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EXPLANATORY STATEMENT

STATUTORY RULES 1982 NO. 372

NATIONAL HEALTH (PHARMACEUTICAL BENEFITS)

REGULATIONS (AMENDMENT)

Issued by the authority of the Minister for Health

Section 140 of the National Health Act 1953 provides that the Governor-General may make regulations, not inconsistent with the Act, prescribing all matters which by the Act are required or permitted to be prescribed, or which are necessary or convenient to be prescribed for carrying out or giving effect to the Act.

The Health Legislation Amendment Act (No. 2) 1982, (No. 112 of 1982), amended Part VII of the National Health Act 1953 in order to introduce a three-tier system of patient contribution under the Pharmaceutical Benefits Scheme with effect from 1 January 1983. The Regulations are necessary to amend the National Health (Pharmaceutical Benefits) Regulations to give effect to this system.

Under this three-tier system, a new class of beneficiary is provided for in Section 84 of the Act, in addition to those persons eligible for pharmaceutical benefits free of charge or at the general contribution rate. This new class, the ‘Concessional Beneficiary’ is required

under Section 87 of the Act to pay an amount which has been set initially at 50% of the general contribution rate of $4.00 for each benefit item. Under Section 84 of the Act, a concessional beneficiary is defined as a person who is being paid an age, inavlid or widow’s pension, a supporting parent’s benefit, a sheltered employment allowance or a rehabilitation allowance under the Social Security Act; a service pension under the Repatriation Act 1920; or other persons who are disadvantaged within the meaning of the Health Insurance Act 1973; and their dependants, who would, if it were not for the application of the income test, be included within the definition of pensioner in the National Health Act.

To clearly identify patient eligibility under the new system, Section 84AA provides that it is the responsibility of the patient or his agent, either of whom must be at least 12 years of age, to establish eligibility by means of a declaration on the back of the prescription form.

Until the commencement of the amending provisions, persons other than pensioners must pay the prescribed maximum amount of $3.20 for a pharmaceutical benefit. As from 1 January 1983 the Act will no longer include


This adjustment of the charges is to recover part of the increasing costs involved in the education of overseas students in Australia.

Regulation 3 also ensures that certain students whose enrolment spans two or more consecutive calendar years (e.g. May to May or November to November) are not required to pay a charge in excess of that required for one calendar year in respect of the year in which the student commences the course and the year in which the student completes the course.

Sub-section 7(2) of the Act contains transitional provisions to exempt an overseas student from the charge so that where a student was enrolled in a prescribed course for a year before 1 January 1980, commenced or commences to undertake that course in that year and was or is enrolled in that course for each succeeding year, the charge is not payable in respect of his enrolment for any year in that course or any other prescribed course that, in accordance with the regulations, is to be treated for the purposes of the sub-section as being the same course as the first-mentioned course.


Sub-section 7A(3) of the Act, as amended, contains transitional provisions to exempt an overseas student from the charge so that where a student has commenced or commences and continues to undertake a course that is declared for the purposes of the Act, the charge is not payable in respect of his enrolment for any year in that course or any other prescribed course that, in accordance with the regulations, is to be treated for the purposes of the section as being the same course as the first-mentioned course.

Regulation 4 of the Overseas Students Charge Regulations provided, for the purposes of sub-section 7(2) of the Act, that certain courses are to be treated as being the same.

Regulation 4 amends regulation 4 of the Overseas Students Charge Regulations so that the concessions granted by sub-section 7A(3) of the Act are the same for students undertaking declared courses as those granted by sub-section 7(2) of the Act.

Under regulation 1 the abovementioned amendments come into operation on 1 January 1983.

Overview

The National Health (Pharmaceutical Benefits) Regulations (Amendment) Statutory Rules 1982 No. 372 were enacted to amend the National Health (Pharmaceutical Benefits) Regulations and introduce a three-tier system of patient contribution under the Pharmaceutical Benefits Scheme, effective from 1 January 1983. This initiative was a response to the Health Legislation Amendment Act (No. 2) 1982, which sought to provide a more nuanced approach to patient contributions. The primary objective of these regulations is to establish a concessional beneficiary class who pay 50% of the general contribution rate for pharmaceutical benefits, thereby addressing the growing costs of healthcare. Additionally, the regulations mandate that patients or their agents establish eligibility for these concessions through a declaration on the prescription form. These amendments were issued under the authority of the Minister for Health and are intended to facilitate the implementation of the new patient contribution system, ensuring that it aligns with the overarching objectives of the National Health Act 1953.

Scope and Application

The National Health (Pharmaceutical Benefits) Regulations (Amendment) Statutory Rules 1982 No. 372 pertain to the amendments introduced by the Health Legislation Amendment Act (No. 2) 1982, which introduced a three-tier system of patient contributions under the Pharmaceutical Benefits Scheme. These regulations apply to individuals and entities involved in the dispensing and administration of pharmaceutical benefits within Australia. The new three-tier system includes a concessional beneficiary class, defined by the Act, who must pay 50% of the general contribution rate. The responsibility of establishing eligibility for these concessions lies with the patient or their agent, who must be at least 12 years of age. These regulations apply nationally across Australia as they are an amendment to the National Health Act 1953, which operates under Commonwealth jurisdiction. There are no exclusions or exemptions specified within the text, and the application of these regulations extends to any relevant subordinate instruments that may be issued under the authority of the Minister for Health.

Key Provisions

The National Health (Pharmaceutical Benefits) Regulations (Amendment) under the National Health Act 1953 introduces a three-tier system for patient contributions in the Pharmaceutical Benefits Scheme (PBS) as of 1 January 1983. This system includes a new class of beneficiaries known as "Concessional Beneficiaries," who are required to pay 50% of the general contribution rate of $4.00 for each benefit item (Section 84, 87). Concessional beneficiaries are defined as those receiving specific payments under the Social Security Act, Repatriation Act 1920, or who are considered disadvantaged under the Health Insurance Act 1973, and their dependants (Section 84AA). The responsibility to establish eligibility for this concession falls on the patient or their agent, who must be at least 12 years of age. These Regulations impose several obligations on the parties involved. Patients or their agents must accurately declare their eligibility for concessional benefits on the prescription form. Healthcare providers, in turn, are required to verify the eligibility declaration before processing prescriptions. The amendment also mandates that concessional beneficiaries pay the specified reduced contribution rate, rather than the full general contribution rate of $8.00. For non-compliance, the Regulations do not explicitly outline specific offences, penalties, or consequences. However, failure to accurately declare eligibility could lead to improper financial benefits, potentially resulting in legal repercussions for fraudulent claims. The accuracy and completeness of declarations are critical to avoid any discrepancies that could lead to financial liabilities or investigations by relevant authorities.

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