Amount of reimbursement
The following amounts can be reimbursed when the client has applied for a Community Services Card, High Use Health Card or Pharmaceutical Subsidy Card, but are yet to be issued with one of these cards.
Health practitioners costs
Consultation fees vary so it is very important to know the amount the general practice would usually charge without a Community Services Card or High Use Health Card before the amount to be reimbursed is calculated.
The following amounts are the maximum reimbursement payment:
Child aged 14-18 years (if under caregiver's card) | $20.00 |
Adult | $15.00 |
Note MSD does not reimburse claims for children under 14 years of age. All children in this age group are entitled to subsidised fees for medical practitioner and nurse practitioner consultations. However, there may be additional charges that are not subsidised, which must be paid by the parent or carer.
Prescriptions
MSD reimburses the difference between what the client actually paid and what they would have paid if they had their card with them.
There is no $5.00 co-payment for fully subsidised prescription items from publicly funded health providers for people:
- under 14 or
- holding a Community Services Card (and their dependents aged 14-17 years old) or
- 65 years or older
If someone in one of the above groups is prescribed items from a publicly funded health provider, they may still have to pay a fee.
For example, if they are prescribed partially subsidised and non-subsidised prescription items.
For example:
Client age and provider type | Client pays | Reimbursement |
Client (all ages) Publicly funded provider | $5.00 | $5.00 |
Clients 18+ years Privately funded provider | $15.00 (no co-payment or part-charge) | $10.00 |
Clients 14-17 years Privately funded provider | $10.00 | $5.00 |
Note there is no government prescription charge on items for children under 14. There may still be a part-charge or pharmacy fees for services such as packaging and faxes that families pay.
