Health Legislation Amendment Act 1985 (Cth)
PART 1 —PRELIMINARY
Section
1. Short title
2. Commencement
PART II—AMENDMENTS OF THE HEALTH INSURANCE ACT 1973
3. Principal Act
4. Interpretation
5. Interpretation
6. Entitlement to medicare benefit
7. Medicare benefits not payable in respect of certain medical expenses
8. Daily bed payments
9. Prohibition of certain medical insurance
10. Schedule 2
PART III—AMENDMENTS OF THE NATIONAL HEALTH ACT 1953
11. Principal Act
12. Interpretation
13. Insertion of new section—
5. Tabling, disallowance, &c. of determinations made for the purposes of definition of “basic private table” in sub-section 4 (1)
14. Insertion of new section—
67. Health insurance business to be carried on only by registered organizations
TABLE
OF PROVISIONS—
Section
15. Application by organization for registration as health benefits organization
16. Reinsurance Account in health benefits fund
17. Directions by Minister to registered organizations
18. Exemption of benefits from basic table
19. Determination of certain hospital benefits by Secretary or Minister
20. Applications for review by Tribunal
21. Schedule
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BE IT ENACTED by the Queen, and the Senate and the House of Representatives of the Commonwealth of Australia, as follows:
5. Section 8 of the Principal Act is amended by omitting “and paragraph 17 (1) (aa)”.
(a) by inserting in paragraph (2) (a) “in the table” after “specified”;
(b) by omitting from paragraph (2) (a) “in the table”; and
(c) by inserting after sub-section (4) the following sub-section:
“(4a) A reference in sub-section (3) to a professional service does not include a reference to a professional service of the kind referred to in paragraph (da) of the definition of ‘basic private table’ or ‘basic table’ in sub-section 4 (1) of the
National Health Act 1953, being a professional service of that kind provided on or after 1 September 1985.”.
(a) by omitting paragraph (1) (aa); and
(b) by omitting sub-sections (1a) to (8) (inclusive).
“(5a)
This section does not apply in relation to a contract of insurance entered into
by a registered organization as insurer in so far as the contract provides for
benefits in accordance with the basic table (whether or not modified by an
election of the kind referred to in the condition set out in paragraph (ba) of
the Schedule to the
(a) by inserting after paragraph (d) of the definition of “basic private table” or “basic table” in sub-section (1) the following paragraphs:
“(da) in respect of a professional service rendered to a person who is an in-patient of a hospital or day hospital facility (being a professional service in respect of which medicare benefit is payable)—a benefit equal to—
(i) the amount (if any) by which the fee specified in the table in respect of the service in relation to the State in which the service is rendered exceeds the medicare benefit payable in respect of the service; or
(ii) if the medical expenses incurred in respect of the service are less than that fee, the amount (if any) by which the medical expenses exceed the medicare benefit payable in respect of the service;
(db) in respect of a day on which a person occupies a bed in a hospital, for a period that does not include part of an overnight stay, for the purpose of permitting the provision of professional attention to the person at the hospital—a benefit equal to—
(i) the amount determined by the Minister, in writing, for the purposes of this paragraph in relation to the State or Territory in which the hospital is situated or, if the Minister determines, in writing, another amount for the purposes of this paragraph in relation to the professional attention, or a class of professional attention in which the professional attention is included, in relation to the State or Territory, the other amount; or
(ii) if the charge made by the hospital in respect of the occupancy by the person of a bed in the hospital on that day is less than that amount or that other amount, as the case may be, the charge;
(dc) in respect of a day on which a person occupies a bed in a day hospital facility, for a period that does not include part of an overnight stay, for the purpose of permitting the provision of professional attention to the person at the day hospital facility, being professional attention, or professional attention included in a class of professional attention, determined by the Minister, in writing, to be professional attention or a class of professional attention, as the case may be, to which this paragraph applies—a benefit equal to—
(i) the amount determined by the Minister, in writing, for the purposes of this paragraph in relation to the State or Territory in which the day hospital facility is situated or, if the Minister determines, in writing, another amount for the purposes of this paragraph in relation to the professional attention, or a class of professional attention in which the professional attention is included, in relation to the State or Territory, the other amount; or
(ii) if the charge made by the day hospital facility in respect of the occupancy by the person of a bed in the day hospital facility on that day is less than that amount or that other amount, as the case may be, the charge;
(dd) in respect of a prosthesis provided to a person who is an in-patient in a hospital, being a prosthesis, or a prosthesis included in a class of prostheses, determined by the Minister, in writing, to be a prosthesis or a class of prostheses, as the case may be, to which this paragraph applies—a benefit equal to—
(i) the amount determined by the Minister, in writing, for the purposes of this paragraph in relation to the prosthesis, or a class of prostheses in which the prosthesis is included, in relation to the State or Territory in which the prosthesis is provided; or
(ii) if the charge made for the prosthesis is less than that amount, the charge;”;
(b) by inserting after the definition of “contributor” in sub-section (1) the following definition:
“ ‘day hospital facility’ means—
(a) premises registered as a hospital under a law of a State or Territory relating to the registration of hospitals; or
(b) premises, or premises included in a class of premises, prescribed for the purposes of this paragraph,
but does not include—
(c) a recognized hospital, a private hospital or a hospital declared by the Minister to be a hospital for the
purposes of the definition of ‘hospital’ in sub-section 3 (1) of the
Health Insurance Act 1973; or(d) premises, or premises included in a class of premises, prescribed for the purposes of this paragraph;”;
(c) by inserting after the definition of “guaranteed medical benefit” in sub-section (1) the following definition:
“ ‘in-patient’, in relation to a day hospital facility, means a person who occupies a bed in the day hospital facility for the purpose of permitting the provision of professional attention to the person at the day hospital facility;”; and
(d) by inserting after sub-section (1a) the following sub-sections:
“(1b) Where a person is an in-patient of a hospital or day hospital facility for a part of a day, the person shall, for the purposes of paragraph (da) of the definition of ‘basic private table’ or ‘basic table’ in sub-section (1), be deemed to have been an in-patient of the hospital or day hospital facility, as the case may be, for the whole of the day.
