19AB Explained
This week, we have put a blog together to explain to you the who, what, when, where, and why of 19AB!
WHAT EVEN IS THE 19AB RESTRICTION?
Section 19AB of the Health Insurance Act 1973 requires some Doctors to work in a Distribution Priority Area (DPA) for 10 years (referred to as the ‘moratorium’) to be able to access Medicare benefits.
WHO IS RESTRICTED BY 19AB?
You will be restricted by 19AB if you completed your degree outside of Australia or New Zealand or enrolled in your Australian degree whilst a temporary resident.
WHAT IS A ‘DPA’ AREA?
The Distribution Priority Area (DPA) classification identifies locations in Australia with a shortage of medical practitioners. You can determine whether a location is DPA using the Health Workforce Locator.
DO I HAVE TO ACCESS MEDICARE BENEFITS?
You do not need to access Medicare Benefits. You can apply for a referral and request a Medicare Provider number and still see patients. However, patients will have to be privately billed and won’t be eligible for a rebate from Medicare.
CAN I REDUCE THE MORATORIUM?
Yes. You can scale down your moratorium as much as five years by working in a rural or remote area.
IF I BECOME A CITIZEN OR PERMANENT RESIDENT OF AUSTRALIA, AM I STILL RESTRICTED?
Yes. You should also be aware that if you get residency or citizenship before you have achieved Fellowship, you will also be restricted by 19AA.
I HAVE A FELLOWSHIP. AM I STILL RESTRICTED BY 19AB?
Yes.
IF I DON’T GET RESIDENCY, WHEN WILL I FINISH MY MORATORIUM?
You will remain restricted by 19AB for as long as you are a Temporary Resident. Once you become a Permanent Resident or Citizen and have completed ten years, you will no longer be restricted.
ARE THERE EXEMPTIONS FROM 19AB?
Yes. These are:
Spousal Exemptions
To be eligible for a spousal exemption, your spouse must be a Medical Practitioner with an unrestricted exemption from 19AB or not restricted by 19AB. Or a skilled migrant who migrated to Australia within the last ten years on a professional occupation visa and currently lives here and works in that occupation.
As a part of the eligibility assessment, they will consider where you intend to practice and where your spouse works. They do not define a distance other than to specify it should be ‘reasonable’.
An application form must be completed, and you’ll need to include the requested list of supporting documentation. This can be submitted separately for AGPT only, otherwise must be submitted alongside a Medicare Provider Application for a specific location.
Replacement Exemption
You may be eligible for a replacement exemption if you replace a doctor with a 19AB exemption. You will require a Statutory Declaration from the GP who has left advising that they will no longer work within the location and confirmation that the provider number has been closed within 12 months of your application.
These documents must be submitted alongside a Medicare Provider Application.
Academic Exemption
The academic class exemption covers overseas trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS) who are employed in an academic position by an Australian medical school to teach medical students. You can seek an academic exemption if all of the following apply:
You have satisfied 19AA
You are employed in an academic capacity with an Australian medical school
You perform clinical services as part of your academic appointment
This exemption does not apply to private practices without teaching responsibilities.
Locum Exemption
You can work in an area that is not DPA by applying for a Locum Exemption. The exemption lasts six months and is practice specific, so you could technically locum in non-DPA areas for your entire moratorium if you wanted to.
To apply, submit a letter of support (from the practice or recruitment agency) with your Medicare provider number application. The letter should say you’re seeking a locum exemption.
Suppose you cease work there before six months. In that case, you will not be permitted to apply for the provider number again until you are unrestricted—no extensions made due to extenuating circumstances or part-time work.
After Hours Exemption
To be eligible for an after-hours exemption, you will be required to work the following:
After 6 pm and prior to 8 am on weekdays
Saturdays & Sundays
Public Holidays
To apply, you need to advise in the practice letter of support that these would be the only hours you are working, alongside a Medicare Provider Application.
Aboriginal & Torres Strait Islander Primary Health Services exemption
You can work at an Aboriginal and Torres Strait Islander Primary Health Service exempted under s19(2) of the Health Insurance Act 1973.
To apply, you should include confirmation of the clinic’s eligibility alongside a Medicare Provider Application for a specific Doctor at the practice location.
Hospital Exemption
Although not technically an exemption, if you are a doctor working in the hospital system, you can work in non-DPA areas as you do not require a Medicare Provider Number that allows you to access Medicare Benefits but rather a Refer and Request Provider Number.
To apply, you would select ‘Refer and Request Only’ on Question 22 of the Medicare HW019 form.
Other Exemptions
You may also be eligible for an exemption if you started negotiations to work with a practice whilst they were a DPA location, but now they’ve lost DPA status.
You would need to provide supporting evidence (ideally a signed contract, although emails may suffice) proving you were in touch with the clinic whilst the location was a DPA, along with the application for Medicare Provider Number.
Just so you know…
If you’re restricted by 19AA, you are unable to apply for most exemptions. You can apply for a spousal exemption if you are applying to the AGPT program. However, according to written confirmation from the Department of Health, this is the only case to be considered.
Keep in mind…
If you’re on a visa, you’ll need to get a Health Workforce Certificate to be sponsored on your visa. This means even if you have an eligible 19AB Exemption, you may still be unable to work in a metropolitan area unless you hold a Health Workforce Certificate.
