{"id":"F2025L01568","name":"Health Insurance (Share by Default) Rules 2025","slug":"health-insurance-share-by-default-rules-2025","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443084,"registerId":"F2025L01568-fast-fetch-1775957992623","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance (Share by Default) Rules 2025","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n![Commonwealth Coat of Arms of Australia](image.001.jpeg)\n\n \n\nHealth Insurance (Share by Default) Rules 2025\n\nI, Mark Butler, Minister for Health and Ageing, make the following rules.\n\nDated 09 December 2025\n\nMark Butler\n\nMinister for Health and Ageing\n\n \n\n \n\n \n\n \n\nContents\n\nPart 1—Preliminary\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Definitions\n\nPart 2—Sharing health information by default\n\nDivision 1—Diagnostic imaging services\n\n5 Diagnostic imaging services—specified professional services and persons\n\n6 Diagnostic imaging services—information to be shared with the My Health Record system\n\n7 Diagnostic imaging services—period for sharing information with the My Health Record system\n\nDivision 2—Pathology services\n\n8 Pathology services—specified professional services and persons\n\n9 Pathology services—information to be shared with the My Health Record system\n\n10 Pathology services—period for sharing information with the My Health Record system\n\n \n\nPart 1—Preliminary\n\n \n\n1  Name\n\n  This instrument is the Health Insurance (Share by Default) Rules 2025.\n\n2  Commencement\n\n (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provisions Commencement Date/Details\n- 1. The whole of this instrument 1 July 2026. 1 July 2026\n\n\nNote: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.\n\n3  Authority\n\n  This instrument is made under the Health Insurance Act 1973.\n\n4  Definitions\n\nNote: A number of expressions used in this instrument are defined in the Act, including the following:\n\n(a) approved pathology practitioner;\n\n(b) My Health Record system;\n\n(c) pathologist‑determinable service;\n\n(d) pathology service;\n\n(e) R‑type diagnostic imaging service.\n\n  In this instrument:\n\nAct means the Health Insurance Act 1973.\n\nradiologist means a medical practitioner recognised as a specialist in diagnostic radiology:\n\n (a) under subsection 3D(1) of the Act; or\n\n (b) by a determination under paragraph 3DB(4)(a) or subsection 3E(1) of the Act that is in effect.\n\nPart 2—Sharing health information by default\n\nDivision 1—Diagnostic imaging services\n\n5  Diagnostic imaging services—specified professional services and persons\n\n (1) For the purposes of subsection 19AD(1) of the Act, this section specifies professional services rendered by or on behalf of persons specified for the service.\n\n (2) The specified services and persons are:\n\n (a) an R‑type diagnostic imaging service referred to in an item of the table in Part 2 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 that is rendered by or on behalf of a radiologist; and\n\n (b) a medical service referred to in an item of the table in Part 4 of Schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2021 that is rendered by or on behalf of a radiologist; and\n\n (c) a health service that:\n\n (i) under a determination in force under subsection 3C(1) of the Act is treated as if it were an item in a table mentioned in paragraph (a) or (b) of this subsection related to the health service; and\n\n (ii) is rendered by or on behalf of a radiologist.\n\n6  Diagnostic imaging services—information to be shared with the My Health Record system\n\n (1) For the purposes of subsection 19AD(1) of the Act, the specified information for a professional service specified in section 5 of this instrument is information that is included in a report or other document that is:\n\n (a) created in respect of that professional service; and\n\n (b) authorised by the radiologist who rendered the service, or on whose behalf the service was rendered.\n\nNote: The information is required to be shared with the My Health Record system for medicare benefit to be payable for the service, unless an exception applies.\n\n (2) Subsection (1) does not apply to images.\n\n7  Diagnostic imaging services—period for sharing information with the My Health Record system\n\n (1) For the purposes of subsection 19AD(1) of the Act, this section specifies the period within which information specified in section 6 of this instrument for a professional service must be shared with the My Health Record system.\n\n (2) The specified period is the period of 24 hours beginning at the time the information is first provided to:\n\n (a) the practitioner who requested the provision of the professional service; or\n\n (b) if there was no such request—the practitioner who is treating the person to whom the information relates.\n\nDivision 2—Pathology services\n\n8  Pathology services—specified professional services and persons\n\n (1) For the purposes of subsection 19AD(1) of the Act, this section specifies professional services rendered by or on behalf of persons specified for the service.\n\n (2) The specified services and persons are:\n\n (a) a pathology service referred to in an item of the table in Part 2 of Schedule 1 to the Health Insurance (Pathology Services Table) Regulations 2020 rendered by or on behalf of an approved pathology practitioner; and\n\n (b) a health service that:\n\n (i) under a determination in force under subsection 3C(1) of the Act is treated as if it were an item in the table mentioned in paragraph (a) of this subsection related to the health service; and\n\n (ii) is rendered by or on behalf of an approved pathology practitioner; and\n\n (c) a pathologist‑determinable service rendered by or on behalf of an approved pathology practitioner.