10ACSafety‑net—families

#### 10AC Safety‑net—families (1) In this section: > relevant service means a service: (a) in respect of which benefit is payable; and (b) the medical expenses in respect of which exceed the amount of benefit that, apart from this section, would be payable in respect of the service; but does not include a service rendered to a person while hospital treatment, or hospital‑substitute treatment in respect of which the person chooses to receive a benefit from a private health insurer, is provided to the person, being a service of that kind provided on or after 1 September 1985. > year means the year beginning on 1 January 1992 or a later year beginning on 1 January. (2) Subject to this Act, if: (a) a claim (in this subsection called the threshold claim) for benefit is made by a claimant in respect of a relevant service: (i) which was rendered to the claimant or to a member of the claimant’s registered family; and (ii) in respect of which the medical expenses are incurred in a year; and the claim is accepted by the Chief Executive Medicare; and (b) other claims (in this subsection called prior claims) have been made for benefit in respect of relevant services: (i) which were rendered to any member of the family; and (ii) in respect of which the medical expenses were incurred during the year; and the prior claims were accepted for payment by the Chief Executive Medicare before the time when the threshold claim was accepted for payment (in this subsection called the relevant time); and (c) the Chief Executive Medicare is satisfied at the relevant time that: (i) the medical expenses of the services relating to the threshold claim and to some or all of the prior claims have been paid; and (ii) the sum of the patient contributions that have been paid in respect of those prior claims is less than the safety‑net amount for that year; and (iii) the sum of the patient contribution in respect of the threshold claim and the patient contributions referred to in subparagraph (ii) is equal to or exceeds the safety‑net amount; the benefit payable in respect of a relevant service rendered to any of the family and in respect of which medical expenses were incurred in respect of that year (being the service to which the threshold claim relates or any service that is not the subject of a prior claim referred to in paragraph (b)) is increased by the amount of the patient contribution in respect of that relevant service. (2A) The patient contributions under subparagraph (2)(c)(ii) (including for the purpose of subparagraph (2)(c)(iii)) are to be reduced by so much of those patient contributions as have been paid as increased benefits under section 10ACA. For this purpose, an amount of a patient contribution is taken to have been paid as an increased benefit under section 10ACA to the extent that the amount of the increase in the benefit payable for the relevant service exceeds the difference between the total medical expenses incurred in respect of the relevant service and the Schedule fee for the relevant service. (3) Where at any time a child is simultaneously a member of 2 families registered in respect of a year: (a) if the Chief Executive Medicare is satisfied that a medical expense incurred at that time in respect of the child has been incurred by an adult belonging to one or other of the families—that expense is to be treated, for the purposes of this Act, as an expense incurred in respect of the child as a member of that family; and (b) if the Chief Executive Medicare is not so satisfied—the expense is to be treated as an expense of which half was incurred in respect of the child as a member of one family and half in respect of the child as a member of the other family. (4) If a family becomes registered before 1 April 1992, this section extends to a benefit that was paid or payable before the registration in respect of a service for which medical expenses were incurred before that date. (5) If a family becomes registered after 31 March 1992, this section applies only to a benefit that becomes payable after the registration, even though expenses incurred before the registration in the year the family becomes registered may be taken into account for the purposes of paragraph (2)(c). (6) For the purposes of this section, without affecting the meaning of an expression in any other provision of this Act: (a) if a person to whom benefit is payable in respect of a relevant service is given or sent a cheque under subsection 20(2) or (2A) for the amount of the benefit, the person is taken to have paid so much of the medical expenses in respect of that service as is represented by the amount of the benefit; and (b) despite anything else in this Act, the question when medical expenses are incurred in respect of services relating to prescribed items is to be determined under the regulations. (7) For the purposes of this section, disregard section 19AD when determining whether medicare benefit is payable. However, this section does not authorise payment of medicare benefit contrary to section 19AD.