Reciprocal Health Care Agreements (RHCA) eligibility for Medicare and Pharmaceutical Benefits Scheme (PBS) 011-44060000

Under section 7 of the Health Insurance Act 1973, the Australian Government has signed RHCA’s with some countries. Under these agreements, visitors from these countries are entitled to medically necessary health cover while visiting Australia. In return, Australians who travel to an RHCA country also get medically necessary care.

The Resources page contains links to information on the Services Australia website for Australians travelling to RHCA countries.

Australia has Reciprocal Health Care Agreements (RHCA) with the following countries:

• Belgium
• Finland
• Ireland (public hospital care and PBS medicines only, not MBS services)
• Italy (eligibility limited to six months from date of arrival)
• Malta (eligibility limited to six months from date of arrival)
• The Netherlands
• New Zealand (public hospital care and PBS medicines only, not MBS services)
• Norway
• Sweden
• Slovenia
• United Kingdom (including Northern Ireland)

Visitors from the United Kingdom (including Northern Ireland) and Italy can submit a Digital Medicare Enrolment (DME). All other customers from Reciprocal Health Care Agreement (RHCA) countries must:

• complete a Medicare enrolment form (MS004), and
• provide supporting documents

Once enrolled the customer will receive a yellow Medicare card.

Note: individuals with different entitlement end dates cannot be enrolled on the same Medicare card.

The Process page contains specific information for each RHCA country including document requirements and processing details.

If a customer has lodged an application and has not given all the required supporting documents Service Officers must

• issue a RHCA - Documents required letter, and
• remove any letter sections not relevant to the required documents for the customer or the relevant RHCA country

See Medicare eligibility and enrolments request for information for further information about pend periods.

Note: residency documents for Finland and Sweden are only required if there is evidence that suggests the applicant may not have resided in the applicable country for more than 6 months before entering Australia.

Identification documents must be verified for all customers enrolling and re-enrolling in Medicare using the Medicare DVS Portal.

If an application is received and processed in a Service Centre, Medicare DVS is only required if the Service Officer is not satisfied with the validity of the documents.

See Identity verification for Medicare enrolments and re-enrolments in the Medicare Document Verification Service (DVS) Portal for more details.

Note: if a customer submits a DME application, DVS is completed in the MEE Portal. See Digital Medicare enrolments (DME) and the MEE Portal

For Medicare eligibility some expired identity documents can be accepted if they can be successfully verified through the DVS Portal.

Commonly accepted expired documents are:

• foreign passports linked to a current Australian visa, and
• ImmiCard that has not been cancelled

For more details on acceptable identity documents, including all expired identity documents see the Process page in Medicare identity documents A to Z.

Service Officers must complete a VEVO when processing a RHCA enrolment. This includes:

• initial enrolments
• re-enrolments, and
• extensions

If a customer does not have evidence of a visa, the customer may have an Electronic Travel Authority (ETA) which can be confirmed through VEVO. If the customer has an ETA, use VEVO and the Medicare enrolment form (MS004) to check and determine the Medicare entitlement period.

RHCAs do not cover medical treatment for a person visiting Australia for:

• the specific purpose of receiving medical treatment, or
• care planned before arriving in Australia

Eligible visitors generally get:

• Medicare benefits for medically necessary out-of-hospital treatment except for visitors from New Zealand and Ireland
• medically necessary care as a public patient in a public hospital including inpatient and outpatient services
• some Pharmaceutical Benefits Scheme (PBS) prescription medicines

Eligible visitors from New Zealand and Ireland are not enrolled in Medicare. For the length of their stay they can get:

• medically necessary care as a public patient in a public hospital (including inpatient and outpatient services)
• some PBS prescription medicines

Note: a New Zealand citizen (including diplomats and students) is not considered a visitor if residing in Australia for 6 months or more. For more information see Medicare eligibility for New Zealand citizens.

RHCAs do not cover:

• private hospital care
• public hospital care as a private patient
• ambulance travel
• care from a physiotherapist, occupational therapist, speech therapist, eye therapist, chiropractor, podiatrist or psychologist unless it is in the Chronic Disease Management scheme
• acupuncture unless from a doctor
• glasses and contact lenses
• hearing aids and other devices
• prostheses
• costs someone else is responsible for, for example an insurer, employer or government agency
• care that is not clinically essential
• cosmetic surgery
• checks for life insurance or superannuation or to join a friendly society
• home nursing
• Assisted Reproductive Technology (ART ) services (Items 13200-13292)
• PBS subsidised In Vitro Fertilisation (IVF) medicines under the Section 100 IVF program

There are specific RHCA eligibility rules for defence force personnel and medical visa holders (subclass 602).

The Process page contains more information on RHCA eligibility for these cohorts.

The RHCA eligibility policy for the UK was updated.

From 1 September 2022 visitors from the UK:

• must be ordinarily residing in the UK, and
• need to provide proof of residency in the UK

Customers who were enrolled before the Policy update and who have not had a break in entitlement are not required to provide evidence of residency. The Process page contains more information on RHCA UK.

Australian citizens that are visiting Australia but live in a RHCA country may be eligible under a RHCA, if they:

• have been residing outside of Australia for more than 5 years and have not returned to Australia to reside, and
• meet the eligibility criteria as outlined under the relevant country’s RHCA

The Process page contains specific information for each RHCA country including document requirements and processing details.

The pathway provides eligible Retirement (subclass 405 and subclass 410) visa holders with the ability to get permanent residence in Australia.

The pathway was announced by the Australian Government on the 8 May 2018 as part of the 2018-19 Budget and was introduced on 17 November 2018.

Eligible retirees may access the pathway by applying in Australia for a:

• Parent visa (subclass 103), or
• Contributory Parent visa (subclass 143)

To be eligible under a RHCA the retiree must have been residing in a RHCA country before arriving in Australia and:

• lodged an application for a Parent visa (subclass 103), or
• Contributory visa (subclass 143)

The Resources page contains more information..