C24/2001 Repatriation Pharmaceutical Benefits Card (Orange Card)

Purpose

The purpose of this Departmental Instruction is to provide legislation, policy and procedural systems information with regards to the 2001/2002 Budget Initiative, “Extend Access to the Repatriation Pharmaceutical Benefits Scheme (RPBS) for British Commonwealth and Allied veterans (BCAL)”, commonly known as the BCAL or Orange Card initiative.

Commencement

The changes commence on 1 January 2002.

ROGER WINZENBERG

Branch Head

INCOME SUPPORT

Introduction

From 1 January 2002, access to the Repatriation Pharmaceutical Benefits Scheme (RPBS) will be extended to eligible Commonwealth and Allied veterans and Allied mariners (herein referred to as BCAL veterans).

Legislation

The Veterans' Affairs Legislation Amendment (2001 Budget Measures) Act 2001, No. 102, 2001 received Royal Assent on 4 September 2001.  Schedule 1 of this Act inserts new Part VA Extension of the Repatriation Pharmaceutical Benefits Scheme.

Link to Act: http://scaleplus.law.gov.au/html/com — a — ct/11/6390/top.htm

New card

BCAL veterans who are eligible for the RPBS under this extension of eligibility will receive a plastic Repatriation Pharmaceutical Benefits Card (Orange Card).

Eligibility for card

To be eligible for the Orange Card a BCAL veteran must:

1. Be 70 years of age or older; and
2. Have rendered qualifying service for either WWI or WWII; and
3. Have been an Australian resident for a continuous period of at least 10 years (or an aggregate period of 10 years, where one of those periods is at least 5 years).

Legislative ref: s 93M VEA

Note that the Orange Card is not subject to the income or assets tests.

Card benefits – medicines

The Orange Card will give BCAL veterans access to all medicines listed in the Pharmaceutical Benefits Scheme (PBS) as well as those items (including  medicines and dressings) listed in the RPBS at the concessional rate.  This means that BCAL veterans will have access to prior approval authorisation for non-listed items through the Veterans' Affairs Pharmaceutical Approval Centre (VAPAC).

More info: for more detailed information on the benefits of the Orange Card, refer to HSV 69, Repatriation Pharmaceutical Benefits Card (Orange Card) on DVA Facts: http://internet-mirror/factsheets/default.htm

Card benefits - PA

The Orange Card entitles the holder to receive the Pharmaceutical Allowance (PA).

Legislative ref: para 118A(1)(c)

Some Orange Card holders may already receive PA as part of their Service Pension or Disability Pension entitlement, or in some cases if they already hold a Repatriation Health Card – for Specific Conditions (White Card) or receive it as part of a Centrelink entitlement.  Note that in cases where PA is already received, it will not be paid twice.

Legislative ref: ss 118B(1A), 118B(2).

No treatment

The Orange Card does NOT entitle the holder to receive any treatment benefits.

Legislative ref: ss 93L(2) VEA

Dual card eligibility –orange & white

Where a veteran holds both a White Card and an Orange Card:

• the White Card should be used for prescribing both treatment and PBS/RPBS listed medicines for treatment of their accepted conditions;
• the Orange Card should be used for prescribing PBS/RPBS listed medicines for treatment of all other conditions (there is NO treatment entitlement).

Dual card eligibility –orange & gold

Some Gold Card holders will also be eligible for the new Orange Card.  This group will have the new eligibility (PBB) recorded, but will not be issued with the Orange Card.  If they lose eligibility for the Gold Card, the Orange Card will be automatically issued.

Claim form

A new claim form, Claim for a Repatriation Pharmaceutical Benefits Card, D2622 is available on DVA Forms.

Link: http://internet-mirror/clientforms/default.htm

Fact Sheet

A new fact sheet, Repatriation Pharmaceutical Benefits Card (Orange Card), HSV 69 is available on DVA Facts.

