Document ID: chunk:federal_register_of_legislation:C2004A01251:clause:1_10ada:p1
Version: federal_register_of_legislation:C2004A01251
Segment Type: clause
Provision Reference: sch 1 cl 10ADA (pt 1/2)
Character Range: 10470–13073

10ADA  Extended safety‑net—individuals

 (1) Expressions used in this section have the same meaning as in section 10ACA.

 (2) Subject to subsection 10AB(3), this section applies to a person who is not a member of a registered family.

 (3) Subject to this Act, if this section applies to a claim (the current claim), the benefit payable in respect of the claim is increased by 80% of the out‑of‑pocket expenses for the current claim.

 (4) The out‑of‑pocket expenses for a claim are:
 (a) the medical expenses incurred in respect of a relevant service for which the claim is made;
reduced by:
 (b) any amounts payable under any other section of this Act in respect of those expenses.

 (5) This section applies to the current claim if:
 (a) the current claim is a claim that is made by the person for a benefit in respect of a relevant service which was rendered to the person; and
 (b) the medical expenses incurred in respect of the relevant service are incurred in a year (the expense year); and
 (c) the person has paid at least 20% of the out‑of‑pocket expenses for the service directly to the person by whom, or on whose behalf, the service was rendered; and
 (d) the current claim is accepted by the Commission; and
 (e) one or more of the following apply to the claim:
 (i) the person is a concessional person in relation to the expense year at the time that the claim is made and the concessional safety‑net applies to the current claim;
 (ii) the extended general safety‑net applies to the current claim.

 (6) A safety‑net mentioned in paragraph (5)(e) applies to the current claim if the Commission is satisfied at the time when the current claim was accepted for payment that the sum of the out‑of‑pocket expenses for the current claim and all relevant prior claims for the expense year is equal to or exceeds the applicable safety‑net amount.

 (7) A claim is a relevant prior claim for the expense year if:
 (a) the claim has been made for benefit in respect of relevant services which were rendered to the person; and
 (b) the claim is related to medical expenses incurred during the expense year; and
 (c) the claim was accepted for payment by the Commission before the time when the current claim was accepted for payment; and
 (d) the Commission is satisfied at the time when the current claim was accepted for payment that the out‑of‑pocket expenses for the claim have been paid.

 (8) If:
 (a) this section applies to the current claim; but
 (b) the sum of the out‑of‑pocket expenses for all relevant prior claims for the expense year is less than the applicable safety‑net amount;