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

Locate the work item in Process Direct.

Select the work item to go to the Customer and Claim Information table on the Transaction Summary (TS) screen, to review and process the customer's claim.

Paper claims

When a Claim for a Health Care card (SS050) is scanned to the customer's record, a Social Application (SOA) shell work item is generated on the customer's record.

If the customer has indicated on the paper claim that their partner will require a Health Care Card (HCC) of their own, create a Social Application (SOA) shell on the record by scanning the paper claim to both records. For further information, see Table 3 > Step 2 in Indexing, reindexing and cancelling claim activities.

This has no claim information apart from:

• the Customer Reference Number (CRN)
• personal detail, and
• receipt date

Claim information will need to be manually added into the SOA claim, using details from the scanned claim and documents.

Note: children in the care of Approved Care Organisations may qualify for a LIC in their own right, as long as no individual is being paid Family Tax Benefit (FTB) for the care of the child. The Claim for a Health Care Card (SS050) must be completed in the name of the child and not in the name of the organisation, or a worker from that organisation.

For information on how to access claims for processing, see Process Direct navigation, common screens and functions.

Is the claim for a child in the care of an Approved Care Organisation?

• Yes, and the child:
• has a person (PER) CRN. Go to Step 2
• does not have a CRN. See Adding a customer to the system, then complete actions to move the digital image to the correct CRN. Go to Step 2
• has an existing child (CHI) CRN. Convert the CHI record to a person (PER) record, then complete actions to move the digital image to correct CRN. Go to Step 2
• No, go to Step 2

The claim status must be In Process before it can be processed.

If this claim has been submitted within 13 weeks of a previously rejected claim, see Request to reassess a rejected claim.

If the previously rejected claim was able to be reassessed, the subsequent claim status should be updated to 'Not Required'.

Is the new or reindexed claim status In Process?

• Yes, go to Step 3
• No, for claim status definitions and actions to take, see Process Direct navigation, common screens and functions

To review the Claim Summary:

• select to view the Claim Summary
• select to expand the Claim Summary
• review the Claim Summary in a new window if needed. Key details, include:
• relationship status
• Australian residence
• Identity requirements for the customer and partner
• income details
• select Documents to view the documents provided by the customer (uploaded online or scanned to their record)

On the Transaction Summary (TS) screen, check the customer’s and if relevant partner’s identity status.

Is the identity status confirmed?

• Yes, go to step 5
• No:
• select the Not Confirmed link, to open a Customer Summary window
• Select Identity Confirmation > Identity Confirmation Dashboard from the Task Selector

For the customer:

• See Identity Confirmation
• If the customer cannot confirm their identity, code any available identity documents, complete an Alternative Identity assessment

For the partner:

If the partner:

• is confirmed or has a no linkage identity status:
• identity requirements have been met for partner
• no documents are required
• go to Step 5
• is receiving an Income Support Pension (ISP), Department of Veterans Affairs (DVA), Low Income Health Care Card (LIC) or Commonwealth Seniors Health Care Card (CSHC):
• no documents are required
• Service Officers must apply an identity review on the partner’s record. The review will auto complete when the linked claim is processed. For the process when the partner is an ISP, DVA, LIC or CSHC recipient, see Alternative Identity
• is none of the above:
• the partner is required to establish their identity by providing 3 approved documents to achieve a no linkage identity status
• on the dashboard, Service Officers are required to select NP - No Linkage required. See Coding identity documents

New LIC claims can only be finalised when Identity Confirmation or Alternative Identity is competed in the Identity Confirmation Dashboard.

Do not update Proof of Identity (POI) screens.

Note: if identity requirements have been met, and the claim presents a POI error, the claim must be regenerated and processed. This is a new claim mapping issue and not related to identity. If the POI error E257CU presents when processing a claim, see details for the error in the Roxy Digital Assistant.

These details must be reviewed/updated before selecting Process. Relationship details are viewed on the Transaction Summary (TS). The:

• Link Summary (LS) table shows all known relationships to the customer, for example:
• Partner and any Relationship Qualifier Code
• Children
• Nominees
• Marital Status (MS) table shows the marital status of the customer

Compare relationship details provided in the claim with the details already recorded in the Marital Status (MS) table.

Has the customer advised within their claim that they are:

• separated/single, go to Step 6
• partnered, go to Step 8

Is the customer already current on a payment or benefit?

