(a) by inserting in sub-section (1), after the definition of “approved”, the following definitions:

“‘basic hospital benefits table’ or ‘basic table’, in relation to a registered hospital benefits organization, means a table that incorporates a range of benefits of the following kinds and no other benefits:

(a) in respect of hospital treatment provided to persons as in-patients of a hospital in the State or Territory to which the table relates—benefits equal to the fees charged for the provision of hospital treatment in a recognized hospital in that State or Territory in respect of a private patient in other than a single room, being a patient who is not entitled to receive compensation or damages in respect of the costs of that hospital treatment;

(b) in respect of hospital treatment provided to persons as in-patients of a hospital in any other State or Territory—benefits equal to—

(i) the fees charged for the provision of hospital treatment in a recognized hospital in the State or Territory to which the table relates in respect of a private patient in other than a single room, being a patient who is not entitled to receive compensation or damages in respect of the costs of that hospital treatment; or

(ii) the fees charged for the provision of hospital treatment in a recognized hospital in the State or Territory in which the hospital is situated in respect of such a patient,

(c) in respect of professional services rendered to persons as in-patients of a recognized hospital, whether situated in the State or Territory to which the table relates or elsewhere, by medical practitioners employed by, or under arrangements made by, the hospital—benefits equal to the charges made by the hospital for the provision of those services to patients who are not entitled to receive compensation or damages in respect of the cost of those services;

(d) in respect of out-patient services provided to persons by a hospital in a State or Territory in which recognized hospitals make charges for the provision of out-patient services—

(i) if that hospital is a recognized hospital—benefits equal to the charges made by that hospital for the provision of those services to persons who are not entitled to receive compensation or damages in respect of the cost of those services; or

(ii) if that hospital is not a recognized hospital—benefits equal to the charges made by that hospital for the provision of those services or the charges made by recognized hospitals in that State or Territory for the provision of services of that kind to persons who are not entitled to receive compensation or damages in respect of the cost of those services, whichever are the less;

(e) benefits of the kind referred to in sub-section (1) of section 73c;

(f) such other benefits (if any) as are prescribed for the purposes of this definition;

“‘basic medical benefits table’ or ‘basic table’, in relation to a registered medical benefits organization, means a table that incorporates a range of benefits of the following kinds and no other benefits:

(a) a range of benefits in respect of the provision of every professional service in respect of which a Commonwealth medical benefit is payable, such that each benefit in respect of a professional service is an amount that, when added to the amount of the Commonwealth medical benefit in respect of that professional service, equals the amount of the guaranteed medical benefit in respect of that professional service;

(b) such other benefits (if any) as are prescribed for the purposes of this definition;”;

(b) by adding at the end of sub-paragraph (i) of paragraph (c) of the definition of “dependant” (in relation to a pensioner) in sub-section (1) “but is under the age of 25 years”;

(c) by inserting after the definition of “Director” in sub-section (1) the following definition:

“‘fund medical benefit’, in relation to a professional service, means the amount payable, in accordance with a basic table, to a contributor to a medical benefits fund conducted by a registered organization;”;

(d) by inserting in sub-section (1), after the definition of “Government nursing home”, the following definition:

“‘guaranteed medical benefit’, in relation to a professional service, means an amount equal to the amount that the Commonwealth medical benefit in respect of that professional service would be if—

(a) the reference in sub-paragraph (i) of paragraph (c) of sub-section (2) of section 10 of the Health Insurance Act 1973 to 40% were a reference to 75%; and

(b) each of the references in sub-paragraph (ii) of paragraph (c) of sub-section (2) of that section to $20 were a reference to $10;”;

(e) by inserting in sub-section (1), after the definition of “nursing home fund benefit”, the following definitions:

“‘optional hospital benefits table’ or ‘optional table’, in relation to a registered hospital benefits organization, means a table of benefits that is declared by the Minister, under section 73e, to be an optional hospital benefits table;

