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Residence assessment for adult customers claiming a Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC) 101-06040050



This document outlines the procedure to assess if an adult claimant of a Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC) satisfies the residence requirements to qualify for the concession entitlements. The assessment includes whether the customer is residentially qualified to lodge a legal claim and whether they are required to serve the Newly Arrived Resident's Waiting Period (NARWP).

On this page:

Determining residence requirements for LIC, FST or EHC

Assessing if the NARWP has been served or there is an exemption

Determining residence requirements for LIC, FST or EHC

Table 1

Step

Action

1

Residence requirements for LIC, FST or EHC + Read more ...

To lodge an eligible claim for LIC, FST or EHC, the customer must generally be:

  • in Australia at the time the claim is lodged, and
  • meet the residence requirements for the card they are claiming

The claim workflow will present the Immigration Enquiry (RSIMME) screen. Ensure the customer's country of birth and any travel documents are recorded. The system will automatically link to the Department of Home Affairs and update the customer's residence and movement information on their Centrelink record.

If more information is required, see Activating the Department of Home Affairs datalink and contingency procedures if datalink is unavailable.

Go to Step 2.

2

Check residence details + Read more ...

Check the:

  • Immigration Advised Movements (RSIM) screen to verify if the customer was in Australia at the time the claim was lodged
  • Legal Residence Details (RSLEG) screen for citizenship and/or visa details and/or New Zealand Residence Status for the customer

Is the customer in Australia?

3

Customer is in Australia and claiming LIC + Read more ...

Check if the customer is:

  • an Australian resident, or
  • a holder of an SCV residing in Australia, or
  • a holder of certain temporary visas that qualify customers for some payments

For assistance to decide if a customer is residing in Australia, see Assessing if a customer is an Australian resident.

Code the decision on the Country of Residence (CRES) screen.

Does the customer meet the residence requirements for LIC?

4

Customer is in Australia and claiming FST + Read more ...

Check if the customer is:

For assistance to decide if a customer is residing in Australia, see Assessing if a customer is an Australian resident.

Code the decision on the Country of Residence (CRES) screen.

Does the customer meet the residence requirements for FST?

5

Customer is in Australia and claiming EHC + Read more ...

Check if the customer is an Australian resident. For assistance to decide if a customer is residing in Australia, see Assessing if a customer is an Australian resident.

Code the decision on the Country of Residence (CRES) screen.

Does the customer meet the residence requirements for EHC?

6

Customer is not in Australia + Read more ...

The customer can only lodge a legal claim for a LIC, FST or EHC while they are outside Australia if they meet an exception to the lodgement inside Australia rule.

Does the customer meet an exception to the lodgement inside Australia rule?

  • Yes, and they are claiming:
    • LIC and are an Australian resident or the holder of an SCV residing in Australia or the holder of certain temporary visas that qualify customers for some payments, see Table 2, Step 1
    • FST and are an Australian resident or the holder of an SCV who is residing in Australia, they meet the residence requirements for an FST. Continue to assess the claim. See Foster Child Health Care Card (FST) . If the claim rejects NIA (Not in Australia), phone Centrelink International Services. Procedure ends here
    • EHC and are an Australian resident, see Table 2, Step 3
    • any card but they do not meet any of the above conditions, go to Step 8
  • No, go to Step 7

7

Customer cannot lodge outside Australia + Read more ...

Advise the customer to lodge a claim if they return to Australia in the future.

Continue to assess the claim, the claim will reject for a residence related reason.

Procedure ends here.

8

Customer does not meet the residence requirements for LIC, FST or EHC + Read more ...

If not already recorded, code the:

Continue to assess the claim, the claim will reject for a residence related reason.

The customer may be entitled to some of the following. Offer to the customer if appropriate:

  • Special Benefit (SpB), in a number of circumstances, including:
    • if the customer is in financial hardship and has suffered an unexpected and significant change in circumstances since being in Australia as the holder of certain temporary visas that qualify customers for some payments
    • if the person is not residentially qualified for any social security payments because they do not hold the required legal residence (for example, they are a temporary visa holder) but they have a child who is an Australian citizen or permanent visa holder, they may be able to claim SpB for the child. See Special Benefit (SpB) for Australian Citizen Child (ACC) and Australian permanent resident children
  • Child Care Subsidy (CCS) if the customer has any dependent children
  • Assistance to look for work, to check a customer's entitlement, see Employment services for visa holders
  • Payments using an international agreement. This only applies to Age Pension, Disability Support Pension (DSP), Carer Payment (CP) and Parenting Payment Single (PPS), in certain circumstances

Procedure ends here.