• Yes, go to Step 7
• No, the customer is claiming LIC only, go to Step 9

Is the customer advising of a change in relationship status within their new claim?

• Yes, the relationship will need to be assessed based on the customer's current payment or benefit, prior to assessing the LIC new claim:
• see Change in relationship status from partnered to single
• go to Step 9
• No, the relationship details within the new claim and on the Marital Status (MS) screen are the same, go to Step 9

Note: a Member of a couple (MoC) assessment is not required for a customer and sharer/other person who are claiming or have a current LIC only.

Is the customer and/or partner current on a payment or benefit, and the current partner is the same as already recorded?

• Yes, the relationship details within the new claim on the MS screen are the same, go to Step 9
• No, the customer has lodged a:
• paper claim form and the partner has:
  - signed the form, go to Step 9
  - not signed the form, see Confirming a partnered relationship to assess the relationship. Once confirmed, go to Step 9
• claim online advising they are partnered:
  - LIC claims do not issue a MOD P or a Temporary Access Code (TAC)
  - see Table 1 > Step 5 in Confirming a partnered relationship to assess the relationship
  - once confirmed, go to Step 9

Check if the customer has met the basic eligibility for LIC

Does the customer qualify for a LIC?

• Yes, go to Step 10
• No, go to Step 11

Check the claim to make sure all required documents have been provided.

Have all relevant supporting documents been provided?

• Yes, go to Step 13
• No, go to Step 11

A customer identified as vulnerable as part of the LIC claim can submit their claim before completing all required tasks.

Does the claim have the keyword 'URGVULN' on the Keyword screen?

• Yes, and:
• only additional documents are now required, go to Step 12
• it has been less than the time allowed to respond since the claim lodgement, hold the claim for the appropriate timeframe from the Claim Submission Date on the Status screen. On the Notes screen, add or update the Claim Progress note for action taken. Procedure ends here
• it has been more than the time allowed to respond since claim lodgement, go to Step 13
• No:
• if additional documents are required, go to Step 12
• if documents have been requested at the time of claim or after, and not returned, go to Step 13

If more details or clarification of the claim or submitted documents are needed to determine the customer's eligibility, make genuine attempts to contact the customer by phone.

If the contact was successful, record the details of the conversation in the Progress of Claim Note.

If the customer:

• has provided required information to assess the claim verbally, or the customer can immediately upload the information, go to Step 13
• cannot immediately upload the information and it is still required, request the information. Procedure ends here
• contact was unsuccessful, or it is not appropriate for the customer to provide the information or evidence verbally, request the information. Procedure ends here

Is the claim to be rejected?

• Yes, see Rejecting a claim for Low Income Health Care Card (LIC). Procedure ends here
• No, go to Step 14

Are further actions required?

• Yes:
• a referral is required, go to Step 15
• actioning a completed Assessment of Care Arrangement referral is required, see Table 2 > Step 4
• No, there are no outstanding referrals, see Table 3 > Step 1

If more than one referral is required, make sure that all referrals are completed.

When a specialist assessment is required:

• select > Referral
• complete the referral details
• when a referral is made, the claim remains on hold until the assessment has been completed. Annotate the Progress of Claim Note with details of the request
• when the referral(s) are completed, continue processing the LIC claim

Unless it is clear the claim must be rejected because basic eligibility criteria has not been met, claims needing a CAO referral should not be finalised until the assessment has been completed.

If the customer’s financial circumstances are complex, for example, they include a trust or company, a CAO referral is needed to make sure the income and assets tests are met.

For referral instructions, see Identifying and making suitable referrals to the Complex Assessment Officer (CAO).

Note: only refer to CAO if all documents for the new claim are received.

See Coding Compensation and damages (MOD C) to request a clearance for referral instructions.

A non-government payment, or a payment made by a private organisation is not a foreign pension and should not be referred to CIS for coding.

If necessary, make sure all foreign pension documents are scanned to the customer record 'S 'INT'OG' ensuring that no work item is created (scan to store). Translation of foreign pension documents is not needed before referring to CIS.

For referral instructions, see Foreign pension coding.

A completed FA012 form must be lodged as part of a LIC claim, where either of the following is advised:

• a change to care arrangements for an existing child, or
• a new child has entered the customer's care

An Assessment of Care Arrangements referral must be created when a Details of your child’s care arrangements (FA012) form has been requested and returned as part of a LIC claim. The Resources page has a link to the form.

