Health Insurance Regulations (Amendment) (Cth)

Statutory Rules

1975 No. 118

REGULATIONS UNDER THE HEALTH INSURANCE ACT 1973.*

I, THE GOVERNOR-GENERAL of Australia, acting with the advice of the Executive Council, hereby make the following Regulations under the Health Insurance Act 1973.

Dated this twelfth day of June, 1975.

John R. Kerr

Governor-General.

By His Excellency's Command,

JOHN M. WHEELDON

Minister of State for Social Security.

Amendments of the Health Insurance Regulations 

1. After regulation 2 of the Health Insurance Regulations the following regulations are inserted:—

Form of agreement assigning right to payment of medical benefit.

“ 2a. For the purposes of sub-section 20 (3) of the Act, the prescribed form, in accordance with which an agreement for the assignment of a right to payment of medical benefit may be entered into, is Form 1a in the Schedule.

Claim form—claim by person who has incurred medical expense.

“ 2b. For the purposes of section 22 of the Act, the prescribed form, in accordance with which a claim for medical benefit by the person who incurred the medical expenses shall be made, is Form 1b in the Schedule.

Claim form—claim by person to whom right to payment of medical benefit has been assigned.

“ 2c. For the purposes of section 22 of the Act, the prescribed form, in accordance with which a claim for medical benefit by a person to whom the right to payment of medical benefit has been assigned under an agreement referred to in sub-section 20 (3) of the Act shall be made, is Form 1c in the Schedule.”.

* Notified in the Australian Government Gazette on 13 June 1975

 Statutory Rules 1975, No. 80

12502/75—Recommended retail price 15c  10/9.6.1975

2. After regulation 4 of the Health Insurance Regulations the following regulations are added:—

Application form—application by organization for approval to provide care and treatment.

“ 5. (1) For the purposes of sub-section 34 (2) of the Act, the prescribed form, in accordance with which an application under that sub-section by an organization shall be made, is Form 3 in the Schedule.

“ (2) An application under sub-section 34 (2) of the Act by an organization shall be signed by a person, being one of the persons responsible for the management of the organization, authorized in writing by the organization to sign that application.

Claim form—claim for daily bed payment.

“ 6. (1) For the purposes of section 35 of the Act, the prescribed form, in accordance with which a claim for payment to a private hospital of a daily bed payment under section 33 of the Act shall be made, is Form 4 in the Schedule.

“ (2) A claim for payment of a daily bed payment under section 33 of the Act to a private hospital shall be made by the proprietor of the hospital and shall be signed—

(a) where the proprietor is a natural person—by the proprietor or a person, being one of the persons responsible for the management of the hospital, authorized in writing by the proprietor to sign that claim; or

(b) where the proprietor is an organization—by a person, being one of the persons responsible for the management of the hospital, authorized in writing by the proprietor to sign that claim.

Claim form—claim for supplementary daily bed payment.

“ 7. (1) For the purposes of section 35 of the Act, the prescribed form, in accordance with which a claim for the payment to an organization of a supplementary daily bed payment under sub-section 34 (4) of the Act shall be made, is Form 5 in the Schedule.

“ (2) A claim for the payment to an organization of a supplementary daily bed payment under sub-section 34 (4) of the Act shall be signed by a person, being -one of the persons responsible for the management of the organization or for the management of the private hospital to which the claim relates, authorized in writing by the organization to sign that claim.

Application form—application for approval as an organization under Part IV of the Act.

“ 8. (1) For the purposes of sub-section 40 (1) of the Act, the prescribed form, in accordance with which an application under that sub-section by an organization for approval as an organization under Part IV of the Act shall be made, is Form 6 in the Schedule.

“ (2) An application under sub-section 40 (1) of the Act by an organization shall be signed by a person, being one of the persons responsible for the management of the organization, authorized in writing by the organization to sign that application.

Application form—application for approval of health service.

“ 9. (1) For the purposes of sub-section 41 (1) of the Act, the prescribed form, in accordance with which an application under that sub-section by an organization for approval of a health service shall be made, is Form 7 in the Schedule.

