Extending medical coverage when there is no medical certificate

Clients are notified before their medical coverage expires, that they need to produce a current medical certificate if they want to continue getting Jobseeker Support on the ground of a health condition, injury or disability.

There may be instances where clients are having difficulty in providing a current medical certificate before their medical coverage expiry date.

To avoid hardship, you may consider applying a discretionary period of up to 4 weeks that extends a client's medical coverage past the expiry date, while waiting for them to provide a current medical certificate.

You must be sure that the client:

• continues to meet the qualifications for Jobseeker Support and
• has a good and sufficient reason for the delay in providing a new medical certificate

Note a medical expiry extension is only available to primary clients getting Jobseeker Support because of a health condition, injury or disability. It cannot be applied for those that have an exemption due to a health condition, injury or disability.

When deciding whether it is appropriate to extend medical coverage past the expiry date, you need to discuss with the client their circumstances and why they are unable to provide a current medical certificate. Examples of good and sufficient reasons are (but not limited to):

• unplanned emergency surgery
• hospitalisation
• an emergency or adverse event
• a death or illness in the immediate family
• client tested positive for COVID-19 or is a close contact and is required to self-isolate at home or in a managed isolation facility
• lack of health practitioner appointments in some circumstances eg
  • unusually longer waiting periods for an appointment
  • unavailability of health practitioners
  • sudden rescheduling of a scheduled appointment.

Each client’s situation must be assessed on a case-by-case basis. See example below:

Example

A client gets a reminder letter from the Ministry advising their medical certificate is due to expire in 2 weeks. Client arranges to see a doctor, but the first available appointment is in 5 weeks.

Client manages to get an earlier doctor’s appointment in 3 weeks once they explained about their benefit situation. The client tells the Ministry about their situation and asks what can be done to prevent their benefit from stopping.

In this situation, the Ministry may consider the client has made reasonable efforts to access the earliest doctor's appointment and made contact with us to confirm their situation.

Therefore, discretion can be used to apply an extension allowing time to attend their appointment and to provide a current medical certificate.

When applying discretion to extend the medical expiry period, you should consider a reasonable and realistic extension timeframe.

For example, if a client tells the Ministry that they are booked in to see their doctor in 10 days' time, you may consider applying a discretionary expiry extension of up to 2 weeks.

This allows for sudden or unpredictable events that may prevent the client from providing the Ministry with their current medical certificate on the same day as the appointment.

There is no limitation as to how many times a client can get a medical expiry extension. A client may ask for an extension each time they are asked to provide a current medical certificate.

Clients who repeatedly need an extension will need to have their entitlement reviewed to assess if they are getting their full and correct entitlement or whether there are other barriers that are preventing them from providing a subsequent medical certificate within the required timeframe.

There may be situations when a client was initially granted an extension of less than 4 weeks but needs more time to provide a current medical certificate (up to 4 weeks after medical expiry date) due to unforeseen circumstances.

Example

A client was given a discretionary extension of 1 week due to a lack of available appointments to see a doctor.

At the appointment, the client was told that the doctor's clinic booked the wrong date and the client could not be seen urgently due to staff shortages.

Another appointment had to be arranged for a later date in 2 weeks. The client contacted the Ministry again to see what can be done to ensure their benefit does not stop.

Due to circumstances beyond the client's control, benefit entitlement can be extended by another 2 weeks allowing time to attend the appointment and provide a current medical certificate.

There may be situations where a client is still unable to produce a current medical certificate within the period that their medical coverage has been extended ie up to 4 weeks. For more information see:

When a decision is made not to apply a discretionary medical expiry extension, you must make sure you have:

• considered the client's individual situation
• considered all factors to determine there is no good and sufficient reason for not providing a current medical certificate in time and
• fully explained to the client the reasons for the Ministry's decision to not extend payments of Jobseeker Support