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 279-20   NOTIFYING PRIVATE HEALTH INSURERS IF AMOUNT IS NOT PAYABLE  

279-20(1)    
If the Chief Executive Medicare considers that a claim is incorrect, the Chief Executive Medicare may either refuse the claim or pay only such part of the claim as he or she is satisfied is correct.

279-20(2)    
The Chief Executive Medicare must notify a private health insurer if the Chief Executive Medicare makes a decision mentioned in subsection (1) .

279-20(3)    
A notice under subsection (2) must include reasons for the decision.

279-20(4)    
The Chief Executive Medicare is taken, for the purposes of this Part, to have decided that a claim is correct if the Chief Executive Medicare does not give notice of his or her decision that the claim is incorrect on or before the day under subsection 279-15(2) on or before which, if the claim were correct, it would have been required to have been paid.