Medical fees

MSD must check if the client qualifies for Disability Allowance for medical fees.

If the client qualifies for Disability Allowance, it must be granted before MSD assess if the client qualifies for Temporary Additional Support.

The client may have allowable health and disability costs for Temporary Additional Support where they do not qualify for Disability Allowance because:

• they do not meet the Disability Allowance income limit or
• their disability will last less than 6 months or
• they are certain refugees, protected persons or residence applicants

A registered medical practitioner or nurse practitioner must complete a Disability Allowance medical certificate confirming the client's disability and the need for treatment is necessary. The certificate must also confirm the treatment is beneficial and of therapeutic value and that the costs are:

• additional and
• ongoing and
• directly related to the client' disability

If the fees, or a portion of the fees, claimed are not covered by the Community Services Card or the High Use Health Card, ACC or other accident insurers, or medical insurance they can be included in Disability Allowance.

Note unless there are exceptional circumstances (e.g. when a public medical specialist doesn't exist in the client's region) Disability Allowance cannot usually be paid for private medical specialist fees. Public specialist fees are free.

Medical fees can also include the fee charged by the medical practitioner or nurse practitioner (or their teams) to complete a repeat prescription for ongoing conditions without the client attending a consultation (including faxing or electronically sending the prescription to the chemist).

This category can also include fees for the following services if a registered medical practitioner or nurse practitioner verifies the client's disability and the need for the services on the client's Disability Allowance medical certificate:

• occupational therapy
• physiotherapy
• speech-language therapy (for adults)
• audio logical
• orthotic
• podiatry
• dental services

The client must provide:

• a Disability Allowance medical certificate completed and signed by a registered medical practitioner or nurse practitioner and
• receipts as proof of their medical/therapy fees (1 receipt is enough proof if it shows the regular cost of each visit, and the registered medical or nurse practitioner signing the certificate has indicated how often the treatment happens)

Note it is not appropriate for MSD to approach the health practitioner directly. The client should provide the receipts.

Example 1

A client is charged $20 for their doctor's visit. This includes an administration fee of $5. This fee is deducted from the total if the account is paid within 7 days, and the account is reduced to $15.

If this is not paid within 7 days, the total charge of $20 can be included as a cost for Disability Allowance.

Example 2

A client has an overdue account with their doctor and has been charged a $10 late fee. The late fee is not an allowable cost for Disability Allowance as this fee is not a direct result of their health condition or disability but due to the client not paying the overdue account.

Example 3

A client goes to see a private rheumatologist specialist and applies for the cost to be covered by Disability Allowance. This is not an allowable cost for Disability Allowance (or Temporary Additional Support) as there is a publicly funded rheumatologist specialist in their region.