Link: http://internet-mirror/factsheets/default.htm

RPBS

A copy of the RPBS is available on CLIK, in the Legislation Library, under Health Schemes and Determinations.

Processing a New Claim with Orange Card eligibility

Processing a Service Pension New Claim through PIPS/PC alone will not automatically produce an Orange Card.  Follow the process shown in the table below for Service Pension New Claims where the veteran is also eligible for an Orange Card.

Step

Action

1

Register an RPB QS claim in CMS (in addition to the New Claim registration)

2

Set attribute to 'Successful'

3

Record 'PBB' eligibility in EATERS (using EN.BC)

4

Process New Claim through PIPS/PC

5

De-register DP Grant (this was automatically created when PBB eligibility was set)

Important: Remember that the process to set PBB eligibility in EATERS will generate an Orange Card - it is not dependent on finalisation of a PIPS/PC case.  This means that the card will still be produced and sent by HIC - for example if the claim results in a rejection (e.g. income/assets in excess), or for some reason the PIPS/PC case is not finalised for some weeks (e.g. perhaps further investigation in necessary).  If you don't want the card to go out, PBB eligibility should be set to 'OFF' to prevent the card being printed.  This must be done in a timely manner.

SP entitlement code

Remember that the SP entitlement code should be changed to an appropriate BCAL type code in Adult Details when processing the claim in PIPS/PC.

New warning

A new Warning will appear in PIPS/PC at create Worksheet and Authorise, for cases where certain SP entitlement codes exist.  The warning is a reminder that EATERS has to be used to set Orange Card eligibility.

Advice – doe pre 1/1/02

New Claims advices (where DoE is prior to 1 Jan 2002) will not have an Orange Card paragraph included in the daily advice.   A standard letter should be sent to advise the veteran of Orange Card eligibility – SLS 'Grant from Claim Pre Jan02' may be used.

Advice – doe on or after 1/1/02

New Claims advices (where DoE is on or after 1 Jan 2002) will have an Orange Card paragraph included in the daily advice, provided EATERS action has been done to set eligibility.

BCAL claims (card only) determined after 28/11/01

Where a veteran lodges a claim for an Orange Card (card only) and the case is determined after 28 November 2001, follow the process shown in the table below.

Step

Action

1

Register an RPB QS claim in CMS

2

If eligible, set attribute to 'Successful'

3

Record 'PBB' eligibility in EATERS (using EN.BC)

4

'Record Decision' in EATERS

5

Grant Pharmaceutical Allowance where appropriate

6

Advise veteran – standard letter.

Other eligibilities - no

If there are no other eligibilities recorded for that veteran, a DP Grant will be automatically registered in CMS – this should be used to grant PA where appropriate.

Other eligibilities - yes

If other eligibilities are recorded for that veteran (e.g. a White Card), a CMS case will not be registered – a DP Data Change case will have to be registered manually.

Interstate Transfers – new transaction EN.BC

There is one minor change to the way in which Interstate Transfers are handled.  From 1 January 2002, and only where the veteran has an Orange Card, an EATERS transaction must be completed prior to the transfer-in action in PIPS/PC.

The transaction is exactly the same as for treatment card issue, except the transaction used to data collect in EATERS will be EN.BC.  Records Administration staff and other staff who process Interstate Transfers need to be aware of this new transaction.

PA processing

The majority of Orange Card holders will already receive PA through another entitlement.  Orange Card holders who require payment of PA are likely to be holders of a Commonwealth Seniors' Health Card, or in receipt of nothing at all from DVA or Centrelink.

Other eligibilities - no

If there are no other eligibilities recorded for a veteran, a 'DP Grant' will be automatically registered in CMS when EATERS action is completed – this should be used to grant PA.

Other eligibilities - yes

If other eligibilities are recorded for a Veteran, a CMS case will not be registered – a 'DP Data Change' case must be registered manually in CMS and PA granted using that registration.

