10Entitlement to Medicare benefit

10 Entitlement to Medicare benefit

(1) Where, on or after 1 February 1984, medical expenses are incurred in respect of a professional service rendered in Australia to an eligible person, medicare benefit calculated in accordance with subsection (2) is payable, subject to and in accordance with this Act, in respect of that professional service.

Note: For eligible person, medical expenses, medicare benefit and professional service see subsection 3(1).

(1A) For the purposes of subsection (1), a professional service that has, whether before or after the commencement of this subsection, been rendered to an eligible person in the course of a domestic journey is taken to have been rendered in Australia even if the person was outside Australia when the service was rendered. (1B) In subsection (1A):

domestic journey means a journey beginning at a place in Australia and ending at the same place, or at another place in Australia, without any intermediate stopping place outside Australia, and includes:

(a) such a journey that, when it began, was intended to end at a place outside Australia; and
(b) such a journey that is a part of a longer journey ending, or intended to end, at a place outside Australia; and
(c) such a journey that is part of a longer journey that began outside Australia.

(2) A benefit in respect of a service is: (a) in the case of a service provided: (i) as part of an episode of hospital treatment; or (ii) as part of an episode of hospital‑substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer; an amount equal to 75% of the Schedule fee; or (aa) in the case of a service to which paragraph (a) does not apply and that is prescribed by the regulations for the purposes of this paragraph—an amount equal to 100% of the Schedule fee; or (b) in any other case—an amount equal to 85% of the Schedule fee. (2A) Without limiting the generality of regulations for the purposes of paragraph (2)(aa), the regulations may prescribe services for the purposes of that paragraph by identifying, in the table, the services concerned. (3) If the Schedule fee exceeds the amount of benefit calculated under paragraph (2)(b) by more than the greatest permissible gap, the benefit is taken to be the Schedule fee less the greatest permissible gap. (4) If an amount calculated under subsection (2) is not a multiple of 5 cents, that amount is to be rounded up to the nearest multiple of 5 cents. (5) In this section:

greatest permissible gap means $50.00.