“ (2) An application under sub-section 41 (1) of the Act by an organization shall be signed by a person, being one of the persons responsible for the management of the organization, authorized, in writing by the organization to sign the application.”.

Schedule.

3. The Schedule to the Health Insurance Regulations is amended—

(a) by inserting before Form 1 the forms set out in Schedule 1; and

(b) by adding at the end thereof the forms set out in Schedule 2.

SCHEDULE 1 Regulation 3

Form 1a Regulation 32A

Assignment Form

(Section 20 (3) Health Insurance Act 1973)

Serial No.........................................

Patient's name............................................................................................................ Sex

(Surname) (Given names) M F

Address.................................................................................................................................................

Medibank Number........................................

Date of service			Description of service		Item No.	Amount of benefit
Day	Month	Year
I assign to:				The above services were performed by me or on my behalf, and 1 accept the assignment of the right to the payment of medical benefits for those services in full payment of all amounts due to me in respect of those services.		Referring practitioner ..................................................
.................................................. my right to the payment of medical benefits for the above services. None of the above services was an examination for the purpose of life assurance or admission to a friendly society.						Referral number......................... ..................................................
..................................................				...........................................................
Signature of Patient or Agent				Signature of Practitioner or Agent

Form 1b Regulation 2B

Claim Form

(Section 22 Health Insurance Act 1973)

Claimant's name.......................................................................................................................................

(Surname)  (Given names)

Address...............................................................................................................Postcode.......................

     

Patient information				Service information
First given name	Sex	Month of birth	Medibank Number	Date of service			Name of doctor
				Day	Month	Year

Where a receipt is not attached I request a cheque payable to the doctor.

Medical benefits are claimed in respect of the professional services listed in the above table.

I incurred the expenses shown in the table.

None of the services claimed was an examination for the purpose of life assurance or admission to a friendly society.

The information is true and correct.

Claimant's signature....................................................................................... Date................................

Form 1c Regulation 2c

Claim for Assigned Medical Benefits

(Section 22 Health Insurance Act 1973)

Practitioner's name...........................................................................	First Assignment
Form Number....................................................................................
Address............................................................................................	Last Number....................................................................................
.........................................................................................................	Number of
Assignment Forms....................................................................................
Amount claimed $....................................................................................

I hereby claim payment of medical benefits in respect of the professional services described in the attached forms of assignment.

I certify that the services were performed by me, or on my behalf.

Signature...............................................................................................................Date............................

SCHEDULE 2 Regulation 3

Form 3 Regulation 5

HEALTH INSURANCE ACT

Application by Organization for Approval to Provide Care and Treatment

To: the Minister of State for Social Security.

(Name of applicant organization)

of

 ,

(Address of applicant organization)

being an organization to which section 34 of the Health, Insurance Act 1973 applies, hereby makes application under sub-section 34 (2) of the Act for approval to provide care and treatment without charge for eligible persons as hospital patients at the hospital described in the Schedule, being a hospital controlled by the organization.

The number of beds in respect of which approval is sought is

SCHEDULE

(Here insert name, address and description of hospital)

Dated this  day of  , 19 .

........................................................................................

(Signature of person authorized to sign application)

........................................................................................

(Position in organization)

Form 4 Regulation 6

HEALTH INSURANCE ACT

Claim for Daily Bed Payment

To: the Health Insurance Commission.

(Name of proprietor)

of

(Address of proprietor)

hereby claims payment to the private hospital specified in Schedule 1 of a daily bed payment under section 33 of the Health Insurance Act 1973 for each approved bed in the hospital for each day on which the bed was, during the claim period specified in Schedule 1, occupied by an eligible person who was an in-patient at the hospital.

The total number of daily bed payments claimed in respect of the occupancy of approved beds in the hospital during the claim period by eligible persons who were in-patients at the hospital is the number specified in Schedule 1.

The total amount claimed is the amount specified in Schedule 1.