If an Assessment of Care Arrangement FA012 form been returned and referral is required, see Table 2 > Step 1.

Go to Document List (DL).

Check the Notes screen, to confirm if a care assessment has been completed. One of the below titles may display (this is not an exhaustive list):

• Change in Care Status
• Changes in Child - No Decision Shared Care Decision
• Add child coming into care
• Care Decision
• Care details update per Child Support Agency (CSA), or
• Care assessment not required

Has a care assessment been completed?

• Yes, go to Step 4
• No, go to Step 2

On the Notes screen, does a Note with the title 'Care Assessment referral' display with a date after the claim submission?

• Yes:
• the care assessment is in progress
• hold the claim and annotate the Progress of claim Note with 'Claim held for 14 days pending Assessment of Care Arrangements'
• procedure ends here
• No, go to Step 3

Select > Referral.

On the Referral screen:

• Referral Type: select Assessment of Care Arrangements Referral > Next
• Referral Reason: select the appropriate referral reason
• Document Lists: select Details of your Child's Care Arrangements (FA012)
• in the What is required? field, add, 'LIC claim lodged DD/MM/YYYY. Care determination and Principal Carer determination is required for:
• Child/ren's Name and date of birth
• New Child advised within LIC claim, care assessment required. FA012 scanned to record'
• in the Have all necessary documents been provided? field, select Yes
• select Finish

Select the Status icon. The Status screen shows the claim has been placed on hold for 14 days.

Select the Notes icon. Annotate the LIC Claim Progress Note with, 'Claim held for 14 days pending Assessment of Care Arrangements'.

Procedure ends here.

Review the Notes for key information to determine the assessment for child/ren in the LIC claim. This includes child/ren name, date of birth (DOB) and care percentage details.

If the assessment outcome is:

• a change to or confirmation of care arrangements for a child already in care, or no change to existing care arrangements:
• select to complete a SAP refresh
• see Table 3 > Step 1
• a new child has entered the customer's care, go to Step 5
• the child is not in the customer's care, go to Step 6

Note: use the steps above to apply different circumstances to each child where there is more than one child listed within the LIC claim, depending on the care assessment results.

If a new child is in the customer's care:

• select > Regenerate Claim
• once the claim has been regenerated, the child should be listed under the Known Relationships
• select > Child
• check the Child in Care (CHC) screen has been coded
• see Table 3 > Step 1

If the child is not in the customer's care:

• select > Regenerate Claim
• go to Known Relationships
• check the child is showing
• under the Claim Relationships table, change the status to 'Not Required'
• see Table 3 > Step 1

Before selecting Process, make sure all outstanding referrals are completed. If not, place the claim back on Hold for a further 14 days and annotate the Progress of Claim Note.

If the relationships details are updated after processing has been started, the claim will need to be regenerated by selecting > Regenerate claim.

Do not start coding before selecting Process as this will result in errors.

Select Process to view the Errors (SWE) screen.

Before coding any screens:

• select Assess
• when the Entitlement (ELD) screen displays, select Back or key 'SWE' in Super Key to return to the SWE screen
• complete the claim coding

Message Log

This section displays any errors with existing coding. These must be fixed before the claim can be assessed. For help, see Using Digital Assistant Roxy in Process Direct.

Task Selectors

These list common screens. Task selectors that have mandatory screens are pre-selected.

Task selectors may not list all screens that must be checked or coded. Check screens to compare historical details with the claim details.

A flag will display against all screens that have provisional claim data. These may not need to be accessed to process the claim:

• select the screens to be checked or updated. There is an option to select all screens
• select Next or press [Enter] to go through the selected screens

Use Super Key to go to screens. Key 'Screens' to view a full list.

The following system errors display when a LIC NCL is more than 10 months old at date of processing:

• E244ZZ - Cannot backdate DOR of a LIC NCL for more than 10 months in the past
• E051LI - LIC NCL cannot be completed for this date of commencement
• E0031 - This date may not be more than one year in the past

Have any of these error messages presented?

• Yes, see Table 4 > Step 1 on the Customer First tab
• No, continue assessing the claim, go to Step 3

Check information provided in the claim (provisional data) is accurate and in line with any evidence that has been provided. See income and financial investments.