“(1ba) A Territory shall, for the purposes of paragraph (da) of the definition of ‘basic private table’ or ‘basic table’ in sub-section (1), be deemed to form part of the State of New South Wales.”.
“5. (1) The Minister shall cause to
be published in the
(a) the fact that the determination has been made; and
(b) the place or places where copies of the determination can be obtained.
“(2) A determination may make provision for or in relation to a matter by applying, adopting or incorporating, with or without modification—
(a) a provision of any Act or any regulation made under an Act or of any other determination as in force at a particular time or as in force from time to time; or
(b) any matter contained in any other instrument or writing as in force or existing at the time when the determination takes effect.
“(3) Sections 48 (other than
paragraph (1) (a)), 49 and 50 of the
“(4) Determinations are not
statutory rules within the meaning of the
“(5) For the purposes of section 5
of the
“(6) In this section, ‘determination’ means a determination made by the Minister for the purposes of the definition of ‘basic private table’ or ‘basic table’ in sub-section 4 (1).”.
“67. (1) A person (other than a registered organization) shall not carry on health insurance business.
“(2) A person who contravenes sub-section (1) is, in respect of each day on which the person contravenes that sub-section (including the day of a conviction of an offence against this sub-section or any subsequent day), guilty of an offence punishable on conviction by a fine not exceeding—
(a) if the person is a body corporate, $20,000; or
(b) if the person is a natural person, $2,000.
“(3) A person shall not be taken to contravene sub-section (1) by reason only that the person is carrying on business for the purpose of discharging liabilities assumed by the person before the commencement of this section.
“(4) In this section—
‘accident and sickness insurance business’ means the business of undertaking liability, by way of insurance, to pay a lump sum, or to make periodic payments, on the happening of a personal accident, disease or sickness, but does not include—
(a) any such business where liability is undertaken with respect to loss arising out of a liability to pay fees or charges in relation to the provision in Australia of hospital treatment or an ancillary health benefit; or
(b) business of a kind prescribed for the purposes of this paragraph;
‘ancillary health benefit’ means—
(a) relevant health services;
(b) services involving the supply, alteration, maintenance or repair of hearing aids, spectacles, contact lenses, artificial teeth, eyes or limbs (including parts of teeth or limbs) or other medical, surgical, prosthetic or dental aids, equipment or appliances;
(c) drugs or medicinal preparations;
(d) ambulance services;
(e) services by an attendant of a person who is sick or disabled; or
(f) any other benefit, or benefit included in a class of benefits, prescribed for the purposes of this paragraph,
but does not include—
(g) the rendering in Australia of a professional service for which medicare benefit is, or but for sub-section 18 (4) of the
Health Insurance Act 1973 would be, payable;(h) hospital treatment; or
(j) any other benefit, or benefit included in a class of benefits, prescribed for the purposes of this paragraph;
‘health insurance business’ means the business of undertaking liability, by way of insurance—
(a) with respect to loss arising out of a liability to pay fees or charges in relation to the provision in Australia of hospital treatment or an ancillary health benefit; or
(b) with respect to, or with respect to the happening of an occurrence connected with, the provision in Australia of hospital treatment or an ancillary health benefit,
but does not include—
(c) accident and sickness insurance business;
(d) liability insurance business; or
(e) business of a kind prescribed for the purposes of this paragraph;
‘hospital’ includes a day hospital facility;
‘hospital treatment’ means accommodation and nursing care for the purpose of permitting the provision of professional attention, and includes—
(a) the provision at, or on behalf of, a hospital of relevant health services to an in-patient of the hospital; and
(b) the provision at a hospital of a facility for an in-patient of the hospital;
‘insurance’ means insurance to which paragraph 51 (xiv) of the Constitution applies;
‘liability insurance business’ means the business of undertaking liability, by way of insurance, with respect to any loss arising out of a liability to pay compensation or damages, and includes motor vehicle insurance business and workers’ compensation insurance business;
‘motor vehicle insurance business’ means the business of undertaking liability, by way of insurance, with respect to any loss arising out of a liability to pay compensation or damages by reason of the use of a motor vehicle;
‘relevant health services’ means medical, surgical, diagnostic, nursing, dental, chiropody, chiropractic, eye therapy, occupational therapy, physiotherapy, speech therapy or similar services or treatment;
‘workers’ compensation insurance business’ means the business of undertaking liability, by way of insurance, with respect to any loss
arising out of a liability to pay compensation or damages to an employee by reason of an event occurring in circumstances connected with the employee’s employment.”.
