Prescription Medicine Coverage in OSHC policy – What You Need to Know!

As an International student, many will be familiar with the Overseas Student Health Cover (OSHC). But we rarely think about the benefits covered by an OSHC policy except when we are faced with an illness or a medical condition which puts us in a situation of financial crunch. That’s when one gets introduced to the nitty-gritty of the insurance policy and terms such as claims and reimbursement starts to sound familiar.

One of the most frequent claim lodged as an Overseas insurance holder is for pharmacy bills. Yet understanding around the entitlements one receives as a policy purchaser towards the pharmacy bills is very vague. Or all pharmacy bills covered? If so, why do I always seem to get less claimable returns than the original bill? Or all pharmacy items covered? These are some of the questions that circle around the minds of International students while spending for their pharmacy bills out of pocket.

In this blog, we have broken down some crucial questions when it comes to coverage for pharmacy expenses and claiming for your pharmacy bills.

So, first off, what is covered?

Pharmacy bills containing prescription medicines prescribed by a doctor/GP while in Australia is covered under your OSHC policy. Which means, medicines that can be purchased over the counter without a prescription from a doctor cannot be reimbursed under this policy. For eg: Betadine, taken for a sore throat without a doctor’s advice.

What exactly is Prescription Medicine?

A prescription medicine refers to the medicines prescribed by the doctor requesting to be dispensed to the patient by the pharmacist. Such medicines need to be listed on the PBS (Pharmacy benefit Schedule) to get reimbursement for pharmacy expenses under the OSHC policy.

So, who pays first?

The student always pays off the pharmacy bill first and then, approaches the OSHC insurance provider for the claim benefits. The OSHC claims officer processes the pharmacy bills and reimburses the student a certain coverage amount.

What coverage can I get from OSHC providers against Prescription Medicine Costs?

Pharmacy expenses coverage always comes with a co-payment. It is a fixed amount paid by the student and the insurance company both, every time a medical service is claimed. Currently, for most of the OSHC providers, the minimum co-payment set by the Pharmaceutical Benefits Scheme (PBS) for international students is $40.30. Also, the maximum coverage one can get per pharmacy item listed in the bill is up to $50.

Still confused, let’s work it out with an example.

For instance, there are 3 items mentioned in a pharmacy bill- Drug A, Drug B and Drug C

Drug A costs $45

Drug B costs $32

Drug C costs $92 and the total bill amount is, $169

This is how co-payment works for this bill.

For Item 1 of the bill, Drug A, the student pays the first $40.30 and the OSHC provider pays $ 4.70

For Item 2, Drug B the student is supposed to pay the whole amount as it costs only $32, as it is less than the co-payment limit of $40.30. This means the student is not eligible for a claim for Drug B listed in the bill.

For Item 3, Drug C, the student pays the first $40.30 and the OSHC provider pays $ 50 as the maximum coverage limit per prescription item is set at $50. The rest of the excess amount will be paid by the student. Hence for Drug C, The student pays a total of $42 while the OSHC insurer pays $50.

It is important to remember that co-payment applies for every single prescription item listed in the pharmacy bill.

Is there an annual limit to the claimable amount towards pharmacy benefits?

Yes, there is! Please see the table below for detailed info on member contribution, maximum coverage per pharmacy item and annual claim limit for single and family policy for each provider

How to know which drugs or medicines are covered by the Pharmaceutical Benefit (PBS) Scheme?

PBS has medicines listing on their website. You can visit here: http://www.pbs.gov.au/browse/medicine-listing to explore the same.

Easy Steps to Claim for Prescription Medicines

• Get your medicines prescribed by the doctor
• Purchase it from a pharmacist and obtain a receipt covering all the information you need to claim
• Complete a claim form available at your OSHC provider’s website along with the receipt.
• Get your co-payment amount

Seeking further assistance on any type of coverage for your OSHC policy? Get started with our experts today at support@getmypolicy.online.