LIC start date

LIC start date defaults to the date of claim lodgement. In some circumstances, based on the information supplied by the customer, Services Officers may need to make a decision on the LIC start date.

LIC income

LIC entitlement is based on the customer's last 8 weeks of income from the LIC start date. If a decision is made to change the defaulted start date, the income assessment period will need to be reassessed and evidence supplied. See Low Income Health Care Card (LIC) income test.

Residency

The customer's residence qualification will be automatically assessed based on the residence information recorded. See Residence assessment for adult customer claiming a Low Income Health Care Card (LIC), Foster Child Health Care Card (FST HCC) or Ex-Carer Allowance (child) Health Care Card (EHC).

Note: residence information must still be recorded if the claim will be rejected for any reason. If residence details are not recorded, the system will override any other rejection reason, and the claim will reject for a residence related reason.

Select all relevant Task Selectors and select Next:

• Key/update required information for each relevant screen
• Check information provided in the claim (provisional data) is accurate and in line with any evidence that has been provided. Update where necessary
• Check nominee information has not been incorrectly ended, for example, Public Trust nominees. See Adding or rejecting a nominee request
• Check there is no historical coding of continuous income that needs to be ended, see Recording and correcting employment income details
• If an STP employer has been presented to the customer (question 'Do you work for (employer) ABN XXXX') within the claim, any provisional income needs to be confirmed. STP income is not presented to the customer within the claim. Service Officers must check evidence supplied, and manually update the Employment Income Paid Details (EAPP) screen with income from the claim and evidence supplied by the customer

If the POI error E257CU presents when processing a claim, see details for the error in the Roxy Digital Assistant. Do not manually code the Proof of Identity (POI) screen.

Has the customer provided all required information?

• Yes:
• and the customer has asked for the start date of the LIC card to be backdated, go to Step 4
• otherwise, go to Step 7
• No:
• streamline reject the claim Fail to Supply Documents - FSD
• see Rejecting a claim for Low Income Health Care Card (LIC)
• procedure ends here

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

The customer must provide evidence to:

• support the request for backdating the start date
• satisfy the income test in the 8 week assessment period ending on the date (service or treatment) and
• remain eligible throughout the period up to the claim date

See Determining a backdated LIC start date.

The start date field on the LIC Start Date (LSD) screen defaults to the DOR.

Has the customer provided evidence and requested the start date to be backdated?

• Yes, and the claim is to be backdated:
• 13 weeks or less from the processing date, go to Step 6
• more than 13 weeks from processing date, go to Step 5
• No, the claim cannot be backdated, go to Step 7

If backdating more than 13 weeks from the processing date, a referral will be required.

Refer to the Level 2 Policy Help Desk - Concessions.

The following information must be included within the referral Enquiry Description:

• backdating start date to be applied
• proof of medical service or treatment
• reason why the customer did not claim from the earlier date if known
• determination that the customer has satisfied the income test for the new relevant 8 week assessment period, prior to the medical service or treatment and throughout the backdated period up to the claim date.

DOC the customer record to advise a referral has been requested

Once response from Level 2 Policy has been provided, go to Step 7.

Go to the LIC Start Date (LSD) screen and select Add.

Complete all required fields:

• Start date: key the backdated date
• Reason for backdating: key a valid reason code:
• MED - Medical services or treatment
• DEL - Delayed processing of claim
• ARO - ARO review of decisions (applies to the outcome of a review officer decision made either by a Subject Matter Expert or an Authorised Review Officer)
• select Assess
• when the Entitlement (ELD) screen displays, manually navigate to relevant screens to make sure all Event Date field entries align with the correct 8 week assessment period and the backdated start date recorded on the LSD screen
• select Save

Go to Step 7.

Does the customer have a dependent child/ren in their care?

• Yes, go to Step 8
• No, go to Step 9

The CHOC screen must be recorded for each child individually, otherwise the child will not be included in the assessment.

Go to the CHOC screen, via the Super Key:

• if the dependent child/ren do not display Service Reason LIC, select Add
• update Start Date:
• for a new claim, the date will default based on the date of receipt of the claim and the child's birth date. For the LIC Income test to be applied correctly, it may be necessary to change the date to the child’s date of birth if the birth occurred in the 8 week assessment period. Future dates are not permitted
• for a reassessment, code the date of the event
• Child Name: select each relevant child separately
• Service Reason: Low Income Health Care Card
• Reason: claim
• select Save

After coding the claim:

• select Assess
• the Errors (SWE) screen will list any validation errors to address
• once the Message Log is clear, select Assess
• the Entitlement (ELD) screen displays the outcome
• make sure the claim outcome is correct for the customer (and partner if applicable)

Is the claim to be rejected?

