How much you can get back for an external breast prosthesis

You can claim a reimbursement of up to $400 for an external breast prosthesis for each breast.

If you get a refund from another source

If you have private health insurance, you need to claim any applicable refunds from them. Then you can seek a reimbursement from us.

We may pay the difference if:

  • you get a refund for your prosthesis from your private health insurer or another source, and
  • the refund is less than the full price paid

This is up to the $400 limit for each prosthesis.

Examples

If you buy 1 prosthesis

If you buy 1 prosthesis that costs you $130, we’ll reimburse you the full $130. This is because it's under the maximum reimbursement amount of $400.

If you buy 2 prostheses

If you had a bilateral mastectomy and you buy 2 prostheses, you can get up to $400 for each prosthesis.

If they cost you:

  • $800, we’ll pay you back the full $800
  • $1,000, we’ll pay you back $800 as this is the most we can give you

This may be less if you already got a refund from your private health fund or another source.

If you got a refund from another source

You need to seek a refund from your private health insurer before you seek a reimbursement from us. If you buy a prosthesis for $500 and get a $200 refund from your private health fund, we’ll pay you $200. This is the difference between the $400 limit and your refund amount.

If you can’t afford the upfront cost of a prosthesis

If you get certain income support payments you may be eligible for an advance payment. You may use this to pay for your prosthesis.

You need to:

  • check if you meet the advance payment rules
  • apply for the advance, and
  • agree to the repayment schedule

If you’re successful, you can use the advance payment to buy your prosthesis. Then request reimbursement for your prosthesis from us. You can use this money to pay back your advance or keep repaying it based on your agreed schedule.

How we’ll pay you

We’ll pay your reimbursement into the bank account you nominate on the claim form. We'll send you a payment statement for your records.

Page last updated: 28 November 2017