Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE REGULATIONS (AMENDMENT) 1998 NO. 204

EXPLANATORY STATEMENT

STATUTORY RULES 1998 NO. 204

issued by authority of the Minister for Health and Family Services

Health Insurance Act 1973

Health Insurance Regulations (Amendment)

Section 133 of the Health Insurance Act 1973 (the Act) provides that the Governor-General may make Regulations prescribing matters for the purposes of the Act,

At present, a patient can only assign Medicare benefits to a third party when the treating medical practitioner bulk bills the patient (ie accepts the Medicare benefit in full payment for the service) or when there is a Medical Purchaser-Provider Agreement (doctor/fund) in existence. There are very few agreements between doctors and funds and very little bulk billing of in-hospital medical treatment.

One of the major complaints made about private health insurance is the time-consuming and frustrating payments systems, which tends to result in private patients tracking dozens of bills. There is also the problem of unpredictable and sometimes very large out-of-pocket costs associated with using private health insurance.

The fact that private patents are faced with complex billing arrangements for medical services associated with hospital care and often unpredictable out-of-pocket costs contributes to the perception that private health insurance does not provide good value for money. Simplified billing together with informed financial consent will help alleviate this problem.

Recent amendments to the Act have enabled billing agents to claim the Medicare benefit on behalf of the patient, thus simplifying the claiming process for patients when no agreements or billing arrangements are in place. Permitting the assignment of benefits for in-hospital episodes will encourage the widespread adoption of simplified billing and informal financial consent across the industry.

Using the power under Subsection 20A(2)(B) of the Act, the Regulations prescribe that the

patient's request for the Medicare benefit to be paid to the billing agent must be in the form approved by the Health Insurance Commission.

The Regulations also prescribe, using the power under Section 20AB of the Act, that an application to be a billing agent must be in the form approved by the Private Health Insurance Administration Council and accompanied by an application fee of $1500. A renewal fee of $1000 is also prescribed.

The Regulations commenced on 1 July 1998.


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