Commonwealth Numbered Acts

NATIONAL HEALTH AMENDMENT ACT 1976 No. 60, 1976 - SECT 23

23. Section 73B of the Principal Act is repealed and the following sections
are substituted:- Revocation, &c., of conditions imposed by Minister.
''73B. (1) The Minister may, at any time-

   (a)  revoke or vary a condition imposed by the Minister as a condition to
        which the registration of an organization is subject; or

   (b)  impose a condition or a further condition as a condition to which the
        registration of an organization is subject.

''(2) Where the Minister revokes, varies or imposes a condition under
sub-section (1) in relation to an organization, he shall, within 1 month after
taking that action, publish in the Gazette a notification setting out-

   (a)  the name of the organization;

   (b)  the particulars of the action so taken, including-

        (i)    where a condition has been revoked-the condition so revoked;

        (ii)   where a condition has been varied-the condition as so varied;
               or

        (iii)  where a condition has been imposed-the condition so imposed;
               and

   (c)  the date on which the action was taken.

''(3) In this section, 'condition' includes a term. Conditions of
registration.
''73BA. (1) The registration of an organization shall be deemed to be subject
to each of the following conditions:-

   (a)  a condition that the organization will not carry on business in
        Australia as a registered medical benefits organization or as a
        registered hospital benefits organization except in a State or
        Territory in respect of which it is registered as a registered medical
        benefits organization or a registered hospital benefits organization,
        as the case may be;

   (b)  a condition that, where the organization conducts a medical benefits
        fund, the organization will permit any contributor to that fund to
        contribute for benefits in respect of himself and his dependants (if
        any) in accordance with the standard medical benefits table;

   (c)  a condition that, where the organization conducts a hospital benefits
        fund, the organization will permit any contributor to that fund to
        contribute for benefits, in respect of himself and his dependants (if
        any) in accordance with the standard hospital benefits table;

   (d)  a condition that the amount of medical benefit or hospital benefit
        payable to a contributor by the organization in respect of a
        professional service or hospital treatment is not to exceed the amount
        of the fees or charges incurred in respect of that
        professional service or hospital treatment;

   (e)  a condition that, where the organization conducts a medical benefits
        fund, the organization will not offer to the contributors to that fund
        medical benefits in respect of professional services that exceed the
        amounts of the fees applicable to those professional services in
        accordance with the table of medical services in force for the
        purposes of the Health Insurance Act 1973-1976;

   (f)  a condition that the organization will not offer health insurance,
        whether on its own behalf or on behalf of another person or
        organization, under which the liability of the insurer is to pay
        medical benefits in respect of professional services of such amount
        that, if they were offered to contributors to a medical benefits fund
        conducted by the organization, the organization would be in breach of
        the condition set out in paragraph (e);

   (g)  a condition that, where, under the rules of the organization, the
        benefits to which a contributor to a medical benefits fund or a
        hospital benefits fund conducted by the organization, being a
        contributor for benefits in accordance with the standard table, is
        entitled are benefits in respect of services, treatment or care only
        if given after the expiration of a waiting period commencing on the
        day on which the contributor became a contributor, that waiting period
        does not exceed 2 months;

   (h)  a condition that, where there is in force, with respect to a medical
        benefits fund or a hospital benefits fund conducted by the
        organization a waiting period of the kind referred to in the condition
        set out in paragraph (g), that waiting period is not to apply in
        relation to a person who, on or before 30 November 1976, becomes a
        contributor to that fund in respect of the standard table;

        (i)    a condition that a contributor to a medical benefits fund or a
               hospital benefits fund conducted by the organization, being a
               contributor for benefits in accordance with the standard table,
               who ceases to pay contributions is, under the rules of the
               organization, to continue to be eligible for benefits, in
               respect of the period of 2 months commencing on the expiration
               of the period in respect of which he has paid contributions, as
               if he had not ceased to pay contributions;

   (j)  a condition that the organization maintain, in such form and manner as
        are determined by the Minister from time to time, a record of the
        contributors, and the dependants of the contributors, to the
        medical benefits fund or hospital benefits fund conducted by it or, if
        it conducts more than one such fund, the contributors, and the
        dependants of the contributors, to each of those funds;

   (k)  a condition that the organization will comply with any direction of
        the Minister under this Act served on the organization.

