23Simplified outline of this Part

23 Simplified outline of this Part

To help certain medical practitioners meet the costs of purchasing medical indemnity, amounts are payable for each premium year to medical indemnity insurers with contracts of insurance providing professional indemnity cover for the practitioners.

For an amount to be payable, the practitioner concerned must:

(a) be a procedural general practitioner practising in a rural area; or

(b) have gross indemnity costs (for the cover) more than 7.5% of the practitioner’s private practice income; or

(c) if the premium year is the year after 1 July 2020—be a practitioner who would have been a member with a MISS entitlement under the old scheme if that scheme had not ceased to be in force.

The amount payable generally depends on the practitioner’s circumstances and private practice income for the year concerned.

The insurer may apply for the payment either:

(a) before, or within 14 months after, the start of the year, on the basis that it is reasonable to expect that the payment will be payable; or

(b) within 13 months after the end of the year, on the basis of the practitioner’s actual circumstances for the year.

The amount payable on the basis of the practitioner’s actual circumstances for the year is reduced by any amount paid on the basis that it was reasonable to expect that an amount would be payable.

The insurer must comply with certain conditions. They include:

(a) asking all medical practitioners it insures whether they want such payments made to the insurer if the practitioners meet the conditions for the payments to be made; and

(b) repaying amounts in certain circumstances.

Practitioners and insurers may apply for review of decisions about whether an amount is payable and how much is payable.