Determining eligibility for Medicare in Australia is not always a straightforward matter. See below answers to 10 frequently asked questions about Medicare:
1) Eligibility for Medicare under Reciprocal Health Care Arrangements (RHCA) derives from country of residence, not citizenship of a country (except for Italy and Malta). How does Medicare ascertain a person is actually resident in the country of the passport they are presenting in their Medicare application?
RHCA eligibility is determined by the specific eligibility criteria set out in each agreement. Proof of residence can vary for each country.
For Finland, Sweden and the United Kingdom (UK), resident status alone is the RHCA eligibility criterion and the visitor can be enrolled in Medicare for the duration of their visa. Malta requires an applicant to be both a citizen and resident and enrolment is limited to six months.
A passport from those countries, or in the case of the UK, a National Health Service (NHS) card or one of the other forms of evidence listed in the UK RHCA, is sufficient to establish eligibility under the RHCA, provided that the passport holder nominates the reciprocal country as their last place of residence on the Medicare enrolment form.
A non-citizen who nominates one of these reciprocal countries as their last place of residence must provide a valid European Health Insurance Card (EHIC) bearing the initials of the relevant country. Where an EHIC or NHS card is unavailable, two substantial residency documents are acceptable.
For Belgium, Italy, the Netherlands, Norway and Slovenia, eligibility depends on the visitor’s membership of their home country’s national health insurance scheme (Evidence must be provided). In these cases, the visitor can be enrolled for the duration of their membership of their particular scheme as shown on the relevant documentation, or the duration of their visa, whichever is the shorter (with the exception of Italy which is limited to six months).
2) What is the different for applicants from Italy and Malta?
To be eligible under the RHCA with Italy, a person must be citizen and eligible for services under the National Health Legislation of Italy . Period of RHCA eligibility is limited to six months.
To be eligible under the RHCA with Malta, a person must be a citizen and resided in Malta prior to arriving in Australia. Period of RHCA eligibility is limited to 6 months.
3) What evidence would, for example, a Polish citizen who was resident in the UK and registered with that relevant health system for several years be required to provide with a Medicare application?
A non-citizen that resided in the UK prior to arriving in Australia would be required to provide evidence of valid EHIC or NHS card. If this is not available they would be required to provide two substantial residency documents.
4) Is a person from an RHCA country on a bridging visa eligible for Medicare or to renew their expired Medicare card? Is there any difference between these two procedures?
A person from a RHCA country can enrol in Medicare or extend their Medicare RHCA eligibility providing they meet the eligibility criteria set out in that country’s RHCA. A person must also hold a valid visa (including bridging visas) to be eligible under RHCA.
5) The definition of 'Australian resident' in Section 3 of Health Insurance Act 1973 includes Remaining Relative Visa applicants onshore as eligible for Medicare, but excludes their dependents? Is this correct?
Under the Health Insurance Act 1973, an applicant for permanent residency is eligible for Medicare if they either have permission to work in Australia, or have a spouse, parent or child that is an Australian citizen or permanent resident visa holder. Each person must met the eligibility criteria.
6) Is a person who has applied for a permanent visa offshore and who then comes onshore, eligible to access Medicare if they are 'resident' in Australia?
Where an applicant has applied for permanent residency offshore they are eligible for Medicare from the date they arrive in Australia to reside, providing all eligibility criteria is met, that is the applicant has permission to work or has a spouse, parent or child that is an Australian citizen or Australian permanent resident visa holder.
However, if there is evidence that suggests that the applicant has not entered Australia to reside at that time, they may be required to provide documents to establish residency.
7) Can you explain how the Medicare and the DIBP IT systems interact?
The Department of Human Services (DHS) and the DIBP systems have a daily data exchange of visa and Medicare enrolment information
DHS also electronically receives a status or outcome of an application (that is, lodged, granted, withdrawn or refused).
8) Onshore Parent Visa applicants are not usually eligible for Medicare, however is there an exception for parents from the RHCA countries?
Parent visa applicants are not generally eligible for Medicare, however, if the applicant is from a RHCA country and meets the eligibility criteria set out in the agreement they are eligible for Medicare under that RHCA.
9) What are the rules around eligibility for Medicare for Australian citizens and residents who have been away from Australia for extended periods of time?
Ministerial Order No 781 allows Australian citizens who have been absent from Australia to continue Medicare eligibility for up to 5 years from their original departure from Australia. The 5 years does not recommence on return visits where they do not reside in Australia.
Where the period of absence has exceed 5 years and the applicant has returned to Australia to reside, they are required to provide their passport and 2 acceptable residency documents or a completed Commonwealth Statutory Declaration, stating reasons why they are unable to provide the necessary residency documents.
Holders of permanent resident visas or New Zealand citizens who permanently reside in Australia may lose their Medicare eligibility when they are absent from Australia for 12 months or more.
A permanent resident or New Zealand Citizen who has returned to Australia to reside after being absent from for 12 months or more, is required to provide their passport and and 2 acceptable residency documents or a completed Commonwealth Statutory Declaration, stating reasons why they are unable to provide the necessary residency documents.
10) Are student visa holders who have applied for onshore Partner Visas immediately eligible for Medicare?
Under the Health Insurance Act 1973, an applicant for permanent residency is eligible for Medicare if they either have permission to work in Australia, or have a spouse, parent or child that is an Australian citizen or permanent resident visa holder. To be eligible a person must hold a current visa, but eligibility is not determined by visa subclass. Student visa holders do not need to wait until their current visa has expired to access Medicare.
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