Private Health Insurance Act 2007

Pt 6-4 heading substituted by No 105 of 2013, s 3 and Sch 2 item 9, effective 1 July 2013. The heading formerly read:

PART 6-4 - ADMINISTRATION OF PREMIUMS REDUCTION AND INCENTIVE PAYMENTS SCHEMES

Div 279 heading substituted by No 105 of 2013, s 3 and Sch 2 item 12, effective 1 July 2013. The heading formerly read:

Division 279 - Provisions applying only to premiums reduction scheme

S 279-20 repealed by No 54 of 2025, s 3 and Sch 2 item 13, effective 1 April 2026. For application, transitional and validation provisions, see note under s 279-1 . S 279-20 formerly read:

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.

S 279-20 amended by No 32 of 2011, s 3 and Sch 4 item 515, by substituting " Chief Executive Medicare " for " Medicare Australia CEO " (wherever occurring), effective 1 July 2011.