Application for Reimbursement of Medical Expenses

Your personal information is protected by law, including under the Privacy Act 1988 (Privacy Act).

Who is collecting your personal information?

This notice explains how the Department of Veterans’ Affairs, including the Repatriation Commission and the Military Rehabilitation Compensation Commission (together, DVA, we, us), collects, uses, discloses and otherwise handles your personal information when you provide it through this webform, through MyService, or via paper based forms.

How we collect your personal information

DVA collects your personal information when you submit information through this webform, through MyService, or through paper based processes for the purposes of administering DVA programs and services, and for performing DVA’s functions under its portfolio legislation.

Information submitted through this webform is collected via a form hosted on GovCMS, the Australian Government’s content management system administered by the Department of Finance. The Department of Finance, through GovCMS, acts as a service provider to DVA by hosting, maintaining and supporting the webform. DVA remains responsible for determining the purposes for which your personal information is collected and how it is used.

Purpose of collection and use

DVA collects your personal information as authorised by, and to perform its functions under, its portfolio legislation. Your personal information may be collected, used and disclosed for the purposes of:

  • receiving, assessing and responding to your submission or request
  • administering and managing DVA programs, services, claims or entitlements relevant to your submission
  • contacting you where necessary in relation to your submission
  • making decisions about your eligibility, entitlements or access to services under relevant legislation
  • conducting internal reporting, program management, quality assurance, evaluation, research, audit and continuous improvement activities
  • any other purpose authorised or required by law.

If you are submitting information on behalf of another person, you must ensure you have appropriate authority to act on their behalf and that you provide that person with a copy of this notice.

Sensitive personal information

Depending on the nature of your submission, DVA may collect sensitive personal information, including health or medical information, where it is relevant and necessary.

You are not required to provide sensitive personal information unless it is necessary to support your submission or request. If you choose to provide sensitive personal information, you consent to DVA collecting, using and disclosing that information for the purposes outlined in this notice and in DVA’s Privacy Policy.

What happens if you do not provide your information

If you choose not to provide some or all of the personal information requested, DVA may be unable to properly respond to your submission or process your request.

Disclosure of your personal information

DVA does not usually disclose your personal information to parties outside DVA except as part of processing your submission or as outlined in its Privacy Policy.

This may include disclosure:

  • to the Department of Finance and its contracted service providers for the purposes of hosting, maintaining and supporting the webform through GovCMS
  • within DVA, or to other Australian Government agencies, where necessary to process your submission or perform DVA’s functions
  • where required or authorised by law.

Further information about the types of disclosures DVA may make, including disclosures to service providers, is set out in DVA’s Privacy Policy.

Storage and retention

DVA stores personal information securely and retains it in accordance with the Archives Act 1983, relevant records authorities, and DVA’s Privacy Policy. This includes secure hosting by third party service providers. When no longer required, information is disposed of securely.

Privacy complaints and access

DVA’s Privacy Policy contains further information about how DVA collects, uses, discloses and manages personal information, including how to seek access to or correction of your personal information and how to make a privacy complaint.

DVA’s Privacy Policy is available at:

If you have a privacy concern or wish to make a complaint, you can contact DVA at:

 

Are any of the services, investigations or treatments associated with this reimbursement request associated with a compensation claim?

Stop!

Do not complete this form. Proceed as outlined on the Transaction Reference Number (TRN) or contact your DVA Initial Liability Claims Delegate.

Complete this form carefully as an incorrect and/or incomplete form may be returned to you for completion.

This form MUST be completed in full and include an attached itemised invoice, plus any required supporting medical information, for reimbursement to be considered. If you have sought reimbursement through Medicare or a private health insurer you MUST provide a copy of your Medicare and/or private health insurance fund statement.

Supporting Information

The Department of Veterans’ Affairs (DVA) generally funds medical services that are listed on the MBS and DVA Allied Health Fee Schedules. However, DVA may also consider reimbursement of treatment and/or medical services which are not listed in these schedules, if there are exceptional circumstances. In these cases a referral and supporting clinical information from the referring provider must be provided. An outline of the supporting documentation required for your application is available.

For Veteran White Card holders you must provide clinical information such as a supporting letter from a medical practitioner and/or a referral which outlines the condition for which you were referred and/or treated for.

For enquiries relating to this application please call 1800 VETERAN (1800 838 372).

 

Application for Reimbursement of Medical Expenses form

Does this reimbursement request pertain to:
1. DVA client details

Stop!

Do not complete this form. Proceed as outlined on the Transaction Reference Number (TRN) or contact your DVA Initial Liability Claims Delegate.

Are you still a current full-time serving member?

If Yes, and your treatment was not for a Non-Liability Health Care condition (NLHC) please seek reimbursement through Defence.

Refer to DVA’s Non-Liability Health Care (mental health) arrangements for eligible veterans.

Are you receiving Department of Health, Disability and Ageing support at home, or a resident of an aged care home?

Some treatments, aids and appliances may be covered by the Department of Health, Disability and Ageing for your Residential Aged Care home. Please discuss this with your care providers.

Find out more:

2. Reimbursement payment details
Select a payment method
I can confirm that DVA has my current banking details.
Once updated, this will be my primary bank account on file.
Whether existing or new to DVA
3. Reason for reimbursement

Find a health provider that accepts the DVA card.

4. Details of reimbursement(s) being applied for
  • Add each item/service
  • Please ensure each item/service and associated fee on the invoice are listed separately
  • If you have more than 50 items, please complete an additional D1181 Webform
  • For reimbursement of treatment or services without an item number, clinical information such as a supporting letter from a medical practitioner or a referral that outlines the condition/s for which you were referred and/or treated must be included in your application.
  • For pharmaceutical items, DVA may reimburse the cost, minus any concessional copayment
  • Some items are not reimbursable under MEPI.
Item / service If White Card: condition Provider name Date of service (dd/mm/yyyy) Cost ($) Benefit from Medicare ($) Benefit from health fund ($)
5. Further circumstances (optional)
For example, isolation, homelessness, mental/physical health, access/wait‑list issues, referrals.

You can get support and counselling

Open Arms – Veterans & Families Counselling is a free and confidential 24-hour service for current and ex-serving ADF members and their families if you reside in Australia. Call 1800 011 046 or go to www.OpenArms.gov.au to get support or find out more.

6. Authorised person details (if client deceased or unable to apply)
Complete this section if you are authorised to act on behalf of the DVA client to complete and lodge this form.
7. Upload each invoice/receipt and any supporting information
Please note, quotes or estimates will not be accepted.
Document type Description Upload file
Maximum 100 files.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
8. Declaration