Daily advices

Some changes have been made to daily advices to cater for the Orange Card.  Additional paragraphs will be included in daily advices when card eligibility changes, when a New Claim is processed and when pensioners transfer interstate.

Standard Letters

A new batch of letters dealing with acknowledgments, grants and rejections are located under the new 'BCAL Card' tab in IS Standard Letters.  Note that Standard letters relating to CSHC, where the claimant is also eligible for an Orange Card, are located in the new CSHC tab.

EATERS – PBB elig type

EATERS has been changed to recognise the new Orange Card.  A new eligibility type 'PBB' has been created for the card.   Eligibility for the Orange Card cannot be set to a date that is prior to 1 January 2002.

EATERS – EN.BC

A new screen 'EN.BC' has been created in EATERS – this screen should be used to set the new eligibility for the Orange Card.  The Country Code field in this screen already exists and new country codes have been created for the BCAL group of Veterans.  These new country codes are at Attachment A – Country Codes.

The functionality of this new screen is no different to existing screens – to make changes to a veteran's eligibility, a CMS case has to be registered and 'Stage Completed' to “Await Prepare Record'.

Entitlement Card (EC)  Changes

Changes have been made to accommodate the new card.  The commands and the functionality in EC have not changed.  There has been an additional field added to EC – 'RPBC card'.  If you need to inquire on or update a veteran's record where that veteran holds an Orange Card, type Y in that field.  If the field is left blank, other card eligibility will be displayed.

VIEW changes

VIEW changes include:

• the addition of a new folder in the Eligibility Tab;
• a new folder in the Cards Tab; and
• a new card type in the Summary Tab.

WAR PREFIX CODE

ENTITLEMENT NAME

COUNTRY CODE

A

Algeria - WW2

DZ

A

Argentina - WW2

AR

A

Belgium - WW1

BE

A

Belgium - WW2

BE

A

Brazil - WW2

BR

BUR

Burma

BU

A

Bulgaria - WW2

BG

A

China - WW2

CN

A

Chile - WW2

CL

CN

Canadian - WW1

CA

CNX

Canadian - WW2

CA

A

Czechoslovakia - WW2

CZ

A

Denmark - WW2

DK

A

Egypt - WW2

EG

A

Estonia - WW2

EE

A

Ethiopia - WW2

ET

A

Finland - WW2

FI

A

France - WW1

FR

A

France - WW2

FR

A

Greece - WW1

GR

A

Greece - WW2

GR

HKX

Hong Kong - WW2

HK

A

Netherlands - WW2

NL

A

Hungary - WW2

HU

IND

INDIA (all conflicts)

IN

A

Italy - WW1

IT

A

Italy - WW2

IT

A

Japan - WW1

JA

A

Latvia - WW2

LV

A

Liberia - WW2

LR

MAL

Malaysian Pensioners

MA

A

Montenegro - WW1

YU

MTX

Malta - WW2

MT

N

New Zealand - WW1

NZ

A

Norway - WW2

NO

WAR PREFIX CODE

ENTITLEMENT NAME

COUNTRY CODE

NX

New Zealand - WW2

NZ

P

British - WW2

GB

A

Panama - WW2

PA

A

Poland - WW2

PL

PMS

British Merchant Navy - WW1

GB

A

Portugal - WW1

PT

PSW

British Merchant Navy - WW2

GB

PX

British - WW2

GB

RD

Rhodesia - WW1

ZW

RDX

Rhodesia - WW2

ZW

A

Rumania - WW1

RO

A

Russia - WW1

RU

A

Russia - WW2

RU

SA

South Africa - WW1

SA

SAX

South Africa - WW2

SA

A

Serbia - WW1

YU

A

Syria - WW2

SY

A

Uruguay - WW2

UY

A

United States - WW1

US

A

United States - WW2

US

A

Venezuala - WW2

VE

A

Yugoslavia - WW2

YU