Commonwealth Numbered Acts

HEALTH INSURANCE AMENDMENT ACT 1991 No. 171 of 1991 - SECT 5

5. After section 10 of the Principal Act the following sections are inserted:
Registered families

"10AA.(1) For the purposes of this section and sections 10AB to 10AK
inclusive, the following are the members of a person's family:

   (a)  the person's spouse;

   (b)  any dependent child of the person or of the person's spouse.

"(2) Subject to subsection (3), a family member may apply to the Commission at
any time, in accordance with a form approved by the General Manager, for
registration of the family, and the Commission must register the family
accordingly.
  "(3)   An application for registration must list the names of all family
members.

"(4) If, at any time, a person becomes a member of a registered family, that
person, or any family member acting on that person's behalf, may apply to the
Commission in accordance with a form approved by the General Manager, for a
variation in the registration to add the new family member, and the Commission
must vary the registration accordingly.

"(5) If, at any time, a person ceases to be a member of a registered family,
that person, or any family member acting on that person's behalf, may apply to
the Commission, in accordance with a form approved by the General Manager, for
a variation in the registration to delete that person, and the Commission must
vary the registration accordingly.

"(6) A person is not entitled to be simultaneously treated as a member of more
than one registered family unless:

   (a)  the person is a child; and

   (b)  members of more than one registered family jointly share the right to
        have, and to make decisions concerning, the daily care and control of
        the child.

"(7) In this section:
`child' means a person who:

   (a)  is under 16; or

   (b)  is a student child;
`dependent child', in relation to any person, means:

   (a)  a child under 16 who is:

   (i)  in the custody, care and control of that person; or

   (ii) where no other person has the custody, care and control of the child -
        is wholly or substantially in the care and control of the
        first-mentioned person; or

   (b)  a student child who is wholly or substantially dependent on the
        person;
`spouse', in relation to a person, means:

   (a)  a person who is legally married to, and is not living, on a permanent
        basis, separately and apart from, that person; and

   (b)  a de facto spouse of that person;
`student child' means a person who:

   (a)  is 16 or more, but under 25; and

   (b)  is receiving full-time education at a school, college or university.
        Consequences of altered family composition

"10AB.(1) Where:

   (a)  a family is registered; and

   (b)  a person becomes a family member after it is so registered; and

   (c)  the family's registration is varied by the addition of the new family
        member; then:

   (d)  claims in respect of his or her medical expenses incurred during the
        calendar year in which the registration is varied but before the
        variation may be taken into account for the purposes of section 10AC
        as if the person had, at all times during that year, been a member of
        the registered family; but

   (e)  increased benefits are not payable under that section in relation to
        medical expenses that are incurred in respect of that person or any
        other family member and in respect of which benefit has already been
        paid.

"(2) Where:

   (a)  a family is registered; and

   (b)  a person ceases to be a family member after it is so registered; and

   (c)  the family's registration is varied by the deletion of the person; and

   (d)  the family members (including the person referred to in paragraph (b))
        have not, at the time of the variation, become entitled under section
        10AC to increased benefits in respect of medical expenses incurred in
        the calendar year in which the variation is made; claims in respect of
        his or her medical expenses incurred during that year may be dealt
        with separately under section 10AD, or, if the person becomes a member
        of another registered family, dealt with under section 10AC.

"(3) Where:

   (a)  a family is registered; and

   (b)  the family members become entitled under section 10AC to increased
        benefits in respect of medical expenses incurred in a year; and

   (c)  a person ceases to be a family member after the family members become
        so entitled and during that year; and

   (d)  the family's registration is varied by the deletion of the person;
        then:

   (e)  claims in respect of his or her medical expenses incurred at any time
        during that year are to be dealt with under section 10AC, as if he or
        she had remained a family member throughout the year; and

   (f)  despite any other provision of this Act and despite the variation, the
        person is not entitled to be treated as a member of another registered
        family during the year. Safety-net - families

"10AC.(1) In this section:
`relevant service' means a service:

   (a)  in respect of which benefit is payable; and

   (b)  the medical expenses in respect of which exceed the amount of benefit
        that, apart from this section, would be payable in respect of the
        service; but does not include a service of the kind referred to in
        paragraph (da) of the definition of `basic private table' or `basic
        table' in subsection 4(1) of the National Health Act 1953, being a
        service of that kind provided on or after 1 September 1985;
`year' means the year beginning on 1 January 1992 or a later year beginning on
1 January.