• Yes, see Rejecting a claim for Low Income Health Care Card (LIC). Procedure ends here
• No, the customer is eligible for LIC:
• select Finish
• review the Claim Outcome Note, following Online Document Recording (ODR)
• if backdating include: the backdated grant date and the reason continuous eligibility was met from the revised grant date
• select Finalise
• select Finish. A box will confirm the claim has been successfully completed
• procedure ends here

Check the claim form to make sure it is fully completed and:

• date stamp the claim form and any supporting documents
• code and verify available identity documents in the Identity Confirmation Dashboard
• scan the claim form and any supporting documents onto the customer's record

Note: if partnered, and both members of the couple wish to claim then the new claim process must be actioned on each individual’s record.

Open the Identity Confirmation Dashboard (dashboard) in Process Direct:

• To update a customer's identity, see Identity Confirmation for claimant
• To update a partner's identity, see Identity requirements for partners on the Background page in Identity Confirmation

Do not process claims if identity has not been completed in the Identity Confirmation in the Identity Confirmation Dashboard in Process Direct for customer and partner.

Do not update Proof of Identity (POI) screens.

If the customer has indicated on the paper claim that their partner will need a Health Care Card (HCC) of their own, create a Social Application (SOA) shell, on the record by scanning the paper claim to both records. For further information, see Table 2 > Step 2 in Process Direct navigation, common screens and functions.

Note: children in the care of Approved Care Organisations may qualify for a LIC in their own right, as long as no individual is being paid FTB for the care of the child. The Claim for a Health Care Card (SS050) must be completed in the name of the child and not in the name of the organisation or a worker from that organisation.

Is the claim for a child in the care of an Approved Care Organisations?

• Yes, and the child:
• has a person (PER) CRN. Go to Step 2
• does not have a CRN, see Adding a customer to the system and complete actions to move the digital image to correct CRN. Go to Step 2
• has an existing child (CHI) CRN. Convert the CHI record to a person (PER) record and complete actions to move the digital image to correct CRN. Go to Step 2
• No, go to Step 2

Has the claim previously been rejected?

• Yes:
• to reassess a previously rejected claim, see Request to reassess a rejected claim
• to re-index the claim, refer to directions for SAP online claims in Indexing, re-indexing and cancelling claim activities. Once claim is re-indexed, go to Step 3
• No, go to Step 3

Select Inbox from the left hand menu, or the Inbox icon from the Customer First tool bar:

• select Ready for Work
• select the Customer's name from the Details assignment block (displayed as a hyperlink) or select Workspace from the left hand menu
• go to Customer Details (CRN/BP)
• under the Interactions History tab select the Claim ID
• select Review Claim from the top of the Claim detail screen
• keeping the Review Claim window open, clear the customer record in Customer First and open Customer Record

Go to Step 4.

Compare relationship details provided in the claim with the details already recorded in the Marital Status (MS) screen.

If the customer advised within their claim that they are:

• separated/single, go to Step 5
• partnered, go to Step 7

Is the customer already current on a payment or benefit?

• Yes, go to Step 6
• No, the customer is claiming LIC only, go to Step 8

Is the customer advising of a change in relationship status within their new claim?

• Yes, the relationship will need to be assessed based on the customer’s current payment or benefit prior to assessing the LIC new claim:
• see Change in relationship status from partnered to single
• go to Step 8
• No, the relationship details within the new claim and on the MS screen are the same, go to Step 8

Note: the single income test will apply from the date the customer became single. The partners income will be assessed for periods within the 8 week assessment period that they were partnered for.

Note: a Member of a couple (MoC) assessment is not required for a customer and sharer/other person who are claiming or have a current LIC only.

Is the customer and/or partner current on a payment or benefit, and the current partner is the same as already recorded?

