Commonwealth Consolidated Acts

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HEALTH INSURANCE ACT 1973 - SECT 20A

Assignment of Medicare benefit

             (1)  Where a medicare benefit is payable to an eligible person in respect of a professional service rendered to the eligible person or to another eligible person, the first-mentioned eligible person and the person by whom, or on whose behalf, the professional service is rendered (in this subsection referred to as the practitioner ) may enter into an agreement, in accordance with the approved form, under which:

                     (a)  the first-mentioned eligible person assigns his or her right to the payment of the medicare benefit to the practitioner; and

                     (b)  the practitioner accepts the assignment in full payment of the medical expenses incurred in respect of the professional service by the first-mentioned eligible person.

             (2)  Where a practitioner determines that a pathology service is necessary to be rendered to an eligible person, the person to whom medicare benefit would be payable in respect of that service may, in accordance with the approved form, make an offer to the approved pathology practitioner by whom, or on whose behalf, the pathology service is to be rendered to enter into an agreement with him or her under subsection (1), when the pathology service is so rendered, with respect to the medicare benefit payable in respect of the pathology service so rendered.

          (2A)  If:

                     (a)  a medicare benefit would, apart from this section, be payable to an eligible person in respect of a professional service rendered to the eligible person or another person while hospital treatment or hospital-substitute treatment is provided to the eligible person or other person; and

                     (b)  the eligible person has entered into a complying health insurance policy with a private health insurer under which he or she is covered (wholly or partly) for liability to pay fees and charges in respect of that professional service;

the eligible person and the insurer, an approved billing agent or another person may enter into an agreement, in accordance with the approved form, under which the eligible person assigns his or her right to the payment of the medicare benefit to the insurer, approved billing agent or other person.

             (3)  Where an assignment under this section takes effect, or an agreement under this section is entered into, with respect to a medicare benefit, the medicare benefit is, subject to section 20B, payable in accordance with the assignment or the agreement, as the case may be.

          (3A)  A medicare benefit payable under subsection (3) shall be paid in such manner as the Chief Executive Medicare determines.

          (3B)  Without limiting subsection (3A), a determination under that subsection may provide for a medicare benefit that is payable under subsection (3) to be paid, in such circumstances and subject to such conditions as are prescribed by the regulations, by means of the electronic transmission of the amount of the benefit to an account kept with a bank.

             (4)  A reference in this section to a person by whom a professional service is rendered shall be read as not including a reference to a person (in this subsection referred to as the agent ) who renders a professional service (other than a pathology service) on behalf of another person or of an organization, but the agent may, if so authorized by that other person or that organization, on behalf of that other person or that organization, enter into an agreement under subsection (1).

          (4A)  Where:

                     (a)  a pathology service is rendered by or on behalf of an approved pathology practitioner; and

                     (b)  the approved pathology practitioner is acting, in relation to the rendering of the pathology service, on behalf of another person;

the pathology service shall be deemed, for the purposes of this section, not to have been rendered on behalf of that other person.

             (5)  An assignment of a medicare benefit shall not be made except in accordance with this section.



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