Policy Directive
Ministry of Health, NSW
73 Miller Street North Sydney NSW 2060
Locked Mail Bag 961 North Sydney NSW 2059
Telephone (02) 9391 9000 Fax (02) 9391 9101
http://www.health.nsw.gov.au/policies/
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Reciprocal Health Care Agreements
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Document Number PD2011_059
Publication date 21-Sep-2011
Functional Sub group Corporate Administration - Fees
Summary Specifies countries that Australia has reciprocal health care agreements
with. Patients from these countries have the choice to receive free
medical treatment subject to certain conditions. Clarifies range of services
provided to New Zealand and Ireland residents.
Replaces Doc. No. Reciprocal Health Care Agreements [PD2011_051]
Author Branch Government Relations
Branch contact Government Relations 9391 9533
Applies to Local Health Districts, Board Governed Statutory Health Corporations,
Chief Executive Governed Statutory Health Corporations, Specialty
Network Governed Statutory Health Corporations, Affiliated Health
Organisations, Public Health System Support Division, Public Hospitals
Audience Local Health Districts and Public Hospitals Staff
Distributed to Public Health System, NSW Ambulance Service, Ministry of Health
Review date 21-Sep-2016
Policy Manual Fees, Patient Matters
File No. 10/6402
Status Active
Director-General
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This Policy Directive may be varied, withdrawn or replaced at any time. Compliance with this directive is mandatory
for NSW Health and is a condition of subsidy for public health organisations.
POLICY STATEMENT
RECIPROCAL HEALTH CARE AGREEMENTS
PURPOSE
This Policy Directive advises NSW public hospitals of current arrangements regarding
Reciprocal Health Care Agreements (RHCA). RHCAs cover treatment that is medically
necessary. Medically necessary treatment means any ill-health or injury which occurs
while the individual is in Australia and requires treatment before their return home.
MANDATORY REQUIREMENTS
Australia has reciprocal health care agreements with a number of countries. Patients
from these countries have the choice to receive free medical treatment as public
patients in NSW public hospitals that are medically necessary.
IMPLEMENTATION
Chief Executives are accountable for ensuring that visitors from Reciprocal Health Care
Countries are provided the choice to access public hospital services that are medically
necessary free of charge.
The attached Reciprocal Health Care Agreements Procedures contains the current list
of Reciprocal Health Care Countries including corresponding eligibility criteria and
coverage details.
Any enquiries regarding this Policy Directive by public hospitals should be referred to
relevant Local Health District. Local Health Districts may contact the Inter-Government
and Strategies Branch at the NSW Department of Health with any enquiries.
REVISION HISTORY
Version
September 2011
(PD2011_059)
Approved by
Director, InterGovernment and
Funding Strategies
Amendment notes
Update to clarify range of services provided to New Zealand
and Ireland residents under the Reciprocal Health Care
Agreements.
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.
August 2011
(PD2011_051)
November 2004
(PD2005_398)
Director-General
Director-General
PD2011_051 is rescinded.
Policy revised to include Slovenia-Australia Reciprocal
Health Care Agreement. Replaced PD2005_398.
Originally issued as Circular 2004/76
ATTACHMENTS
1. Reciprocal Health Care Agreements: Procedures.
PD2011_059
Issue date: September 2011
Page 1 of 1
RECIPROCAL HEALTH CARE AGREEMENTS
PROCEDURES
RECIPROCAL HEALTH CARE AGREEMENTS
COUNTRIES COVERED UNDER THE AGREEMENTS
Australia currently has RHCAs with the following countries:
•
Belgium
•
Finland
•
Italy
•
Malta
•
New Zealand (for temporary residents who entered Australia after 1 September
1999).
•
Norway
•
Republic of Ireland (Eire)
•
Slovenia
•
Sweden
•
The Netherlands
•
The United Kingdom (includes Northern Ireland)
VISA CATEGORIES AND PERIOD OF COVER
Diplomats:
All Agreements with the exception of New Zealand provide diplomats and their families
with full access to the Australian health care system for the duration of their stay. These
diplomats are “eligible” persons without any restrictions. They are not restricted to
immediately necessary treatment, or public patient admission. They are also eligible for
treatment as a private patient in a public or private hospital.
Diplomats and their families from New Zealand are to be charged at the ineligible rate for
services provided.
Overseas Students:
Students are not covered by the RHCAs. They are not “eligible persons” and do not
receive Medicare or free hospital services. All foreign students studying in Australia, with
the exception from Norway and Sweden, are required to take out Overseas Student
Health Cover (OSHC).
OSHC should be purchased prior to arrival in Australia and needs to be maintained for
the duration of a student’s stay. OSHC provides cover for medical, shared ward public
hospital and private hospital fees.
Students from Norway and Sweden are not required to have OSHC provided they and
their dependents hold appropriate health insurance from their own country. These
patients must be informed that the hospital will raise accommodation charges at the
ineligible rate and that the patient will also be responsible for meeting the costs for all
medical services provided by the treating doctor.
PD2011_059
Issue date: September 2011
Page 1 of 5
RECIPROCAL HEALTH CARE AGREEMENTS
PROCEDURES
Retirement Visas (class 410 visas):
Applicants for parent visas from RHCA countries who applied for their visa prior to
1 December 1998 are entitled to make a choice between whether they access RHCA
equivalent benefits or seek an exemption from the Medicare levy. Those who have
chosen to continue to receive RHCA equivalent benefits will have a Medicare card
marked “Visitor RHCA”.
