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  • Medicare levy variation declaration

    Use this Medicare variation levy declaration to vary the amount withheld from your pay for the Medicare levy. Or, instead, you can do it easily online by going to MyGov, then to ATO online services.

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    Easier ways to do this

    Instead of a paper form, you can easily complete a Medicare levy variation declaration online. Visit myGov and go to ATO online services. Then, under the Employment menu, go to New employment and you can complete the declaration online.

    How to get a copy of the form

    You can download the Medicare levy variation declaration (PDF 424KB, NAT 3093)This link will download a file and either:

    • complete it on your computer, then save and print it
    • print a blank copy of the form and complete it by hand.

    Who should use this declaration?

    Complete this declaration if you want to:

    • increase the amount withheld from payments to you to cover your Medicare levy surcharge
    • claim an exemption from the Medicare levy
    • reduce the pay as you go (PAYG) amount withheld that covers Medicare levy from payments to you
    • claim an exemption from compulsory Higher Education Loan Program (HELP), VET Student Loan (VSL), Student Start-up Loan (SSL), Financial Supplement (FS) or Trade Support Loan (TSL) repayments.

    Claiming an exemption or varying the amount withheld

    Complete this declaration to claim an exemption from the Medicare levy or to vary the amount withheld for the levy if one of the following applies:

    • You are in one of the Medicare levy exemption categories.
    • The combined weekly income of you and your spouse is less than $924 or, if you maintain a child or student, less than the relevant amount shown in Table A.
    • You are a sole parent with a weekly income of less than $1,009 or, if you maintain more than one child or student, less than the relevant amount shown in Table A.
    • You have to pay the Medicare levy surcharge and want to increase the amount withheld from payments to you to cover the surcharge (for more information, see Question 4).

    Also complete this declaration if you want to claim an exemption from HELP, VSL, FS, SSL or TSL repayments for a year because you are entitled to a reduction of the Medicare levy or you do not have to pay the Medicare levy, due to having a spouse or dependants and low family income.

    Reduced Medicare levy

    Most people in Australia have the Medicare levy automatically withheld from their wages. However, some people:

    • may qualify for an exemption from the levy
    • can pay a reduced levy
    • may have to pay the Medicare levy surcharge.

    Refer to Table A to check if your weekly income qualifies you to either:

    • be exempt from the Medicare levy
    • vary the amount withheld for the levy.
    Table A: Weekly income

    Number of dependent children

    Weekly income

    0

    $924

    1

    $1,009

    2

    $1,094

    3

    $1,179

    4

    $1,264

    5

    $1,349

    6

    $1,434

    7

    $1,519

    8

    $1,604

    9

    $1,689

    10

    $1,774

    Help completing this form

    Section A: Payee's declaration

    In this section

    Question 1 – What is your tax file number (TFN)?

    We and your payer are authorised by the Taxation Administration Act 1953 to request your tax file number (TFN). It is not an offence not to quote your TFN. However, quoting your TFN reduces the risk of administrative errors and having extra tax withheld. Your payer is required to withhold the top rate of tax from all payments made to you if you do not provide your TFN or claim an exemption from quoting your TFN.

    How do you find your TFN?

    If you already have a TFN and don't remember the number, you can find it online in ATO online services via your myGov accountThis link opens in a new window.

    If you don't have a myGov account, you can find your TFN on:

    • your notice of assessment
    • letters you have received from us, such as a statement of account
    • an income statement or payment summary (provided by your payer)
    • your superannuation account statement.

    If you have a tax agent, you can ask them for your TFN.

    If you still can't find your TFN after checking these options, phone us.

    Questions 2 and 3

    Complete with your personal information. For details about the information we collect see Privacy notice – Medicare levy variation declaration.

    Question 4 – Do you want your payer to increase the amounts withheld from you to cover the Medicare levy surcharge?

    You are liable for the Medicare levy surcharge if you meet all of the following conditions:

    • you and your dependants (including your spouse) are not in any of the three Medicare levy exemption categories
    • you do not have private patient hospital cover for yourself, your spouse and all your dependent children
    • you are either  
      • single, have no dependants and your income for surcharge purposes is more than $90,000
      • a member of a family that has a combined income for surcharge purposes of $180,000 or more. If you have more than one child, add $1,500 for the second and subsequent children.
       

    The Medicare levy surcharge is income tested against the following income tier thresholds.

    Single

    Income threshold

    Rate

    $90,000 or less

    0%

    Tier 1
    $90,001–$105,000

    1%

    Tier 2
    $105,001–$140,000

    1.25%

    Tier 3
    $140,001 or more

    1.5%

    Families

    Income threshold

    Rate

    $180,000 or less

    0%

    Tier 1
    $180,001–$210,000

    1%

    Tier 2
    $210,001–$280,000

    1.25%

    Tier 3
    $280,001 or more

    1.5%

    For more information, see:

    If you and your spouse's combined income for surcharge purposes exceeded the family surcharge threshold described above, but your own income for surcharge purposes did not exceed $21,980, you are not liable for the surcharge for any part of the year. However, your spouse may still be liable for the surcharge.

