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Eligibility for Publicly Funded Health and Disability Services
Health and Disability Services Eligibility Direction 2003 - plain language version
Background
Eligibility Criteria
New Zealand citizen
New Zealand permanent residents
Australian citizens or permanent residents
Work permit holders here for two years or more
Work Permit holders participating in the Ministry of Education’s Foreign Language Teaching Assistantship Scheme
Refugees
Students
Children
Visitors
Pregnant women
Reciprocal Agreement - Australia
Reciprocal Agreement – United Kingdom
Public Health
Prisoners
Injuries
Other publicly funded health and disability services
HIV infected pregnant women
Immunisations
Disputes
Background
In 2003 the Minister of Health issued new criteria
*
for eligibility to publicly funded health and disability services, in the form of the 2003 Eligibility Direction. The Direction was made after consulting with District Health Boards (DHBs), and was made in accordance with section 32 of the New Zealand Public Health and Disability Act 2000 (NZPHD Act).
If a person does not meet one of the criteria set out in the direction, they are not entitled to free or subsidised services and are liable to be charged for any health or disability services accessed.
The direction covers:
all services publicly funded through DHBs
services funded by the Ministry of Health where the Ministry is acting as purchasing agent for a DHB pursuant to an agency agreement
services funded using funds provided by the Crown under a Crown Funding Agreement, or section 88 notice, or service agreement entered into under section 301 of the Injury Prevention, Rehabilitation and Compensation Act 2001 (IPRAC) Act
services provided in or outside a hospital, or other facility for the provision of services operated by a DHB (whether or not located in a hospital), and without limitation includes primary health services
public health acute services funded under the IPRAC Act, including any successor to that Act and any Regulations made under that Act.
The direction does not cover:
services funded by a DHB using funds provided by any person or agency other than the Crown or under the IPRAC Act, whether or not the purchasing of those services results in a part charge to the person receiving the services.
Eligibility:
means the right to be considered for receipt of publicly funded services, but does not equate to an entitlement to receive those services,
AND
is assessed at the time services are sought, and applies from the time the person first becomes eligible. In those instances where the services are provided after a person has applied for renewal of a permit, after their previous permit has expired, and before a new permit is issued, the person is considered ineligible. If they are later found to have been eligible (if Immigration New Zealand issues a new permit valid during the period that the services were received), the service provider may claim public funding for them and reimburse the patient for any payments.
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Eligibility Criteria
*
A person is eligible for personal health, mental health and disability support services funded by a DHB if he or she is in New Zealand
**
at the time of seeking services and meets one or more of the following criteria:
New Zealand citizen
1. New Zealand citizens, who have New Zealand citizenship under the Citizenship Act 1977 or the Citizenship (Western Samoa) Act 1982, and including those living in the Cook Islands, Niue or Tokelau who visit New Zealand on a temporary basis).
New Zealand permanent residents
2. A person who:
holds a residence permit issued under the Immigration Act 1987,
AND
holds a current Returning Resident’s Visa issued under the Immigration Act 1987;
OR
immediately prior to seeking services, has remained in New Zealand for a period that equals or exceeds two years.
Australian citizens or permanent residents
3. An Australian who:
is lawfully in New Zealand at the time of seeking services
AND
is a citizen of the Commonwealth of Australia
OR
holds a current resident return visa issued by the Government of Australia,
AND
can demonstrate an intention, on reasonable grounds, to remain in New Zealand for a period that, together with the time that person has already been in New Zealand immediately prior to seeking the services, equals or exceeds two years.
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Work permit holders here for two years or more
4. A Work Permit holder who:
is lawfully in New Zealand at the time of seeking services
AND
holds a work permit issued under section 26 of the Immigration Act 1987:
entitling that person to remain in New Zealand for a period that equals or exceeds two years;
OR
entitling that person to remain in New Zealand for a specified period of time which, together with the period of time that person has already been lawfully in New Zealand immediately prior to obtaining the permit, equals or exceeds two years; and
includes a dependent child aged 19 years or younger, of a Work Permit holder who meets the criteria.
Work Permit holders participating in the Ministry of Education’s Foreign Language Teaching Assistantship Scheme
5. A participant in the Ministry of Education’s Foreign Language Teaching Assistantship Scheme.
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Refugees
6. A person who:
has refugee status in New Zealand,
OR
is in the process of having an application for refugee status determined by Immigration NZ,
OR
is in the process of having an appeal against refusal of refugee status determined by the Refugee Status Appeal Authority.
Students
7. A student receiving funding under the New Zealand Agency for International Development (NZAID) Official Development Assistance Programme (
ODA Scholar
),
OR
a partner (husband, wife or partner where the parties are legally married or have entered into a civil union, or a de facto partner within the meaning of that term in section 2C of the Property (Relationships) Act 1976), of an ODA Scholar, or
a dependent child, aged 17 years or younger, of an ODA Scholar.
8. The holder of a postgraduate university scholarship awarded to a member of the Commonwealth under the Commonwealth Scholarship and Fellowship Plan (
Commonwealth Scholarship holder)
.
9. A person with a current student permit, who:
had a visitor’s or student permit before 29 October 2003 that allowed them to be in New Zealand for two years or more, and
has held consecutive permits (of any type) to remain in or re-enter New Zealand since 29 October 2003 (even where the individual leaves New Zealand for short periods (of up to four months).