''(2) The regulations may provide that it is a condition of registration of a
registered medical benefits organization or of a registered hospital benefits
organization that the organization will permit any contributor to a
medical benefits fund or hospital benefits fund conducted by the organization
to contribute for such health benefits as are prescribed in relation to
medical benefits funds or hospital benefits funds, as the case may be.
Reinsurance Account in hospital benefits fund.
''73BB. (1) It is a condition of registration of a registered hospital
benefits organization that, as on and from 1 October 1976 or the date of its
registration, whichever is the later, it shall establish and maintain a
Reinsurance Account in the hospital benefits fund, or in each of the hospital
benefits funds, from time to time conducted by it.

''(2) Where hospital benefits have been paid, or are payable, by a
registered organization, in accordance with the standard table, to a
contributor to a hospital benefits fund in respect of hospital treatment, or
both hospital treatment and professional services, for a period of, or periods
amounting in the aggregate to, 60 days in any year of the contributor-

   (a)  the organization may debit to the Reinsurance Account maintained by it
        in that fund the amounts of any payments of benefits made by it out of
        that fund, in accordance with the standard table, to that contributor
        in respect of any subsequent period in that year; and

   (b)  where such a debit is made-the organization shall credit to that
        Reinsurance Account the amounts of any contributions in respect of the
        standard table made by that contributor to the fund in respect of the
        remainder of that year after the expiration of that period of 60 days
        or the last of the periods amounting in the aggregate to 60 days.

''(3) A registered organization may debit to the Reinsurance Account
maintained by it in a hospital benefits fund the amount of any reasonable
management expenses approved by the Minister after consultation with the
Trustees appointed under section 73BC.

''(4) A registered organization-

   (a)  shall maintain such records relating to the operation of the
        Reinsurance Account maintained by it in a hospital benefits fund as
        the Minister determines from time to time;

   (b)  shall keep the records referred to in paragraph (a) separate and
        distinct from any other records maintained by the organization; and

   (c)  shall furnish to the Permanent Head, at such times as the Minister
        determines, such information drawn from the records referred to in
        paragraph (a) as the Minister requires.

''(5) In this section, 'year', in relation to a contributor to a hospital
benefits fund, means-

   (a)  the period of 12 months commencing on the first day after 30 September
        1976 on which hospital treatment, or both hospital treatment and
        professional services, is or are provided for the contributor or a
        dependant of the contributor, being hospital treatment in respect of
        which hospital benefits are payable, in accordance with the standard
        table, to the contributor from the hospital benefits fund; or

   (b)  any period of 12 months commencing on the anniversary of that first
        day. Hospital Benefits Reinsurance Trust Fund.
''73BC. (1) The purpose of this section is to make provision for registered
organizations that conduct hospital benefits funds and the Commonwealth to
share the burden of meeting any deficits in Reinsurance Accounts in those
funds.

''(2) The Minister may appoint such number of Trustees as he considers
necessary to establish and operate a Hospital Benefits Reinsurance Trust Fund.

''(3) The Trustees hold office at the pleasure of the Minister.

''(4) The property in the money in the Fund is vested in the Trustees.

''(5) The Trustees shall establish, operate and administer the Fund in
accordance with principles determined by the Minister from time to time and
notified to the Trustees.

''(6) It is a condition of registration of a registered hospital benefits
organization that, on and after 1 October 1976 or the date of its
registration, whichever is the later, it shall participate with other
registered hospital benefits organizations in the operation of the Fund by
making such payments into the Fund as the Trustees determine from time to time
to be appropriate payments in relation to that organization.

''(7) The Commonwealth shall pay into the fund, out of such moneys as are
appropriated by the Parliament from time to time for the purpose, such amounts
as the Minister determines from time to time.

''(8) Where the Trustees determine an amount to be paid into the Fund by a
registered hospital benefits organization, they shall notify the organization
accordingly and shall specify in the notification the date on or before which
the payment is to be made.

''(9) Where a registered hospital benefits organization fails to pay an amount
into the Fund in accordance with a notification under sub-section (8), the
Trustees may determine that, in addition to that amount, a further amount be
paid into the Fund, by way of penalty, by the organization, being an amount
calculated at the prescribed rate upon the first-mentioned amount, or such
part of that first-mentioned amount as from time to time remains unpaid, to be
computed from the time when that first-mentioned amount became payable.

