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Division 2: Benefits

15.5.6 Purpose

The purpose of this Division is to outline the benefits available for an eligible person's health care during a long-term posting.

15.5.7 Medical costs

  1. A member is eligible to be reimbursed out-of-pocket expenses for medical services incurred for an eligible person in a financial year. These conditions apply.

    1. The medical service must be one for which the person would be entitled to a Medicare benefit in Australia.

    2. The member must reach the following minimum threshold in out-of-pocket medical expenses for the eligible person.

      1. If the eligible person is less than 15 years old at the beginning of the financial year, the minimum threshold is AUD 25.

      2. If the eligible person is 15 years or older at the beginning of the financial year, the minimum threshold is AUD 69.

    3. The minimum threshold amount is not reimbursed.

    Exception: Costs associated with assisted reproductive services (ARS) provided overseas are not reimbursable under this section.

  2. See: Health Directive No. 203, Provision of Assisted Reproductive Services to Members of the Australian Defence Force.

  3. If a member is only eligible for part of the financial year, the threshold amounts in paragraph 1.b are reduced in proportion.

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

  4. If a member incurs a cost for medical treatment in Australia, the threshold is only reduced by the out-of-pocket cost to the member. The threshold is not reduced by any refunded Medicare benefit amount.

    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

  1. A member is eligible to be reimbursed costs for hospital accommodation, treatment and related charges incurred for an eligible person. This is if the hospital facilities are similar to the standard for a public hospital patient in Australia.

  2. The member may incur additional costs because hospital facilities of that standard were not available at the posting location. The CDF may approve payment of an amount of additional costs the CDF considers reasonable in the circumstances. The CDF must consider all these criteria.

    1. The nature of the illness or condition of the eligible person.

    2. The standard of available hospital accommodation, treatment and medical equipment at the posting location.

    3. Any other factor relevant to the treatment of the eligible person.

Persons who can make the decision under subsection 15.5.8.2 on behalf of the Secretary/CDF:
Senior ADF Representative at the overseas post
A person who is authorised to manage Defence personnel administration at the overseas post and is not below WO2(E)/APS 5.
A person working in the Pay and Administration Centre – Victoria who is authorised to manage Defence pay and administration at overseas posts and is not below WO2(E)/APS 5.
Director of Attaché and Overseas Management

15.5.9 Pharmaceutical costs

  1. A member is to be reimbursed costs for pharmaceutical products for an eligible person. The following conditions apply.

    1. The pharmaceutical product must be a drug or medicinal preparation prescribed by a doctor.

    2. The amount payable is any amount by which an item exceeds AUD 31.30.

      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.

  2. During a calendar year, a member may pay repeated threshold costs outlined in paragraph 1.b for an eligible person. After the total threshold payments exceed AUD 1,141.80 for the calendar year, the member is to be reimbursed the amount by which an item exceeds AUD 5.00.

    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.

  3. If a member is accompanied at the post by the eligible person for part of the calendar year, the first threshold total in subsection 2 is reduced in proportion.

    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.

  4. A member may incur a cost during a calendar year for an eligible person's pharmaceutical products supplied in Australia during the period of the posting. In this case, the first threshold total in subsection 2 must be reduced by that cost.

    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.

  5. This section does not apply to any item provided at the posting location at Commonwealth expense. This includes the Medical Equipment Set Individual Foreign Service.

15.5.10 Pharmaceutical costs – health care card

  1. A member is to be reimbursed costs for pharmaceutical products for a dependant during a calendar year if the following conditions are met.

    1. The member has a recognised dependant with special needs.

    2. The dependant held a Government issued Health Care Card which was valid at the time of leaving Australia, and provides evidence of that to their overseas post administration section.

    3. The pharmaceutical product supplied is a drug or medicinal preparation prescribed by a doctor.

    4. The pharmaceutical product supplied is listed on the Pharmaceutical Benefits Scheme.

      See: Pharmaceutical Benefits Scheme

    5. The pharmaceutical product is for the person specified on the Health Care Card who is a member or a dependant of the member. If the pharmaceutical product is not for the person specified on the Health Care Card then section 15.5.9 applies.

  2. The amount reimbursed is the difference paid above the Pharmaceutical Benefits Scheme threshold of AUD 5 for each item.

  3. During a calendar year, a member may pay repeated threshold costs outlined in subsection 2 for a Health Care Card holder. After the total threshold payments reach AUD 290, the member is then eligible for the full reimbursement for each item, for the rest of the year.