\n\n9  Pathology services—information to be shared with the My Health Record system\n\n  For the purposes of subsection 19AD(1) of the Act, the specified information for a professional service specified in section 8 of this instrument is information that is included in a report or other document that is:\n\n (a) created in respect of that professional service; and\n\n (b) authorised by the approved pathology practitioner who rendered the service, or on whose behalf the service was rendered.\n\nNote: The information is required to be shared with the My Health Record system for medicare benefit to be payable for the service, unless an exception applies.\n\n10  Pathology services—period for sharing information with the My Health Record system\n\n (1) For the purposes of subsection 19AD(1) of the Act, this section specifies the period within which information specified in section 9 of this instrument for a professional service must be shared with the My Health Record system.\n\n (2) The specified period is the period of 24 hours beginning at the time the information is first provided to:\n\n (a) the practitioner who requested the provision of the professional service; or\n\n (b) if there was no such request—the practitioner who is treating the person to whom the information relates.\n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":5,"scope_assessment":{"changed":true,"description":"The instrument narrows and operationalises subsection 19AD(1) of the Act by specifying which diagnostic imaging and pathology professional services—and what information (authorised reports, excluding images)—must be shared, and by imposing a 24‑hour upload deadline as a condition of Medicare benefit. It therefore alters the operational scope of information‑sharing obligations by turning general statutory authority into specific, time‑bound requirements (see ss.5–7 and 8–10)."},"complexity_factors":["Extensive cross-references to the Health Insurance Act 1973 and multiple external tables and determinations (ss.3, 5(a)–(b), 8(a))","Technical definitions and reliance on statutory terms (eg. 'R-type diagnostic imaging service', 'approved pathology practitioner') defined elsewhere (s.4)","Strict, short timeframe for required uploading (24 hours) creates operational and IT timing constraints (ss.7(2), 10(2))","Conditioning of Medicare benefit on compliance introduces administrative and financial incentives and penalties for providers (notes to ss.6 and 9)","Delegation of 'authorisation' to the rendering practitioner creates discretionary judgement about what is shared (ss.6(1), 9)","Exclusion of images while requiring reports may create workflow and scope‑of‑data decisions for providers (s.6(2))","References to determinations treating services 'as if' in a listed table create potential edge cases and interpretive complexity (ss.5(2)(c), 8(2)(b))"],"plain_english_summary":"This rule makes sharing authorised pathology and diagnostic-imaging reports to the My Health Record system a condition for Medicare benefits for services rendered by radiologists and approved pathology practitioners. Images are excluded. Reports created and authorised by the practitioner must be uploaded within 24 hours of first being provided to the requesting or treating practitioner. It shifts compliance costs and timing onto those practitioners and ties Medicare payment to electronic sharing (see ss.5–7 and 8–10)."},"flash_summary_failed":{"failed":true,"reason":"Unauthenticated. Configure AI_GATEWAY_API_KEY or use a provider module. Learn more: https://ai-sdk.dev/unauthenticated-ai-gateway","source":"analysis-cron"},"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument appears to be implementing a specific, narrow policy objective (mandatory sharing of diagnostic reports to My Health Record) under the existing authority of section 19AD of the Health Insurance Act 1973. The scope aligns with the stated purpose of the enabling provision and does not appear to have expanded beyond the original legislative intent for 'share by default' mechanisms."},"complexity_factors":["Short instrument (10 sections total)","Minimal defined terms (only 2 defined in the instrument: 'Act' and 'radiologist')","Heavy reliance on external references (cross-references to Health Insurance Act 1973, Diagnostic Imaging Services Table Regulations, Pathology Services Table Regulations, and General Medical Services Table Regulations)","Simple conditional structure (if service rendered by X, then share Y within Z timeframe)","No nested exceptions or complex logical operators within the instrument itself (though exceptions exist in the parent Act)","Parallel structure between Division 1 (Diagnostic Imaging) and Division 2 (Pathology) makes it readable but repetitive"],"plain_english_summary":"This rule requires radiology and approved pathology reports for specified Medicare services to be uploaded to My Health Record within 24 hours of being sent to the requesting/treating doctor as a condition of receiving Medicare rebates. It creates a share-by-default system affecting radiologists, approved pathology practitioners, ordering doctors and Medicare patients.\n\nOnly reports/documents (not raw images) are mandated; limited exceptions apply."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-share-by-default-rules-2025","history":"/api/acts/health-insurance-share-by-default-rules-2025/history","analysis":"/api/acts/health-insurance-share-by-default-rules-2025/analysis","conflicts":"/api/acts/health-insurance-share-by-default-rules-2025/conflicts","importantCases":"/api/acts/health-insurance-share-by-default-rules-2025/important-cases","documents":"/api/acts/health-insurance-share-by-default-rules-2025/documents"}}