“‘optional medical benefits table’ or ‘optional table’, in relation to a registered medical benefits organization, means a table of benefits that is declared by the Minister, under section 73e, to be an optional medical benefits table;”;

(f) by inserting in sub-section (1), after the definition of “qualified nursing home patient”, the following definition:

“‘records’, in relation to a registered organization, includes claims for Commonwealth medical benefits or fund benefits by contributors or registered persons lodged with the organization and any other documents in the custody or control of the organization relating to such claims;”;

(g) by inserting in sub-section (1), after the definition of “restricted membership organization”, the following definition:

“‘supplementary hospital table’, in relation to a registered hospital benefits organization, means a table of benefits that—

(a) is not a basic table or an optional table; and

(b) includes benefits in respect of—

(i) the provision of hospital accommodation in a single room in a recognized hospital; or

(ii) the provision of hospital accommodation in a private hospital;”;

(h) by omitting from sub-section (1) the definitions of “the standard hospital benefits table” or “the standard table” and “the standard medical benefits table” or “the standard table”;

(j) by omitting from sub-section (1) the definition of “the Northern Territory”;

(k) by adding at the end of sub-section (1) the following definition: “‘waiting period’, in relation to a contributor, means a period that, by virtue of section 4a, is to be deemed to be a waiting period for the purposes of this Act in relation to that contributor.”;

(l) by omitting from paragraph (a) of sub-section (1b) “the standard hospital benefits table” and substituting “a basic table or an optional table”; and

(m) by omitting from paragraph (b) of sub-section (1b) “the standard hospital benefits table” and substituting “that table”.

(a) by omitting from sub-section (1) the definitions of “basic benefit entitlement”, “Commonwealth and miscellaneous fund benefit”, “extra charges”, “fund benefit”, “pre-existing ailment”, “special account”, “special account contributor” and “standard rate benefit”; and

(b) by omitting sub-section (2).

(a) by omitting from sub-paragraph (i) of paragraph (c) of sub-section (2) “medical fund benefits, or any other benefits” and substituting “fund benefits”; and

(b) by omitting from sub-paragraph (i) of paragraph (c) of sub-section (4) “medical fund benefits, or any other benefits” and substituting “fund benefits”.

(a) by omitting from sub-paragraph (i) of paragraph (c) of sub-section (2) “hospital fund benefits, or any other benefits” and substituting “fund benefits”; and

(b) by omitting from sub-paragraph (i) of paragraph (c) of sub-section (4) “hospital fund benefits, or any other benefits” and substituting “fund benefits”.

(a) by omitting from sub-sections (2) and (4) “the standard table” (wherever occurring) and substituting “a basic table or an optional table”;

(b) by omitting sub-section (10); and

(c) by adding at the end thereof the following sub-section:

(a) those benefits shall be deemed to be hospital benefits;

(b) those benefits shall be deemed to be included in a basic table; and

(c) any contributions that are identifiable as contributions solely in respect of those benefits shall be deemed to be contributions in respect of a basic table.”.

(a) by omitting from paragraph (a) of sub-section (1) “the standard table” and substituting “a basic table”;

(b) by omitting from sub-section (1) “the standard table” (second occurring) and substituting “that table”;

(c) by omitting from sub-paragraph (i) of paragraph (c) of sub-section (3) “the standard table” and substituting “the table to which the request relates”; and

(d) by omitting from sub-section (4) “the standard table” (wherever occurring) and substituting “the table to which the request relates”.

(a) shall be made by delivering the request to the Director for the State or Territory in respect of which the organization is registered; and

(b) shall be accompanied by a statement setting out the circumstances of the refusal.

(a) inform the registered organization concerned that the request has been made;

(b) furnish to the registered organization a copy of the statement that accompanied the request in accordance with paragraph (b) of sub-section (2); and

(c) require the registered organization to furnish to him, in writing, within 14 days after receipt of the requirement—

(i) a statement of its general practice in respect of the acceptance of contributions from persons who are, or wish to become, contributors, in respect of a basic table, to the fund concerned; and

(ii) any comments it wishes to make concerning the statement referred to in paragraph (b).