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Children
10. A child aged 17 years or younger who is for the time being in the care and control of his or her:
parent;
OR
guardian (guardian has the same meaning as in section 15 of the Care of Children Act 2004 or any successors to that Act);
OR
a person who is in the process of legally adopting that child,
AND
- that parent or guardian or person in the process of legal adoption is a:
New Zealand citizen or permanent resident,
OR
Australian citizen or permanent resident,
OR
Work Permit holder who:
is lawfully present in New Zealand at the time of seeking services
AND
holds a work permit issued under section 26 of the Immigration Act 1987:
entitling that person to remain in New Zealand for a period that equals or exceeds two years;
OR
entitling that person to remain in New Zealand for a specified period of time which, together with the period of time that person has already been lawfully in New Zealand immediately prior to obtaining the permit, equals or exceeds two years;
AND
includes a dependent child aged 19 years or younger, of a Work Permit holder who meets the criteria,
OR
person with a current student or visitor’s permit, who:
had a visitor’s or student permit before 29 October 2003 that allowed them to be in New Zealand for two years or more,
AND
has held consecutive permits (of any type) to remain in or re-enter New Zealand since 29 October 2003 (even where the individual leaves New Zealand for short periods (of up to four months).
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Visitors
11. A person with a current visitor’s permit, who:
had a visitor’s or student permit before 29 October 2003 that allowed them to be in New Zealand for two years or more,
AND
has held consecutive permits (of any type) to remain in or re-enter New Zealand since 29 October 2003 (even where the individual leaves New Zealand for short periods (of up to four months).
Pregnant Women
12. An otherwise ineligible pregnant partner of an eligible person is eligible for certain maternity-related services, on the basis that the pregnancy is a shared responsibility.
An Eligible Person is one who meets any of criteria 1-12 above
A Partner is:
where the parties are legally married or in a civil union, the wife or partner, as the case requires;
OR
a de facto partner within the meaning of that term in section 2C of the Property (Relationships) Act 1976.
Reciprocal Agreement – Australia
13. A resident of Australia who:
is in New Zealand on a temporary basis
is eligible for services required to be provided under the agreement referred to in the Schedule to the Health Benefits (Reciprocity with Australia) Act 1986 or any of its successors.
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Reciprocal Agreement – United Kingdom
14. A citizen of the United Kingdom who:
has his or her usual place of abode in the United Kingdom,
AND
is in New Zealand on a temporary basis
is eligible for services required to be provided under the agreement set out in the Schedule to the Health Benefits (Reciprocity with the United Kingdom) Act 1982 or any of its successors.
Public Health
15. A person receiving or eligible to receive compulsory services under:
the Tuberculosis Act 1948,
OR
the Health Act 1956,
OR
the Alcoholism and Drug Addiction Act 1966,
OR
the Mental Health (Compulsory Assessment and Treatment) Act 1992,
OR
any Regulations made under any of those Acts
is eligible for compulsory treatment services.
Prisoners
16. A prison inmate (including an individual on remand in prison custody, a Gazetted police jail, or corrective training institution):
is eligible for health and disability services they require that are not available through the prison health services.
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Injuries
17. A person who:
has cover and entitlement to treatment under the Injury Prevention, Rehabilitation and Compensation Act 2001 (IPRC Act), and any successor to that Act, and any Regulations made under that Act,
AND
requires public health acute services covered by a Crown Funding Agreement and has not been disentitled to those services,
OR
has cover and entitlement under the IPRC Act, and any successor to that Act, and any Regulations made under that Act,
AND
seeks primary-referred pharmaceutical and laboratory services covered by a Crown Funding Agreement for those services;
OR
requires disability support services but has been disentitled to those services under any of sections 118-122 of the IPRC Act.
Other publicly funded health and disability services
Apart from people eligible to receive services under compulsory treatment orders, the 2003 Eligibility Direction has no reference to control of communicable diseases for people who do not meet the eligibility criteria for publicly funded health and disability services. In practice, there are two areas where publicly funded services are offered to ineligible people. These are detailed below.
HIV infected pregnant women
In addition to the services detailed in the 2003 Eligibility Direction, the Minister and DHBs have also agreed that any pregnant woman who is infected with HIV has free access to:
a hospital-based lead maternity carer
blood tests to determine HIV viral load in the pregnant woman
a funded course of antiretroviral drug(s), noting that there is no entitlement to ongoing antiretroviral treatment for the mother
information around safe alternatives to breastfeeding
a caesarean section for those cases where specialist medical opinion considers that a caesarean section is required for delivery to effectively limit the HIV transmission risk to the child
post caesarean section hospitalisation (approximately one week)
postnatal hospital visits for the child for the purpose of disease exclusion, that is, to determine the HIV status of the child,
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Immunisations
Immunisations set out in the Immunisation Schedule are usually available to ineligible children.
Disputes
The 2003 Eligibility Direction provides that if any question or dispute arises as to whether or not a person satisfies any of the eligibility criteria, that question or dispute shall be determined by the Ministry of Health.
This means that the Ministry of Health will advise a District Health Board, or parties in a dispute, of the Ministry’s view of whether particular circumstances meet the criteria in the 2003 Eligibility Direction.
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*
The criteria in this document are those set out in the 2003 Eligibility Direction, but reformatted for ease of understanding.
**
New Zealand
includes all waters within the outer limits of the territorial sea of New Zealand as defined in section 3 of the Territorial Sea and Exclusive Economic Zone Act 1977, but does not include the Cook Islands, Niue, Tokelau or the Ross Dependency.
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Page last updated: 4 March 2009