Document ID: chunk:federal_register_of_legislation:F2025C00117:body:0:p4
Version: federal_register_of_legislation:F2025C00117
Segment Type: other
Provision Reference: 
Character Range: 8219–10878

Psychiatric care, rehabilitation and palliative care

      (1) For item 1 in the table in subsection 72‑1(2) of the Act, the minimum benefit for hospital treatment specified in that item is the amount set out, or worked out using the method for working out the minimum benefit for that treatment, in Schedules 1, 2, 3 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.

           Note: Item 1 in the table in subsection 72‑1(2) of the Act requires that each policy that covers hospital treatment must cover any part of hospital treatment that is psychiatric care, rehabilitation or palliative care if the treatment is provided in a hospital and no medicare benefit is payable for that part of the treatment.
(2) Despite subrule (1), the minimum benefit for the treatment may be reduced by the amount of any co‑payment or excess that is required to be paid under the insured person's policy in respect of that treatment.

5. Other hospital treatments

      (1) For item 5 in the table in subsection 72‑1(2) of the Act, for a policy that covers any type of hospital treatment provided in a hospital, other than treatment referred to in rule 4, the minimum benefit for that treatment is the amount set out, or worked out using the method for working out the minimum benefit, for that treatment in Schedules 1, 2, 3, 4 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.

      (2) Despite subsection (1), if a policy covers a type of hospital treatment, other than treatment referred to in rule 4, and the insurer for that policy has a negotiated agreement with the hospital in which the treatment is provided, the minimum benefit for that treatment is the amount specified for the treatment in the negotiated agreement.

      (3) Despite subrules (1) and (2), the minimum benefit for the treatment may be reduced by the amount of any co‑payment or excess that is required to be paid under the insured person's policy in respect of that treatment.

6. Benefit not to exceed hospital fees or charges

      (1) In respect of treatment referred to in rule 4 and in rule 5 other than hospital treatment for a nursing‑home type patient (as set out in Schedule 4), the amount of benefit payable by the insurer in respect of hospital treatment for a person will not exceed the fees or charges incurred in respect of that hospital treatment.

      (2) In respect of treatment referred to in rule 5 of this Part, the amount of benefit payable by the insurer in respect of hospital treatment for a nursing‑home type patient