be reimbursed.
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.
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.
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.
