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Medical Treatment Overseas Program

Medical Treatment Overseas Program
Financial Assistance to Australian Residents Medical Treatment Overseas

The Medical Treatment Overseas (MTO) Program provides financial assistance for Australians with a life-threatening medical condition to receive proven life saving medical treatment overseas where effective treatment is not available in Australia.

MTO Program Eligibility
Guidelines for Applicants
Application and Assessment Process
MTO Program Application Form (PDF 93 KB)
Financial Assistance for approved applicants
Confidentiality
Contact Us

1. Program Eligibility

To be eligible to apply to the Medical Treatment Overseas Program applicants must be a permanent resident of Australia and be eligible for Medicare benefits (evidence that the applicant holds a current Medicare Card is required).

To establish eligibility for financial assistance, a Medical Adviser in the Department of Health and Ageing assesses applications against four mandatory medical criteria. The criteria are:

1. the proposed overseas treatment or an effective alternative treatment must not be available in Australia in time to benefit the applicant;
2. the treatment must be significantly life-extending and potentially curative;
3. there must be a real prospect of success for the applicant; and
4. the treatment must be accepted by the Australian medical profession as a standard form of treatment for the applicant’s condition.

All four criteria must be met to be eligible for financial assistance. Further information about the Program can be found in the Guidelines for Applicants.

2. Application and Assessment Process

Applications must be submitted on the MTO Program Application Form (PDF 93 KB)

Applicants should seek the assistance of the specialist(s) from whom they are receiving treatment in Australia to complete the application and provide supporting medical documentation. The specialist that has supported the completion of the application must sign where specified on the application form.

Receipt of applications will be acknowledged by the MTO Program Administrator within 7 days and they will request any further information that may be required prior to the assessment of the application commencing.

Applications are processed as quickly as practicable given the nature of the Program and all applicants will be notified by formal written advice once the Minister’s Delegate has made a decision.

Please allow a minimum of 6 weeks to process an application. This allows time for the medical assessment against the mandatory eligibility criteria including consultation with relevant college/s and medical groups and then for a package of information to be provided to the Minister’s Delegate.

Completed applications can be sent to:

The Administrator
Medical Treatment Overseas Program
Medical Benefits Division
MDP 850
Department of Health and Ageing
GPO Box 9848
CANBERRA ACT 2601

Or email MTOP

Assessment Process

A Medical Adviser in the Department of Health and Ageing will conduct an assessment of the applicant’s condition and proposed treatment. This assessment includes consultation with relevant specialist college/s and medical/craft groups. If the Medical Adviser's assessment is favourable, a recommendation will be made to the Minister’s Delegate.

Once the Minister’s Delegate has made a final decision, applicants will be notified by a formal written letter.

Negative medical assessment

If the Medical Adviser’s assessment is unfavourable the applicant will be given a copy of the draft medical assessment, including clinical information and advice obtained through the assessment process.

The applicant will then be given 21 days to provide any additional information in support of their application. Additional information will be considered by the Medical Adviser in a final assessment before proceeding to the Minister’s Delegate for a final decision.

Retrospective Claiming

Retrospective claims will only be accepted up to two years from the treatment commencement date. Retrospective applications are assessed on the treatment available at the time the applicant undertook treatment not at the time of application.

Travel and Treatment prior to assessment and approval/non approval

Due to the urgency of their medical condition, many patients arrange to leave Australia at very short notice. The fact that a patient will soon depart, or has already departed for treatment overseas, will not affect the determination of an applicant’s eligibility against the mandatory medical criteria and where assistance is approved it will be retrospective.

Any costs incurred will remain the applicant’s responsibility until their application has been approved.

Commencing treatment

Following approval for financial assistance, the treatment regime is required to commence within six months of the approval date.
If treatment has not commenced within six months of the approval date, MTO Program funding recipients will need to reapply for approval and provide reasons for not commencing the treatment following the initial approval. Top of page

3. Financial Assistance for approved applicants

For approved applicants, the following assistance is allowable:

• the full cost of reasonable hospital accommodation plus costs of services normally provided by hospitals in Australia associated with the approved treatment;
• the full cost of medical services, less any benefits payable (e.g. private health insurance rebates), associated with the approved treatment;
• the full cost of return business class airfare for the patient and one attendant (if medically required) to the place of treatment; and
• 100 per cent of reasonable (3.5 star equivalent) non-hospital accommodation expenses for the patient and one attendant (if medically required).

More information about what assistance is available to approved applicants under the MTO Program, including what expenses are not covered, is in the Guidelines for Applicants.

Public Appeals - Community Raised Moneys

Where community raised funds are available the amount of government assistance will be reduced by the balance of community money available after additional reasonable ‘unapproved’ costs to the funding recipient have been met.

The Department has no control over the disbursement of these moneys, but will require evidence of their disbursement prior to acquittal. All MTO Program funding recipients are required to complete and sign a declaration stating that any funds raised via public appeals/donations will be utilised before applying for government funding.

For acquittal purposes, MTO Program funding recipients must provide to the Department of Health and Ageing details of all monies recovered or recoverable from private health funds or from any other source including through a tax offset, Centrelink payment, other Commonwealth or State authorities, insurance claims (eg travel or third party), or settlement of a compensation claim, or public fund raising, donations and/or charitable funds in relation to their approved treatment. Top of page

4. Confidentiality

Details of all applications will be treated in accordance with the requirements of the Privacy Act 1988. The Department will not discuss the details of a specific application with anyone, on behalf of an applicant, unless the Department has written authorisation from the applicant, specifically naming those persons to whom information can be provided. This includes parents or guardians of applicants over 18 years of age.

During the assessment process the Medical Adviser may need to discuss the application with the applicant’s supporting Australian and overseas specialists. Authorisation for these discussions is assumed, unless the applicant specifically advises the MTO Program Administrator otherwise.

Confidentiality of all applicant information is maintained at all times. ALL relevant information should be disclosed when completing the application form and during the ongoing treatment process. Failure to disclose all information may affect the final assessment of your application or ongoing financial support.
The Commonwealth requests that applicants keep the MTO Program Administrator fully informed if there is any media involvement in their circumstance.

If an applicant’s case is the subject of a media report or inquiry, the Department or the Minister may respond, including publicly, to correct or to confirm the content of such a report or inquiry.
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5. Contact Us

The Administrator
Medical Treatment Overseas Program
Medical Benefits Division
MDP 850
Department of Health and Ageing
GPO Box 9848
Canberra ACT 2601

Phone
(02) 6289 7496 (from overseas: 0011-61-2-6289 7496)

Fax
(02) 6289 3562 (from overseas: 0011-61-2-6289 3562)

Or email MTOP

Useful Links

MTO Program Application Form (PDF 93 KB)
Guidelines for Applicants (PDF 55 KB)

The documents linked to this page are in PDF format. If you are unable to view them, please contact the Medical Treatment Overseas Program Administrator and a copy will be sent to you.
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