10ACAExtended safety‑net—families

10ACA Extended 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.

year means a calendar year.

(2) Subject to this Act, if this section applies to a claim (the current claim), the benefit payable in respect of the claim is increased by 80% of the out‑of‑pocket expenses for the current claim. (3) The out‑of‑pocket expenses for a claim are: (a) the medical expenses incurred in respect of a relevant service for which the claim is made; reduced by: (b) any amounts payable under any other section of this Act in respect of those expenses. (4) This section applies to the current claim if: (a) the current claim is a claim that is made by a claimant for a benefit in respect of a relevant service which was rendered to the claimant or to a member of the claimant’s registered family; and (b) the medical expenses incurred in respect of the relevant service are incurred in a year (the expense year); and (c) the claimant has paid at least 20% of the out‑of‑pocket expenses for the service directly to the person by whom, or on whose behalf, the service was rendered; and (d) the current claim is accepted by the Chief Executive Medicare; and (e) one or more of the following apply to the claim: (i) the person to whom the service was rendered is a concessional person in relation to the expense year at the time that the claim is made and the concessional safety‑net applies to the current claim; (ii) the person to whom the service was rendered is a member of an FTB(A) family in relation to the expense year at the time that the claim is made and the FTB(A) safety‑net applies to the current claim; (iii) the extended general safety‑net applies to the current claim.

Note: Subsection 10AC(3) deals with a person being a member of more than one family.

(5) A safety‑net mentioned in paragraph (4)(e) applies to the current claim if the Chief Executive Medicare is satisfied at the time when the current claim was accepted for payment that the sum of the out‑of‑pocket expenses for the current claim and all relevant prior claims for a safety‑net for the expense year is equal to or exceeds the applicable safety‑net amount. (6) A claim is a relevant prior claim for a safety‑net for the expense year if: (a) the claim has been made for benefit in respect of relevant services which were rendered to: (i) for the concessional safety‑net—any member of the family who is a concessional person in relation to the expense year at the time that the current claim is made; and (ii) for the FTB(A) safety‑net or the extended general safety‑net—any person who is a member of the family at the time that the current claim is made; and (b) the claim is related to medical expenses incurred during the expense year; and (c) the claim was accepted for payment by the Chief Executive Medicare before the time when the current claim was accepted for payment; and (d) the Chief Executive Medicare is satisfied at the time when the current claim was accepted for payment that the out‑of‑pocket expenses for the claim have been paid. (7) If: (a) this section applies to the current claim; but (b) the sum of the out‑of‑pocket expenses for all relevant prior claims for the expense year is less than the applicable safety‑net amount; the benefit payable in respect of the claim is not increased under subsection (2) but is instead increased by the amount worked out using the formula: