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Health Insurance Amendment Act 1976

Authoritative Version
  • - C2004A01490
  • No longer in force
Act No. 59 of 1976 as made
An Act to amend the Health Insurance Act 1973-1975.
Date of Assent 05 Jun 1976
Date of repeal 25 Mar 2015
Repealed by Amending Acts 1970 to 1979 Repeal Act 2015

HEALTH INSURANCE AMENDMENT ACT

1976

 

No. 59 of 1976

 

An Act to amend the Health Insurance Act 1973-1975.

 

BE IT ENACTED by the Queen, and the Senate and House of Representatives of the Commonwealth of Australia, as follows:—

Short title and citation.

1. (1) This Act may be cited as the Health Insurance Amendment Act 1976.

(2) The Health Insurance Act 1973-1975 is in this Act referred to as the Principal Act.

(3) The Principal Act, as amended by this Act, may be cited as the Health Insurance Act 1973-1976.

Commencement.

2. (1) Sections 1, 2, 10 and 13 shall come into operation on the day on which this Act receives the Royal Assent.

(2) The remaining provisions of this Act shall come into operation on 1 October 1976.

Interpretation.

3.   Section 3 of the Principal Act is amended—

(a) by omitting from sub-section (1) the definition of “diagnostic service”;

(b) by omitting from sub-section (1) the definition of “eligible person” and substituting the following definition:—

“‘eligible person’ means an Australian resident;”;

(c) by omitting paragraph (b) of sub-section (2) and substituting the following paragraph: —

“(b) where there are two or more newly born children of the same mother in a hospital and those children are not inpatients of the hospital by virtue of paragraph (a)—each such child in excess of 1 shall be deemed to be an inpatient of the hospital.”; and

(d) by adding at the end thereof the following sub-sections:—

“(7) Where an eligible person is, or has been, a contributor to a medical benefits fund and a hospital benefits fund conducted by a registered organization or registered organizations, being a contributor for benefits in accordance with the standard medical benefits table and the standard hospital benefits table, and, by reason of being, or having been, such a contributor, would, if there were rendered to him, or, if he has a dependant or dependants, to that dependant or any of those dependants, any service treatment or care to which those tables relate, be entitled to benefits in accordance with those tables, then—

(a) the eligible person shall, for the purposes of this Act, be deemed to be a privately insured person; and

(b) that dependant or each of those dependants shall, for the purposes of this Act, be deemed to be a privately insured person.

“(8) In sub-section (7), a word or phrase defined for the purposes of the National Health Act 1953-1976 has the meaning that it would have if used in that Act.”.

Interpretation.

4.   Section 8 of the Principal Act is amended by adding at the end thereof the following sub-section:—

“(2) In this Part, ‘eligible person’ does not include a privately insured person.”.


 

5.   Sections 18 and 19 of the Principal Act are repealed and the following sections substituted:—

Medical benefit not payable where compensation, &c., is payable.

“18. (1) Where—

(a) a person has lodged a claim for medical benefit in respect of a professional service that has been rendered to an eligible person in the course of the treatment of, or as a result of, an injury; and

(b) the eligible person has received, or established his right to receive, in respect of that injury, a payment by way of compensation or damages (including a payment in settlement of a claim for compensation or damages) under the law that is or was in force in a State or internal Territory, being a payment the amount of which was, in the opinion of the Minister, determined having regard to any medical expenses incurred, or likely to be incurred (whether by the eligible person or by another person), in the course of the treatment of, or as a result of, that injury,

the Minister may determine that the whole or a specified part of the payment referred to in paragraph (b) shall, for the purposes of this section, be deemed to relate to the medical expenses incurred in respect of the professional service referred to in paragraph (a).

“(2) Where—

(a) the Minister has made a determination under sub-section (1); and

(b) the amount of the medical benefit that would, but for this section, be payable in respect of the professional service to which the determination relates is not in excess of the amount so determined,

medical benefit is not payable in respect of that professional service.

“(3) Where

(a) the Minister has made a determination under sub-section (1); and

(b) the amount of the medical benefit that would, but for this section, be payable in respect of the professional service to which the determination relates is in excess of the amount so determined,

the medical benefit payable in respect of that professional service shall not exceed the amount of that excess.

“(4) Where, at the time at which a claim for medical benefit is made, it appears to the Minister that the claim may become a claim that will give rise to a determination under sub-section (1), the Minister may direct that no medical benefit be paid at that time in respect of the claim but that there be made to the claimant a provisional payment of such amount of medical benefit as the Minister thinks fit.

“(5) If and when a determination under sub-section (1) is made with respect to a claim referred to in sub-section (4), the claimant is liable to repay to the Commonwealth—

(a) where, by virtue of sub-section (2), no medical benefit is payable in respect of the professional service to which the determination relates—an amount equal to the provisional payment; or

(b) in any other case—the amount by which the amount of the provisional payment exceeds the amount of the medical benefit payable in respect of the professional service to which the determination relates.

“(6) An amount that a person is liable to repay under sub-section (5) is recoverable as a debt due to the Commonwealth.

“(7) In this section, ‘injury’ includes a disease.

“(8) The Minister may, either generally or as otherwise provided by the instrument of delegation, by writing signed by him, delegate to the General Manager, or a member of the staff, of the Commission any of his powers under this section, other than this power of delegation.

“(9) A power so delegated, when exercised by the delegate, shall, for the purposes of this Act, be deemed to have been exercised by the Minister.

“(10) A delegation under sub-section (8) does not prevent the exercise of the power by the Minister.

Medical benefit not payable in respect of certain professional services.

“19. (1) A medical benefit is not payable in respect of a professional service that is a medical examination for the purposes of—

(a) life insurance;

(b) superannuation or provident account schemes; or

(c) admission to membership of a friendly society.

“(2) Unless the Minister otherwise directs, a medical benefit is not payable in respect of a professional service that has been rendered by, or on behalf of, or under an arrangement with—

(a) the Commonwealth;

(b) a State;

(c) a local governing body; or

(d) an authority established by a law of the Commonwealth, a law of a State or a law of an internal Territory.

“(3) Unless the Minister otherwise directs, a medical benefit is not payable in respect of a professional service rendered to a person if—

(a) the medical expenses in respect of that professional service were incurred by the employer of that person; or

(b) the person to whom that professional service was rendered was employed in an industrial undertaking and that professional service was rendered to him for purposes connected with the operation of that undertaking.

“(4) A medical benefit is not payable in respect of a professional service rendered in the course of the carrying out of a mass immunization.

Regulations may provide that medical benefit be not payable in respect of prescribed class of professional services.

“19a. (1) Subject to sub-section (2), the regulations may provide that, unless the Minister otherwise directs, medical benefits are not payable in respect of professional services rendered in prescribed circumstances.

“(2) Regulations shall not be made for the purposes of sub-section (1) except in accordance with a recommendation made to the Minister by the Medical Benefits Advisory Committee under paragraph (aa) of sub-section (1) of section 61.”.

Persons entitled to medical benefits.

6.   Section 20 of the Principal Act is amended—

(a) by omitting paragraph (b) of sub-section (3) and substituting the following paragraph:—

“(b) the second party accepts—

(i) the assignment; or

(ii) the assignment and the payment, or the promise of payment, of an amount not exceeding the amount by which the amount of the appropriate fee specified in the item to which the medical benefit relates exceeds the amount of the medical benefit,

in full payment of the medical expenses incurred by the first party in respect of that professional service; and

(b) by inserting after sub-section (3) the following sub-section:—

“(3a) Where, in calculating the amount of the medical benefit referred to in paragraph (a) of sub-section (3), the amount of the fee in relation to that medical benefit is ascertained in accordance with section 15 or 16, the reference in sub-paragraph (ii) of paragraph (b) of sub-section (3) to the amount of the appropriate fee specified in the item to which that medical benefit relates shall be read as a reference to the amount of the fee so ascertained.”.

Medical Services outside Australia

7.   Section 21 of the Principal Act is amended—

(a) by inserting in sub-section (1), after the words “Australian resident” the words “, other than a privately insured person”; and

(b) by omitting from that sub-section the word “Australia” (second occurring) and substituting the words “New South Wales”.

Undertakings with respect to pensioners.

8. (1) Section 23 of the Principal Act is amended—

(a) by omitting from sub-section (1) the words “a person” (second occurring) and substituting the words “an eligible person”;

(b) by omitting paragraph (b) of sub-section (1) and substituting the following paragraph:—

“(b) if the person indicates that he so wishes—

(i) arrangements are made for the making of the assignment under sub-section 20 (3); and

(ii) the medical practitioner accepts the assignment in full payment of the medical expenses.”; and

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

“(4) Where a medical practitioner has lodged with the Minister an undertaking under sub-section (1), he may, at any time, by notification served on the Minister, revoke that undertaking.”.

(2) Notwithstanding the amendment made by sub-section (1), an undertaking given by a medical practitioner under section 23 of the Principal Act and in force immediately before the commencement of this section continues in force after the commencement of this section as if it had been given by the medical practitioner under section 23 of the Principal Act as amended by this Act.

Common form of undertaking.

9. (1) Section 23a of the Principal Act is amended—

(a) by omitting from paragraph (d) of sub-section (2) the words “a person” and substituting the words “an eligible person”; and

(b) by omitting sub-paragraph (iv) of paragraph (d) of sub-section (2) and substituting the following sub-paragraph:—

“(iv) if the person indicates he so wishes—

(A) arrangements are made for the making of the assignment under sub-section 20(3); and

(B) the optometrist accepts the assignment in full payment of the medical expenses;

(2) Notwithstanding the amendment made by sub-section (1), an undertaking accepted by the Minister under section 23b of the Principal Act and in force immediately before the commencement of this section continues in force after the commencement of this section as if it had been accepted by the Minister under section 23b of the Principal Act as amended by this Act.

