Document ID: chunk:federal_register_of_legislation:F2022L00095:clause:2_1:p1
Version: federal_register_of_legislation:F2022L00095
Segment Type: clause
Provision Reference: sch 2 cl 1 (pt 1/2)
Character Range: 4690–9806

1  Chapter 8 Part 9 (National ADF Family Health Program)
   Omit the Part, substitute:

Part 9: National ADF family health program

8.9.1    Purpose
   This Part provides reimbursement for health costs incurred within Australia by a dependant registered under the national ADF family health program.

8.9.2    Definitions
   In this Part the following apply.
   Allied health service has the same meaning given under section 4 of the Health Insurance (Allied Health Services) Determination 2014.
   Claimant means any of the following.
   a.                                                                                                                                                                                                                                                            The member.
   b.                                                                                                                                                                                                                                                            The member's eligible dependant.
   c.                                                                                                                                                                                                                                                            A legal personal representative of the member or an eligible dependant.
   Eligible dependant means a member's dependant who meets all of the following.
   a.                                                                                                                                                                                                                                                            They are listed on PMKeyS as a dependant.
   b.                                                                                                                                                                                                                                                            They are registered for the family health program.
   c.                                                                                                                                                                                                                                                            They are not a member.
   Medicare benefit means an item for which a rebate is payable under the Health Insurance Act 1973.
   Out of pocket expense means the difference between the amount that is charged for a service or a product 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.
   Family health program means the national ADF family health program.

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