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Factsheet HSV64 - Medical Expenses Privately Incurred

Purpose

This Factsheet provides information on how you can request reimbursement for Medical Expenses Privately Incurred (MEPI).

When can I claim for medical expenses privately incurred?

There are two situations where you may request reimbursement from the Department of Veterans’ Affairs (DVA) for out-of-pocket medical expenses that you have incurred.

These two situations are defined as ‘in-time’ and ‘out-of-time’. The below table provides the definitions.

Terminology Definition
"In-time'

An ‘in-time’ MEPI is an expense incurred before you are notified of your entitlement.

This situation covers the period between the date of eligibility (the accepted date of onset of the injury or disease) and the date you received advice from DVA regarding your eligibility.

‘Out-of-time’

An ‘out-of-time’ MEPI is an expense privately incurred after you were granted entitlement.

This situation covers exceptional circumstances where a medical expense was privately incurred after the date on which you were granted entitlement, i.e. you have a DVA Health Card (Gold, White or Orange), and you:

were not able to use this card when you received a service, and

paid for the service out of your own pocket.

Note: If you hold a DVA Gold or White Health Card, please check with your health provider prior to your consultation or receiving treatment that the provider accepts DVA Health Card arrangements.

Note: If you have a provider who does not accept DVA Health Card arrangements, it is not possible to reimburse repeat visits to this provider. To be able to use your DVA Health Card please locate a provider in your area who does accept DVA Health Card arrangements.

What medical expenses can be reimbursed?

DVA will generally only pay for services that are listed on the Medicare Benefits Schedule (MBS) or the DVA Fee Schedules.

In-Time

If you fall into the ‘in-time’ category outlined above, DVA will consider reimbursement for the reasonable costs of your treatment, including pharmaceuticals that you have paid for, in the period between the effective date of eligibility and the date you received advice from DVA regarding your eligibility. Only medical treatment and services that DVA would usually cover may be reimbursed.

Out-of-Time

If you fall into the 'out-of-time' category outlined above, DVA will consider reimbursement at the DVA rate only, for the following:

  • services listed in the Medicare Benefits Schedule (MBS)
  • allied health services, e.g. physiotherapy, osteopathy etc., that appear in the relevant DVA Fee Schedule and are provided by a registered Medicare provider
  • pharmaceuticals, and / or
  • Rehabilitation Appliance Program (RAP) items.

MEPI claims for unlisted-services

DVA generally funds medical services that are listed on the MBS and DVA Allied Health Fee Schedules. However, DVA may also consider reimbursing MEPI requests for 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. These claims will generally only be considered for reimbursement at the DVA scheduled fee.

There are some services that are not covered by DVA. For more information on services that are covered, please see Factsheets HSV01 - Health Services Available to the Veteran Community and HSV131 - Alternative Therapies.

Gold Card

If you are granted a DVA Health Card – All Conditions (Gold) or Totally & Permanently Incapacitated (Gold), DVA may reimburse you for health care, pharmaceutical and travel expenses relating to any medical condition, within Australia. For more information about the Gold Card, please see Factsheets HSV59 - Eligibility for the DVA Health Card - All Conditions (Gold) or Totally & Permanently Incapacitated (Gold) and HSV60 - Using the DVA Health Card - All Conditions (Gold) or Totally & Permanently Incapacitated (Gold).

When overseas, reimbursement only applies to your accepted conditions, and does not include travel costs. Please see Factsheet HSV65 - Medical Treatment while Overseas for more information.

White Card

If you are granted a DVA Health Card – Specific Condition (White), DVA may reimburse you for medical expenses that relate to your accepted conditions only. For more information about the White Card, please see Factsheet HSV61 - DVA Health Card - Specific Conditions (White).

Orange Card

If you are granted a DVA Health Card - Pharmaceuticals Only (Orange), DVA may reimburse the amount of the subsidy for pharmaceuticals and items available under the Repatriation Pharmaceutical Benefits Scheme (RPBS). Expenses incurred for services other than prescription medicines, including travelling expenses, are not covered. For more information about the Orange Card, please see Factsheet HSV69 - DVA Health Card - Pharmaceuticals Only.

How do I seek reimbursement?

For In-Time claims

While you are waiting for your eligibility to be assessed, you may seek reimbursement for your medical expenses through Medicare or your Private Health Insurance Fund. Once your eligibility has been assessed, and if accepted, you may seek reimbursement of the balance between the Medicare or Private Health Insurance Fund reimbursement, and the amount paid by DVA, for clincially required treatment of any health condition (if you have a Gold Card), or for your accepted condition/s (if you have a White Card).

For Out-of-Time claims

If you are already the holder of a Gold, White or Orange Card, you may lodge your claim directly with DVA, without seeking rebates through Medicare or your Private Health Insurance Fund. If you choose to claim through Medicare or your Private Health Insurance Fund, you are unable to claim reimbursement through DVA. This includes any gap payment you may incur.

Application form and supporting documentation for MEPI claims

Applications for reimbursement of MEPI claims should be submitted on form D1181 – Application for Reimbursement of Medical Expenses Privately Incurred and must be supported by:

  • Paid itemised accounts or receipts;
  • Medicare rebate statements and / or private health insurance statements; and
  • Clinical information such as a supporting letter from a medical practitioner and a referral (where possible).

Where supporting financial documentation is not available, you can provide a Statutory Declaration Form

Note: Supporting clinical information cannot be provided on a statutory declaration.

Refunds for prescribed medicines must have a copy of the prescription, or an itemised receipt certified by the dispensing pharmacist.

You should submit your application to your nearest DVA office, or via the following contact details:

Postal Address

Department of Veterans' Affairs - Primary Health

GPO Box 9998

Brisbane; QLD; 4001

Email: medtreat@dva.gov.au

More Information

DVA General Enquiries

Phone: 1800 555 254 *

Email: GeneralEnquiries@dva.gov.au

DVA Website: www.dva.gov.au

Factsheet Website: www.dva.gov.au/factsheets

* Calls from mobile phones and pay phones may incur additional charges.

Related Factsheets

Related Forms

Disclaimer

The information contained in this Factsheet is general in nature and does not take into account individual circumstances. You should not make important decisions, such as those that affect your financial or lifestyle position on the basis of information contained in this Factsheet. Where you are required to lodge a written claim for a benefit, you must take full responsibility for your decisions prior to the written claim being determined. You should seek confirmation in writing of any oral advice you receive from DVA.

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27 March 2019