Form D1181 - Application For Reimbursement Of Medical Expenses Privately Incurred - Australian Department Of Veterans' Affairs Page 2
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2DVA will not reimburse repeat visits to a provider in Australia who does not accept DVA cards. As soon
as possible please find a provider in your area who will accept DVA cards.
1. If you wish to claim a refund from Medicare Australia and/or a private health insurance fund you should do this
before you lodge this form to DVA - once your form has been lodged you are not entitled to claim further refunds.
2. Some treatments are not covered by DVA, have certain limits or require prior approval. Contact DVA for more
information or refer to the DVA Fact Sheets (see below).
3. You will receive written advice once your claim is finalised; written acknowledgement of receipt is not made.
Your claim must include itemised accounts supported by:
Receipts - Original receipts should be supplied. Please retain a copy of the receipts for your records.
Paid Accounts - All accounts must show the name of the person that received the treatment, the date of each
treatment, the item number/s or a description of the service, and the doctor’s full name, address and provider
number.
Medicare Australia Refunds - If you have claimed a refund through Medicare Australia please supply the
“Statement of Claim and Benefit Received”.
Private Health Insurance Fund Refunds - If you have claimed a refund through your Private Health Insurance
Fund please supply a copy of the refund.
White Cards - If you are a white card holder all receipts and/or accounts should state the condition that was
treated.
The following additional information is required for treatment received whilst Overseas (all information to
be provided in English)
Doctors’ Accounts - In addition to information required under ‘Accounts’ above, all overseas doctors’ accounts
must show the nature of the condition treated and be signed by the treating doctor.
Hospital Accounts - All accounts must show the date of admission and discharge from hospital, state the
nature of the condition treated, include an itemised list of all charges and be signed by the treating doctor.
Ambulance Accounts - All accounts must be accompanied by a referral from the doctor who authorised the
transport that states the disability for which transport was required and the date when the ambulance was
required.
Allied Health Accounts (e.g. treatment provided by a chiropractor, osteopath, physiotherapist or podiatrist) - All
accounts must show the date and cost of each treatment and be accompanied by a referral from the doctor who
prescribed the treatment.
Dental Accounts - All accounts must be supported by a certificate from the treating dentist indicating the
treatment provided and the cost of each treatment.
Pharmaceutical Accounts (not all pharmaceuticals are eligible for a refund) - All accounts must be supported
by a copy of each prescription related to the account or an itemised dispensary receipt that includes the name of
the beneficiary, cost, quantity and date or each pharmaceutical dispensed and be signed by the dispensing
pharmacist.
Surgical Aids and Appliances (including spectacles) - All accounts must be supported by a referral from the
doctor who prescribed the aid and/or appliance. All accounts must show the type of aid and/or appliance
dispensed as well as the date of supply.
Dressings - All accounts must be supported by a referral from the doctor who prescribed the dressings. All
accounts must show the type of dressing applied and/or supplied as well as the date of supply.
For further detailed information please refer to DVA Factsheets - Medical Expenses Privately Incurred
(HSV64) and/or Receiving Health Services while Overseas (HSV65).
Please include any further relevant information relating to page one of this form:
Please send the completed form with all the required information to:
Department of Veterans’ Affairs - Primary Health
GPO Box 9998, Brisbane,
QLD, 4001
Email: Medtreat@dva.gov.au
D1181 - 08/17 - p2 of 2
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