Assessing if the NARWP has been served or there is an exemption

Table 2

Step

Action

1

Check citizenship + Read more ...

An automatic exemption from the NARWP applies to a customer who is an Australian citizen. Citizenship must be verified. To determine if the customer is an Australian citizen, see Proof of Australian citizenship.

Country of citizenship details are recorded on the Legal Residence Details (RSLEG) screen.

Is the customer an Australian citizen?

  • Yes, they are not subject to a NARWP and meet the residence requirements for LIC or EHC:
    • Check the details are recorded correctly on the RSLEG screen
    • Continue to assess the claim. If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, and the customer is claiming:

2

Check if the LIC claimant has already served the NARWP + Read more ...

The customer will have a 2 year (104 week) NARWP if:

  • their first permanent residence visa was granted before 1 January 2019, or
  • they hold or have held an SCV 444 and not granted a permanent visa after 1 January 2019, or
  • they hold or have held visa subclass 115, 117, 835 or 837, or
  • they hold a partner provisional visa (subclasses 309 and 820)

Otherwise, the customer is required to serve a 4 year (208 week) NARWP.

Note: if the holder of an SCV or partner provisional visa (subclasses 309 and 820) is granted a permanent visa on or after 1 January 2019, they will become subject to a 4 year (208 week) NARWP for the LIC. The calculation of the NARWP still commences from the application date for partner provisional visa (subclasses 309 and 820), and does not restart upon commencement of the permanent visa.

The NARWP generally starts on the day the person:

  • first became an Australian resident, and
  • was present in Australia

For LIC claimed by a person who holds a 309 or 820 partner provisional visa, the NARWP starts on the day the person:

  • lodges an application for the relevant visa, and
  • is present in Australia

Check the Periods of Australian Presence (RSPAP) screen. This screen displays the periods the customer has been physically in Australia while an Australian resident.

Has the customer been in Australia as an Australian resident, a holder of an SCV residing in Australia or after lodging an application for a 309 or 820 visa for at least 2 years (104 weeks) or 4 years (208) weeks?

  • Yes, they have served the NARWP and meet the residence requirements for LIC:
    • Continue to assess their claim. If the claim rejects NIA (Not in Australia) phone Centrelink International Services
    • Procedure ends here
  • No, go to Step 3

3

Check if the LIC claimant is the holder of a visa subclass 060, 070, 449, 785, 786, 790 or ZB951 + Read more ...

Check the Legal Residence Details (RSLEG) screen for visa details.

Is the customer the holder of a visa subclass 060, 070, 449, 785, 786, 790 or ZB951 (coded as 787)?

  • Yes, they are exempt from the NARWP and meet the residence requirements for LIC:
    • Continue to assess their claim. If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, go to Step 5

4

Check if the EHC claimant has already served the NARWP + Read more ...

The customer will have a 2 year (104 week) NARWP if:

  • their first permanent residence visa was granted before 1 January 2019, or
  • they hold or have held a visa subclass 115, 117, 835 or 837

Otherwise, the customer is required to serve a 4 year (208 week) NARWP.

Check the Periods of Australian Presence (RSPAP) screen. This screen displays the periods the customer has been physically in Australia while an Australian resident.

Has the customer been in Australia as an Australian resident for at least 2 years (104 weeks) or 4 years (208 weeks)?

  • Yes, they have served the NARWP and meet the residence requirements for EHC:
    • Continue to assess the claim. If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, go to Step 5

5

Check if customer holds visa subclass 852 + Read more ...

The holder of a visa subclass 852 is exempt from the NARWP.

Check the RSLEG screen for a current or previous visa subclass 852. This can also generally be found in the customer’s passport.

Does the customer hold visa subclass 852?

  • Yes, they are exempt from the NARWP and meet the residence requirements for LIC or EHC:
    • Check the visa details are recorded correctly on the RSLEG screen
    • Continue to assess their claim. If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, go to Step 6

6

Check if a refugee visa is or was held + Read more ...

A customer who is a refugee or former refugee has an automatic exemption from the NARWP.

To determine if the customer is a refugee or former refugee, go the RSLEG screen.

If the customer's visa subclass (either now or previously) was a refugee visa, it should have been automatically recorded on this screen from the Immigration Datalink. Refugee visas can be determined using:

If the customer advises they are or were a refugee and this is not evident on the RSLEG screen or from their passport contact Centrelink International Services (CIS) or refer to CIS via the Immigration Match Questionnaire (IMQ).

Is the customer a refugee or former refugee?

  • Yes, they are exempt from the NARWP and meet the residence requirements for LIC or EHC:
    • Check the visa details are recorded correctly on the RSLEG screen
    • Continue to assess their claim. If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, go to Step 7

7

Family member of a refugee or former refugee + Read more ...

