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HEALTH INSURANCE ACT 1973 - SECT 3 Interpretation

HEALTH INSURANCE ACT 1973 - SECT 3

Interpretation

  (1)   In this Act, unless the contrary intention appears:

"ABN" has the meaning given by section   41 of the A New Tax System (Australian Business Number) Act 1999 .

"accredited pathology laboratory" means premises in respect of which there is in force an approval under section   23DN.

"accredited podiatrist" means a podiatrist who is accredited by the Minister in writing under section   3AAA.

"approved accreditor" has the meaning given by paragraph   23DZZIAA(1)(b).

"approved billing agent" means a person or body in respect of whom an approval under section   20AB is in force.

"approved form" means a form approved by the Minister, by writing signed by him or her, for the purposes of the provision in which the expression occurs.

"approved pathology authority" means a person in respect of whom there is in force an undertaking given by the person, and accepted by the Minister, under section   23DF.

"approved pathology practitioner" means a person in respect of whom there is in force an undertaking given by the person, and accepted by the Minister, under section   23DC.

"Australia" includes Norfolk Island, the Territory of Cocos (Keeling) Islands and the Territory of Christmas Island.

"Australian resident" means a person who resides in Australia and who is:

  (a)   an Australian citizen; or

  (b)   a person who is, within the meaning of the Migration Act 1958 , the holder of a permanent visa; or

  (ba)   a person who has been granted, or who is included in, a return endorsement or a resident return visa in force under the Migration Act 1958 ; or

  (c)   a New Zealand citizen who is lawfully present in Australia; or

  (d)   a person (not being a person referred to in paragraph   (a), (b), (ba) or (c)) who is lawfully present in Australia and whose continued presence in Australia is not subject to any limitation as to time imposed by law; or

  (f)   a person who:

  (i)   is, within the meaning of the Migration Act 1958 , the holder of a temporary visa; and

  (ia)   is not covered by regulations made under subsection   6A(1); and

  (ii)   has applied for a permanent visa under that Act and the application has not been withdrawn or otherwise finally determined; and

  (iii)   has not, both:

  (A)   on or after the commencement of this paragraph, made an application for a protection visa under that Act (whether or not the person has applied for any other visa), other than an application that has been withdrawn or otherwise finally determined; and

  (B)   whether before or after the commencement of this paragraph, made an application for a parent visa under that Act (whether or not the person has applied for any other visa and whether or not the application for the parent visa has been withdrawn or otherwise finally determined); and

  (iv)   has not, whether before or after the commencement of this paragraph, made an application for a parent visa under that Act (whether or not the person has applied for any other visa), other than an application that has been withdrawn or otherwise finally determined; and

  (v)   in respect of whom either:

  (A)   another person, being the person's spouse, parent or child (each having the same meaning as in the Migration Act 1958 ), is an Australian citizen or the holder of a permanent visa under that Act; or

  (B)   an authority to work in Australia is in force.

"Australian university" has the same meaning as in the Higher Education Support Act 2003 .

"bank" includes, but is not limited to, a body corporate that is an ADI (authorised deposit - taking institution) for the purposes of the Banking Act 1959 .

"base for mobile diagnostic imaging equipment" has the meaning given by section   23DZL.

"base for mobile radiation oncology equipment" has the meaning given by section   23DZZK.

"Bonded Medical Program" : see section   124ZD.

"Bonded Medical Program rules" : see section   124ZT.

"bonded participant" : see section   124ZE.

"census date" has the same meaning as in the Higher Education Funding Act 1988 .

"Chief Executive Centrelink" has the same meaning as in the Human Services (Centrelink) Act 1997 .

"Chief Executive Medicare" has the same meaning as in the Human Services (Medicare) Act 1973 .

"chiropractor" means a person who is registered under the National Law in the chiropractic profession.

"civil penalty order" means an order under subsection   125A(2).

"civil penalty provision" has the meaning given by section   125B.

"clinically relevant service" means a service rendered by a medical or dental practitioner or an optometrist that is generally accepted in the medical, dental or optometrical profession (as the case may be) as being necessary for the appropriate treatment of the patient to whom it is rendered.

"complying health insurance policy" has the meaning given by section   63 - 10 of the Private Health Insurance Act 2007 .

"consultant physician" , in relation to a particular specialty (other than general practice), means a medical practitioner in relation to whom there is in force a determination under section   3DB or 3E that the medical practitioner is recognised for the purposes of this Act as a consultant physician in that specialty.

"course of study in medicine" has the same meaning as in the Higher Education Support Act 2003 .

"dental benefit" has the same meaning as in the Dental Benefits Act 2008 .

"dental practitioner" means a person who is registered under the National Law in the dental profession.

"diagnostic imaging accreditation scheme" means a scheme established by the Minister under section   23DZZIAA.

