Document ID: chunk:federal_register_of_legislation:C2005A00031:clause:1_6
Version: federal_register_of_legislation:C2005A00031
Segment Type: clause
Provision Reference: sch 1 cl 6
Character Range: 9802–11917

6                   a gap permitted prosthesis  a day hospital facility   (a) must be at least the minimum benefit amount for the prosthesis determined by the Minister under subsection 73AAG(7); and
                                                                          (b) must not exceed the maximum benefit amount for the prosthesis determined by the Minister under that subsection.

 (3) Paragraphs (d) and (e) of Schedule 1 do not apply to benefits covered by this section.

Contributor not liable for no gap prosthesis

 (4) If the prosthesis is a no gap prosthesis, the agreement must provide that the hospital or day hospital facility agrees to accept payment by the organization under the agreement in relation to the episode in satisfaction of any amount that the contributor would, apart from the agreement, owe the hospital or day hospital facility for the prosthesis.

Limitation on contributor's liability for gap permitted prosthesis

 (5) If the prosthesis is a gap permitted prosthesis, the agreement must provide that the payment by the organization under the agreement in relation to the episode will not leave the contributor liable to the hospital or day hospital facility in relation to the prosthesis for an amount that exceeds the difference between:
 (a) if the amount paid by the organization under the agreement is less than or equal to the minimum benefit amount for the prosthesis determined by the Minister under subsection 73AAG(7)—the maximum and minimum benefit amounts for the prosthesis determined by the Minister under that subsection; or
 (b) if the amount paid by the organization under the agreement is more than the minimum benefit amount for the prosthesis determined by the Minister under subsection 73AAG(7)—the maximum benefit amount for the prosthesis determined by the Minister under that subsection and the amount paid by the organization under the agreement.

Obligation on organizations regarding agreements

 (6) An organization must not enter into a hospital purchaser‑provider agreement that does not contain the terms required by subsections (4) and (5).