Document ID: chunk:federal_register_of_legislation:C2025C00097:section:3
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 3
Character Range: 80004–81609

3                                                                      if the policy *covers *hospital‑substitute treatment—hospital‑substitute treatment covered under the policy for which a *medicare benefit is payable.                                                                                                                                                                  (a) if the charge for the treatment is less than the *schedule fee for the treatment—so much of the charge (if any) as exceeds 75% of the schedule fee; and
                                                                                                                                                                                                                                                                                                                                                                                              (b) otherwise—at least 25% of the schedule fee for the treatment;
                                                                                                                                                                                                                                                                                                                                                                                              but the benefit must not be provided if a medicare benefit of an amount that is at least 85% of the schedule fee is claimed for the treatment (or could be claimed for the treatment but for section 19AD of the Health Insurance Act 1973).