(a) if—

(i) after consideration of the statement that accompanied the request and of any statement and comments furnished by the organization, he is satisfied that there were no reasonable grounds for the refusal to accept payment of the contributions of the person; or

(ii) the organization has failed to furnish a statement in pursuance of the requirement referred to in paragraph (c) of sub-section (3),

(b) in any other case—refuse to give that direction.

(a) by inserting in sub-section (1) “, being benefits that became payable before 1 November 1978,” after “benefits”;

(b) by omitting from sub-section (2) “the Health Insurance Commission” and substituting “him”; and

(c) by omitting sub-section (3).

‘hospital benefits table’ means a table of benefits offered, or to be offered, by a registered hospital benefits organization, other than a basic table;

‘medical benefits table’ means a table of benefits offered, or to be offered, by a registered medical benefits organization, other than a basic table.

(a) where the determination is a determination with respect to hospital benefits tables—every registered hospital benefits organization; or

(b) where the determination is a determination with respect to medical benefits tables—every registered medical benefits organization.

(a) a hospital benefits table—

(i) includes benefits with respect to the provision of hospital treatment in a hospital in respect of a private patient in other than a single room;

(ii) includes benefits of a kind referred to in sub-section (1) of section 73c; and

(iii) where guidelines are in force under sub-section (2) with respect to hospital benefits tables—complies with those guidelines; or

(b) a medical benefits table—

(i) includes benefits with respect to the provision of a professional service; and

(ii) where guidelines are in force under sub-section (2) with respect to medical benefits tables—complies with those guidelines,

“(c) fund benefits payable out of the fund;”.

(a) by omitting sub-sections (1), (2), (3) and (4) and substituting the following sub-sections:

(a) the constitution of the organization;

(b) the articles of association of the organization; or

(c) the rules of the organization,

(a) the benefits, the amounts of the benefits or the conditions relating to the provision of the benefits provided by the organization in accordance with a basic table;

(b) the amounts of the contributions, or the conditions relating to the payment of the contributions, for benefits in accordance with any table; or

(c) the assets, income, expenditure, or the probable income or expenditure, of the organization,

(b) by adding at the end of paragraph (a) of sub-section (5) “or”;

(c) by omitting paragraph (c) of sub-section (5); and

(d) by omitting sub-section (8a).

(a) by omitting from the definition of “brand” in sub-section (1) “pharmaceutical benefit” (wherever occurring) and substituting “drug or medicinal preparation”;

(b) by inserting in sub-section (1), after the definition of “Joint Committee” the following definition:

“‘participating dental practitioner’ means a dental practitioner in relation to whom an approval is in force under section 84a;”; and

(c) by omitting from the definition of “pharmaceutical benefit” in sub-section (1) “the next succeeding section” and substituting “section 85”.

(a) by omitting sub-section (5); and

(b) by omitting sub-section (7).

(a) determine the maximum quantity or number of units of the pharmaceutical benefit that may, in one prescription, be directed to be supplied on any one occasion;

(b) determine the maximum number of occasions on which the supply of the pharmaceutical benefit may, in one prescription, be directed to be repeated, either for all purposes or for particular purposes; and

(c) determine the manner of administration that may, in a prescription, be directed to be used in relation to the pharmaceutical benefit.

(a) by inserting in sub-section (1) “or dental treatment by a participating dental practitioner” after “practitioner”; and

(b) by omitting sub-section (2).

(a) by inserting in sub-section (1) “, a participating dental practitioner” after “practitioner”; and

(b) by omitting from sub-section (5) “section 85” and substituting “ sub-section (2) of section 85a”.

(a) there be supplied on one occasion a quantity or number of units of the pharmaceutical benefit in excess of the maximum quantity or number of units (if any) applicable under a determination of the Minister under sub-section (2) of section 85a; or

(b) the pharmaceutical benefit is to be administered in a manner other than the manner (if any) applicable under a determination of the Minister under sub-section (2) of section 85a.

