Health Insurance Act 1973

An eligible person (the assignor) to whom a medicare benefit is or will be payable (or would be payable if section 19AD were disregarded) in respect of a professional service may enter into an agreement to assign the assignor’s right to the payment of the medicare benefit if:

the professional service is or will be rendered to the assignor or to another eligible person; and

the agreement is entered into with the person by whom, or on whose behalf, the professional service is or will be rendered (the professional); and

the agreement provides that:

the assignor assigns the assignor’s right to the payment of the medicare benefit to the professional at the time the agreement is entered into or when the medicare benefit becomes payable (whichever is the later); and

the professional accepts the assignment in full payment of the medical expenses that have been or will be incurred in respect of the professional service by the assignor; and

any requirements specified in the regulations are met.

The professional must, if asked to, give the assignor a copy of the terms of the agreement: see subsection 127(1).

Regulations made for the purposes of paragraph 127(2)(c) may require the professional to give the assignor other notifications.

Regulations made for the purposes of paragraph (1)(d) may operate by reference to a determination made under subsection 20AAB(1).

The regulations may provide for and in relation to enduring agreements. An enduring agreement is an agreement under subsection (1) that relates to professional services rendered by, or on behalf of, a professional from time to time.

Without limiting paragraph (1)(d) or subsection (1A), the regulations:

may specify circumstances in which enduring agreements:

may, or may not, be entered into; or

cease to be in effect; and

may specify kinds of professional services that enduring agreements may, or may not, apply to.

An eligible person (the assignor) to whom a medicare benefit would, apart from this section, be payable in respect of a professional service is taken to have assigned the assignor’s right to the payment of the medicare benefit if:

the professional service is rendered to the assignor or another eligible person while hospital treatment or hospital‑substitute treatment is provided to the assignor or that other eligible person; and

under a complying health insurance policy issued by a private health insurer (the insurer), the assignor or another person is covered (wholly or partly) for liability to pay fees and charges in respect of the professional service; and

a claim is made under section 20B for the medicare benefit that would, apart from this section, be payable to the assignor in respect of the professional service; and

subsection 20AAA(1), (3) or (5) applies to the assignor’s right to the payment of the medicare benefit in respect of the professional service.

If the right to payment of a medicare benefit is taken to be assigned under subsection (2) of this section, it is taken to be assigned to the person specified in subsection 20AAA(2), (4) or (6).

Where an assignment under this section takes effect, or an agreement under this section is entered into, with respect to a medicare benefit, the medicare benefit is, subject to section 20B, payable in accordance with the assignment or the agreement, as the case may be.

A medicare benefit payable under subsection (3) shall be paid in such manner as the Chief Executive Medicare determines.

Without limiting subsection (3A), a determination under that subsection may provide for a medicare benefit that is payable under subsection (3) to be paid, in such circumstances and subject to such conditions as are prescribed by the regulations, by means of the electronic transmission of the amount of the benefit to an account kept with a bank.

A reference in this section to a person by whom a professional service is rendered shall be read as not including a reference to a person (in this subsection referred to as the agent) who renders a professional service (other than a pathology service) on behalf of another person or of an organization, but the agent may, if so authorized by that other person or that organization, on behalf of that other person or that organization, enter into an agreement under subsection (1).

Where:

a pathology service is rendered by or on behalf of an approved pathology practitioner; and

the approved pathology practitioner is acting, in relation to the rendering of the pathology service, on behalf of another person;

An assignment of a medicare benefit shall not be made except in accordance with this section.

Without limiting this section, regulations prescribing requirements for the purposes of this section may specify:

requirements relating to the content of agreements to be entered into, or the manner and form in which the agreements are to be entered into; and

requirements relating to information that must be given and the manner and form in which the information must be given; and

requirements relating to the giving of notifications before or at the time agreements are entered into, or before or after information is given.

Regulations made for the purposes of paragraph (c) of this subsection may specify that paragraph 127(6)(c) applies. Subsection 127(6) is a civil penalty provision.