• Yes, the relationship details within the new claim and on the MS screen are the same, go to Step 8
• No, the customer has lodged a:
• paper claim form and the partner has:
  - signed the form, go to Step 8
  - not signed the form, see Confirming a partnered relationship to assess the relationship. Once confirmed, go to Step 8
• claim online advising they are partnered:
  - LIC claims do not issue a MOD P or a Temporary Access Code (TAC)
  - see Table 1 > Step 5 in Confirming a partnered relationship to assess the relationship
  - once confirmed, go to Step 8

Check if the customer has met the basic eligibility for LIC.

Does the customer qualify for LIC?

• Yes, go to Step 9
• No, the customer does not meet basic eligibility for LIC. See Rejecting a claim for Low Income Health Care Card (LIC). Procedure ends here

Check the claim to make sure all required documents have been provided.

Have all the relevant supporting documents been provided?

• Yes, go to Step 11
• No:
• if additional documents are needed, go to Step 10
• if documents have been requested at the time of the claim or after, and not returned, the claim must be rejected. See Table 3 > Step 2

If more details or clarification of claim or submitted documents are needed to determine the customer's eligibility, make genuine attempts to contact the customer by phone.

If the contact is successful, record the details of the conversation in the Progress of Claim (POC) DOC, and if the customer:

• has provided the required information to assess the claim verbally and/or the customer can immediately upload the information, go to Step 11
• cannot immediately upload the information and it is still required, and/or it is not appropriate for the customer to provide information or evidence verbally:
• issue a request for information, see Requesting information (CLK)
• tell the customer the claim may be rejected if they do not provide the required evidence. The claim will be placed on hold to allow customer to respond
• procedure ends here

If the contact was unsuccessful or it is not appropriate for the customer to provide the information or evidence verbally:

• request for information, see Requesting information (CLK)
• record the details of the genuine attempts, including what information is needed in the Progress of claim DOC. Procedure ends here

Are further actions required?

• Yes:
• a referral is required, go to Step 12
• actioning a completed Assessment of Care Arrangement referral is required, see Table 2 > Step 4
• No, there are no outstanding referrals, see Table 3 > Step 1

If more than one referral is required, make sure that all referrals are completed.

When a specialist assessment is required:

• complete the referral details
• when a referral is made, the claim remains on hold until the assessment has been completed. Annotate the Progress of Claim DOC with details of the request
• when the referral(s) is/are completed, continue with processing of LIC claim

Unless it is clear the claim must be rejected because basic eligibility criteria has not been met, claims needing a CAO referral should not be finalised until the assessment has been completed.

If the customer’s financial circumstances are complex, for example, they include a trust or company, a CAO referral is needed to make sure the income and assets tests are met.

See Identifying and making suitable referrals to the Complex Assessment Officer (CAO) for referral instructions.

Note: only refer to CAO if all documents for the new claim are received.

See Coding Compensation and damages (MOD C) to request a clearance for referral instructions.

A non-government payment, or a payment made by a private organisation is not a foreign pension and should not be referred to CIS for coding.

If necessary, make sure all foreign pension documents are scanned to the customer record 'S 'INT’OG' ensuring that no work item is created (scan to store). Translation of foreign pension documents is not needed before referring to CIS.

For referral instructions, see Foreign pension coding.

A completed FA012 form must be lodged as part of a LIC claim where either of the following is advised:

• a change to care arrangements for an existing child, or
• a new child has entered the customer's care

Use the Request for Information guided procedure, see Requesting information.

The Resources page has a link to the Details of your child's care arrangements form (FA012).

Returned and scanned FA012 forms are allocated to the Families Assessment area for assessment. Check Document Tools for an FAO12 scanned to the customer's record.

If an Assessment of Care Arrangement FA012 form been returned and referral is required, see Table 2 > Step 1.

If an Assessment of Care Arrangements (care assessment) has already been completed a DOC will be listed with one of the following titles (this is not an exhaustive listing):

• Change in Care Status
• Changes in Child - No Decision Shared Care Decision
• Add child coming into care
• Care Decision
• Care details update per Child Support Agency (CSA), or
• Care assessment not required

Has a care assessment been completed?

• Yes, go to Step 4
• No, go to Step 2

Hold the claim for a further 14 days.

Annotate Progress of Claim DOC to advise action taken, for example, 'Claim held for a further 14 days pending Assessment of Care Arrangements'.

Procedure ends here.

The time allowed to respond can be extended where there are special circumstances preventing the claimant from lodging the requested documents for the claim.

See Table 1 > Step 10 on the Customer First tab in Requesting information (CLK).

