1.1.S.10 Safety net (HCC, PCC, CSHC)

Definition

For the purposes of HCC, PCC and CSHC, there are 2 safety nets which protect individuals and families from large overall expenses for medicines and out-of-pocket medical costs. These are:

• the Pharmaceutical Benefits Scheme (PBS) (1.1.P.260) safety net, and
• the extended Medicare safety net.

PBS safety net & co-payment arrangements

The Government subsidises a wide range of prescription medicines through the PBS with the highest subsidies being made available to those with chronic illness, or greatest financial need. Safety net arrangements apply to further assist in limiting the cost of medicines for those patients and families who require a large number of PBS items.

In 2011:

• cardholders and listed dependants must pay $5.60 toward their PBS prescriptions. Once they have reached the concessional PBS safety net threshold of $336.00, they will usually be supplied with any further PBS prescriptions without charge for the remainder of the calendar year.
• non-cardholders must pay $34.20 toward their PBS prescriptions. Once they have reached the general PBS safety net threshold of $1,317.20, they are required to pay $5.60 toward any further PBS prescriptions for the remainder of the calendar year.

Act reference: National Health Act 1953, refer to Part 7

Policy reference: SS Guide 1.1.P.270 Pharmaceutical concessions (HCC, PCC, CSHC)

Extended Medicare safety net

The extended Medicare safety net provides an additional rebate for Australian families and singles who have out-of-pocket costs for Medicare eligible out-of-hospital services once an annual threshold in out-of-pocket costs has been met.

In 2011, the annual threshold for:

• concession cardholders and people who receive FTB Part A is $578.60.
• singles and families who do not hold a concession card or receive FTB Part A is $1,157.50.

Once the relevant annual threshold has been met, Medicare will pay for 80% of any future out-of-pocket costs for Medicare eligible out-of-hospital services for the reminder of the calendar year.

Out-of-hospital services include general practitioner and specialist attendances and services provided in private clinics.

Act reference: Health Insurance Act 1973, refer to Part 2

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Last reviewed: 1 July 2011