"(2) Subject to this Act, if:

   (a)  a claim (in this subsection called the `threshold claim') for benefit
        is made by a claimant in respect of a relevant service:

   (i)  which was rendered to the claimant or to a member of the claimant's
        registered family; and

   (ii) in respect of which the medical expenses are incurred in a year; and
        the claim is accepted by the Commission; and

   (b)  other claims (in this subsection called `prior claims') have been made
        for benefit in respect of relevant services:

   (i)  which were rendered to any member of the family; and

   (ii) in respect of which the medical expenses were incurred during the
        year; and the prior claims were accepted for payment by the Commission
        before the time when the threshold claim was accepted for payment (in
        this subsection called the `relevant time'); and

   (c)  the Commission is satisfied at the relevant time that:

   (i)  the medical expenses of the services relating to the threshold claim
        and to some or all of the prior claims have been paid; and

   (ii) the sum of the patient contributions that have been paid in respect of
        those prior claims is less than the safety-net amount for that year;
        and

   (iii) the sum of the patient contribution in respect of the threshold claim
        and the patient contributions referred to in subparagraph (ii) is
        equal to or exceeds the safety-net amount; the benefit payable in
        respect of a relevant service rendered to any of the family and in
        respect of which medical expenses were incurred in respect of that
        year (being the service to which the threshold claim relates or any
        service that is not the subject of a prior claim referred to in
        paragraph (b)) is increased by the amount of the patient contribution
        in respect of that relevant service.

"(3) Where at any time a child is simultaneously a member of 2 families
registered in respect of a year:

   (a)  if the Commission is satisfied that a medical expense incurred at that
        time in respect of the child has been incurred by an adult belonging
        to one or other of the families - that expense is to be treated, for
        the purposes of this Act, as an expense incurred in respect of the
        child as a member of that family; and

   (b)  if the Commission is not so satisfied - the expense is to be treated
        as an expense of which half was incurred in respect of the child as a
        member of one family and half in respect of the child as a member of
        the other family.

"(4) If a family becomes registered before 1 April 1992, this section extends
to a benefit that was paid or payable before the registration in respect of a
service for which medical expenses were incurred before that date.

"(5) If a family becomes registered after 31 March 1992, this section applies
only to a benefit that becomes payable after the registration, even though
expenses incurred before the registration in the year the family becomes
registered may be taken into account for the purposes of paragraph (2)(c).

"(6) For the purposes of this section, without affecting the meaning of an
expression in any other provision of this Act:

   (a)  if a person to whom benefit is payable in respect of a relevant
        service is given or sent a cheque under subsection 20(2) for the
        amount of the benefit, the person is taken to have paid so much of the
        medical expenses in respect of that service as is represented by the
        amount of the benefit; and

   (b)  despite anything else in this Act, the question when medical expenses
        are incurred in respect of services relating to prescribed items is to
        be determined under the regulations.

"(7) If, as a result of an assignment to a medical practitioner under section
20A by a person of his or her right to the payment of a benefit in respect of
a service, the Commission makes a payment to the practitioner, this section
has effect as if:

   (a)  that person had made a claim for a benefit in respect of that service;
        and

   (b)  that claim had been accepted by the Commission; and

   (c)  the medical expenses in respect of that service had been paid.
        Safety-net - individuals

"10AD.(1) Expressions used in this section have the same meaning as in section
10AC.

"(2) Subject to subsection 10AB(3), this section applies to a person who is
not a member of a registered family.

"(3) Subject to this Act, if:

   (a)  a claim (in this subsection called the `threshold claim') for benefit
        is made by a claimant in respect of a relevant service:

   (i)  which was rendered to the claimant; and

   (ii) in respect of which the medical expenses are incurred by the claimant
        in a year; and the claim is accepted by the Commission; and

   (b)  the claimant has made other claims (in this subsection called the
        `prior claims') for benefit in respect of relevant services:

   (i)  which were rendered to the claimant; and

   (ii) in respect of which the medical expenses were incurred in that year;
        and the prior claims were accepted for payment by the Commission
        before the time when the threshold claim was accepted for payment (in
        this subsection called the `relevant time'); and

