About the program
The program covers the cost of the approved treatment, airfares and accommodation for approved Australians who need life-saving medical treatment that’s only available overseas. It covers the costs of:
- hospital accommodation and services related to the approved medical treatment
- travel costs including airfares, passport fees and travel insurance
- accommodation costs before and after hospitalisation
- carer travel and accommodation expenses (automatic for those aged under 18 years, or as approved if medically required for adults).
Why it is important
This program ensures Australians with a life-threatening condition may be able to access life-saving treatment they need, even if it is not available in Australia. This can save or significantly extend their life.
To be eligible for the program you must:
- live in Australia
- be eligible for Medicare benefits
- have a life-threatening condition
- be seeking treatment that is intended to cure the disease and is not experimental
- have an application signed, supported and submitted by your Australian treating specialist that provides evidence you meet the 4 medical criteria.
- The proposed overseas treatment or an effective alternative treatment are not available in Australia, and won’t be available in time to benefit you.
- The overseas treatment will either significantly extend your life or potentially cure your condition.
- The overseas treatment has a real prospect of being successful.
- The Australian medical profession accepts the overseas treatment as a standard form of treatment for your condition.
As well as considering the medical criteria, our decision-maker must also consider if the planned spending for the overseas treatment aligns with the Commonwealth’s policies, particularly those relating to whether the use of public money is efficient, effective, economical and ethical.
What’s not eligible
The program does not cover travel overseas to:
- get medical advice or a medical assessment
- receive experimental treatments
- take part in clinical trials
- receive treatments for conditions that are not life threatening
- receive an organ transplant
- get palliative care that does not aim to cure the disease.
To apply for the program you must:
- complete and sign the application form – it must be for a specific treatment of a specified life-threatening condition
- provide advice from your specialist confirming that
- the treatment you are applying to get overseas is not available in Australia
- no other effective treatments are available in Australia
- ensure your specialist signs the application form
- ensure your specialist provides supporting medical documentation, including clinical evidence that show the
- condition is life threatening
- treatment has a real chance of curing you or significantly extending your life
- treatment has a strong chance of success
- Australian medical profession accepts the treatment as standard for your condition.
If you are applying for proton beam radiation therapy, your specialist must provide comparative proton versus photon plans. Photon therapy is available in Australia and may be effective for applicants requiring radiotherapy.
A panel of medical advisers will assess your application to confirm whether you meet the 4 medical criteria, and then a recommendation will be made to the Delegate to the MTOP as to whether the application is approved or not. Allow a minimum of 6 weeks for us to process your application.
When completing your application form, read the guidelines for applicants to make sure you include all the required information and documentation.
We will not assess your application if:
- you are not eligible for Medicare
- your Australian treating medical specialist hasn’t signed the application
- you haven’t provided a treatment plan
- the proposed treatment is not for a life-threatening condition
- the treatment is palliative rather than curative
- you haven’t provided enough medical and clinical information
- you have applied for treatment that’s not eligible
- when applying for proton beam radiation therapy, you have not provided a comparison plan with photon therapy.
Aspex Consulting did an independent review of the program in 2020 to determine the program's effectiveness.
Advice is being prepared for the government for its consideration in relation to the report and the findings of the Review. The release of the report, and any response to it, will be a matter for the government to decide.