Other visitors on class 410 visas are ineligible patients and are responsible for meeting
the cost of treatment provided (see also page 2.2 NSW Health Fees Procedure Manual
for Public Health Organisations). Provision has been made in the Inpatient Statistics
Collection for the collection of data for RHCA episodes. Hospitals should ensure that this
information is collected correctly to assist with quantifying the actual cost of RHCA’s in
NSW.
Period of Cover:
With the exception of Italy and Malta, people covered under the above agreements are
covered for the duration of their approved stay in Australia. Residents of Italy and Malta
are only covered for six months from the date of their arrival in Australia.
Visitors from Belgium require their European Health Insurance card to enrol in Medicare.
They are eligible until the expiry date indicated on the card, or to the length or their
authorised stay in Australia if earlier.
ELIGIBILITY CRITERIA
Hospitals should check either the patient’s Reciprocal Health Care Card or passport with
respect to the country of residence and authorised period of stay in Australia.
Visitors from New Zealand (citizens only) and the Republic of Ireland will not have a
Reciprocal Health Care Card. The provision of a passport is sufficient identification.
However, New Zealand RESIDENTS’ (those people on foreign passports who have been
granted residency in New Zealand, not New Zealand CITIZENS) passports should be
checked to ensure that the passport contains a “Residence Visa”, a “Returning Residents
Visa” or a “Residence and Returning Residents Visa”. These stamps will have an expiry
date which should be in force at the time treatment is to be provided. These are the only
visa stamps that prove eligibility of New Zealand visitors.
In respect of New Zealand citizens, presentation of a New Zealand passport is sufficient
identification where treatment is being sought under reciprocal health care agreement
arrangements.
Those New Zealanders who are permanent residents of Australia, or intend to remain
permanently in Australia are eligible for Medicare in the normal manner and should be
requested to provide their Medicare card.
Overseas visitors who are eligible under RHCAs and require admitted hospital treatment
should be given a choice to be treated as a public (non-chargeable) patient or as a
private (chargeable) patient. Those patients electing treatment as a private patient
should be classified as ineligible and charges raised accordingly. These patients must
be informed that the hospital will raise accommodation charges at the ineligible rate and
PD2011_059
Issue date: September 2011
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RECIPROCAL HEALTH CARE AGREEMENTS
PROCEDURES
that the patient will also be responsible for meeting the costs for prostheses and all
clinical, diagnostic and medical services.
All people who wish to obtain treatment under an RHCA should be asked to provide
appropriate identification as listed above. Where this identification is not produced,
procedures relating to ineligible patients should be followed (see NSW Health Fee
Procedures Manual for Public Health Organisations p2.5) until such identification is
produced.
Patients having difficulty proving their eligibility should be directed to call the Medicare
Hotline on 132 011 (local call charge) who can assist in this task.
COVERAGE DETAILS
The RHCAs cover treatment that is medically necessary. Medically necessary treatment
means any ill-health or injury which occurs while the individual is in Australia and requires
treatment before their return home. The RHCAs 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 of specialist
services)
•
Pre-existing conditions (any necessary monitoring or treatment)
•
Psychiatric care where medically necessary (eg: to stabilise 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 (ie: 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.
PD2011_059
Issue date: September 2011
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RECIPROCAL HEALTH CARE AGREEMENTS
PROCEDURES
Maternity Services:
1.
Short Stay Visitor (ie: under 9 months)
•
Routine antenatal care is covered
•
Confinements are not covered unless
o Emergencies or complications arise (eg: premature births)
o Special cases (eg: where a patients visit to Australia is primarily for her, or
her partner’s work, and the patient has no choice other than to have the
baby in Australia)
2.
Long Stay Visitor (ie: over 9 months)
•
Confinements and antenatal care are covered, including routine ultrasound
•
Tests such as chromosome sampling where medically indicated (eg: where
the mother is in an at risk age group or there is a family history of deformities)
What is not covered:
•
Ambulance services
•
Dental care
•
Optometry services
•
Medical repatriation
•
Funerals
•
Treatment in private hospitals, or as private patients in public hospitals
•
Treatment that is not immediately necessary
•
Elective treatment
•
Treatment that has been prearranged before arrival in Australia
Special conditions relating to certain RHCA visitors:
Magnetic Resonance Imaging (MRI)
MRI services provided to admitted RHCA patients are covered free under the
agreements.
Visitors from New Zealand (who do not hold a valid Medicare card) and the Republic of
Ireland are not covered by MRI services provided on a non-admitted patient basis.
Charges should be raised on these patients at the service determined rate with the
minimum charge to be the MBS rate.
PD2011_059
Issue date: September 2011
Page 4 of 5
RECIPROCAL HEALTH CARE AGREEMENTS
PROCEDURES
Renal Dialysis
Renal Dialysis is not covered by these agreements. However, NSW has determined that
free dialysis treatment is to be provided to visitors from RHCA countries (except Italy,
Malta and Finland) provided:
•
arrangements are made in advance of arriving in NSW;
•
no more than 10 treatments are required during any one visit; and
•
the RHCA country provides dialysis treatment free of charge to visiting NSW
residents.
Prior arrangements are to be made directly between the overseas health authority and
NSW hospitals for people requiring dialysis.
Highly Specialised Drugs:
Supply of these drugs is limited to the original prescription only. No repeats are to be
issued.
PD2011_059
Issue date: September 2011
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