''(10) Where the Trustees make a determination under sub-section (9) in
relation to a registered hospital benefits organization, they shall notify the
organization, in writing, accordingly.

''(11) A notification under sub-section (8) or (10) shall be served either
personally or by post by the Trustees on the public officer of the
organization.

''(12) For the purposes of this section, the Trustees may pay an amount out of
the fund to a registered hospital benefits organization on the condition that
that amount, except to the extent that the Trustees otherwise direct, be
credited to the Reinsurance Account kept in a hospital benefits fund conducted
by it, and the organization shall deal with that amount accordingly.

''(13) In this section-

'Fund' means the Hospital Benefits Reinsurance Trust Fund;

'Trustee' means a Trustee appointed under sub-section (2). Remuneration and
allowances of Trustees of Hospital Benefits Reinsurance Fund.
''73BD. (1) A Trustee of the Hospital Benefits Reinsurance Fund shall be paid
such remuneration as is determined by the Remuneration Tribunal but, if no
determination of that remuneration by the Tribunal is in operation, he shall
be paid such remuneration as is prescribed.

''(2) A Trustee referred to in sub-section (1) shall be paid such allowances
as are prescribed.

''(3) This section has effect subject to the Remuneration Tribunals Act
1973-1975. Directions by the Minister to a registered organization.
''73BE. The Minister may give a direction to a registered organization with
respect to any of the following matters:-

   (a)  the rates of contributions to be paid by contributors, or contributors
        included in a class of contributors, to a medical benefits fund or a
        hospital benefits fund conducted by the organization;

   (b)  the scope and level of benefits that are to be available to
        contributors, or to contributors included in a class of contributors,
        to a medical benefits fund or a hospital benefits fund conducted by
        the organization;

   (c)  the provision of a service provided, or to be provided, by the
        organization to a contributor to a medical benefits fund or a hospital
        benefits fund conducted by the organization or to the dependants of
        such contributors;

   (d)  the transfer by the organization of moneys between funds, being
        medical benefits funds or hospital benefits funds or a
        medical benefits fund and a hospital benefits fund, conducted by the
        organization;

   (e)  any other matter that is prescribed. Direction to admit person as
        contributor to a registered organization.
''73BF. (1) Where a registered organization refuses to admit a person as a
contributor in respect of the standard table to a medical benefits fund or a
hospital benefits fund conducted by it the person may request the Minister to
direct that organization or another registered organization to admit the
person as a contributor in respect of the standard table to a medical benefits
fund or a hospital benefits fund, as the case may be, conducted by it.

''(2) Where the Minister receives a request from a person under sub-section
(1), he shall-

   (a)  conduct an inquiry into the matter;

   (b)  determine the medical benefits fund or the hospital benefits fund, as
        the case may be, that he considers is the most appropriate fund with
        respect to the person; and

   (c)  direct the registered organization that conducts that fund to admit
        the person as a contributor to that fund.

''(3) Before making a determination under paragraph (b) of sub-section (2)
with respect to a particular medical benefits fund or hospital benefits fund,
the Minister shall give the registered organization conducting that fund an
opportunity to make representations concerning the matter the subject of the
inquiry being conducted by the Minister and take into account any
representations made by the organization in that behalf.

''(4) Where a direction under this section is given to a restricted membership
organization, the direction shall not require the organiz- ation to admit as a
contributor to a medical benefits fund or a hospital benefits fund as the case
may be, conducted by it a person who is not eligible, in accordance with the
rules of the organization, for membership of that fund. Information for Health
Insurance Commission.
''73BG. (1) The object of this section is to ensure that payments of benefits
under the Health Insurance Act 1973-1976 are not made to persons who, or to
organizations which, are not entitled to them.

''(2) The Minister may direct a registered medical benefits organiz- ation or
a registered hospital benefits organization to furnish to the Health Insurance
Commission such information in the possession, or under the control, of the
organization that relates to the contributors, or dependants of contributors,
to a medical benefits fund or a hospital benefits fund conducted by the
organization as the Minister considers necessary to be furnished to achieve
the object of this section. Directions by Minister.
''73BH. A direction given by the Minister under this Act to a registered
medical benefits organization or a registered hospital benefits organization-

   (a)  shall be in writing signed by the Minister; and

   (b)  may be served on the organization by serving a copy of it, either
        personally or by post, on the public officer of the organization.''.