    If you take out private patient hospital cover during the year, or cancel your cover, you may be liable for the surcharge for the part of the year when you and all your dependants (including your spouse) were not covered.

    Questions 5, 6, 7 and 8 – Claiming a Medicare levy exemption or reduction

    Do you have more than one job?

    If you are entitled to an exemption and have more than one job, you must lodge this declaration only with the payers you are claiming the tax-free threshold from.

    If you receive income from more than one source, contact us to arrange for a reduced amount to be withheld from your income from other sources.

    Full exemption

    You are entitled to a full Medicare levy exemption if any of the following apply:

    • You and all your dependants are in one of the Medicare levy exemption categories.
    • You are in exemption category 1 and your dependants had to pay the Medicare levy (for example, your only dependant is your spouse who is not in an exemption category but has to pay the Medicare levy).
    • You are in exemption category 1 and have a dependent child who is not in an exemption category but the child is also a dependant of your spouse, who has to pay the Medicare levy.

    If you are entitled to a full exemption, answer yes at questions 5 and 6 to claim the exemption.

    Half exemption

    You are exempt from half the Medicare levy if you are in exemption category 1 and have dependants who are not in an exemption category and do not have to pay the Medicare levy (for example, they are low income earners).

    If you are entitled to a half exemption, answer yes at question 5, no at question 6, and yes at question 7.

    Medicare levy exemption categories

    You are in an exemption category if you were one of the following:

    • a blind pensioner or you received the sickness allowance from Services Australia category 1
    • entitled to full free medical treatment for all conditions under Defence Force arrangements or Veterans’ Affairs Repatriation Health Card (Gold Card) or repatriation arrangements – category 1
    • not an Australian resident for tax purposes – category 2
    • a member of a diplomatic mission or consular post in Australia (or a member of such a person's family and you were living with them) and you are not Australian citizen and do not ordinarily live in Australia – category 3
    • have a Medicare Entitlement StatementThis link opens in a new window (MES) from Services Australia showing the period in a year that you are not entitled to Medicare benefits. A letter from Services Australia is not sufficient – category 3.
    Reduction based on family income

    If you are not in an exemption category, you may be able to claim a reduction based on your family income. To be eligible, you must be in one of the following categories:

    • You had a spouse (married or de facto) on the last day of the financial year.
    • Your spouse died during the year and you did not have another spouse before the end of the year.
    • You were a sole parent at some time during the year (that is, you had sole care of any dependent children or students). This includes any child for whom you had sole care, not just your own child.

    If you are eligible, one of the following must also apply:

    • You are a sole parent with a gross weekly income of less than $1,009 or, if you have more dependants, less than the relevant amount shown in Table A.
    • You have a spouse and your combined gross weekly income is less than $924 or, if you have one or more dependants, less than the relevant amount shown in Table A.

    For example, the relevant income amount for both parents with two dependent children is $1,094 a week. If your combined weekly income is less than this amount, answer yes at question 8.

    If you are entitled to a reduction, answer yes at question 8.

    Questions 9 and 10

    Complete with your personal information.

    Question 11 – Do you have a Higher Education Loan Program (HELP), VET Student Loan (VSL), Financial Supplement (FS) Student Start-up Loan (SSL) or Trade Support Loan (TSL) debt?

    Answer yes if you have a HELP, VSL, FS, SSL, or TSL debt.

    Answer no if you do not have a HELP, VSL, FS, SSL or TSL debt, or have repaid your debt in full.

    You have a HELP debt if either:

    • the Australian Government lends you money under HECS-HELP, FEE-HELP, OS-HELP, VET FEE-HELP, Vet Student loans prior to 1 July 2019 or SA-HELP
    • you have a debt from the previous Higher Education Contribution Scheme (HECS).

    You have a SSL debt if you have an ABSTUDY SSL debt.

    You have a separate VSL debt that is not part of your HELP debt if you incurred it from 1 July 2019.

    For more information, see Study and training support loans.

    Question 12 – Do you have dependent children?

    Answer yes if you have dependent children and write the number of children at this question.

    For more information, see Dependent child for Medicare levy family income reduction purposes.

    Declaration

    Make sure that you have signed and dated the declaration.

    Give your completed declaration form to your payer.

    Section B: Payer's declaration

    This section is to be completed by the payer. The following information will help you comply with your PAYG withholding obligations.

    Payer obligations

    If you withhold amounts from payments, or are likely to withhold amounts, your payee may give you this form with section A completed. A Medicare levy variation declaration applies to payments made after the declaration is provided to you. The information provided on this form is used to work out the amount of tax to be withheld from payments based on the PAYG withholding tax tables we publish. If your payee gives you another declaration, it overrides any previous one.

    Last modified: 01 Nov 2021QC 17088