Issue of certificate of approval of Premises as hospital.

10. Section 25 of the Principal Act is amended by omitting from sub-section (1) the word “authorized” and substituting the word “prescribed”.

Supplementary daily bed payments to private hospitals.

11. Section 34 of the Principal Act is amended by omitting sub-section (10) and substituting the following sub-section:—

“(10) In this section—

‘approved bed’, in relation to a hospital, means a bed included in the number of beds at the hospital to which the approval under this section relates;

‘eligible person’ does not include a privately insured person.”.


 

12. After section 35 of the Principal Act the following section is inserted:—

Certain daily bed payments not payable where compensation, &c., is payable to patient.

35a. (1) Where—

(a) a private hospital has lodged a claim for daily bed payments in respect of an eligible person who is or was an in-patient at the hospital receiving hospital treatment in the course of the treatment of, or as a result of, an injury; and

(b) the eligible person has received, or established his right to receive, in respect of that injury, a payment by way of compensation or damages (including a payment in settlement of a claim for compensation or damages) under the law that is or was in force in a State or internal Territory, being a payment the amount of which was, in the opinion of the Minister, determined having regard to any hospital expenses incurred, or likely to be incurred (whether by the eligible person or by another person), in the course of the treatment of, or as a result of, that injury,

the Minister may determine that the whole or a specified part of the payment referred to in paragraph (b) shall, for the purposes of this section, be deemed to relate to the hospital expenses incurred in respect of the hospital treatment referred to in paragraph (a).

“(2) Where—

(a) the Minister has made a determination under sub-section (1); and

(b) the amount of the daily bed payments, that would, but for this section, be payable in respect of the days on which the patient to whom the determination relates occupies a bed for the purpose of receiving the hospital treatment to which the determination relates is not in excess of the amount so determined,

daily bed payments are not payable in respect of those days.

“(3) Where—

(a) the Minister has made a determination under sub-section (1); and

(b) the amount of the daily bed payments that would, but for this section, be payable in respect of any days on which the patient to whom the determination relates occupies a bed for the purpose of receiving the hospital treatment to which the determination relates is in excess of the amount so determined,

the amount of the daily bed payments in respect of those days shall not exceed the amount of that excess.

“(4) Where, at the time at which a claim for daily bed payments is lodged, it appears to the Minister that the claim may become a claim that will give rise to a determination under sub-section (1), the Minister may direct that no daily bed payments be paid at that time in accordance with the claim but that there be made to the claimant a provisional payment of an amount of daily bed payments not exceeding the amount that would, but for this sub-section, be payable to the claimant in accordance with the claim.

“(5) If and when a determination under sub-section (1) is made with respect to a claim referred to in sub-section (4), the claimant is liable to repay to the Commonwealth—

(a) where, by virtue of sub-section (2), no daily bed payments are payable in respect of any days on which the patient to whom the determination relates occupies a bed for the purpose of receiving the hospital treatment to which the determination relates—an amount equal to the provisional payment; or

(b) in any other case—the amount by which the amount of the provisional payment exceeds the amount of the daily bed payments payable in respect of the days on which the patient to whom the determination relates occupies a bed for the purpose of receiving the hospital treatment to which the determination relates.

“(6) An amount that a person is liable to repay under sub-section (5) is recoverable as a debt due to the Commonwealth.


 

“(7) In this section—

‘daily bed payments’ means daily bed payments payable under sub-section (1) of section 33;

‘injury’ includes a disease.

“(8) The Minister may, either generally or as otherwise provided by the instrument of delegation, by writing signed by him, delegate to the General Manager, or a member of the staff, of the Commission any of his powers under this section, other than this power of delegation.

“(9) A power so delegated, when exercised by the delegate, shall, for the purposes of this Act, be deemed to have been exercised by the Minister.

“(10) A delegation under sub-section (8) does not prevent the exercise of the power by the Minister.

Minister to consult with Commission.

13. Section 44 of the Principal Act is amended by omitting the word “Australian”.

Functions of committee.

14. Section 67 of the Principal Act is amended by inserting in sub-section (1), after paragraph (a), the following paragraph:—

“(aa) in pursuance of a reference to it by the Minister, to consider whether medical benefits should continue to be payable in respect of professional services rendered in circumstances specified by the Minister in the reference, and to make recommendations, in writing, to the Minister arising out of that consideration;”.

Health Insurance Funds.

15. Section 126 of the Principal Act is amended—

(a) by omitting paragraph (b) of sub-section (3) and substituting the following paragraph: —

“(b) amounts recovered by the Commonwealth under section 18, 23c, 35a, 43 or 106;”; and

(b) by adding at the end of sub-section (3) the following word and paragraph:—

“and (d) contributions paid under section 8a of the Health Insurance Commission Act 1973-1976.”.