6. Benefits for prostheses provided as p

6. Benefits for prostheses provided as part of hospital treatment

(1) For a no gap prosthesis provided as part of an episode of hospital treatment in a private hospital, the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’. (2) For a gap permitted prosthesis provided as part of an episode of hospital treatment in a private hospital: (a) the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and (b) the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’. (3) For a no gap prosthesis provided as part of an episode of hospital treatment in a public hospital: (a) the minimum benefit is the lesser of the following amounts:

(i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or

(ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and

(b) the maximum benefit is the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule.

(4) For a gap permitted prosthesis provided as part of an episode of hospital treatment in a public hospital: (a) the minimum benefit is the lesser of the following amounts: (i) the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or (ii) the amount of the insured person’s liability to the public hospital for that prosthesis; and (b) the maximum benefit is the amount for that prosthesis listed in the column under the heading ‘Maximum Benefit’ in the Schedule.

Note: Paragraphs (d) and (e) of subsection 72-10(5) of the Act deal with the fixing of minimum and maximum benefits when the Minister is making or varying the Private Health Insurance (Prostheses) Rules.