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HEALTH INSURANCE ACT 1973 - SECT 23DZZIF

Meaning of permitted benefit

  (1)   For the purposes of this Part, a benefit asked for or accepted by, or offered or provided to, a person (the beneficiary ) who is, or is connected to, a requester is a permitted benefit if:

  (a)   both of the following apply:

  (i)   it is covered by subsection   (2), (3), (4), (5) or (6);

  (ii)   it is not excluded by subsection   (7); or

  (b)   it is covered by a determination by the Minister under section   23DZZIG.

Distributions of profits or shares

  (2)   The benefit is a permitted benefit if both of the following apply:

  (a)   the benefit consists of a distribution of profits or shares to the beneficiary, in respect of the operation of a business that renders pathology services or diagnostic imaging services (as the case requires), by the body corporate, trust, partnership or other body that carries on the business;

  (b)   the amount of the benefit is proportionate to the interest that the beneficiary holds in that body corporate, trust, partnership or other body.

Remuneration

  (3)   The benefit is a permitted benefit if both of the following apply:

  (a)   the benefit consists of the payment of remuneration (whether salary, wages, commission, allowances or bonuses) to the beneficiary as an employee or under a contract for services;

  (b)   the amount of the benefit is not substantially different from the usual remuneration paid to persons engaged in similar employment or under similar contracts.

Payments for shared property, goods or services

  (4)   The benefit is a permitted benefit if:

  (a)   the benefit consists of a payment (whether or not made to the beneficiary) for property, goods or services that are shared between the beneficiary and another person; and

  (b)   the amount of the benefit is proportionate to the other person's share of the cost of the property, goods or services; and

  (c)   if the benefit is a payment for the use or occupation, by a provider of a kind of pathology service, of a part of premises or a particular space in a building:

  (i)   an approved collection centre or an accredited pathology laboratory is established in that part of the premises or that space at the time, or within 60 days after, the arrangement for the use or occupation is entered into; or

  (ii)   the provider renders professional services in that part of the premises or that space;

    and that part of the premises or that space is not used or occupied under the arrangement for any other purpose.

Payments for other property, goods or services

  (5)   The benefit is a permitted benefit if:

  (a)   the benefit consists of a payment (whether or not made to the beneficiary) for property, goods or services that are not shared between the beneficiary and another person; and

  (b)   the amount of the benefit is not substantially different from the market value of the property, goods or services; and

  (c)   if the benefit is a payment for the use or occupation, by a provider of a kind of pathology service, of premises (including a part of premises) or a particular space in a building:

  (i)   an approved collection centre or an accredited pathology laboratory is established in the premises or space at the time, or within 60 days after, the arrangement for the use or occupation is entered into; or

  (ii)   the provider renders professional services in the premises or space;

    and the premises or space are not used or occupied under the arrangement for any other purpose.

Provision of property, goods or services

  (6)   The benefit is a permitted benefit if:

  (a)   the benefit consists of the provision of property, goods or services to the beneficiary; and

  (b)   the benefit is provided for consideration that is not substantially different from the market value of the property, goods or services.

Exclusions

  (7)   However, the benefit is not a permitted benefit if:

  (a)   the benefit is related to the number, kind or value of requests for pathology services or diagnostic imaging services made by the requester; or

  (b)   the benefit consists of the provision of staff or equipment at premises of the beneficiary for the purpose of providing pathology services or diagnostic imaging services, whether the staff or equipment are stationed at the premises full - time or part - time, or visit or are brought to the premises from time to time.

  (8)   To avoid doubt, a benefit is related to the number of requests for pathology services or diagnostic imaging services made by a requester if the provision of the benefit is dependent on the requester requesting all, or a proportion of, the requests for one or more kinds of services that the requester makes from a particular provider.

Market value

  (9)   For the purposes of paragraphs   (5)(b) and (6)(b), the regulations may prescribe a method of working out whether the amount of a payment or of consideration is substantially different from the market value, or an amount determined by a method prescribed in the regulations to be the market value, of a specified class of property, goods or services.


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