(a) by inserting after sub-section (2) the following sub-sections:
“(2a) Paragraph (2) (c) does not apply to an organization that—
(a) was not a registered organization immediately before the commencement of this sub-section;
(b) is carried on for the purposes of profit or gain to the individual members or shareholders of the organization; and
(c) applies for registration as a registered organization in respect of the State concerned within the period of 6 months after the day of that commencement or such further period as the Minister (whether before or after the expiration of that period of 6 months), by notice in writing served on the organization, allows.
“(2b) The regulations may provide that a specified provision of this Act does not apply, or applies with prescribed modifications, in relation to an organization referred to in sub-section (2a).
“(2c) The power conferred by sub-section (2b) to make modifications by regulation includes the power to omit any matter or add any new matter.”;
(b) by omitting from paragraph (3) (b) “the last preceding sub-section” and substituting “sub-section (2)”; and
(c) by inserting in paragraph (3) (b) “in that sub-section and sub-section (2a)” after “references” (last occurring).
(a) by omitting sub-section (2) and substituting the following sub-section:
“(2) For the purposes of this section, where benefits have been paid, or are payable, by a registered organization to a contributor, in accordance with a basic table (whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba) of the Schedule), in respect of the provision of treatment, a service or another matter on any day—
(a) if the matter was provided for 1 person only—that day counts as 1 patient day of the contributor; or
(b) if such a matter was provided for 2 or more persons—that day counts, subject to sub-section (8), as a number of patient days of the person equal to the number of those persons.”;
(b) by inserting in sub-section (4) “(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba) of the Schedule)” after “basic table”;
(c) by omitting from sub-section (8) “hospital treatment being received by” and substituting “matters being provided for”;
(d) by omitting from sub-section (8) “hospital treatment provided” and substituting “the matters provided”; and
(e) by inserting after sub-section (8) the following sub-section:
“(9) This section does not apply to benefits included in a class of benefits prescribed for the purposes of this sub-section.”.
“(5) Without limiting the generality of sub-section (1), the directions that may be given by the Minister by virtue of paragraph (1) (b) include directions with respect to the scope and level of benefits that may be offered to contributors in lieu of the benefits that are payable in accordance with a basic table.”.
(a) by omitting from sub-section (1) all the words after “or to be conducted, by” and substituting “it, any benefits, or any benefits included in a class of benefits, specified in the application (other than benefits that the Secretary or the Minister determines, under section 73g, are to be payable)”;
(b) by inserting in paragraph (2b) (a) “(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba) of the Schedule)” after “basic table”; and
(c) by omitting from sub-section (2b) in respect of the provision of hospital treatment,” and substituting “(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba) of the Schedule)”.
“(1) An application may be made to the Tribunal for review of a decision of the Minister under paragraph 68 (2a) (c).
“(1a) An application may be made to the Tribunal for review of a decision of the Minister under section 73 refusing an application for registration of the organization.”.
(a) by omitting from paragraph (b):
“The organization”,
and substituting—
“Subject to the condition set out in paragraph (ba), the organization”;
(b) by inserting after paragraph (b) the following paragraphs:
“(ba) Where—
(i) the organization offers contributors of a health benefits fund conducted by it lesser benefits in lieu of the benefits that are payable in accordance with the basic table; and
(ii) a contributor to the health benefits fund elects, in accordance with the rules of the organization, to contribute for those lesser benefits,
the organization will permit the contributor to contribute for benefits in respect of the contributor and the contributor’s dependants (if any) in accordance with the basic table as modified by the election.
(bb) The organization will permit a contributor to a health benefits fund conducted by the organization, being a contributor who has made an election of the kind referred to in the condition set out in paragraph (ba), to revoke the election, but may, subject to the condition set out in paragraph (be), provide for a waiting period before such an election (whether made to the organization or to another organization) ceases to have effect (whether by reason of revocation or otherwise).
