Residence assessment for customers claiming Commonwealth Seniors Health Card (CSHC) 065-06040010

To qualify for a CSHC the customer must meet all the following:

• generally, be in Australia at the time the claim is lodged
• be an Australian resident or the holder of an Special Category Visa (SCV) who is residing in Australia at the time the claim is lodged
• remain an Australian resident or the holder of an SCV who is residing in Australia, and
• satisfy a 2 year (104 week) or 4 year (208 week) Newly Arrived Resident's Waiting Period (NARWP) or alternatively they may have an exemption from the NARWP in certain circumstances

Ensure the customer's country of birth and any travel documents are recorded. The system will automatically link to immigration information and update the customer's visa and movement information. For more details, see Activating the Department of Home Affairs datalink and contingency procedures if datalink is unavailable.

To activate the Immigration Datalink, go to the Immigration Enquiry (RSIMME) screen.

Check the following screens:

• Immigration Advised Movements (RSIM), that the customer was in Australia at the time the claim was lodged, and
• Legal Residence Details (RSLEG), for citizenship and/or visa details for the customer

If the customer is:

• in Australia as:
• an Australian resident or the holder of an SCV who is residing in Australia, see Table 2 Step 1
• a non-resident (such as a temporary visa holder) or an SCV holder who is not residing in Australia, go to Step 5
• not in Australia, go to Step 3

The customer can only lodge a legal claim for a CSHC 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:
• an Australian resident or the holder of an SCV who is residing in Australia, see Table 2 Step 1
• not an Australian resident (such as a temporary visa holder) or an SCV holder who is not residing in Australia, go to Step 5
• No, go to Step 4

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.

• Code the correct citizenship and the correct visa subclass on the RSLEG screen
• Code the customer's country of residence on the Country of Residence (CRES) screen
• 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. Generally, this only applies to Age Pension, Disability Support Pension (DSP) and Carer Payment (CP) in limited circumstances

Procedure ends here.

An Australian citizen has an automatic exemption from the NARWP. Citizenship must be verified. For more details, 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 they meet the residence requirements for CSHC
• Ensure that the details are recorded correctly on the RSLEG screen
• Continue to assess the claim. If the claim rejects NIA (Not in Australia) phone Centrelink International Services
• Procedure ends here
• No, go to Step 2

If the customer was granted their first permanent residence visa:

• before 1 January 2019, or they hold an SCV subclass 444, or they hold or have held a subclass 115, 117, 835 or 837, they need to serve a 2 year (104 week) NARWP
• all other customers need to serve a 4 year (208 week) NARWP

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

For SCV holders, check the Residency Results Explanation (RSREX) screen. This displays periods of Australian residence as an SCV holder.

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

• Yes, they have served the NARWP, and they meet the residence requirements for CSHC, go to Step 9
• No, check if the customer qualifies for an exemption from the NARWP, go to Step 3

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

Check the RSLEG screen for a current or previous visa subclass 852.

Has the customer held a visa subclass 852?

• Yes, the customer is not subject to a NARWP, and they meet the residence requirements for CSHC
• Continue to assess the claim
• If the claim rejects NIA (Not in Australia) phone Centrelink International Services
• Procedure ends here
• No, go to Step 4

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:

• Chapter 9 of the Guide to Social Security Law, see the References page, or
• Refugee, Humanitarian and Permanent Protection Visa sub-classes

If the customer advises they are or were a refugee and this is not evidenced on the RSLEG screen or from their passport, contact Centrelink International Services (CIS):

In Process Direct, create an International Services referral. This will place the online claim On Hold pending the outcome of the referral:

• Go to the customer's Process Direct landing page
• Select More Options.
• Procedure ends here

Is the customer a refugee or former refugee?

• Yes, they are exempt from the NARWP, and they meet the residence requirements for CSHC
• Check the visa details are recorded correctly on the RSLEG screen
• Continue to assess the claim. If the claim rejects NIA (Not in Australia) phone Centrelink International Services
• Procedure ends here
• No, go to Step 5

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 of 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?

• Yes, go to Step 6
• No, this exemption does not apply, go to Step 9

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

• Yes, and the refugee or former refugee:
• is still alive, go to Step 7
• has since died, go to Step 8
• No, this exemption does not apply, go to Step 9

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 can 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 they meet the residence requirements for CSHC:
• Once the claim is fully assessed, refer case to CIS for exemption coding
• Once CIS has coded the exemption, continue to assess the claim. If the claim rejects NIA (Not in Australia) phone Centrelink International Services
• Procedure ends here
• No, this exemption does not apply, go to Step 9

Note: the customer must have also been the family member of that person at the time the refugee first arrived in Australia.

Was the customer the family member of a refugee or former refugee when the refugee or former refugee died?

• Yes, they are exempt from the NARWP, and they meet the residence requirements for CSHC
• Once the claim is fully assessed, refer case to CIS for exemption coding
• Once CIS has coded the exemption, continue to assess the claim. If the claim rejects NIA (Not in Australia) phone Centrelink International Services
• Procedure ends here
• No, this exemption does not apply, go to Step 9

If the customer has served the NARWP:

• if the system calculates that the NARWP has not yet been served and the customer was an Australian resident prior to 1 September 1994, past periods of residence should be recorded on the Country of Residence (CRES) screen
• if the claim is rejecting NW2 (Residency less than 104 weeks) or NWA (NARWP assessment not met) or shows as assessed, and the customer has been in Australia for the period of the NARWP as an Australian resident, check the Immigration Limiting Date (ILD) is set correctly to count sufficient periods
• if the claim rejects NIA (Not in Australia) phone Centrelink International Services

If the customer has not served the NARWP:

• The claim will reject NW2 (Residency less than 104 weeks) or NWA (NARWP assessment not met)
• Tell the customer about future entitlement:
• the end date of the NARWP (assuming they remain in Australia) is calculated and displayed on the Periods of Australian Presence (RSPAP) screen
• the Projected end 104wks/208wks Aust.Presence (inc.SCV) field on the Residency Results Explanation (RSREX) screen displays the date a non-protected SCV holder has 104 weeks/208 weeks presence in Australia
• 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

Is the customer residentially qualified for CSHC?

• Yes, continue to assess the claim, this procedure ends here
• No, go to Step 10

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

• If the customer has an FTB child in their care, they may be entitled to a Low Income Health Care Card (LIC)
• Depending on the type of visa held and their circumstances, the customer may have entitlement to some assistance looking for work. See Employment services for visa holders
• Payments using an international agreement. Generally, this only applies to Age Pension, Disability Support Pension (DSP) and Carer Payment (CP) in limited circumstances. All claims under an international agreement are assessed by Centrelink International Services (CIS). See Claims for Australian payments under International Agreements
• 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 a certain temporary visas that qualify customers for some payments even though they may not be an Australian resident (cannot be granted if the person is a non-protected SCV holder)
• 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 non-protected SCV 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