Commonwealth Numbered Acts

HEALTH INSURANCE AMENDMENT ACT 1991 No. 171 of 1991 - SECT 9

9.(1) If a person has become, or, at any time after this section commences,
becomes, entitled to increased benefits under subsection 10(3) of the
Principal Act in respect of professional services in respect of which medical
expenses were incurred before 1 July 1991, the person's entitlement to those
increased benefits is unaffected by this section.

(2) Despite the amendments of section 10 of the Principal Act made by this
Act, subsection 10(3) of that Act is taken to have applied in respect of the
year commencing on 1 January 1991 (in this section called the "transitional
year") as if the transitional year were a year for the purposes of that
subsection but subject:

   (a)  to the modifications to that section set out in subsections (3), (4),
        (5) and (6); and

   (b)  to the modifications to sections 20A, 20C and 20D of the Principal Act
        as amended by this Act that are set out in sections 10, 11 and 12 of
        this Act.

(3) For the purposes of subsection 10(3) of the Principal Act as so applied:

   (a)  any patient contribution in respect of a professional service to which
        subsection (1) of this section applies is to be disregarded in
        computing a person's entitlement to increased benefits; and

   (b)  any patient contribution in respect of any other professional service
        in respect of which medical expenses were incurred during the
        transitional year is to be taken into account in computing a person's
        entitlement to increased benefits; and

   (c)  subsection 10(4A) of the Principal Act continues to apply, despite its
        repeal, for the whole of the transitional year; and

   (d)  subsections 10(5) and (6) of the Principal Act are to be treated as if
        they had been repealed on 1 January 1991.

(4) If, as a result of an assignment to a medical practitioner under section
20A of the Principal Act by a person of his or her right to the payment of a
benefit in respect of a professional service rendered on or after 1 December
1991, the Commission makes a payment of medicare benefit to the practitioner,
subsection 10(3) of the Principal Act as so applied 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.

(5) For the purposes of subsection 10(3) of the Principal Act as so applied:

   (a)  where a person to whom medicare benefit is payable in respect of a
        professional service is given or sent a cheque under subsection 20(2)
        of the Principal Act for the amount of the medicare 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
        medicare benefit; and

   (b)  a reference to a professional service is taken, if the service is a
        service in respect of which expenses are incurred before 1 December
        1991, to be a reference to a service:

   (i)  in respect of which medicare benefit is payable; and

   (ii) the medical expenses in respect of which exceed the amount of medicare
        benefit that, but for subsection 10(3) of the Principal Act as so
        applied, would be payable in respect of the service.

(6) For the purposes of subsection 10(3) of the Principal Act as so applied:

"medicare benefit" has the meaning:

   (a)  before 1 December 1991 - given by subsections 10(2), (2A) and (4) of
        the Principal Act; and

   (b)  on or after 1 December 1991 - given by subsections 10(2), (3) and (4)
        of the Principal Act as amended by this Act;

"patient contribution", in relation to a claim for medicare benefit in respect
of a professional service for which medical expenses were incurred before 1
December 1991, means an amount equal to the difference between:

   (a)  the Schedule fee or, if the medical expenses in respect of the service
        are less than that fee, those medical expenses; and

   (b)  the amount of medicare benefit that, but for subsection 10(3) of the
        Principal Act as so applied, would be payable in respect of that
        service;

"patient contribution", in relation to a claim for benefit in respect of a
professional service in respect of which medical expenses are incurred on or
after 1 December 1991, means:

   (a)  if benefit is payable under section 20 of the Principal Act as amended
        by this Act - an amount equal to the difference between:

   (i)  the Schedule fee or, if the medical expenses in respect of the service
        are less than that fee, those expenses; and

   (ii) the amount of benefit that apart from subsection 10(3) of the
        Principal Act as it applies to the transitional year, would be payable
        in respect of the service; and

   (b)  if benefit is assigned under section 20A of the Principal Act as
        amended by this Act and the practitioner concerned is entitled under
        that section to charge an amount not exceeding $2.50 in respect of the
        service - $2.50; and

   (c)  in any other case - nil;

"relevant amount" means $246;

"Schedule fee", in relation to a professional service, means the fee specified
in the table in respect of that service.