YankDownUnder

Hi, I'm looking for advice -- and also issuing a word of warning to future migrants.

The 1-year clock for immigrants taking out private cover in order to avoid being subject to the lifetime health cover loading for 10 years starts on the date you become eligible for medicare -- NOT on the date that you register for it, unless you were overseas until the date you register for it.

There's a LOT of misunderstanding about this, and even the Private Healthcare Insurance Ombudsman initially thought I'd met the deadline appropriately, just to give you a sense of how hard this can be to get right.

I was granted PR on Anzac Day, April 25, 2013. I did not, however, register for Medicare until June, 2013. I'm older but not a sickly woman, so it just wasn't a priority to me. I had had GREAT, comprehensive cover under temporary 457 worker's insurance from one of the big names and was told it would still work until I switched to my new policy.

What happened was that I was sick with the flu during the week of Anzac Day, 2014. I don't go to the doc when I've got that, because they can't fix it... only time can do it. However, I was concerned that I was running the clock on my insurance and would HAVE to go out sick and queue up to change my cover. So I called Medicare to verify my deadline.

They looked up when I registered and said, oh, don't worry, you've got until June, 2014 (a year after I *registered* for Medicare). Whew. However, I was now worried about the same thing happening in June (getting sick at the last minute), so I resolved to handle the issue ASAP.

That next Monday morning, I was at my insurer's office to switch my policy over.

At some time later, I got a letter from Medicare reminding me that time was running out to register for Private Cover and that I'd face LHC if I didn't register for it by June, 2014 (whoops, typo, initial version of this post said 2013, which was incorrect). Having already done this, of course, I smiled and tossed the letter. (THIS is why I usually throw NOTHING away even if I'm sure it's not needed. Big mistake here.)

Imagine my surprise upon getting my tax statement and seeing a 40% LHC cover loading on it!

The days between the date on which I had to register for Private Cover to avoid LHC and the date on which I did register included ONLY ONE BUSINESS DAY -- the others were weekend or public holidays.

Based on ONE BUSINESS DAY of lateness -- which I incurred because Medicare incorrectly advised me of my deadline (and then followed it up with a letter to me indicating the same deadline several weeks later) -- I am being socked with an extra $110 a month for the next 10 years (so far... and I'm sure it'll go up...). And this is despite the fact that for all of these days, I had insurance equivalent to what I have today PLUS which covered me for any services normally reimbursed by Medicare.

Can anyone suggest a way to appeal? The Private Health Insurance Ombudsman has already insisted to me that there *IS* no appeal, because the legislation was not set up to allow for it, and that my only shot is petitioning my Federal Member to attempt to change the legislation to provide an appeal path. It seems that at least one member here has had success talking to the Department of Ageing, so I'm going to try that tomorrow. Any other ideas?

Swerv-o

Hmmm. This does seem very unfair, and it's possible that things like this can be appealed at the Administrative Appeals Tribunal:

Administrative Appeals Tribunal (AAT) home page

Seems to be a catch all for all administrative wrongdoing on behalf of the powers that be.

I don't think that they will be able to influence the decisions of your fund, but they may be able to identify that Medicare provided you with the wrong information and hence you can use that in your defence.

Worth a try - Good luck!


S

spouse of scouse

You can get a copy of the Medicare letter you threw out through the Freedom of Information Act About freedom of information| Office of the Australian Information Commissioner - OAIC

YankDownUnder

Will they really have a copy of the form letter Medicare sent me, stored somewhere? (I'm in IT, and most systems I've ever been involved with that sent form letters didn't store copies of them.) A copy of the actual letter would be amazingly ideal. If there is even a record that a letter was SENT, that letter WAS DEFINITELY SENT AFTER I CHANGED MY PLAN FROM 457 COVER TO PR COVER, and that should help. Thanks!

spouse of scouse

Electronic storage of information is a big deal in Oz, particularly in government departments. Anything at all sent to an individual, whether in hard copy or electronic format, is stored and retrievable. A government department is required by law to allow you to access your personal information/communication under FOI legislation. There are a few caveats, such as sensitive information about other people (if present) will be censored from your document/s before you receive them.

YankDownUnder

Interesting idea. It MAY BE that the way to work around this is to get the government to tweak my Medicare eligibility date based on a mistake having been made.

