Who is eligible for participation in the Stoma Appliance Scheme?

General requirements

To access stoma related products under the SAS, a person must:

  • have a temporary or permanent artificial body opening (created surgically or otherwise) which facilitates the removal of urine and/or products of the gastrointestinal tract where the person does not have normal gastrointestinal tract or bladder functions, and provide evidence, consisting of a certificate from a registered medical practitioner or STN in an approved form (PB049);
  • be an eligible person within the meaning of the Health Insurance Act 1973. An eligible person means an Australian resident or an eligible overseas resident;
  • reside in Australia in order to receive stoma-related products under the SAS (products will not be supplied under the Scheme if a period of more than six months is spent overseas); and
  • have one of the following forms of identifying information which must be provided as part of a claim for payment for the supply of a product:
  • a current Medicare or Department of Veterans’ Affairs entitlement number;
  • a current Australian Reciprocal Medicare Card number (if the person is a resident of a country that has signed a Reciprocal Health Care Agreement with Australia); or
  • a current passport number if the person is a resident of New Zealand or the Republic of Ireland.

Reciprocal Healthcare Agreements

Visitors to Australia who are eligible to receive benefits under a Reciprocal Health Care Agreement (RHCA) can access stoma-related products under the SAS for the period of their stay in Australia by virtue of subsection 7(2) of the Health Insurance Act 1973.

There is no legislative basis for visitors to Australia to be excluded from receiving products through programs subsidised under Section 9A of the National Health Act 1953 (unless the Guidelines for the program specifically state the exclusion). Therefore, access to benefits under the RHCAs should be honoured by the SAS.

The RHCAs do not exclude pre‑existing conditions from eligibility; the only exclusion is ‘medical tourism’, where someone enters Australia for the express purpose of receiving treatment. It is at the discretion of the stoma association as to whether the visitor is required to become a temporary association member.

Norfolk Island members

From 1 July 2016 mainland Australian taxation, social security, immigration, biosecurity, customs and health arrangements, including Medicare and the Pharmaceutical Benefits Scheme, were extended to Norfolk Island. Ostomates residing in Norfolk Island must still satisfy the definition of an ‘SAS participant’  and meet general eligibility requirements.