Lifetime Health Cover (LHC) eligibility in Medicare 011-44080000

In accordance with the Private Health Insurance Act 2007, LHC is applicable to an eligible person within the meaning of Section 3 of the Health Insurance Act 1973.

An eligible person means a person who resides in Australia who is:

• a newly arrived Australian citizen not previously enrolled in Medicare
• a migrant (holder of a permanent resident visa, including return residents)
• a conditional migrant (applicant for permanent residency)
• an Applicant for Permanent Protection
• a New Zealand citizen
• an Applicant under a Ministerial order

Any complaints received from persons covered under a Ministerial order, if their applicable LHC date is before November 2022, must be escalated to Medicare Consumers Policy for advice.

Department of Health and Aged Care mail out letters

In May each year, the Department of Health and Aged Care undertakes a mail out to tell people about LHC and the implications of not taking out private hospital cover. An information letter and fact sheet is sent to the following people:

• Persons approaching the age of 31 years enrolled in Medicare
• Newly arrived migrants enrolled in Medicare - with entitlement types of:
• Conditional Migrant
• Migrant
• Permanent protection
• New Zealand citizen, and
• Ministerial order

The mail out of these letters occurs in the first week of May each year.

LHC letters issued by Services Australia

Eligible newly arrived Australian residents aged 31 years or over will not have to pay an LHC loading if private hospital cover is purchased within 12 months of being enrolled in Medicare.

They need to contact Services Australia to request an LHC letter as proof of their full Medicare registration date. For LHC, the full Medicare registration is the date registered for interim or full Medicare benefits (blue or green Medicare card). They give this to their private health insurer as evidence of their Medicare eligibility to decide if LHC applies. Anyone in the eligible cohort can request an LHC letter, regardless of their age.

Note: for LHC the full Medicare registration date means the date on which they are registered (processing date) in Medicare, not their Medicare entitlement date.

The Process page contains details about responding to requests for LHC letters.

LHC arrangements before 1 April 2007

LHC cover started in July 2000. On 1 April 2007, changes were made to LHC arrangements. The changes included the applicable date for LHC.

The applicable LHC date for persons who enrolled in Medicare:

• before 1 April 2007 was their Medicare entitlement start date
• from 1 April 2007 is their Medicare registration date (processing date)

It is unlikely that a person enrolled in Medicare before 1 April 2007 would request an LHC letter. It would be of no use to them as they must take out private hospital cover within 12 months of being registered for Medicare to avoid paying the LHC loading.

If a person enrolled in Medicare before 1 April 2007 requests an LHC letter they may have been absent from Australia and an LHC – Unable to confirm applicable date letter should be used.