Document ID: chunk:federal_register_of_legislation:F2025C00160:reg:3:p114
Version: federal_register_of_legislation:F2025C00160
Segment Type: reg
Provision Reference: reg 3 (pt 114/293)
Character Range: 2288522–2293744

for which a reimbursement may be made under this Part and the amount of Medicare or private health insurance rebate that may be paid for that item.
   Specialist means a person who meets the definition of specialist under section 3 of the Health Insurance Act 1973.
   Specialist services means services which are provided by a specialist in consulting rooms, or in a hospital or institutional setting.

8.9.2A Eligible dependant

   In relation to a member, eligible dependant means a person who meets all of the following.
   a.                                                                                           They are one of the following.
                                                                                                i.                               Resident family of the member.
                                                                                                ii.                              Recognised other person under paragraph 1.3.37.1.d.of the member.

                                                                                                                                 Note:  Paragraph 1.3.37.1.d applies to a person who has an interdependent relationship with the member.
   b.                                                                                           All of the following apply.
                                                                                                i.                               They are listed on PMKeyS as resident family or as a recognised other person of the member.
                                                                                                ii.                              They are registered for the family health program.
                                                                                                iii.                             They are not a member.

8.9.3 Members this Part applies to

   This Part applies to any of the following members and their eligible dependant.
   a.                                                                               A member of the Permanent Forces.
   b.                                                                               A member of the Reserves on continuous full-time service.

8.9.4 Registration of newborns

   The registration day of a newborn in the family health program is their date of birth if they are registered in the family health program within 3 months of their date of birth.

8.9.5 Application for reimbursement

   A claimant must apply for reimbursement under this Part within 12 months of the services or products being provided.

8.9.6 Reimbursement – General practice setting

1.  Subject to subsection 2, a claimant is eligible to be reimbursed out-of-pocket expense incurred in relation to medical services that meet all of the following.
    a.                                                                                                                                                               The service is provided to an eligible dependant.
    b.                                                                                                                                                               The service is provided by, or on behalf of, a general practitioner within their general practice setting.
2.  A medical service in subsection 1 must meet one of the following.
    a.                                                                                                                                                               If the claimant is eligible for Medicare — the service has a Medicare benefit item number.
    b.                                                                                                                                                               If the claimant is not eligible for Medicare — it is reasonable to expect a Medicare rebate for the service would be payable if they were eligible for Medicare.

8.9.6A Reimbursement benefit

1.  A claimant is eligible to be reimbursed up to $800 in a financial year for each of their eligible dependants for services or products provided under any of the following.
    a.                                                                                                                                                                          Section 8.9.7, Reimbursable items – Specialists, allied health services and related products.
    b.                                                                                                                                                                          Section 8.9.7A, Reimbursable items – Nicotine dependency reduction.
    c.                                                                                                                                                                          Section 8.9.7B, Reimbursable items – Ambulance cover.
    d.                                                                                                                                                                          Section 8.9.7C, Reimbursable items – Healthy eating programs.
    e.