Complex eligibility and entitlement type of newborn child enrolments in Medicare 011-19042334

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This document explains the Medicare eligibility requirements for a newborn child born in Australia. Also, the processes to follow when enrolling a newborn child where the maximum number of persons are already on Medicare enrolment. The applicant has conditional migrant entitlement, parents and newborn to be on new Medicare card and applicant (parent) is under 15 years of age.

Family and domestic violence

Services Australia (the agency) plays a critical role in providing support to people with family and domestic violence concerns. The agency gives access to the services and support they may need. Family and domestic violence can pose a serious risk to the safety and wellbeing of our customers. It is important to discuss all options with the customer.

Eligibility for a newborn child born in Australia

A newborns eligibility for Medicare is based on their parent who has the highest Medicare entitlement type.

Before enrolling a newborn, Service Officers must check the applicants (parent) Medicare entitlement type in the Consumer Directory Maintenance System (CDMS) to determine if the newborn can be added to their Medicare number.

If the applicant (parent) has an entitlement type of Conditional Migrant, further investigation must be undertaken to determine the entitlement type of the other parent. The newborn is eligible for enrolment with the same entitlement type of the parent with the strongest Medicare entitlement. For example, the newborn must not be enrolled as a Conditional Migrant if the other parent has an entitlement type of Australian Citizen. The Process page has more details.

The Resources page has more details on determining entitlement type for newborn.

Note: if the parents visa has been refused before the newborns birth, the newborn is not eligible for Medicare until the newborn is an applicant for permanent residency and a holder of a bridging visa with work rights. See Child born in Australia enrolling in Medicare for more details.

Maximum number of persons on a Medicare enrolment

Up to 9 people can be listed on the same Medicare card number with a maximum of 5 people on the first card and 4 people on a second card. All 9 persons do not have to be active on the card but they remain with the Individual Reference Number (IRN) and no further people can be added to this card.

When registering a newborn in the Consumer Directory Maintenance System (CDMS) and the error message 00685 Maximum IRN on card appears. Additional group members cannot be added as the Medicare card limit of 9 IRN’s has been reached.

The Process page has more details.

Applicant is not the birth parent

In some circumstances, a newborn can be enrolled in Medicare at the request of someone who is not the birth parent. Evidence that the newborn is in the care of someone other than the birth parent is required.

Examples of when a person other than the parent can request to enrol the newborn is when the newborn is in the care of:

A guardian (for example a grandparent). They must provide evidence that the newborn is in their care. Acceptable documents are:

Court Order
Centrelink documents confirming the requestor is receiving benefits for the newborn (do not accept documents where only the newborns first name is notated, the document must state newborns full name)
Confirmation from professional members of the community who have regular contact with the family, such as police, ministers of religion, doctors or lawyers
Social worker reports

A Child Protection Agency (DCP). These applications must be actioned by the Medicare Eligibility trained Service Officers - Medicare Public. See Child Protection Agency - Medicare card number requests for children and young people in out-of-home care (OOHC). The DCP must provide:

Medicare enrolment application form (MS004 or MS045) (completed by the DCP caseworker)
Court Order
Proof of birth document
Cover letter on DCP letterhead

An adoptive parent (where the adoption is either finalised or in the pre-adoption phase), see Adopted child enrolments in Medicare

The Process page has the process to follow when the applicant enrolling a newborn child is not the birth parent.

Checking Partner details

The group members on a Medicare card must be checked before enrolling a newborn.

If a customer presents a Medicare card number that includes their ex-partner, the customer must be contacted and transferred to a new Medicare card before enrolling the newborn child.

See Errors and exceptions with newborn child enrolments in Medicare for more information.

The Resources page has:

links to acceptable proof of birth documents
the MS004, MS011 and MS045 forms, and
a list of Medicare entitlement types for newborns