7

7 Conditions to be satisfied in relation to the provision of listed items

(1) For the purposes of paragraphs (c) and (d) of the column headed “There must be a benefit for …” in item 4 of the table in subsection 72‑1(2) of the Act, subsection (2) of this section sets out the conditions that must be satisfied in relation to the provision of a listed item in the circumstances mentioned in those paragraphs. (2) The conditions are: (a) if a condition is specified in the column headed “Condition” of the table in Schedule 1 for that listed item—that condition; and (b) if the listed item is for an insulin infusion pump—the following additional conditions: (i) the professional service associated with the provision of the insulin infusion pump must be a professional attendance by a consultant physician in the practice of the consultant physician’s specialty. (ii) the professional service must be provided as a certified Type C procedure or a certified overnight Type C procedure; (iii) the insulin infusion pump must be provided for the purpose of administering insulin.

Note: Item 4 of the table in subsection 72‑1(2) of the Act sets out other requirements in relation to benefits for the provision of listed items that a policy that covers hospital treatment must meet. These requirements relate to benefits for hospital treatment and, if the policy covers hospital‑substitute treatment, to the benefits of that coverage as well.