Low Income Health Care Card (LIC) renewals 101-06040020

The preferred method of renewing a LIC is online, if the customer is deemed unable or unsuitable to complete an online claim, staff should offer to complete an Assisted Customer Claim (ACC) with the customer.

If a processing officer receives a LIC renewal work item, see Step 1 in Table 2.

If the customer query is about:

• declining an ACC, offer a replacement renewal form
• timeframes relating to completing the renewal, see Important dates and periods for assessing eligibility for LIC renewals
• a replacement form, go to Step 2
• lodging a LIC renewal form, go to Step 3
• help to complete the renewal, see Viewing and processing online and Assisted Customer Claim (ACC), go to Step 4
• urgent processing, go to Step 4

Service Officers must promote online claiming or offer Assisted Customer Claim (ACC) first.

Customers can request a replacement form if:

• their LIC is still current, or
• it is within 13 weeks of the previous card expiry date

Service Officers can create and print a LIC renewal form (SS054M) manually then issue it personally in the service centre or post it to the customer’s address.

Service Officers must check the following details are correct before manually printing the form:

• customer's name
• address
• Customer Reference Number (CRN)
• renewal period
• return address and
• date of issue

Procedure ends here.

Customers can lodge a Renewing your Health Care Card (SS054) form or submit a LIC renewal online.

Is the LIC still current or within 13 weeks of the previous card's expiry date?

• Yes:
• check the renewal form to ensure it is fully completed and signed
• scan the SS054 and any supporting documents onto the customer's record, go to Step 4
• No:
• customer must submit a new claim for LIC
• procedure ends here

If the customer is requesting the renewal to be processed urgently or immediately, see Immediate new claim and non-new claim priority processing.

Does the customer meet the criteria for immediate processing?

• Yes, see Step 1 in Table 2
• No:
• tell the customer the renewal will be allocated to processing staff to complete
• procedure ends here

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 renewal (SS054) is scanned to the customer’s record, a Social Application (SOA) shell work item is generated on the customer’s record. This has no claim information apart from:

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

Manually add claim details into the work item using information from the scanned claim and documents.

For guidance on accessing claims for processing and creating a SOA shell, see Process Direct navigation, common screens and functions.

Has the renewal previously been rejected?

• Yes, to reassess a previously rejected claim:
• if rejected FSD or POI, see Request to reassess a rejected claim
• re-index the claim. Once the claim is re-indexed, go to Step 3
• No, go to Step 3

Select to view the claim details provided by the customer:

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

To view supporting documents, select one of the following:

• links at the bottom of the expanded Claim Summary
• from the bottom of the open Process Direct window, or
• the Documents icon

Check the date the document was scanned.

Note: documents that have been requested at Next Step in the claim must not be requested again, the claim must be rejected.

Have all relevant supporting documents been provided?

• Yes, go to Step 5
• No:
• if additional documents are needed, go to Step 4
• if documents have been requested at the time of claim or after and not returned, the claim must be rejected

If more details or clarification and/or submitted documents are needed to determine the customer’s eligibility, make genuine attempts to contact the customer.

If contact was successful, record the details of the conversation in the Progress of claim note, and if the customer:

• can immediately upload the information or has verbally provided the required details to assess the claim, go to Step 5
• cannot immediately upload the information and it is still required:
• issue a request for any additional information by selecting > Request Documents
• do not re-request documents that have previously been requested at Next Step of the claim. This process is only relevant where more information or evidence is required to clarify the customer’s circumstances to assess the claim
• 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 the 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:

• issue a request for information via > Request Documents
• record the details of the genuine attempts, including what information is needed in the Progress of Claim note
• Note: documents that have been requested at Next Step in the claim must not be requested again, the claim must be rejected

Procedure ends here.

These details must be reviewed/updated before selecting Process.

On the TS screen:

• Link Summary (LS) table shows linked records, for example
• Partner and any Relationship Qualifier Code
• Children
• Marital Status (MS) table shows the customer's relationship details. For coding help, see Table 4 in Process Direct navigation, common screens and functions

Compare relationship details provided in the claim with the details already recorded in the Marital Status (MS) table. If the customer has given different information about their relationships in the claim to the confirmed data in the MS table, make genuine attempts to contact the customer to confirm the correct relationship details and dates. If phone contact is unsuccessful, apply the relationship details supplied in the claim.

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 Low Income Health Care Card (LIC) only.

When any updates have been made to relationship details, the claim will need to be regenerated, select > Regenerate claim to regenerate the claim.

Go to Step 6.

Are further actions required?

• Yes:
• a referral is required, go to Step 7
• actioning a completed Assessment of Care Arrangement referral is required, see Table 2 in the Process Direct tab of Processing Low Income Health Care Claims
• No, there are no outstanding referrals and LIC renewal is ready to be processed, go to Step 1 in Table 3

If a specialist assessment is required, select > Referral and complete the referral details.

Note: if more than one referral is required, ensure that all referrals are completed.

Complex Assessment Officer (CAO) referrals

Unless it is clear the claim must be rejected due to not meeting basic eligibility criteria, 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), make a CAO referral to ensure the income and assets tests are met.

Compensation Clearance request referrals

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

Centrelink International Services Officer (CIS) referrals

If necessary, check all foreign pension documents are scanned to the customer’s record as ‘INT’OG' ensuring that no work item is created (scan to store). Translation of foreign pension documents is not needed before referring to CIS. Referrals to CIS should not be made for a non-government payment or a payment made by a private organisation, as this is not a foreign pension.

Assessment of Care Arrangement referral

A completed FA012 form must be lodged as part of a LIC claim if:

• there is 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. If an Assessment of Care Arrangement FA012 form has been returned and a referral is required, see Table 2 in the Process Direct tab of Processing Low Income Health Care Claims.

After 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
• procedure ends here until referral is completed

Select Process at bottom right of the claim to start coding and assess the claim. Do not start coding before selecting Process as this will result in errors.

The Errors (SWE) screen will display.

Before coding any screens:

• select Assess to send the claim details to ISIS. The Entitlement (ELD) screen will display
• return to the SWE screen to complete the claim coding by selecting Back or keying SWE in Super Key

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

Go to Step 2.

Based on the information available, is a streamline rejection needed?

• Yes, action the streamline rejection. Procedure ends here
• No, go to Step 3

Check information provided in the claim (provisional data) is accurate and in line with any evidence provided. See Income and financial investments for coding instructions.

See the Resources page for help in determining the right Date of Event.

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

Has the customer provided all required information?

• Yes, go to Step 4
• No:
• streamline reject the claim as Failed to Supply Documents - FSD
• procedure ends here

After coding the claim and addressing the data validations:

• select Assess
• the Errors (SWE) screen will list any validation errors to address
• once the Message Log is clear, select Assess
• the ELD Entitlement screen displays the outcome. Ensure the outcome is correct for the customer (and partner if applicable)
• select Finish
• review the Claim Outcome DOC and ensure the Getting it Right (GIR) Minimum Standards are met
• select Finalise
• select Finish. A box will confirm the claim has been successfully completed

Procedure ends here.