Another thing I didn't mention is that my grant of PR was fubared, and this might have contributed to the strangeness. I was not actually IN AUSTRALIA on my PR visa until December 31, 2013, although I was in Australia. I found out that my PR visa wasn't in effect ON MY WAY BACK INTO THE COUNTRY AFTER A CHRISTMAS HOLIDAY!

I *may* have been technically visa-less between April, 2013 and late December, 2013. I never pressed anyone too strongly to give me an answer because I didn't want to have to request a waiver when I applied for citizenship, for having spent part of my time in the country illegally due to an administrative error. I did, however, have to request a waiver via Special Ministerial Discretion for having spent part of my time in Australia LEGALLY but not in a way that was recognized by their computer system, in order to apply for citizenship after my one year of PR was up, counting from April, 2013, because their automated eligibility verification system would only count from December, 2013 due to the error.

What happened is that my visa was granted as an off-shore visa, even though I was on-shore at the time. I noticed this mistake, and phoned immigration, and they corrected it to say that it was granted as an on-shore visa. However, because the date the visa came into effect (as opposed to the date it was granted) is not part of the online system, I could verify that they'd fixed it to say on-shore, but had no way of knowing that the correction they'd made was only partial, and that my visa was not yet in effect.

And I didn't find out until the next time I left the country and tried to get back in, much later that year.

Yes, I have copies of the paperwork saying my visa was granted as an off-shore visa, and of my correspondence to get this fixed. And it was believed by the IBP Minister's office, because they did indeed grant my citizenship via special ministerial discretion before December, 2014.

So it may well be that THIS also complicated my situation somehow.

Yep, I probably have something worth taking to the AAT.

YankDownUnder

Cool! Because the document was definitely specific to me, as it had my name and a specific date (I believe in June, a year from when I registered for Medicare) on it. Fingers crossed.

spouse of scouse

Best of luck. Private health insurance is expensive enough, without the ******* loading on top of it.

Beoz

Dim question. What is Lifetime Loading?

I remember when I moved to Australia 4 years ago the private health people tried to hit me with that because I'm an Australian citizen but I hadn't been a resident in Australia for a very long time. I can't remember much of the detail, but somehow it went away, I think, better check, wouldn't know where to start.

Swerv-o

It's the loading they apply to your premium for every year that you are over 30 when you take up PHI.

I think it's something like 2% per year is added. As a fresh immigrant, you get a grace period of 1 year from a certain date that has something to do with Medicare - though nobody actually seems to know which date it is - to take up PHI without loading irrespective of how old you are above 30.

This is known as your certified age, and should be shown on your PHI statement.


S

Beoz

Cool

So yes I was definitely over 30. How do I find out if I'm paying the loading?

YankDownUnder

You can probably ask your insurer. Otherwise, at the end of the tax year, your insurer will send you a tax statement, and if you are paying loading, the tax statement should mention that. (That's how I found out about mine.)

Beoz

ah nice one. thanks

YankDownUnder

Well, the Department of Health said that they couldn't help me, and it sounds like it's a Medicare problem, so they gave me the number to someone there who might be able to help.

Before I start poking in that direction, I want to get the FOI request for the correspondence in. I don't want people covering tracks later by claiming that the letter I keep talking about that told me of my June deadline to register for private health cover was actually sent earlier and pertained to the April deadline. (I vividly, vividly remember even where I was standing when I opened the letter, and my relief at thinking, "Oh, I've already handled this, so I don't have to worry about it", so I'm quite sure the letter says what I think it does and that it arrived in May, 2013 -- telling me about a FUTURE deadline that could not possibly have been in APRIL, since it was already MAY.)

Japonica

Good luck with that. We had a similar issue when we first moved here. We arrived in Australia at the end of August 2009 but didn't register for Medicare until about two weeks later in mid-Sept. When we decided to get the PHC at the beginning of September 2010 to avoid the loading, imagine our surprise when we were told that we'd missed it. Semantics. Turns out when the website says, "one year from the day you registered for Medicare," they don't actually mean that. They mean, "the day you became eligible to be registered," which was the day we stepped off the plane. We argued this point for days with Medicare managers, explaining that the language they used was misleading, but it got us nowhere. We still had to pay the loading.