(a) for the treatment of persons included in a prescribed class of persons;

(b) for a prescribed purpose, including the treatment of a prescribed disease or condition, either in relation to persons generally or in relation to persons included in a prescribed class of persons; or

(c) subject to prescribed conditions.”.

(a) by omitting from sub-section (1) “or” (first occurring) and substituting “, a participating dental practitioner or an”;

(b) by inserting after paragraph (a) of sub-section (1) the following paragraph:

“(aa) the approval of a dental practitioner as a participating dental practitioner under section 84a;”;

(c) by omitting from sub-section (5) “or the approval or authority of a medical practitioner” and substituting “, the approval or authority of a medical practitioner or the approval of a dental practitioner as a participating dental practitioner”; and

(d) by inserting in sub-section (8) “, dental practitioner” after “practitioner”.

“(aa) a participating dental practitioner requests that his approval as a participating dental practitioner under section 84a be cancelled;”.

(a) by inserting in paragraph (d) of sub-section (5) “, a participating dental practitioner” after “practitioner”; and

(b) by omitting paragraph (e) of sub-section (5).

(a) by inserting in sub-section (1) “or a participating dental practitioner” after “chemist”; and

(b) by inserting in sub-section (2) “or a participating dental practitioner” after “chemist”.

(a) the Permanent Head; and

(b) 4 dental practitioners.

(a) the Director; and

(b) 4 dental practitioners.

(a) by inserting in sub-section (1) “or a participating dental practitioner” after “practitioner”; and

(b) by inserting in sub-section (2) “or a participating dental practitioner” after “practitioner”.

(a) in the case of a medical practitioner—suspend—

(i) the authority to write a prescription for the supply of pharmaceutical benefits conferred upon that medical practitioner by section 88;

(ii) any approval of that medical practitioner under section 92; or

(iii) the authority to supply prescribed pharmaceutical benefits conferred upon that medical practitioner by section 93;

(b) in the case of a participating dental practitioner—suspend the approval of that dental practitioner as a participating dental practitioner under section 84a; or

(c) in the case of an approved pharmaceutical chemist—suspend the approval of that pharmaceutical chemist under section 90.

(a) where the Permanent Head has, under sub-section (1), suspended an authority or approval that relates to the medical practitioner, dental practitioner or pharmaceutical chemist—remove that suspension; and

(b) suspend, or further suspend, for such period as he specifies in the notice, or revoke, any authority or approval referred to in a paragraph of sub-section (1), being an authority or approval that relates to the medical practitioner, dental practitioner or pharmaceutical chemist.

(a) remove a suspension, or further suspension, imposed under sub-section (2); or

(b) restore any approval or authority revoked under sub-section (2).

(a) any act or conduct to which the charge relates shall not be referred for investigation or report by a Committee of Inquiry; and

(b) any investigation by a Committee of Inquiry into any such act or conduct shall cease.”.

(a) the authority conferred upon a medical practitioner by section 88 is suspended or revoked; or

(b) the approval of a dental practitioner as a participating dental practitioner under section 84a is suspended or revoked,

“(da) a dental practitioner was or was not approved as a participating dental practitioner under section 84a;”.

(a) 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) The organization will permit any contributor to a medical benefits fund or a hospital benefits fund conducted by it to contribute for benefits in respect of himself and his dependants (if any) in accordance with a basic table.

(c) Where the organization conducts a hospital benefits fund, the organization will not offer to the contributors to that fund, whether on its own behalf or on behalf of another person or organization, health insurance in respect of nursing home care other than in accordance with a basic table or an optional table.

(d) The amount of fund benefit payable to a contributor by the organization in respect of a professional service or hospital treatment or other service will not exceed—

(i) in the case of a professional service—the amount by which the medical expenses incurred in respect of that professional service exceed the Commonwealth medical benefit in respect of that professional service; or

(ii) in the case of hospital treatment or other service—the fees or charges incurred in respect of that hospital treatment or other service.

