Document ID: chunk:federal_register_of_legislation:C2025C00097:section:5:p37
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 5 (pt 37/56)
Character Range: 176403–179095

(a) the private health insurer did not make a claim in respect of the month on or before the seventh day of the following month; and
 (b) premiums in respect of the month under the *complying health insurance policies issued by the private health insurer were reduced because of the operation of this Division.
 (2) The private health insurer may apply to the Chief Executive Medicare for payment of an amount (the additional amount) not exceeding the sum of the amounts by which premiums in respect of the month under the *complying health insurance policies issued by the private health insurer were reduced because of the operation of Division 23.
 (3) An application under subsection (2) may relate to more than one month.

279‑35  Content and timing of application
 (1) An application by a private health insurer under section 279‑25 or 279‑30 for payment of an additional amount must be in the *approved form.
 (2) The application must be made:
 (a) if the application relates to only one month—within 3 years of the end of that month; or
 (b) if the application relates to more than one month—within 3 years of the end of the first of those months.

279‑40  Decision on application
 (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.
 (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.
 (3) The Chief Executive Medicare must notify the private health insurer of the Chief Executive Medicare's decision on the application.
 (4) A notice under subsection (3) must include reasons for the decision.
 (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.
 (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