   (c)  the Commission is satisfied at the relevant time that:

   (i)  the medical expenses of the services relating to the threshold claim
        and some or all of the prior claims have been paid; and

   (ii) the sum of the patient contributions that have been paid in respect of
        those prior claims is less than the safety-net amount for that year;
        and

   (iii) the sum of the patient contribution in respect of the threshold claim
        and the patient contributions referred to in subparagraph (ii) is
        equal to or exceeds the safety-net amount; the benefit payable in
        respect of a relevant service rendered to the claimant and in respect
        of which medical expenses were incurred in respect of that year (being
        the service to which the threshold claim relates or any service that
        is not the subject of a prior claim referred to in paragraph (b)) is
        increased by the amount of the patient contribution in respect of that
        service.

"(4) For the purposes of this section, without affecting the meaning of an
expression in any other provision of this Act:

   (a)  if a person to whom benefit is payable in respect of a relevant
        service is given or sent a cheque under subsection 20(2) for the
        amount of the benefit, the person is taken to have paid so much of the
        medical expenses in respect of that service as is represented by the
        amount of the benefit; and

   (b)  despite anything else in this Act, the question when medical expenses
        are incurred in respect of relevant services relating to prescribed
        items is to be determined under the regulations.

"(5) If, as a result of an assignment to a medical practitioner under section
20A by a person of his or her right to the payment of a benefit in respect of
a service, the Commission makes a payment to the practitioner, this section
has effect as if:

   (a)  that person had made a claim for a benefit in respect of that service;
        and

   (b)  that claim had been accepted by the Commission; and

   (c)  the medical expenses in respect of that service had been paid.
        Confirmation of family composition
  "10AE.(1)   If the Commission is satisfied that, apart from this section, a
registered family would be, or would be likely soon to become, entitled to
increased benefits under subsection 10AC in respect of a calendar year, the
Commission must, in writing, request that that person or another family member
state, in writing, whether or not:

   (a)  the composition of the family remains, or (if the year has already
        ended) remained, in that year, as originally registered under section
        10AA; or

   (b)  if, after the registration, the Commission has been notified of a
        change in the family composition - the composition of the family
        remains, or (if that year has already ended) remained, in that year,
        as last notified to the Commission.
  "(2)   Until a family member provides the information sought under
subsection (1), then, despite sections 10AC and 10AF:

   (a)  increased benefits are not payable in respect of the family members in
        respect of the year for which the confirmation was sought; and

   (b)  a safety-net concession card cannot be issued in respect of the family
        members and that year. Eligibility for issue of safety-net concession
        card

"10AF.(1) Subject to subsection (6), if the Commission is satisfied of the
matters referred to in paragraph 10AC(2)(c) in relation to a family in respect
of a year, the Commission must issue a safety-net concession card in respect
of that year to the person who registered the family or, if that person has
ceased to be a member of the family, to another family member.

"(2) Subject to subsection (6), if the Commission is satisfied of the matters
referred to in paragraph 10AD(3)(c) in relation to a person in respect of a
year, the Commission must issue a safety-net concession card in respect of
that year to that person.

"(3) A safety-net concession card must be in the form approved by the General
Manager for that card.

"(4) Without limiting the generality of subsection (3), a card, other than an
additional safety-net concession card, must include particulars of:

   (a)  the year in respect of which the card is issued; and

   (b)  the person to whom the card is issued and, if the person is a member
        of a registered family, each other person who is a family member.

"(5) If a member of the person's registered family is omitted from the card at
the time it is issued, the validity of the card is not affected.

"(6) A safety-net concession card must not be issued in respect of a year
other than the year of its issue. Persons covered by card

"10AG. Subject to section 10AH, where a safety-net concession card is issued
to a person, the person and each other person who is, at the time the card is
issued, a member of his or her registered family, is taken, for the purposes
of this Act, to be a holder of the card. Additional and replacement cards

"10AH.(1) Where a safety-net concession card has been issued in respect of a
year, an additional card may, in accordance with the regulations, be issued in
respect of that year to a person who is a holder of the card.

"(2) Without limiting the generality of subsection (1), regulations made for
the purposes of that subsection may provide for the issue of an additional
card to a person:

   (a)  who is or was a holder of a card that has been lost, stolen, damaged
        or destroyed; or

   (b)  who is a holder of a card but whose particulars are not included on
        the card.

