Medicare levy exemption certification application and supporting information form (3169)

To obtain an exemption from the Medicare levy if you are ineligible for Medicare complete this form. If you were a resident of a Reciprocal Health Care Agreement country prior to your arrival in Australia, have applied for permanent resident status (conditions apply), are a New Zealand citizen who is residing in Australia or a permanent resident visa holder you may be eligible for enrolment in the Medicare program, therefore ineligible to claim exemption from payment of the Medicare levy.

Please forward your completed application and supporting documents to the address below:

Medicare Levy Exemption Unit
Department of Human Services
GPO Box 9822
Adelaide  SA  5001