A customer who is a family member of a refugee or former refugee has an automatic exemption from the NARWP.

For this purpose, family members include the following:

  • A partner of the person
  • A dependent child of the person
  • Another person who, in the opinion of the Secretary, should be treated for the purposes of this definition as a partner or dependent child of the person

To be eligible for an exemption as the family member of a refugee or former refugee, a person must have been a family member, both:

  • at the time the refugee or former refugee arrived in Australia, and
  • currently or when the refugee or former refugee died

Does the customer have a family member who could be considered under this exemption?

8

Check if the customer was the family member of a refugee or former refugee when they arrived in Australia + Read more ...

Was the customer a family member of a refugee or former refugee at the time that the refugee or former refugee arrived in Australia?

9

Check if the customer is currently the family member of a refugee or former refugee + Read more ...

Note: the customer must have been the family member of that person at the time the refugee first arrived in Australia. However, if the family member is now an Australian citizen, they are no longer considered to be a refugee (they are a former refugee) and the customer may be covered by this exemption provision.

Is the customer currently the family member of a refugee or former refugee?

  • Yes, they are exempt from the NARWP and meet the residence requirements for LIC or EHC:
    • Once the claim is assessed, refer to CIS for exemption coding
    • Once response has been returned from CIS, continue to assess the claim. If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, and they are claiming:

10

Check if the customer was the family member of a refugee or former refugee when the refugee or former refugee died + Read more ...

Note: the customer must have been the family member of that person at the time the refugee first arrived in Australia. If the family member had become an Australian citizen, they are considered to have been a former refugee and the customer can be covered by this exemption provision.

Was the customer the family member of a refugee or former refugee at the time the refugee/former refugee died?

  • Yes, they are exempt from the NARWP and meet the residence requirements for LIC or EHC:
    • Once the claim is assessed, refer to CIS for exemption coding
    • Once response has been returned from CIS, continue to assess the claim. If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, and they are claiming:

11

Substantial change in circumstances (LIC only) + Read more ...

Has the customer suffered a substantial change in circumstances beyond their control and the change in circumstances occurred after the customer's arrival in Australia?

  • Yes, they are exempt from the NARWP and meet the residence requirements for LIC:
    • Continue to process the claim
    • Navigate to the LIC Start Date (LSD) screen and record appropriate details in:
      Date of Event
      Exemption
      Reason
    • If the claim rejects NIA, phone Centrelink International Services
    • Procedure ends here
  • No, go to Step 12

12

Customer claiming LIC and has FTB child in their care + Read more ...

Is the customer claiming LIC and has a Family Tax Benefit (FTB) child in their care?

  • Yes, they are exempt from the NARWP and meet the residence requirements for LIC:
    • This is an automatic exemption from the NARWP if at least one child is recorded as being in the customer's care
    • If the customer does not have at least one child recorded as being in their care, check whether a Details of your child's care arrangements form (FA012) has been issued or lodged. If not, the customer will need to complete a FA012 before a NARWP exemption can be granted
    • Continue to assess the claim
    • Procedure ends here
  • No, go to Step 13

13

Customer is claiming LIC or EHC and has not yet served the NARWP + Read more ...

Continue to assess the claim.

The end date of the NARWP (assuming they remain in Australia) is calculated and displayed on the Periods of Australian Presence (RSPAP) screen. This can be used to advise the customer of future entitlement.

For an SCV holder claiming LIC, the Projected end 104wks/208 wks Aust. Presence (inc. SCV): field on the Residency Results Explanation (RSREX) screen displays the date when a non-protected SCV holder has 2 years (104 weeks) or 4 years (208 weeks) presence in Australia.

As the customer has not yet served the NARWP, the claim will either:

  • reject NW2 (Residency less than 104 weeks), or
  • reject NWA (NARWP assessment not met)

If the claim is incorrectly granting when the customer has not served or is not exempt from the NARWP, check the Family Member/Refugee Code on the Residence Savings (RSS) screen. If FMC, FME or PRE is coded, refer case to CIS for exemption coding to be ended.

Note: if the claim is granted with a start date more than 13 weeks in the future, but no exemption is coded on RSS, manually reject the claim with a reason of 'NRQ' on the Benefit Action (BA) screen. An automatic letter will be issued. The customer may be entitled to some of the following.

Offer to the customer if appropriate:

  • Assistance to look for work. To check a customer's entitlement, see Employment services for visa holders
  • Payments using an international agreement. This only applies to Age Pension, Disability Support Pension (DSP), Carer Payment (CP) and Parenting Payment Single (PPS), in certain circumstances