Processing Commonwealth Seniors Health Card (CSHC) claims 065-18102915

This document outlines how to process online claims, Assisted Customer Claims (ACC) and paper CSHC claims. It includes instructions for Process Direct, and for Customer First when required. It also explains how to reassess a rejected or cancelled CSHC claim.

Verified income over the income limit but lower this financial year

If a customer's verified income is over the income limit but is likely to be lower in the current financial year, then an estimate of their income may be taken.

An estimate can only be accepted when a change in circumstances:

has already occurred
can be satisfactorily demonstrated, and
is an acceptable condition for using an estimate of income for the CSHC income test
and details of verified income that is over the income limit from either of the last two financial years (reference tax years) has been provided and coded

An estimate is reasonable if:

the customer's explanation of how they calculated the estimate is consistent with the estimated amount, and
the reason for the revised income is reasonable and remains an acceptable condition for using an estimate of income for the CSHC income test (the reasons given are consistent with the reduction in income)

Note: when a customer provides an estimate, a superannuation withdrawal under the First Home Super Saver (FHSS) Scheme is not counted towards their taxable income.

Re-claim after CSHC rejected/ cancelled due to income estimate

A customer may lodge another claim or re-claim if their CSHC claim is rejected or their CSHC is cancelled due to an estimate of income provided for an acceptable condition for the current financial year, plus any deemed income from account-based income streams.

The customer must provide a revised estimate of the current financial year with details of why the estimate has changed.

Note: customers cannot lodge a claim or re-claim using income details before the financial year already confirmed.

The revised estimate should only be accepted if it is considered reasonable and remains an acceptable condition for using an estimate of income for the CSHC income test.

Care assessment for CSHC claims

Customers advising in the claim of a child entering care need to provide a completed Details of your child's care arrangement (FA012) before they can submit their claim.

Where an Assessment of Care Arrangements Referral is required the assessment must be completed by a suitably skilled Families Service Officer before the claim can be finalised.

After the care assessment has been completed, Commonwealth Seniors Health Card processing staff will proceed to claim assessment and finalisation.

Overseas absence from Australia

If the customer does reclaim CSHC upon their return to Australia, the CSHC date of claim will be automatically taken as the immigration advised date of return when:

the customer lodges a CSHC re-claim within 14 days of the date of return to Australia, and
the date of return is less than 26 weeks since their CSHC cancellation date

This will apply to CSHC online claims, customised claims, paper claims and verbal re-claims. Where a customer’s CSHC has been cancelled for more than 26 weeks they will need to complete a full new claim.

Customer has recently died after lodging a claim

Under some circumstances, claims lodged after the death of a customer will still need to be determined.

The Resources contains links to forms and publications, Services Australia website, contact details and the Australian Taxation Office (ATO) website.