Commonwealth Numbered Acts

Health Acts Amendment Act 1981 No. 118 of 1981 - SECT 75

75. (1) The Schedule to the Principal Act is amended-

   (a)  by omitting from paragraph (c) ''other than in accordance with a basic
        table or an optional table'';

   (b)  by omitting from paragraph (g) ''or an optional table'';

   (c)  by omitting from paragraph (h) ''or an optional table'';

   (d)  by omitting from paragraph (j) ''or an optional table'';

   (e)  by omitting paragraph (n) and substituting the following paragraphs:

''(n) the rules of the organization will not provide for a waiting period for-

        (i)    contributors for benefits in accordance with a basic table who
               have transferred to a medical benefits fund or a hospital
               benefits fund conducted by the organization from such a fund
               conducted by another organization whose registration under Part
               VI has been cancelled or is under consideration by the Minister
               with a view to cancellation; or

        (ii)   eligible persons who, on or before 1 November 1981, become
               contributors to a medical benefits fund or a hospital benefits
               fund conducted by the organization, being contributors for
               benefits in accordance with a basic table.

''(na) The organization will not, in determining, in relation to any
contributor to a basic table or to a contributor included in a class or kind
of contributors to a basic table-

        (i)    whether or not benefits are payable in accordance with the
               table;

        (ii)   if benefits are payable in accordance with the table-the amount
               of the benefits so payable; or

        (iii)  the amount of the contributions payable in respect of the
               table,

have regard to any of the following matters:

        (iv)   the suffering by the contributor, or a dependant of the
               contributor, from a chronic disease, illness or other medical
               condition or from a disease, illness or medical condition of a
               particular kind;

        (v)    the age of the contributor or of a dependant of the
               contributor;

        (vi)   the frequency of the rendering of professional services to the
               contributor or to a dependant of the contributor;

        (vii)  the amount, or extent, of the benefits to which the contributor
               becomes, or has become, entitled during a period; or

        (viii) any matter prescribed for the purposes of this
               sub-paragraph.''; and

   (f)  by omitting paragraphs (r) and (s) and substituting the following
        paragraphs:

''(r) Where the determination of a claim for a Commonwealth medical benefit,
or for a benefit in accordance with a basic medical benefits table, that is
lodged with the organization (whether in pursuance of section 20B of the
Health Insurance Act 1973 or in pursuance of the rules of the organization) is
subject to, or may be affected by, the exercise of a power conferred on
the Permanent Head of the Department of Health or on a Minister by a provision
of Part II of the Health Insurance Act 1973 in relation to a matter, the
organization will refer the claim to the Department so that the matter may be
considered by the Permanent Head or the Minister, as the case may be, in
accordance with that Act.

''(s) Where a claim for a benefit payable by the organization out of a medical
benefits fund or a hospital benefits fund conducted by the organization is, or
has been, lodged with the organization, the organization will pay that claim
within 2 months, or such longer period as the Permanent Head approves in a
particular case, after-

        (i)    the date of commencement of this condition; or

        (ii)   the date of lodgement of the claim with the organization,

whichever is the later date.

''(sa) Where an exemption has been granted under section 73F in relation to a
basic medical benefits table conducted by the organization, the organization
will, within a period of 1 month after the granting of the exemption-

        (i)    furnish to all contributors to any medical benefits fund
               conducted by the organization and to all persons registered
               with it as registered persons; and

        (ii)   publish, in a manner satisfactory to the Minister, for the
               information of persons who may wish to become contributors to a
               basic medical benefits fund conducted by the organization and
               persons who may wish to register with the organization as
               registered persons,

the particulars of the exemption, including the date on which the exemption
takes effect and a description of the professional service or
professional services affected by the exemption, and a statement setting out
the effect of the exemption on the rights of contributors and registered
persons.

''(sb) Where an exemption has been granted under section 73F in relation to a
basic hospital benefits table conducted by the organization, the organization
will, within a period of one month after the granting of the exemption-

        (i)    furnish to all contributors to any hospital benefits fund
               conducted by the organization; and

        (ii)   publish, in a manner satisfactory to the Minister, for the
               information of persons who may wish to become contributors to a
               hospital benefits fund conducted by the organization,

the particulars of the exemption, including the date on which the exemption
takes effect and a description of the hospital treatment affected by the
exemption, and a statement setting out the effect of the exemption on the
rights of contributors.

''(sc) Where-

        (i)    an exemption is in force under section 73F in relation to the
               organization;

        (ii)   at any time during the period of 3 months from the granting of
               that exemption, a contributor, in accordance with a
               basic table, to a medical benefits fund, or to a hospital
               benefits fund, conducted by the organization (being a person
               who has been such a contributor since before the granting of
               the exemption) transfers to another registered organization and
               becomes a contributor, in accordance with a basic table, to a
               medical benefits fund, or to a hospital benefits fund,
               conducted by that other organization; and

        (iii)  that person, as such contributor in relation to the other
               organization, is subject to a waiting period commencing from
               the date of that transfer,

the first-mentioned organization will continue to treat that person, during
that waiting period, as a contributor, in accordance with a basic table, to
the relevant fund conducted by that first-mentioned organization and, for that
purpose, will disregard the exemption.

''(sd) Where a payment of a benefit may be made by the organization, by virtue
of section 81A, notwithstanding the rules of the organization, the
organization will make that payment.''.

(2) The conditions set out in paragraphs (1) (e) and (f) apply in relation to
a registered organization whether the registration of the organization was
effected before, or is effected after, the commencement of this section.