(bc) Where the rules of the organization provide for a waiting period before an election made by a contributor, being an election of the kind referred to in the condition set out in paragraph (ba), ceases to have effect, the waiting period will not exceed—
(i) in relation to benefits in respect of a matter related to a pre-existing ailment, being an ailment included in ailments of a kind determined by the Minister to be ailments to which the condition set out in paragraph (k) applies— 12 months;
(ii) in relation to benefits in respect of a matter related to an obstetric condition—9 months; or
(iii) in relation to benefits in respect of any other matter—2 months.”;
(c) by omitting from paragraph (d):
“or other service”
(first occurring) and substituting—
“of a kind referred to in paragraph (a) or (d) of the definition of “basic private table’ or ‘basic table’ in sub-section 4(1)”;
(d) by omitting from paragraph (d):
“or other service”
(last occurring);
(e) by adding at the end of paragraph (f):
“(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba))”;
(f) by inserting in paragraph (g):
“(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba))”
after “table” (wherever occurring);
(g) by inserting in paragraph (j):
“(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba))”
after “table”;
(h) by omitting from sub-paragraph (j) (i):
“hospital treatment or other service”
and substituting—
“a matter”;
(j) by omitting from sub-paragraph (j) (ii):
“hospital treatment or other service”
and substituting—
“matter”;
(k) by inserting in paragraph (k):
“(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba))”
after “basic table” (first and second occurring);
(m) by omitting from sub-paragraphs (k) (i) and (ii):
“24”
and substituting—
“12”;
(n) by omitting from paragraph (1):
“The organization”
and substituting—
“Subject to the condition set out in paragraph (bb), the organization”;
(o) by inserting in paragraph (1):
“(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba))”
after “table”;
(p) by inserting in sub-paragraphs (m) (i) and (ii):
“(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba))”
after “table”;
(q) by omitting from sub-paragraph (m) (ii):
“or”;
(r) by inserting after sub-paragraph (m) (ii) the following sub-paragraph:
“(iia) whether or not the contributor is entitled to make or revoke an election of the kind referred to in the condition set out in paragraph (ba); or”;
(s) by omitting from paragraph (o):
“hospital treatment”
and substituting—
“benefits”;
(t) by inserting in sub-paragraph (p) (ii):
“(whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba))”
after “basic table” (wherever occurring); and
(u) by omitting from paragraph (p):
“a basic table”
(last occurring) and substituting—
“the first-mentioned basic table”.
(a) the following paragraph were inserted after paragraph (h):
“(ha) The rules of the organization shall not provide for a waiting period with respect to contributors for benefits in accordance with a basic table (whether or not modified by an election of the kind referred to in the condition set out in paragraph (ba)) otherwise than for—
(i) benefits in respect of a matter related to a pre-existing ailment, being an ailment included in ailments of a kind determined by the Minister to be ailments to which the condition set out in paragraph (k) applies; or
(ii) in respect of a matter related to an obstetric condition.”; and
(b) paragraph (j) (ii) were omitted.
1. No. 42, 1974, as amended. For previous amendments, see No. 58, 1975; Nos. 59, 91, 101, 109 and 157, 1976; No. 75, 1977; Nos. 36, 89 and 133, 1978; Nos. 53 and 123, 1979; No. 132, 1980; Nos. 118 and 176, 1981; Nos. 49, 80 and 112, 1982; Nos. 54 and 139, 1983; and Nos. 15, 46, 63, 120, 135 and 165, 1984.
2. No. 95, 1953, as amended. For previous amendments, see No. 68, 1955; Nos. 55 and 95, 1956; No. 92, 1957; No. 68, 1958; No. 72, 1959; No. 16, 1961; No. 82, 1962; No. 77, 1963; No. 37, 1964; Nos. 100 and 146, 1965; No. 44, 1966; Nos. 14 and 100, 1967; No. 100, 1968; No. 102, 1969; No. 41, 1970; No. 85, 1971; No. 114, 1972; Nos. 49 and 202, 1973; No. 37, 1974; Nos. 1, 13 and 93, 1975; Nos. 1, 60, 91, 99, 108, 157 and 177, 1976; Nos. 98 and 100, 1977; Nos. 36, 88, 132 and 189, 1978; Nos. 54, 91 and 122, 1979; Nos. 117 and 131, 1980; Nos. 40, 74, 92, 118, 163 and 176, 1981; Nos. 49, 80 and 112, 1982; Nos. 35, 54 and 139, 1983; and Nos. 46, 63, 72, 120, 135 and 165, 1984.
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House of Representatives on 15 May 1985
Senate on 28 May 1985
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