Private Health Insurance Act 2007

CHAPTER 6 - ADMINISTRATION  

PART 6-4 - ADMINISTRATION OF PREMIUMS REDUCTION SCHEME  

Division 279 - Reimbursement of participating insurers and powers of Chief Executive Medicare  

Subdivision 279-A - Reimbursement of private health insurers for premiums reduced under scheme  

SECTION 279-40   DECISION ON APPLICATION  

279-40(1)    
If a private health insurer makes an application under section 279-25 or 279-30 for payment of an additional amount, the Chief Executive Medicare must pay the additional amount sought if the Chief Executive Medicare is satisfied:

(a)    that the additional amount sought is correct; and

(b)    that it would be reasonable to grant the application.

279-40(2)    
The Chief Executive Medicare may refuse the application, or decide to pay only part of the additional amount sought, if the Chief Executive Medicare is satisfied:

(a)    that the additional amount sought is incorrect; or

(b)    that it would not be reasonable to grant the application.

279-40(3)    
The Chief Executive Medicare must notify the private health insurer of the Chief Executive Medicare ' s decision on the application.

279-40(4)    
A notice under subsection (3) must include reasons for the decision.

279-40(5)    
The Chief Executive Medicare is taken, for the purposes of this Part, to have decided that:

(a)    the additional amount sought is correct; and

(b)    that it would be reasonable to grant the application;

if the Chief Executive Medicare does not give notice of his or her decision that the additional amount sought is incorrect, or that it would not be reasonable to grant the application, within the period of 3 months after the application was received by the Chief Executive Medicare.

279-40(6)    
If the Chief Executive Medicare is taken to have made a decision under subsection (5) in respect of a private health insurer, the Chief Executive Medicare is taken to have given notice of that decision to the private health insurer.