Visitors to Australia Covered by Reciprocal Health Care Agreements

Australia has Reciprocal Health Care Agreements with nine countries - Ireland, Italy, Finland, Malta, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom. Under these Agreements, residents of these countries have restricted access to Medicare while visiting Australia.

 

These Agreements give visitors from these countries access to Medicare and the Pharmaceutical Benefits Scheme for the treatment of an illness or injury which occurs during their stay, and which requires treatment before returning home (that is, these Agreements cover immediately necessary medical treatment). The Agreements do not allow for visitors to access Medicare or the Pharmaceutical Benefits Scheme where the treatment is not immediately necessary. Prearranged and elective treatment is not covered.

 

In Australia there are both public and private hospital services. The Agreements provide for free accommodation and treatment as public hospital services, but do not cover treatment as a private patient in any kind of hospital. People who choose to be treated as a private patient, either in a private or public hospital, will be responsible for all of their health costs, including doctors' fees.

 

Eligible visitors who are admitted as public patients during their visit to Australia should tell hospital staff that they wish to be treated as a Medicare public patient under a Reciprocal Health Care Agreement. They may be required to produce evidence of their eligibility. Visitors can phone 132 011 (local call cost if calling from within Australia) or visit a Medicare office to confirm what documentation they will need to provide. Medicare office locations are available from the Medicare Australia web site. 

 

Each of the Agreements provides access to affordable medicines under the Pharmaceutical Benefits Scheme. Eligible persons are asked to produce evidence of their eligibility when presenting prescriptions at community pharmacies. Further information on this requirement can be obtained by telephoning the Pharmaceutical Benefits Scheme Information Line on 1800 020 613. Only medicines prescribed for immediately necessary treatment are covered.

 

Each Agreement is different from the others:

 

The Agreements with Finland, Italy, Malta, the Netherlands, Norway, Sweden and the United Kingdom provide free care as a public patient in public hospitals, subsidised out-of-hospital medical treatment under Medicare, and subsidised medicines under the Pharmaceutical Benefits Scheme.

 

The Agreement with New Zealand and the Agreement with Ireland provide free care as a public patient in public hospitals and subsidised medicines under the Pharmaceutical Benefits Scheme, but do not cover out-of-hospital medical treatment.

 

Visitors from Finland, Ireland, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom are covered for the duration of their stay in Australia, while visitors from Italy and Malta are covered for a period of six months only.

What is covered:

 

The agreements are intended to cover treatment of any immediately necessary nature which arises during a stay in Australia and which requires treatment before returning home. The agreements do not cover pre-arranged or elective treatment, or treatment for which there is no immediate medical necessity. Those people entering the country for the specific purpose of receiving treatment are excluded under the agreements.

 

All agreements except for those with New Zealand and the Republic of Ireland cover residents of those countries for:

 

·         Free treatment as a public hospital inpatient or outpatient

·         Medicare benefits for out of hospital treatment (ie: provided by doctors operating in private practice)

·         Subsidised pharmaceuticals under the Pharmaceutical Benefits Scheme.

Visitors from New Zealand and the Republic of Ireland are only covered for:

·         Free treatment as a public hospital inpatient or outpatient

·         Subsidised pharmaceuticals under the Pharmaceutical Benefits Scheme.

“Immediately necessary care” is more than just emergency treatment and may include:

·         Routine primary care

·         Subsequent investigation (eg: referrals to pathology, diagnostic or specialist services)

·         Pre-existing conditions (any necessary monitoring or treatment)

·         Psychiatric care where medically necessary (eg: to stabilize the patient’s condition to enable the journey home)

The longer a visitor stays in Australia, the greater the range of services that are likely to be immediately necessary and that should be made available (i.e. they will be treated more like Australian residents). Where there is doubt over individual services, patients should seek a note from the doctor indicating the medical necessity for the proposed service. Where required individual cases should be judged on merit.

 

The Agreements do not cover all health services. Some services not covered under the agreements are:

 

·         Ambulance cover

·         Dental care

·         Medical evacuation to your home country

·         Funerals

·         Treatment in private hospitals, or as a private patient in a public hospital

·         Treatment that is not immediately necessary

·         Elective treatment

·         Treatment that has been pre-arranged before arrival in Australia  

For this reason it is highly recommended that all visitors to Australia from Reciprocal Health Care Agreement countries buy health or travel insurance designed for overseas visitors.

If you are staying temporarily in Australia for an extended period and will be covered by an Agreement, you may be able to enrol in Medicare by visiting a Medicare office with your passport. If you are from Italy or the Netherlands, you will also need to show proof that you are enrolled in your home country's health system. You can telephone 132 011 (local call cost if calling from within Australia) or visit a Medicare office to confirm what documentation you will need to provide. Medicare office locations are available from the Medicare Australia website (Once on the Medicare Australia website a list of office locations can be accessed by clicking on 'Public', then 'Medicare', then 'Office Locations').

  

Health Insurance for Visitors from Overseas

 

People without access to Medicare are responsible for all health costs incurred in Australia. For this reason it is highly recommended that all overseas visitors to Australia (including visitors from Reciprocal Health Care Agreement countries who have only restricted Medicare access) arrange suitable insurance cover. Domestic private health insurance for Australian residents, as provided by the organisations registered under Australian health law, is not suitable for visitors to Australia because this insurance is a supplement to Medicare and will therefore not adequately cover the costs of a person who is not eligible for Medicare.

 

Private health insurance for overseas visitors in Australia is available from Australian registered health organisations, insurance brokers and general insurers.

 

Please contact Nevett Ford Lawyers Melbourne if you require any further information in relation to this issue, or if you require specific legal advice regarding any aspect of the Reciprocal Health Care arrangements.