(e) Where the organization conducts a medical benefits fund, the organization will not offer to the contributors to that fund fund benefits in respect of professional services that exceed the amounts by which the fees applicable to those professional services for the purpose of the calculation of Commonwealth medical benefits in respect of those professional services exceed those Commonwealth medical benefits.

(f) 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 fund benefits in respect of professional services of such amounts 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) Where the organization conducts a hospital benefits fund, the organization will not permit a person to contribute to the fund for benefits in accordance with a supplementary hospital table unless the person also contributes to that fund for benefits in accordance with a basic table or an optional table.

(h) Where the organization conducts a hospital benefits fund, the organization will not offer to the contributors to that fund a table of benefits, not being a basic table or an optional table, that includes benefits with respect to the provision of hospital treatment in a hospital in respect of a private patient in other than a single room.

(j) Where a contributor to a medical benefits fund or a hospital benefits fund conducted by the organization, being a contributor for benefits in accordance with a basic table or an optional table, has ceased to pay contributions, the rules of the organization will—

(i) permit the contributor, at any time before the expiration of a period, being a period of not less than 2 months, specified in the rules to pay the contributions due in respect of the period (in this paragraph referred to as ‘the period in arrears’) commencing on the expiration of the period in respect of which he has paid contributions and ending not later than the date on which he makes the payment; and

(ii) provide that, if the contributor makes the payment referred to in sub-paragraph (i), he is to continue to be eligible for benefits, in accordance with the appropriate table, in respect of the period in arrears.

(k) The organization will institute, and maintain, in a form and manner satisfactory to the Minister, a record of the contributors, and the dependants of the contributors, to any medical benefits fund or hospital benefits fund conducted by it.

(l) Where the organization is a party to an agreement under section 20c of the Health Insurance Act 1973, the organization will institute, and maintain, in a form and manner satisfactory to the Minister—

(i) a record of the persons registered with it as registered persons and the dependants of those persons; and

(ii) a record of such other information in relation to the persons referred to in sub-paragraph (i) as the Minister directs, from time to time, by notice in writing served on the organization.

(m) Where the rules of the organization provide for a waiting period with respect to contributors for benefits in accordance with a basic table, that waiting period will not exceed 2 months.

(n) The rules of the organization will not provide for a waiting period for—

(i) contributors for benefits in accordance with a basic table or an optional 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 January 1979, 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 or an optional table.

(o) Where the organization conducts a medical benefits fund, the organization will not pay a benefit from the fund to a person who has taken an assignment of the benefit from the person who is entitled under the rules of the organization to payment of the benefit unless—

(i) that last-mentioned person is a pensioner; and

(ii) the service in respect of which the benefit is payable was rendered in respect of the pensioner or a dependant of the pensioner.

(p) Where the organization conducts a medical benefits fund, the organization will institute and maintain procedures satisfactory to the Minister for the payment out of the funds of the organization or out of advances made under section 20e of the Health Insurance Act 1973 of all claims for Commonwealth medical benefit lodged with the organization in accordance with section 20b of the Health Insurance Act 1973.

(q) Where—

(i) a claim for a Commonwealth medical benefit in respect of a professional service is lodged with the organization in accordance with section 20b of the Health Insurance Act 1973 (including such a claim lodged together with a claim for fund medical benefit in respect of the professional service); and

(ii) the medical expenses incurred in respect of the professional service have not been paid,

(r) Where there is forwarded with a claim for a Commonwealth medical benefit lodged with the organization in accordance with section 20b of the Health Insurance Act 1973 a statement by the person by, or on whose behalf, the service was rendered that the service was of unusual length or complexity, the organization will refer the claim to the Department to be dealt with under section 11 of that Act.

(s) Where an exemption is in force under section 73f in relation to the organization, the organization will—

(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 eligible persons who may wish to register with the organization as registered persons,

(t) The organization will comply with any direction of the Minister under this Act served on it.”.