Medical Expenses Privately Incurred

Back to top

When can I claim for medical expenses privately incurred?

There are two situations where the Department of Veterans’ Affairs (DVA) may consider reimbursing your out-of-pocket medical expenses that you have incurred. These two situations are defined as ‘in-time’ and ‘out-of-time’.

The below table provides the definitions.

Terminology	Definition
"In-time'	An ‘in-time’ MEPI is an expense incurred before you are notified of your entitlement. This situation covers the period between the date of eligibility (the accepted date of onset of the injury or disease) and the date you received advice from DVA regarding your eligibility.
‘Out-of-time’	An ‘out-of-time’ MEPI is an expense privately incurred after you were granted entitlement. This situation covers exceptional circumstances where a medical expense was privately incurred after the date on which you were granted entitlement, i.e. you have a DVA Health Card/Veteran Card (Gold, White or Orange), and you: were not able to use this card when you received a service, and paid for the service out of your own pocket.

If you hold a Veteran Gold Card or Veteran White Card, please check with your health provider prior to your consultation or receiving treatment that the provider accepts DVA Health Card/Veteran Card arrangements.

If you have a provider who does not accept DVA Health Card/Veteran Card arrangements, it is not possible to reimburse repeat visits to this provider. To be able to use your DVA Health Card/Veteran Card please locate a provider in your area who does accept DVA Health Card/Veteran Card arrangements.

Back to top

What medical expenses can be reimbursed?

DVA will generally only pay for services that are listed on the Medicare Benefits Schedule (MBS) or the DVA Fee Schedules.

In-Time

If you fall into the ‘in-time’ category outlined above, DVA will consider reimbursement for the reasonable costs of your treatment, including pharmaceuticals that you have paid for, in the period between the effective date of eligibility and the date you received advice from DVA regarding your eligibility. Only medical treatment and services that DVA would usually cover may be reimbursed.

Out-of-Time

If you fall into the 'out-of-time' category outlined above, DVA will consider reimbursement at the DVA rate only, for the following:

• services listed in the Medicare Benefits Schedule (MBS)
• allied health services, e.g. physiotherapy, osteopathy etc., that appear in the relevant DVA Fee Schedule and are provided by a registered Medicare provider
• pharmaceuticals, and / or
• Rehabilitation Appliance Program (RAP) items.

Back to top

MEPI claims for unlisted-services

DVA generally funds medical services that are listed on the MBS and DVA Allied Health Fee Schedules. However, DVA may also consider reimbursement of - treatment and/or medical services which are not listed in these schedules, if there are exceptional circumstances.

In these cases a referral and supporting clinical information from the referring provider must be provided.

There are some services that are not covered by us. For more information on services that are covered, please see  Health Services Available to the Veteran Community and  Alternative Therapies.

Gold Card

If you are granted a Veteran Gold Card, we may reimburse you at the DVA rate for treatment, pharmaceutical, aids and/or appliances and travel expenses relating to any medical condition, within Australia. Please see Claim for Travelling Expenses for more information.

When overseas, reimbursement can only be considered for your accepted conditions, not including Non-Liability Health Care (NLHC) conditions and does not include travel costs. Please see Medical Treatment while Overseas for more information.

White Card

If you are granted a Veteran White Card, we may reimburse you for medical expenses that relate to your accepted conditions only.

Orange Card

If you are granted an Veteran Orange Card, we may reimburse the amount of the subsidy for pharmaceuticals and items available under the Repatriation Pharmaceutical Benefits Scheme. Expenses incurred for services other than prescription medicines, including travelling expenses, are not covered.

Back to top

How do I seek reimbursement?

For In-Time claims

While you are waiting for your eligibility to be assessed, you may seek reimbursement for your medical expenses through Medicare or your Private Health Insurance Fund. Once your eligibility has been assessed, and if accepted, you may seek reimbursement of the balance between the Medicare or Private Health Insurance Fund reimbursement, and the amount paid by DVA, for clinically required treatment for any health condition (if you have a Gold Card), or for your accepted condition/s (if you have a White Card).

For Out-of-Time claims

If you are already the holder of a Gold, White or Orange Card, you may lodge your claim directly with DVA, without seeking rebates through Medicare or your Private Health Insurance Fund.

Application form and supporting documentation for MEPI claims

Applications for reimbursement of claims should be submitted on form Application for Reimbursement of Medical Expenses Privately Incurred and must include the following:

• Paid itemised accounts or receipts
• Medicare rebate statements and / or private health insurance statements; and
• Referral and clinical information such as a supporting letter (where possible).

For Veteran White Card holders you must provide clinical information such as a supporting letter from a medical practitioner and/or a referral which outlines the condition for which you were referred and/or treated for. Where supporting financial documentation is not available, you can provide further information in the form of a letter or a declaration.

NOTE: Supporting clinical information cannot be provided on a declaration.

Refunds for prescribed medicines must have a copy of the prescription, or an itemised receipt certified by the dispensing pharmacist.

You should submit your application to your nearest DVA office, or via the following contact details:

Back to top

Postal Address

Department of Veterans' Affairs - Primary Health

GPO Box 9998

Brisbane; QLD; 4001

Email: medtreat [at] dva.gov.au

Back to top