Veteran Cards, prior approval and referrals

Find out what a Veteran Card covers, when prior approval is required and how to refer to other services.

Veteran Cards

Our clients use their Veteran Card to pay for medical appointments at the DVA rate. You cannot charge gap fees with Veteran Card payments.

Veteran Cards provide different coverage for card holders.

What a Veteran Card covers

Not all Veteran Card holders are veterans. Civilians including war widowed partners and dependants may also hold Veteran Cards.

What a Veteran Gold Card covers

Gold Card holders can access the following clinically necessary treatment, pharmaceuticals, support and services for all health conditions, even if they are not related to the veteran's service:

• Medicare Benefits Schedule (MBS) listed treatment and allied health
• non-MBS treatments if we give prior approval
• pharmaceutical items on the Pharmaceutical Benefits Scheme (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS)
• non-listed pharmaceutical items if our pharmacists give prior approval.

What a Veteran White Card covers

White Card holders can access services for health conditions related to their service – these are called accepted conditions – where it is clinically required. These are:

• MBS listed treatment and allied health
• non-MBS treatments if we give prior approval
• pharmaceutical items on the PBS or RPBS
• mental health care for a diagnosed mental health condition
• non-listed pharmaceutical items if our pharmacists give prior approval.

What a Veteran Orange Card covers

Orange Card holders can access clinically required pharmaceutical items for all medical conditions if these items are:

• on the PBS or RPBS
• non-listed pharmaceutical items if our pharmacists give prior approval.

How to check what's covered

Veteran Card holders may show their Veteran Card as a digital card in the wallet, in the myGov app, a digital card in the DVA online portal MyService, or the plastic card.

They may also show their Veteran Card confirmation letter.

The Veteran Card in the myGov wallet has a ‘Manage your card’ feature, which links to the MyService ‘Cards’ screen. 

For White Card holders, you can view your patient’s health conditions that are covered by DVA in their MyServiceCards screen, on their device. The accepted conditions will be itemised in ‘Conditions listed’, under the image of their Veteran Card. 

You can also check what’s covered by calling 1800 550 457.

Non-liability health care (NLHC)

DVA will pay for a veteran’s treatment for some conditions without accepting these conditions as service related. This is referred to as Non-Liability Health Care (NLHC). DVA may cover:

• a client's treatment costs by a mental health provider for any mental health condition, such as posttraumatic stress disorder – this can be accessed after one day full time service
• a client's treatment costs when diagnosed with cancer (malignant neoplasm) or pulmonary tuberculosis – there are service-related eligibility criteria.

Prior approval

You need prior approval from us for treatments not listed on the Medicare Benefits Schedule (MBS).

• Prior approval for Magnetic Resonance Imaging (MRI)/Positron Emission Tomography (PET) scans is not required if:
  • An MBS item number exists for the scan and the MBS fee is charged.
  • The DVA client is a Veteran Gold Card holder; and/or
  • The scan is for an accepted Veteran White Card condition.
• The DVA Form D9292 provides prompts to assist clinics to identify when prior approval is required or not. 
• When you refer a patient for an MRI/PET which requires specialist involvement, the Form D9292 prompts you to include the specialist’s details so the imaging clinic can provide this information to DVA in the approval request (i.e. the specialist the patient will be attending and who will be reviewing the MRI/PET results with the patient).
• An MRI/PET request should not be listed as urgent when it is a standard request. ‘Urgent’ status should only be given when the request is genuinely urgent. It is important an MRI/PET is not booked at the time a client presents to the clinic and then given an urgent status to progress it quickly because it has already been booked. The MRI/PET should only be booked once DVA has provided approval.

Referrals to other providers and services

When referring your veteran patient to other providers or services, you can use your own stationery or our DVA referral form.

Referrals to allied health providers

Referrals to allied health providers and psychologists last either 12 sessions or one year, whichever ends first. This is in accordance with the allied health treatment cycle.

Referrals can be repeated, and the cycle can be renewed if ongoing treatment is required.

For veterans with chronic and severe health conditions, the At Risk Client Framework (PDF 230 KB) may be applicable.