  4. If a member is accompanied at the post by the eligible person for part of the calendar year, the threshold totals in subsection 3 are reduced in proportion.

    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.

  5. A member may incur a cost during a calendar year for an eligible person's pharmaceutical products supplied in Australia during the period of the posting. In this case, the total threshold amounts in subsection 3 must be reduced by that cost.

    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.

  6. This section does not apply to any item provided at the posting location at Commonwealth expense. This includes the Medical Equipment Set Individual Foreign Service.

15.5.11 Ancillary services

  1. A member is eligible to be reimbursed costs for ancillary services for an eligible person.

  2. An ancillary service includes an additional service not covered by Medicare, but covered by Medibank Private Extras in Australia. A list of examples is provided in the table below.

    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.

    See: Chapter 14 Part 2 Division 1, Pre-departure certificate of fitness

    Examples of ancillary services
    An ancillary service includes services like these... dental treatment that is medically necessary
    optical services
    Example: An eligible person requires a change of prescription lenses. The member would be eligible for the reimbursement of the costs incurred under subsection 3.
    physiotherapy, speech pathology, occupational therapy
    ambulance transport
    and excludes services like these... cosmetic dental treatment
    Example: 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.
    cosmetic optical treatment
    Example: coloured contact lenses with no corrective property.
  3. The member is eligible to the additional cost above the cost of a similar service in Australia. The Australian cost is determined by reference to either of these health funds.

    1. The private health fund the member belongs to.

    2. Medibank Private, if the member does not have private health insurance.

    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.

  4. When cost data is not available at the posting location, the Welfare Unit of the Department of Foreign Affairs and Trade, Canberra, will be able to help. They will also provide a copy of their advice to the Overseas Administration Team.

15.5.12 Dental costs for young children

  1. This section covers dental treatment for a child who meets both of these conditions has not yet started secondary education and is an eligible person under this Part.

    1. They have not yet started secondary education.

    2. They are an eligible person under this part.

  2. A member is eligible to be reimbursed the cost of some kinds of dental treatment for an eligible child. Costs that may and may not be reimbursed are shown in this table.

    Dental costs
    Item Costs that may be reimbursed Costs that may not be reimbursed
    1. Cleaning Dentures
    2. Dental check-ups Orthodontic appliances

    Example: Braces
    3. Dental education
    4. Emergency treatment
    5. Extractions
    6. Fillings
    7. Preventative care
    8. X-rays
  3. The member is not eligible to be reimbursed for costs under subsection 2 until the costs have passed a threshold.

    1. That threshold is AUD 40 (or the equivalent in local currency) in each financial year.

    2. The threshold amount is not reimbursed to the member.

    3. The threshold figure applies for each eligible child.

      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.

    4. A member may be eligible for reimbursement under this section for only a proportion of a financial year. The threshold in respect of that child must be reduced in the same proportion.

      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.

    5. The threshold may be reduced to reflect Medicare benefits the member is eligible for. The threshold will be reduced by the difference between the cost incurred and the Medicare benefit. All these conditions must be met.

      1. The cost must relate to necessary dental treatment.

      2. The treatment must have been provided in Australia.

      3. The treatment must qualify for a Medicare benefit.

      4. The treatment must have been in the same financial year as the threshold to be varied.

      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

A member is eligible to be reimbursed costs for ambulance transport or other necessary medical transport for an eligible person.

15.5.14 Routine medical checks

  1. The CDF may approve reimbursement for an eligible person who requires a routine medical check. This can be during or after a posting.

  2. The CDF must consider both these criteria.

    1. The general standard of health at the posting location.

    2. The incidence of diseases at the location that are unlikely to be contracted in Australia.

  3. If the CDF is satisfied that routine medical checks will be necessary, the member may be reimbursed these costs.

    1. The medical check.

    2. Return travel to the medical facility for the member and eligible person.

  4. The amount reimbursed must be reduced by any amount payable under either of the following.

    1. Medicare Benefits Schedule.

    2. The eligible person's health insurance fund.

Persons who can make the decision under subsection 15.5.14.1 on behalf of the Secretary/CDF:
Senior ADF Representative at the overseas post
A person who is authorised to manage Defence personnel administration at the overseas post and is not below WO2(E)/APS 5.
A person working in the Pay and Administration Centre – Victoria who is authorised to manage Defence pay and administration at overseas posts and is not below WO2(E)/APS 5.
Director of Attaché and Overseas Management

Application to Reservists: Yes, on continuous full-time service.




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