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DVA HEALTH CARD ARRANGEMENTS
FAQs
What are DVA health card arrangements?
The health card arrangements are the main way the Department of
Veterans’ Affairs (DVA), on behalf of the Australian Government,
provides convenient access to health and other care services for
veterans, war widows and eligible dependents. Our arrangements
are based on providing access to clinically appropriate and
required treatment, which is evidence-based. The Australian
Government provides more than $5 billion in funding in health
treatment, services and support to veterans and their families
every year.
The DVA health card allows card holders a streamlined
administrative process, whereby the health card holder only has
to present their card when receiving treatment and not worry
about seeking reimbursement or obtaining receipts and invoices
for payment. How do the health card arrangements work? The
health card arrangements are based on providing access to
clinically appropriate and required treatment, which is
evidence-based.
For medical and pharmaceutical services, although DVA
arrangements are based on Medicare arrangements, DVA provides
access to a broader range of health services than is available
to the general population through Medicare. DVA’s scheduled fees
(or payments) to doctors and other medial providers for medical
services are higher than the Medicare fee.
For subsidised pharmaceuticals, the Repatriation Pharmaceutical
Benefits Scheme (RPBS) provides DVA clients with access to a
wider range of pharmaceuticals and wound dressings than are
available to the general population.
For other services, such as the Rehabilitation Appliances
Program (RAP), DVA maintains its own schedules and fee
arrangements. The RAP is a veteran-specific service for Gold and
White card holders (for accepted conditions) to give access to
appliances which might aid recovery, assist in managing illness
or injury or enable the client to remain in their own home.
What about health care providers?
Most providers in Australia accept DVA health cards. Providers
who accept health cards are registered by the Australian
Government and, as a requirement of accepting the cards, agree
to accept DVA’s scheduled fee as full payment for the services.
No health provider should charge a DVA health card holder a gap
fee.
DVA encourages health card holders to ask providers whether they
accept the DVA health card prior to making any arrangements for
treatment. What do the health card arrangements cover?
DVA health cards provide access to a broad range of treatments
and services, including private or public hospital treatment,
theatre fees, intensive care, GP services, referred specialist
services, allied health services, dental services, optical
services and ambulance cover. Health card holders are also
covered for a wide range of rehabilitation devices and
appliances, pharmaceutical needs and travel for treatment.
What type of health cards are there?
There are 3 categories of DVA health cards. They include Gold,
White and Orange.
Gold card - ‘DVA health card - For all conditions’ A Gold card
entitles the holder to DVA funding for services for all
clinically necessary health care needs, and all health
conditions, whether they are related to war service or not. The
card holder may be a veteran or the widow/widower or dependant
of a veteran. Only the person named on the card is covered.
White card - ‘DVA health card - For specific conditions’ A White
card entitles the holder to care and treatment for: accepted
injuries or conditions that are war caused or service related;
malignant cancer, pulmonary tuberculosis, posttraumatic stress
disorder, anxiety and/or depression whether war caused or not;
and the symptoms of unidentifiable conditions that arise
within 15 years of service (other than peacetime service).
Services covered by a White card are the same as those for a
Gold card but must be for treatment of war caused or service
related accepted conditions. The card also entitles the holder
to transport related to treatment and access to the Repatriation
Pharmaceutical Benefits Scheme (RPBS) for their accepted
conditions.
Orange card - ‘DVA health card – For pharmaceuticals only’ The
Orange card enables the holder to access the range of items
available under the Repatriation Pharmaceutical Benefits Scheme
(RPBS). The Orange card is for pharmaceuticals only, and cannot
be used for any medical or other health care treatment.
Have there been any changes to DVA health card arrangements?
No. One of the Government’s key priorities is to provide the
best possible services in a cost effective and fair way. This
involves regular assessments of the services that can be
accessed through the health card arrangements, to assess how
well the services are being delivered.
This takes into account issues such as changing clinical
practice and advances in technology, to ensure that services
better meet our clients’ needs.
For example:
There has recently been some relatively minor changes to
optometry, where clinical evidence supported a change that saw
card holders over 65 years old move to annual consultations.
In 2014, a comprehensive review of the RAP schedule was
undertaken and a new category of dementia items in this area was
included.
In 2013, a comprehensive review was undertaken of the dental
services. This led to greater flexibility taking into account
technological advances within the dental industry.
It is important to note that through prior approval
arrangements, DVA can provide access to services which are not
generally covered. This is only in circumstances where the
services are clinically appropriate and required, and
appropriate evidence is provided, usually by the treating
practitioner. Do DVA health card holders require private health
insurance? If you are a Gold card holder you do not require
private health insurance as you are covered for all clinically
required treatment within Australia. However, the Department
does encourage Gold card holders to consider travel insurance
particularly when travelling overseas. White card holders should
consider private health insurance for treatment of conditions
not accepted through their White card. It should be noted that
health card holders remain free to choose whether to use their
Gold card or be treated as a private or Medicare patient as they
see fit. How is DVA working with the Department of Defence to
address continuity of care? DVA and Defence work closely to
improve the care and support provided to transitioning ADF
members. A Memorandum of Understanding (MoU) between the
departments for the Cooperative Delivery of Care and Support to
Eligible Persons has been in place since February 2013. Under
the MoU, the Support for Wounded Injured or Ill Program, now in
its third phase, is focussing on efficient sharing and use of
information held by both departments to improve care and
support. Numerous improvements in the way information is shared
have already been implemented and planning is underway to
identify and progress additional initiatives aimed at further
improving connectivity. For separating members of the ADF, DVA
honours the rehabilitation determination made by a delegate of
the Chief of the Defence Force and will usually continue the
rehabilitation program already commenced by the person. Ideally,
this also entails continuing with the same rehabilitation
service provider, wherever possible. It is worth noting that it
is common for members to relocate considerable distances when
transitioning out of the ADF. This presents a challenge because
the member needs a new specialist they are comfortable with, and
the new doctor may provide a different care plan. How do DVA’s
travel for treatment arrangements work? DVA operates travel for
treatment arrangements. The Department facilitates well over one
million car trips and several thousand domestic flights for
clients every year. DVA has a strong focus on monitoring the
quality and responsiveness of the travel for treatment
arrangements and appreciates clients advising us when the system
doesn’t quitee work for them. In order to support clients
individual needs, DVA has the following arrangements in place:
For VEA clients, transport bookings can be made by call DVA
during business hours (Metro callers: 1300 550 455, Regional
callers: 1800 550 455) or 24 hours a day, 7 days a week through
DVA’s MyAccount. In these circumstances, the health card holder
is usually informed of who the transport provider is and can
contact them directly if needed. If the provider fails to attend
and the health card holder is unaware of the provider, the
health card holder can organise their own transport and then
claim reimbursement. MRCA/SRCA clients normally make their own
travel for treatment appointments. Travel costs are then claimed
by lodging a claim online using MyAccount, or by fax, email or
post. In circumstances where a client is unable to manage their
travel arrangements for clinical reasons, the Department can
provide assistance. Clients can request assistance with travel
for treatment by calling the Department during business hours
(Metro callers: 133 254, Regional callers: 1800 555 254).
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