DVA Provider News article - January 2020.

Understanding the DVA Gold Card

The DVA Gold Card entitles the holder to DVA-funded services for all health conditions, whether they are related to war/military service or not.

DVA veterans' Gold Card

All treatments must be clinically necessary to treat the client’s condition/s, and DVA does place some restrictions on the range of treatments and services that will be funded.

Services covered with a valid referral and/or prescription include primary health care (including dental and allied health); hospital care (public and private); rehabilitation aids and appliances; home and respite care; community nursing; and a range of other support services.

The card also entitles the holder to access the Repatriation Pharmaceutical Benefits Scheme and transport to travel for treatments.

See DVA health cards for the full list of services covered under the DVA Gold Card, if assessed by the relevant health provider as clinically necessary for their client.

There are some limitations consistent with the limits imposed under the Medicare Benefits Schedule (MBS), which health providers need to be aware of when treating DVA clients. They include:

  • Generally, medical services funded by DVA are consistent with those listed on the MBS, including any limits imposed under the MBS.
  • Medical services not listed on the MBS, above-fee procedures or non-listed prosthesis items, may be considered in exceptional circumstances. A request for prior financial approval must first be submitted to DVA before providing these services, to be able to claim payment.
  • DVA will not pay for treatment of a disease or injury where the patient has already received compensation or damages – from a third party or as a result of a court settlement or decision – for the effects of the same injury or disease.
  • DVA gives Gold Card holders access to a limited dental program, which covers all conditions, but places restrictions on the extent of treatment and funding provided for a small number of high-cost treatments.

It is important to note that health providers cannot charge co-payments for services provided to DVA card-holders.

Health Providers should check the Rules for providers and Schedules of Fees specific to their profession to identify: services covered by DVA and their applicable fees; items that require prior financial approval from DVA; and the obligations of providers claiming for services.