Ministry of Health Entitlements

The Breast Prosthesis Service Payment is payment to people who have undergone a partial or full mastectomy, either unilateral or bilateral, and/or have undergone a lumpectomy, have congenital needs, or have had failed reconstructive surgery, as specified by a specialist or general practitioner (GP).


The payments are to reduce the cost of purchasing breast prosthesis or prostheses and other related products. This is usually paid directly to the supplier of the product, who will be registered with the Ministry of Health. However you can also claim the funding yourself directly if you apply for a claimant code.

Funding is now available if you have asymmetry (significant difference in size between your breasts) where that occurs as a result of surgery, or naturally. We at The Fitting Room have a letter you can show your GP to describe what details are needed.


WHO CAN CLAIM THIS SERVICE PAYMENT?

You may claim for this service payment if: you are a New Zealand citizen, or are ordinarily resident in New Zealand; and your specialist or GP gives you a current medical certificate with your NHI number, and details of your need for a Breast Prosthesis or prostheses.

HOW MUCH CAN I CLAIM?

Your entitlement is $613.33 (GST incl) per side for a 4-year period. You may claim any amount up to the total amount of $613.33 (or $1226.66 for bilateral) at any time during the 4-year entitlement period.

WHAT CAN I USE THE SERVICE PAYMENT FOR?

The service payment is available to cover the cost of the following items only:

  • Breast prosthesis or breast forms (these may include standard breast forms, swim form, foam filler, shell prosthesis and lumpectomy shells)
  • Special bras to hold the breast prosthesis or breast forms
  • Surgical bras and normal bras
  • Swimwear with a built-in modification to hold a swim form
  • Modifications to bras to hold a prosthesis or breast form (or modifications to alternative undergarments where a person cannot wear a bra due to their medical condition)
  • Prosthetic nipples

HOW DO I CLAIM?

Your GP or specialist will inform you about the service payment and issue you with a medical certificate for your claim. At The Fitting Room, we have a template letter we can give you to take to your GP or specialist, outlining what details are needed. Generally, they are aware of what needs to be provided to you.

Shops which stock breast forms and pocketed bras are registered with the Ministry of Health and can make the claim on your behalf. You just need to take the doctor's letter with you to the shop for your first claim. We recommend making an appointment with us at The Fitting Room so that one of our trained and experienced fitters will be available when you arrive and a changing room will be set aside for you. We will help you find and choose the right products to have you looking and feeling wonderful. We then process the claim on your behalf; all you will need to do is sign a form. You do not pay for the product yourself but keep a copy of the receipt the supplier gives you for your records.

If you wish, you are able to pay for items yourself and claim the subsidy back; however it is a more complicated process; see http://www.health.govt.nz/new-zealand-health-system/claims-provider-payments-and-entitlements/breast-prosthesis-subsidy.

NOTE: The entitlement period begins on the date you make your first purchase from a supplier and ends 4 years from this date

WHAT IF THE PRODUCTS I CHOOSE COST MORE THAN I AM ENTITLED TO?

Where items are purchased that are more than your entitlement balance, you are responsible for the additional cost. For example, if for your first purchase totals $695, the final cost to you above the $613.33 (that will be claimed for), will be $81.67.

WHAT HAPPENS WHEN MY ENTITLEMENT PERIOD ENDS?

At the end of your entitlement period any unspent amount will be cancelled and another 4-year entitlement of $613.33 or $1226.66 will be allocated. You can phone the Ministry of Health yourself on 0800 458 448 to find out how much subsidy you have left. Your retailer can also phone on your behalf if they have your date of birth and other details.

For further information, either contact us at The Fitting Room, or the Ministry of Health contact centre on 0800 458 448

The above information has been sourced and adapted from http://www.health.govt.nz/new-zealand-health-system/claims-provider-payments-and-entitlements/breast-prosthesis-subsidy