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

Before enrolling the newborn, check the Medicare card number given to determine the entitlement type of the applicant.

• Go to CDMS home page
• Select Inquire on Consumer Details
• Key Medicare card number from the Newborn Child Declaration (FA081)/Medicare enrolment application (MS004) form in the ID Number field
• Select Medicare Card Number from the list
• Select Group
• Select Members Details tab

This will list all members on the card.

Notate the entitlement type of the applicant (Etm Type field):

• A - Australian Citizen
• E - Migrant
• P - Conditional Migrant
• R - Reciprocal Health Care Agreement
• ENZ - New Zealand Citizen

The newborn is eligible for Medicare on the same terms as the parent who has the highest Medicare entitlement cover.

Note: confirm parents visa has not been refused, before newborns birth, via DIAC Link, see Background page for more details.

See Resources page for details about determining entitlement type for a newborn.

If the applicant is not the birth parent, proof of birth and documents to confirm the child is in their care is required to enrol the newborn.

The applicant (who is not the birth parent) needs to complete a Medicare enrolment application (MS004) form or lodge their enrolment online via Medicare online accounts and provide acceptable proof of birth and relationship documents.

See Resources page for a list of acceptable proof of birth documents.

Evidence that the child is in the care of a person other than the birth parent:

Evidence that the child is in the applicants care, such as:

• Court orders
• Guardianship order
• Centrelink document confirming child is in their care (must state child’s 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

If insufficient documents are supplied, tell the applicant verbally or by letter that more documents are needed.

See Resources page for a link to the Medicare enrolment application and more information required letter (z0137).

Child protection agency requests must only be actioned by Medicare Eligibility trained Service Officers.

If not trained contact Medicare Eligibility Local Peer Support (LPS).

To list all members on the Medicare card:

• select Inquire on Consumer Details
• key the Medicare card number, in ID Number field
• select Group
• select Members Details tab

Are all 9 members still associated with the Medicare card?

• Yes, go to Step 3
• No, when a person is no longer associated with a Medicare card there will be a:
• date of death, or
• consumer end date, or
• an association end date
• go to Step 4

Newborn must be enrolled onto their own card with the applicant (parent) as the group contact.

See Process newborn enrolment to their own Medicare card in CDMS table.

Procedure ends here.

Contact the applicant to discuss the option to transfer all remaining members to a new Medicare card number.

Is contact successful?

• Yes, go to Step 5
• No, go to Step 6

• Perform a security check or sight identification, see Authenticating a Medicare customer for more details
• Obtain consent from the applicant
• Obtain consent from the group contact
• Must all reside at the same address

Note: care must be taken when transferring a family to a new card to make sure children are not removed from another existing card. If unsure get help.

See Transfer person to new or existing Medicare card in CDMS table.

Procedure ends here.

• Newborn must be enrolled onto their own card with the applicant (parent) as the group contact. See Process newborn enrolment to their own Medicare card in CDMS table.
• Add the following comment to Group in CDMS for newborns card: unsuccessful attempt was made to contact applicant
• Notate MS004 or annotate the DOC on the Document List of CRN with the same details

The applicant is a Conditional Migrant (P) and the only person listed on the Medicare card, and details have been provided on the Newborn Child Declaration (FA081) form or Medicare enrolment application (MS004) form for the partner (for example, other birth parent).

Confirm the entitlement type of the other parent in the Consumer Directory Maintenance System (CDMS).

If it has been determined that the other parent is an Australian citizen, migrant or New Zealand citizen, enrol the newborn onto their Medicare card with their entitlement type.

The Resources page has information about determining a newborns entitlement type.

Add a comment in Group in CDMS for applicant:
biological parent is a conditional migrant, newborn added to Medicare number with parent.

Contact must be made with the applicant.

Is the applicant contacted?

• Yes, go to Step 3
• No, go to Step 6

• Perform a security check or sight Identification
• Tell them that:
• the newborn must be enrolled on the Medicare card of the parent that has the highest Medicare eligibility
• we need to determine if their partner has higher Medicare eligibility
• Confirm if the partner is available

Is the partner available?

• Yes, go to Step 4
• No, go to Step 5

• Get their Medicare number and verify entitlement type
• Perform a security check or sight Identification
• Get consent from the other parent to enrol the newborn on their Medicare card number
• Enrol newborn on their Medicare card
• In the Consumer Directory Maintenance System (CDMS) add a comment in Group:
  applicant is a conditional migrant, newborn added to Medicare number with <<biological parents>> consent received

Procedure ends here.

