10Benefits for prostheses provided as part of hospital‑substitute treatment

10 Benefits for prostheses provided as part of hospital‑substitute treatment

(1) For a no gap prosthesis provided as part of an episode of hospital‑substitute treatment the minimum benefit and the maximum benefit are both the amount for that prosthesis listed in the column in Schedule 1 under the heading ‘Minimum Benefit’. (2) For a gap permitted prosthesis provided as part of an episode of hospital‑substitute treatment: (a) the minimum benefit is the amount for that prosthesis in the column in Schedule 1 under the heading ‘Minimum Benefit’; and (b) the maximum benefit is the amount for that prosthesis in the column in Schedule 1 under the heading ‘Maximum Benefit’.

Note 1: Private health insurers cannot cover, as part of hospital‑substitute treatment, a service for which medicare benefit is payable unless the service is specified in the Private Health Insurance (Health Insurance Business) Rules ―see paragraph 121‑10(3)(a) of the Act.

Note 2: 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.