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.