"(3) Where:

   (a)  a person (in this section called the `original card holder') has been
        issued with a card in respect of a year; and

   (b)  a person (in this section called the `new family member') becomes,
        through a variation of the registration of the original card holder's
        family, registered as a member of that family; a replacement card may,
        in accordance with the regulations, be issued in respect of that year
        to the original card holder.

"(4) A replacement card issued under subsection (3) must include particulars
of the holders of the original card and of the new family member and each
original card holder and the new family member is taken, from the time when
the replacement card is issued, to be a replacement card holder.

"(5) If an officer makes a decision under subsection (1) or (3) refusing to
issue an additional card or replacement card (as the case may be), a notice of
that decision must be issued to the person who made the request for the
additional card or replacement card. Review of decisions

"10AI.(1) In this section: `decision' has the same meaning as in the
Administrative Appeals Tribunal Act 1975.

"(2) If a decision is made:

   (a)  by an officer under subsection 10AH(1) or (3) refusing to issue an
        additional safety-net concession card or replacement safety-net
        concession card (as the case may be); or

   (b)  by the General Manager to issue a notice under subsection 10AK(1);
        then:

   (c)  in the case of paragraph (a), the person who requested the additional
        card or replacement card (in this section called the `applicant'); or

   (d)  in the case of paragraph (b), the person to whom the notice was issued
        under subsection 10AK(1); may apply to the General Manager for
        reconsideration by the General Manager of the decision.

"(3) An application under subsection (2) must be made by an applicant or the
person to whom a notice was given (as the case may be), within 28 days after
the applicant or the person receives:

   (a)  in the case of a decision under subsection 10AH(1) or (3), a notice
        under subsection 10AH(5); or

   (b)  in the case of a decision under subsection 10AK(1), a notice under
        that subsection.

"(4) If an applicant applies to the General Manager under subsection (2) for
reconsideration of a decision to issue an additional concession card or
replacement concession card (as the case may be), the General Manager may:

   (a)  affirm the decision; or

   (b)  make a decision to issue an additional card or replacement card, as
        the case requires.

"(5) If a person to whom a notice was issued under subsection 10AK(1) applies
to the General Manager under subsection (2) for a reconsideration of the
decision, the General Manager may:

   (a)  affirm the decision; or

   (b)  make a decision to withdraw the notice given to the person.

"(6) Where the General Manager makes a decision under subsection (4) or (5), a
written notice must be given to the applicant containing:

   (a)  the terms of the decision and the reasons for it; and

   (b)  a statement to the effect that, subject to the Administrative Appeals 
        Tribunal Act 1975 , application may be made to the Administrative
        Appeals Tribunal for a review of the decision.

"(7) A notice under subsection (6) must be given within 28 days after the
General Manager makes a decision under subsection (4) or (5), as the case may
be.

"(8) Failure to include in a notice under subsection (6) a statement of the
kind mentioned in paragraph (6)(b) does not affect the validity of the General
Manager's decision.

"(9) Subject to the Administrative Appeals Tribunal Act 1975, application may
be made to the Administrative Appeals Tribunal by:

   (a)  a person whose interests are affected by a decision of the General
        Manager made under paragraph (4)(a); or

   (b)  a person whose interests are affected by a decision under paragraph
        (5)(a); for review of that decision.

"(10) Despite section 131, the General Manager may, in writing, delegate his
or her powers under subsection (4) or (5) to a person holding or performing
the duties of the office of Assistant General Manager or Deputy State Manager
(however described) of the Commission. Period of effect of card

"10AJ. Where a safety-net concession card is issued in respect of a calendar
year, it begins to have effect on the day on which it is issued and ceases to
have effect at the end of that year. Return of card

"10AK.(1) Where a safety-net concession card is issued to a person who is not
eligible to be issued with the card, the General Manager may, by notice in
writing to a card holder, require the holder to deliver the card, within such
period (not being a period of less than 7 days) as is specified in the notice,
to the Commission for cancellation and the holder must comply with the notice.

"(2) A person must not, without reasonable excuse, fail to comply with a
notice given to the person under subsection (1).
Penalty: $6,000 or imprisonment for 12 months, or both.".