26General conditions

26 General conditions

Basic rule (1) An amount is payable to a medical indemnity insurer on behalf of a medical practitioner for a premium year if: (a) there is a contract of insurance between the insurer and the practitioner that provides professional indemnity cover for the practitioner in relation to a premium period in the year; and (b) the practitioner is an eligible medical practitioner for a premium period in the year because of the contract; and (c) the practitioner: (i) has agreed to the payment of the amount to the insurer on behalf of the practitioner; and (ii) has given the insurer the information (relevant to determining whether the amount is payable and how much the amount is) requested by the insurer in the form, and within the time, requested by the insurer; and (iii) if the Chief Executive Medicare has, under section 44 of the Act, made a request of the practitioner for information relevant to determining whether the amount is payable or how much the amount is—has complied with the request; and (iv) has paid the insurer the difference between the premium for the contract and the amount; and (d) the insurer complies with the requirements in Division 6 (Conditions to be complied with by insurers) so far as they can be complied with before the amount is paid (whether or not the requirements relate only to the practitioner); and (e) the insurer makes a complying application in accordance with Subdivision B of Division 4 for a subsidy to be paid to the insurer on behalf of the practitioner for the year.

Note: The amount payable under this subsection may be reduced (possibly to nil) if an amount is payable under subsection (2) and paid to the insurer on behalf of the practitioner: see section 45.

Advance payment based on reasonable expectation (2) Also, an amount is payable to a medical indemnity insurer on behalf of a medical practitioner for a premium year if: (a) the conditions in paragraphs (1)(a), (c) and (d) are met; and (b) it is reasonable to expect that an amount would be payable under subsection (1) to the insurer on behalf of the practitioner for the year because of the contract: (i) assuming the condition in paragraph (1)(e) were met; and (ii) disregarding section 45 (about the amount of subsidy being reduced by advance subsidy); and (c) the insurer makes a complying application in accordance with Subdivision A of Division 4 for advance subsidy to be paid to the insurer on behalf of the practitioner for the year.

Note 1: A practitioner’s private practice income may affect whether the practitioner is an eligible medical practitioner (because the practitioner has substantial insurance costs) and how much subsidy is payable on behalf of the practitioner (whether the practitioner has substantial insurance costs or not).