Procedure ends here until FA012 is returned.

Review the Progress of claim DOC for key information to determine the correct assessment result for the LIC claim. This includes:

• child's name
• date of birth (DOB), and
• care percentage details

If there is no change to care, and the DOC indicates a LIC card has recently been issued, the LIC claim must still be processed.

Note: use the steps above to apply different circumstances to each child where there is more than one child listed within the LIC claim, depending on the care assessment results.

Once assessment complete, see Table 3 > Step 1.

Note: if both members of the couple wish to claim, a new claim process will need to be actioned on each individual's record.

Check the claim to make sure all required documents have been provided.

If the customer is not receiving an income support payment, check if they may be eligible (for example, JobSeeker Payment (JSP) or Disability Support Pension (DSP)). Issue relevant forms as appropriate.

Have all relevant supporting documents been provided?

• Yes:
• if the customer has asked for the start date of the LIC card to be backdated, go to Step 3
• otherwise, go to Step 6
• No, go to Step 2

If the customer has failed to return formally requested documents within 14 days, a decision to reject the LIC claim may be made at any time from that point.

For all LIC claims including paper claims, the Service Officer must make genuine attempts to contact the customer by phone before rejecting the claim, to advise of the decision. A final decision should be made within 28 days of claim registration.

See Rejecting a claim for Low Income Health Care Card (LIC).

Procedure ends here.

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

The customer must:

• provide evidence to support the request for backdating the start date
• satisfy the income test for the relevant income assessment period, and
• remain eligible throughout the period up to the claim date

See Determining a backdated LIC start date.

The Start Date field on the LIC Start Date (LSD) screen defaults to the DOR.

Has the customer provided evidence and requested the start date to be backdated?

• Yes, if the claim is to be backdated:
• 13 weeks or less from processing date, go to Step 5
• more than 13 weeks from processing date, go to Step 4
• No, the claim cannot be backdated, go to Step 6

If backdating more than 13 weeks from the processing date, a referral will be required.

Refer to the Level 2 Policy Help Desk - Concessions.

The following information must be included within the referral Enquiry Description:

• backdating start date to be applied
• proof of medical service or treatment
• reason why the customer did not claim from the earlier date, if known
• determination that the customer has satisfied the income test for the new relevant 8 week assessment period, prior to the medical service or treatment and throughout the backdated period up to the claim date.

DOC the customer record to advise a referral has been requested.

Once response from Level 2 Policy has been provided, go to Step 6.

Select the LSD screen:

• Start Date: key the backdated date
• Reason: the reason for backdating a valid reason code must be keyed. Valid reason codes are:
• MED - Medical service or treatment
• DEL - Delayed processing of claim
• ARO - ARO review of decision (applies to the outcome of a review officer decision made either by a Subject Matter Expert or an Authorised Review Officer)

Index the claim, add person (and partner/dependants) and/or update person data as appropriate. If the partner is also claiming a LIC on the same claim form, a new claim will need to be indexed for the partner. The correct marital status must be coded on the Marital Status (MS) screen (for example, 'SIN'gle, 'MAR'ried', 'DEFacto', 'WIDowed'). This will make sure the correct income limit is applied. Service Officers must not use the codes 'UNK' or 'NRE' on the MS screen, as this will result in an incorrect outcome for the customer.

Note: online claims lodged by authenticated customers, will generally be auto indexed. Complete the claim once the auto data load has occurred.

When a customer and their partner have indicated they both wish to claim LIC:

• complete the claim for the customer and then conduct a second claim for the partner
• use the same Date of Receipt (DOR)

Enter identity and Commencement of Identity and proof of arrival in Australia information (needed for proof of residence) via the Identity Confirmation Dashboard in Process Direct for the customer.

LIC start date defaults to the date of claim lodgement. In some circumstances, based on the information supplied by the customer, Service Officers may need to make a decision on the LIC start date.

LIC entitlement is based on the customer's last 8 weeks of income from the LIC start date. If a decision is made to change the defaulted start date, the income assessment period will need to be reassessed. See Low Income Health Care Card (LIC) income test.

The customer's residence qualification will be automatically assessed based on the residence information recorded.

See Residence assessment for adult customer claiming a Low Income Health Care Card (LIC), Foster Child Health Care Card (FST HCC) or Ex-Carer Allowance (child) Health Care Card (EHC).

Note: residence information must still be recorded if the claim will be rejected for any reason. If residence details are not recorded, the system will override any other rejection reason and the claim will reject for a residence related reason.

Go to the Low Income Health Care Card Task Selection (LITS) screen and select each income item for the customer ('S'), partner ('P') or both ('B'):

• income from employment (ongoing, casual or one-off) is coded on Employment Income Paid Details (EAPP) screen and the method of coding depends on the type of customer. The MS screen coding is also important, as the partner of a LIC claimant is classified as a dependant. Service Officers must not use the codes 'UNK' or 'NRE' as this will result in an incorrect outcome for the customer. For coding information, see Low Income Health Care Card (LIC) income test
• financial investment or self-employment details for a customer receiving an income support payment, primary benefit rules apply. For coding information, see Low Income Health Care Card (LIC) income test

Note: income from previous claims may duplicate and affect the LIC payability. Check before finalising the claim.

Lump sum leave payments and redundancy payments are recorded on the Income Maintenance Period (IMP) screen. For coding information, see Low Income Health Care Card (LIC) income test.

The effects of lump sum leave, and redundancy payments are displayed on the LIC Income Maintenance Lump Sum (LIM) screen, which indicates details of income apportionment over 12 months.

The effects of lump sum compensation payments show on the LIC Compensation Lump Sum (LIL) screen, which indicates details of income apportionment over 12 months. This information transfers from the Compensation Claim Summary (CMCS) screen which is maintained by the Compensation team.

For LIC income limits, see Rates and Thresholds.

When a LIC new claim is being processed, an effect date equal to the start of the 8 week income period is defaulted to the EAPP screen. This does not mean the 8 week amount has to be recorded as an IMP. For coding information, see Low Income Health Care Card (LIC) income test.

• Select CHILD on the LITS screen, to set up LIC qualified children for inclusion in the claim assessment
• Finalise the activity on the Assessment Results (AR) screen. The card will usually be sent to the customer's postal address, and display the customer's residential address. However, if the customer has more than one address recorded on the system (for example, term), they can nominate a preference of which of these is to be used for postal and/or display purposes
• Complete all related scanned images on the customer's record, see Viewing Centrelink customers' digital images

If the claim was rejected automatically or needs to be rejected manually, see Rejecting a claim for Low Income Health Care Card (LIC), Foster Child Health Care Card (FST) or Ex-Carer Allowance (child) Health Care Card (EHC).

Income affecting LIC assessment is summarised on the LIC Assessment Summary (LIAS) screen.

Note: when granting a new LIC, check that the EPED for any existing payments has not been altered.

Before finalising the claim:

• go to the LSD screen manually
• check the Start Date field entry is correct
• check there is no duplication of income

Manually go to relevant screens, for example, Employment Income Summary (EANS), Savings Summary (SVS) screens to correct all Event Date field entries, to align with the corrected date recorded on the LSD screen.

Go to the Assessment Results (AR) screen to confirm the correct outcome, then finalise the claim.

Create a Fast Note. Select Auto Text, use Concession Cards > Claims > Low Income HCC (LIC) NCL Grant/Reject DOC.

• correct grant date particulars, including the revised grant date and reasons for backdating
• eligibility was checked and is continuous from grant date to LIC claim date. They have remained in Australia during the period
• the income was not above the threshold during the assessed period

LIC is automatically issued on the card carrier (SS357). No separate grant letter is sent.

Note: if the claim has been finalised in Customer First due to Level 2 Policy advice, go to Process Direct and update the claim Status to Completed.

Procedure ends here.

The following system errors display when a LIC NCL has not been processed and is more than 10 months old:

• E244ZZ - Cannot backdate DOR of a LIC NCL for more than 10 months in the past
• E051LI - LIC NCL cannot be completed for this date of commencement
• E0031 - This date may not be more than 1 year in the past

If these errors messages occur, update the LIC NCL Status to On Hold.

• Identify the correct LIC start date by checking the date of claim submission
• Make sure the customer meets eligibility and qualification criteria
• the income test for 8 weeks before the intended start date of the LIC claim
• Record details on a DOC
• the correct LIC start date
• the reason(s) for backdating, and
• that eligibility has been confirmed

Refer to Level 2 Policy Helpdesk - Concessions requesting claim to be backdated.

Procedure ends here until Level 2 Policy response has been provided.