Confirm with the applicant the partners Medicare entitlement (if known). For example:

• Australian citizen
• permanent resident (migrant)
• New Zealand citizen
• applicant for permanent residence

Note: do not search partners details in the Consumer Directory Maintenance System (CDMS) without their consent.

If applicant confirms the partners Medicare eligibility is Australian citizen, New Zealand citizen or Migrant (permanent resident), tell the applicant to either:

• Resubmit the FA081 form (all pages) online, via mail or in person at a service centre. Make sure all the partners details have been provided including their signature and Medicare number, or
• Partner to complete and submit Part C of the MS004 form along with evidence of their parental relationship to the child (birth certificate or other legal documents), or
• If the nominated partner in Part C of the MS004 form is the birth parent and they also sign the form, the form can be submitted along with the back age of the FA081 form or the doctor/midwifes declaration of birth, in person at a service centre
• On CDMS add comment in Group, for example:
  Birth parent is a conditional migrant, newborn to be added to other biological parents card

In the following circumstances, the newborn can be enrolled on the applicants Medicare card with the same entitlement as the applicant:

• the other parent does not have the strongest Medicare eligibility
• the other parent has the same Medicare eligibility as the applicant
• the other parent is not known, or
• the other parent is not the applicants partner

See Processing newborn child enrolments in Medicare.

Procedure ends here.

• Enrol newborn on applicants Medicare card with the same entitlement type and country of relevance, see Processing newborn child enrolments in Medicare
• In CDMS add comment in Group:
  unsuccessful attempt was made to contact the applicant newborn enrolled with same entitlement type as applicant

Note: if a parent advises at a later date that the newborn should have a different entitlement type, refer to Medicare Eligibility Local Peer Support (LPS).

If an applicant requests for both themselves, their partner and newborn to be transferred to a new Medicare card as a family, either by phone or face-to-face:

• Perform a security check or sight Identification
• Get consent from the applicant
• Get consent from the partner
• The applicant and partner must reside at the same address
• The applicant and partner must have a compatible entitlement type. For example, an Australian citizen and conditional migrant cannot be enrolled together

If the new parents:

• are enrolled on separate Medicare cards with children from previous relationships, and
• they want to now be enrolled on the same card with all children and their newborn

Care must be taken to make sure that the children are only copied onto the new Medicare card.

Do not transfer them off their other biological parents card unless the other parents consent is given or exceptional circumstances apply.

Note: if other children (other than the newborn) are requested to be included on the new family card (and they are not currently enrolled on either existing card of the applicant or partner), tell the applicant and partner that:

• An Application to copy or transfer from one Medicare card to another (MS011) form needs to be completed, see Resources page for a link to the form
• All people to be listed on the card need to be detailed on the application form
• Evidence is required that, either:
• the additional child/children are a biological child of either the applicant or the partner, or
• the additional child/children are in their care, such as Court Order, Centrelink letter confirming they receive benefits for the child

To copy or transfer a person or child to another Medicare card, see the Transfer person to new or existing Medicare card in CDMS table.

• Yes, the newborn can be enrolled on the applicants (parents) Medicare card. See Process newborn enrolment to existing Medicare card in CDMS table. Procedure ends here
• No, go to Step 2

Contact the applicant (parent of newborn) by phone or face-to-face.

Is the applicant contacted?

• Yes, go to Step 3
• No, go to Step 4

• Perform a security check or sight identification
• Confirm and obtain consent from the applicant (parent) to transfer to a new or existing Medicare card (this could be the partners card)
• Notate in either the PaNDA work item, in Customer First, on the Newborn Child Declaration (FA081) or Medicare enrolment application (MS004) form: consent was obtained to transfer
• Transfer person to new or existing Medicare card
• Register newborn
• In CDMS add comments in Group for new card:
  consent was obtained to transfer

or

• Confirm if applicant (parent) wants the newborn enrolled on the existing family card (allowing for 3 generations on the one Medicare card)
• Register newborn
• In CDMS add comments to Group:
  consent was obtained

If unable to contact the applicant the parent must not be transferred to their own card:

• enrol newborn on the existing family card (3 generations on the one card)
• Add comments to Group (CDMS):
  unsuccessful attempt was made to contact applicant
• Notate either Medicare enrolment application (MS004) or Newborn Child Declaration (FA081) form