Medicare Safety Nets (MSN) 011-43080000

Term

Description

Medicare benefits

Medicare benefits are the dollar amount paid to either a customer or provider for an Medicare Benefit Schedule (MBS) item claimed through Medicare.

Child dependent

For MSN purposes, a child dependent (CD) is a person under 16 years who is in the custody, care and control of the parent/guardian.

Commonwealth concession cardholders

For Medicare Safety Net purposes, a Commonwealth concession cardholder is a person who holds either a:

• Commonwealth seniors health card
• Health care card, or
• Pensioner concession card

Extended Medicare Safety Net (EMSN)

EMSN is one of the 2 Medicare Safety Nets available for customers.

The EMSN is reached through the accumulation of out of pocket expenses.

See Extended Medicare Safety Net (EMSN).

EMSN Benefit cap

The MSN benefit cap is:

• the maximum EMSN benefit payable for an MBS item, and
• paid in addition to the standard Medicare benefit

EMSN concessional threshold

A lower EMSN threshold for customers who are Commonwealth concession cardholders.

See Extended Medicare Safety Net (EMSN) concessional threshold.

Confirmation

For MSN purposes, confirmation:

• is when a customer informs Medicare that members registered to the MSN family are correct. Customers are reminded to confirm their registered MSN family each year when they reach 70% of their relevant EMSN threshold. Customers will get a:
• myGov notification if they have a digital letter preference, or
• Letter F
• allows members of a registered MSN family to receive higher benefits once the threshold is reached

Family contact

The family contact (FC) is:

• a member type for a registered MSN family
• the person who will get correspondence about MSN family registration. For example Letter F

Fortnightly Family Tax Benefit (FTB) Part A payment

FTB Part A payment is an instalment payment eligible Centrelink customers receive on a fortnightly basis.

The date of the first fortnightly payment in a calendar year determines the date of eligibility for EMSN FTB Part A threshold.

See Family Tax Benefit Part A in Medicare Safety Net.

EMSN FTB Part A threshold

Families receiving FTB A may be eligible for the Extended Medicare Safety Net (EMSN) FTB A threshold.

See Family Tax Benefit Part A in Medicare Safety Net.

Gap amount

Gap amounts are the difference between the Medicare benefit and the Schedule fee of the MBS item.

Gap amounts count towards the Original Medicare Safety Net (OMSN) threshold.

Lump sum payment

Lump sum payment is a FTB Part A payment delivery option. It is a Centrelink payment received after the end of the relevant financial year, where FTB Part A entitlement is calculated once actual income details are available.

How a customer chooses to receive their FTB Part A payments determines their family's eligibility start date to the EMSN FTB Part A threshold.

See Extended Medicare Safety Net (EMSN) - Family Tax Benefit (FTB) Part A threshold.

Original Medicare Safety Net (OMSN)

The OMSN is:

• one of 2 Medicare Safety Nets available to customers
• reached through the accumulation of gap amounts

The OMSN is reached through the accumulation of gap amounts.

Out of pocket (OOP)

OOP expenses are the difference between the health professionals charge for the service and the Medicare benefit paid.

OOP expenses count towards reaching the EMSN threshold.

Paid accounts

For MSN purposes a paid account is where the customer has paid their health professional account in full. That is, no balance remains outstanding to the health professional.

Eligible out of pocket expenses incurred by or on behalf of a patient are automatically recorded toward the relevant MSN thresholds in CDMS, when:

• a claim with a paid account is submitted to Medicare, and
• the Medicare benefit is paid

Registered MSN family

Couples or families can register as an MSN family to combine their out of pocket expenses incurred for EMSN, and gap amounts for OMSN.

A MSN family must have:

• more than 1 member, and
• no more than 20 members

There are 4 different member types:

• FC - Family contact (mandatory)
• SP - Spouse / de facto partner
• SD - Student dependent
• CD - Child dependent

Customers do not need to be enrolled on the same Medicare card to register themselves as a MSN family.

Schedule fee

The Schedule fee is a dollar amount set by the Department of Health, Disability and Ageing for each service listed in the MBS.

Medicare benefits are calculated on fees determined for each service. The fee is referred to as a 'Schedule fee'.

Spouse

A spouse for MSN purposes is a:

• husband or wife, or
• de facto partner

Student dependent

A student dependent (SD) for MSN purposes is a person who is:

• between 16 - 25 years
• receiving full time education at a school, college or university, and
• a dependent of the family

Threshold

An MSN threshold is a dollar amount. Individuals or a registered MSN family must reach the threshold before they are entitled to receive MSN benefits. The following are calculated to reach the threshold:

• eligible out of pocket expenses, or
• eligible gap amounts

Unpaid account

For MSN purposes, an unpaid account is where the customer has not paid their health professional account in full. That is, either the full balance, or partial balance remains outstanding to the health professional.

When a claim with an unpaid account is submitted to Medicare, a Medicare benefit is paid by a 'pay doctor via claimant' (PDVC) cheque. It is then the patient's responsibility to provide evidence/proof of payment that the health professional’s account has been paid in full.

Unverified payments (Unsubstantiated)

For MSN purposes, unverified payments relate to out of pocket (OOP)expenses and gap amounts not yet counted toward a threshold, as they have not been verified.

Unpaid or partially paid accounts need verification. The claimant must provide proof of payment for the outstanding balance owed to the health professional for the service provided. This verifies the OOP expenses incurred, and the verified amounts are recorded toward the relevant MSN thresholds.

Verified payments (substantiated)

For MSN purposes, verified payments relate to out of pocket expenses and gap amounts counted toward a threshold. They have been verified as an expense incurred by the claimant.

Verify (Substantiate)

For MSN purposes, verifying or verification is where a Service Officer has evidence that a customer has paid an outstanding balance to their health professional for any unverified payments.

Once verified, the out of pocket expenses and gap amount count towards the customer's MSN threshold.