Processing Low Income Health Care Card (LIC) claims 101-18042300

Customers in vulnerable circumstances who have a genuine difficulty providing documents with the claim can lodge a claim and provide the documents later.

The actual claim date will be the lodgement date and the deemed claim date (under sections 13 and 14 of the Social Security (Administration) Act 1999) will be the contact date where applicable.

Examples of vulnerable circumstances include (but are not limited to) where the customer is:

• in a crisis situation and is unable to fully complete a claim due to being homeless
• affected by a major disaster
• impacted by family and domestic violence
• a recent humanitarian entrant
• recently released from prison or psychiatric confinement
• a young person who is unable to live at home (ongoing situation)

Customers may be presented with pre-filled Single Touch Payroll (STP) data during their online claim. Employer details, including name and ABN, will be presented to the customer if STP data has been provided to the Australian Taxation Office (ATO) within the 8 weeks prior to claim.

The system will also request a customer to update income if the assessment period changes due to delay in claim submission.

If a customer asks for an explanation or applies for a formal review of the decision, the Service Officer must enter their own logon as the Decision Maker and the customer's local service centre when running the script.

If the claim was incorrectly granted, give feedback via Digital Assistant ROXY.

To cover medical, pharmaceutical or other related expenses already incurred, the start date of a LIC may be backdated, to a particular date of the medical service or treatment.

The customer must provide evidence of the medical service or treatment to support the request for backdating the start date.

Claims may only be backdated for a medical service or treatment if the customer has remained eligible for the entire period between the date of medical service or treatment and the date of claim.

This means that the customer must be able to verify that:

• the income in the 8 weeks ending on the date of medical service or treatment was below the allowable income limit applicable to the customer and/or partner, and
• their relevant income remained below the LIC threshold for the entire past period ending on the date the claim was lodged, and
• the customer continued to satisfy the LIC residency requirements for the entire period

The start date field on the LIC Start Date (LSD) screen defaults to the Date of Receipt (DOR). The LSD screen may be changed during a new claim activity. If a request has been made to backdate the claim for longer than 13 weeks due to medical service or treatment please escalate to the Level 2 Policy Helpdesk.