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

An eligible person can request an LHC letter by any of the following:

• Over the telephone the caller must be authenticated
• In person at a service centre the customer must be authenticated
• Written request with:
• name
• Medicare number, and
• signature
• Medicare enrolment form (MS004) - the Medicare enrolment form (MS004) can be used to request an LHC letter at the same time as enrolling in Medicare
• Digital Medicare enrolment (DME) and extensions (DMX)
• Customers can request an LHC letter as part of their digital Medicare application
• For customers over 31 years, Service Officers must create LHC letters requested as part of a digital Medicare application in the MEE Portal. See Digital Medicare enrolments and extensions in the MEE Portal for the process
• If a customer under 31 years requests a LHC letters as part of their digital Medicare application, Service Officers must create a LHC letters manually. Go to Step 2

Note:

• the letter should only be given to the person requesting it
• if there are multiple persons on the one card that require the letter, each individual over 14 years should request one separately
• if an enrolment application is received and persons under 14 years are included with the request for a LHC letter, these persons can be included on the LHC letter of the applicant
• if all persons are present or on the phone and request to be on the same letter:
• get the individual's consent for the letter and complete a security check
• if the request is received and the individual wishes to add a person under 14 years, these persons can be included on the LHC letter of the applicant, provided the persons are on the same Medicare card
• add comments to the Personal tab to record that the customer consented to be on the same letter as the requestor
• LHC letters do not apply to:
• diplomats, and
• customers of Reciprocal Health Care Agreement (RHCA) countries

Note: if the Production Control address is recorded on the customer's record, the customer's Group address must be updated:

• before sending an LHC letter update to a valid postal address, and
• after successful completion of a security check and appropriate confirmation of identity

See:

• Amend address in the Consumer Directory Maintenance System (CDMS) for Medicare
• Authenticating a Medicare customer
• the Resources page for Medicare entitlement types and eligibility for LHC letter

On CDMS home page, select inquire on consumer details.

• key the Medicare card number in the ID Number field
• select Personal

On Personal Detail Inquiry screen:

• select the consumer using the radio button
• scroll to bottom of page and select Summary
• select History from dropdown menu

On Consumer History Summary screen:

• select Program Entitlement from the All Events dropdown menu
• select Filter Results

All events that have a program entitlement will show.

Select the radio button of any event that has Program MCARE.

Select History details tab.

The History detail – Program Entitlement screen will show all previous, current and deleted program entitlement details.

See the Reference column to find the Medicare registration date (applicable date for LHC letter).

If a person has multiple entitlements, go to Step 4.

If a person has Medicare entitlement type/s) of:

• Migrant (only)
• LHC date = date of registration (processing date)
• Conditional migrant (only)
• LHC date = date of registration (processing date)
• Ministerial order
• LHC date = date of registration (processing date)

Conditional migrant and RHCA

• LHC date = date on which the Conditional migrant was registered (processed date)
• Conditional migrant and Migrant
• LHC date = date on which the Conditional migrant was registered (processed date)
• RHCA and Migrant
• LHC date = date on which the Migrant was registered (processed date)
• Australian citizen newly arrived and not previously enrolled
• LHC date = date on which the Australian citizen was registered (processed date)
• if the person was previously enrolled and has been absent from Australia and recently returned, see the Medicare entitlement types and eligibility for LHC letter table on Resources page
• New Zealand citizen newly arrived and not previously enrolled
• LHC date = date on which the New Zealand citizen was registered (processed date)
• if the person was previously enrolled and has been absent from Australia and recently returned, see the Medicare entitlement types and eligibility for LHC letter table on Resources page

Choose the appropriate letter. See the Medicare entitlement types and eligibility for LHC letter table on the Resources page.

• Z0138 Lifetime Health Cover - applicable date
• Z2780 Lifetime Health Cover Unable to confirm applicable date - International Movement Record may be required
• Z2781 Lifetime Health Cover does not apply to you

Use the options available in the Standard Letter Template (SLT) to create a letter.

To complete the Address and Signatory tab:

• for a person with only one name, key the name in the mandatory first name field in Addressee Details of the letter
• use the customer's first name and last name recorded in the Personal tab in CDMS
• there is a blank option in the title field dropdown menu
• use the address recorded in the Group tab in CDMS

To complete the Details of People Covered tab (only in the Z0138 letter):

• key the customer's first name/s, middle initial (if they have one) and last name recorded in the Personal tab in CDMS
• for a person with only one name, key the name in the first name field
• add one of the following comments in the Personal tab in CDMS:
• Z0138 - LHC letter for date of registration <insert date> and (if applicable). Customer consented to be included in the same letter as the applicant
• Z2780 - Unable to confirm applicable date in Medicare letter sent, or
• Z2781 - Lifetime Health Cover does not apply to you letter sent

Once completed:

• upload the letter with PaNDA work item ID if LHC was requested in writing (Medicare enrolment form MS004 or email request)
• refer the letter for quality assurance, see Preparing, quality and peer to peer checking of Medicare external mail

Once approved by the delegate, give (if in person) or mail the letter to the customer.