Except as specified in Schedule 2, the charge made by the hospital in respect of the occupancy for a day during the claim period of an approved bed in the hospital (other than a bed that is an approved bed for the purposes of section 34 of the Act) has, in no case, been less than the amount of the daily bed payment specified in sub-section 33 (1) of the Act.

Except as specified in Schedule 3, the average cost to the hospital of maintaining an approved bed in the hospital (other than a bed that is an approved bed for the purposes of section 34 of the Act) for each day during the claim period was not less than the amount of the daily bed payment specified in sub-section 33 (1) of the Act.

SCHEDULE 1

NAME OF HOSPITAL

ADDRESS OF HOSPITAL

CLAIM PERIOD

TOTAL NUMBER OF DAILY

BED PAYMENTS CLAIMED

TOTAL AMOUNT CLAIMED $

SCHEDULE 2

(Specify days during the claim period for which the charge made by the hospital in respect of the occupancy of an approved bed (other than a bed that is an approved bed for the purposes of section 34 of the Act) was less than the amount of the daily bed payment specified in sub-section 33 (1) of the Act, the number of occupancies in respect of which such a charge was made for each of those days, and the amount of each such charge)

SCHEDULE 3

(Specify days during the claim period for which the average cost of maintaining an approved bed (other than a bed that is an approved bed for the purposes of section 34 of the Act) was less than the amount of the daily bed payment specified in sub-section 33 (1) of the Act, and specify the average cost for each of those days)

Dated this  day of  19 .

........................................................................................

(Signature of proprietor or of person authorized to sign claim)

........................................................................................

(Position in hospital)

Form 5 Regulation 7

HEALTH INSURANCE ACT

Claim for Supplementary Daily Bed Payment

To: the Health Insurance Commission.

(Name of claimant organization)

of

(Address of claimant organization)

being an organization to which section 34 of the Health Insurance Act 1973 applies, hereby claims payment of a supplementary daily bed payment under that section for each approved bed within the meaning of that section in the private hospital specified in the Schedule, being a hospital controlled by the organization to which an approval under that section relates, for each day on which the bed was, during the claim period specified in the Schedule, occupied without charge by an eligible person who was a hospital patient at the hospital.

The total number of supplementary daily bed payments claimed in respect of the occupancy of approved beds in the hospital during the period by eligible persons who were hospital patients at the hospital is the number specified in the Schedule.

The total amount claimed is the amount specified in the Schedule.

SCHEDULE

NAME OF HOSPITAL

ADDRESS OF HOSPITAL

CLAIM PERIOD

TOTAL NUMBER OF

SUPPLEMENTARY DAILY

BED PAYMENTS CLAIMED

TOTAL AMOUNT CLAIMED $

Dated this  day of  19 .

.........................................................................

(Signature of person authorized to sign claim)

......................................................................

(Position in hospital or organization)

Form 6 Regulation 8

HEALTH INSURANCE ACT

Application for Approval as an Organization Under Part IV

To: the Minister of Stale for Social Security.

(Name of applicant organization)

of

(Address of applicant organization)

hereby makes application under sub-section 40 (1) of the Health Insurance Act 1973 for approval as an organization under Part IV of that Act.

Dated this  day of  19  .

.........................................................................

(Signature of person authorized to sign application)

.........................................................................

(Position in organization)

Form 7 Regulation 9

HEALTH INSURANCE ACT

Application for Approval of a Health Service

To: the Minister of State for Social Security.

(Name of applicant organization)

of

(Address of applicant organization)

being an approved organization within the meaning of Part IV of the Health Insurance Act 1973, hereby makes application under sub-section 41 (1) for approval of the health service described in the Schedule, being a health service provided, or to be provided, by the organization.

SCHEDULE

(Here insert description of health service and address or addresses at which the service is to be provided.)

Dated this  day of  19  .

.........................................................................

 (Signature of person authorized to sign application)

.........................................................................

(Position in organization)

Printed by Authority by the Government Printer of Australia