"diagnostic imaging equipment" means equipment that is primarily used in the carrying out of a diagnostic imaging procedure.

"diagnostic imaging premises" has the meaning given by section   23DZM.

"diagnostic imaging procedure" means a procedure for the production of images (for example, X - rays, computerised tomography scans, ultrasound scans, magnetic resonance imaging scans and nuclear scans) for use in the rendering of diagnostic imaging services.

"Diagnostic Imaging Register" means the Register kept under section   23DZK.

"diagnostic imaging service" means:

  (a)   an R - type diagnostic imaging service; or

  (b)   an NR - type diagnostic imaging service;

to which an item of the diagnostic imaging services table relates.

"diagnostic imaging services table" means the table prescribed under section   4AA.

"eligible location" means:

  (a)   an area prescribed by the Bonded Medical Program rules as a regional, rural or remote area; or

  (b)   an area prescribed by the Bonded Medical Program rules as an area of workforce shortage.

"eligible midwife" has the meaning given by section   21.

"eligible nurse practitioner" means a person who:

  (a)   is a nurse practitioner; and

  (b)   meets the requirements (if any) specified in the regulations for the purposes of this paragraph.

"eligible overseas representative" means a person who is:

  (a)   the head of a diplomatic mission of another country, or the head of a consular post of another country, established in Australia; or

  (b)   a member of the staff of such a diplomatic mission, or a member of the staff of such a consular post; or

  (c)   a member of the family of a person referred to in paragraph   (a) or (b), being a member who forms part of the household of that person;

being a person who is neither an Australian citizen nor a person domiciled in Australia but who, under an agreement between the Government of the Commonwealth and the Government of that other country, is to be treated, for the purpose of the provision of medical, hospital and other care, as if the person were an Australian resident.

"eligible person" means an Australian resident or an eligible overseas representative.

"excessive pathology service" means a pathology service:

  (a)   in respect of which medicare benefit has become or may become payable; and

  (b)   that is not reasonably necessary for the adequate medical or dental care of the patient concerned.

"extended compliance determination" has the meaning given by subsection   124ZUA(1).

"finally determined" has the same meaning as in the Migration Act 1958 .

"friendly society" means:

  (a)   a body that is a friendly society for the purposes of the Life Insurance Act 1995 ; or

  (b)   a body that is registered or incorporated as a friendly society under a law of a State or Territory; or

  (c)   a body that is permitted, by a law of a State or Territory, to assume or use the expression friendly society ; or

  (d)   a body that, immediately before the date that is the transfer date for the purposes of the Financial Sector Reform (Amendments and Transitional Provisions) Act (No.   1) 1999 , was registered or incorporated as a friendly society under a law of a State or Territory.

"general medical services table" , means the table prescribed under section   4.

"general practitioner" means:

  (a)   a medical practitioner who is registered under the National Law in the specialty of general practice; or

  (b)   a medical practitioner of a kind prescribed by the regulations for the purposes of this paragraph.

"hospital" has the meaning given by subsection   121 - 5(5) of the Private Health Insurance Act 2007 .

"hospital service" means a health service of a kind provided in a hospital and includes:

  (a)   accommodation in a hospital for the purposes of receiving treatment; and

  (b)   nursing care and treatment; and

  (c)   medical care and treatment including diagnostic services; and

  (d)   outpatient, accident and emergency services.

"hospital-substitute treatment" has the same meaning as in the Private Health Insurance Act 2007 .

"hospital treatment" has the meaning given by section   121 - 5 of the Private Health Insurance Act 2007 .

"Human Services Department" means the Department administered by the Human Services Minister.

"Human Services Minister" means the Minister administering the Human Services (Centrelink) Act 1997 .

"Immigration Department" means the Department administered by the Minister administering the Migration Act 1958 .

"initiate" , in relation to a pathology service or a diagnostic imaging service, means make the decision by reason of which the service is rendered.

"item" means an item in the table.

"listed" :

  (a)   in relation to diagnostic imaging equipment--has the meaning given by subsections   16D(4) and (5); and

  (b)   in relation to radiation oncology equipment--has the meaning given by subsections   16F(6) and (7).

"medical entrepreneur" has the meaning given by section   3B.

"medical expenses" means an amount payable in respect of a professional service.

"medical practitioner" means a person who is registered under the National Law in the medical profession.

"medicare benefit" means a medicare benefit under Part   II.

"medicare number" has the same meaning as in subsection   84(1) of the National Health Act 1953 .

"medicare program" has the same meaning as in the Human Services (Medicare) Act 1973 .

"midwife" means a person who is registered under the National Law in the midwifery profession.

"Migration Regulations" means regulations made under the Migration Act 1958 .

"month" means a month of the year.

"National Law" means:

  (a)   for a State or Territory (other than Western Australia)--the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld), as it applies (with or without modification) as a law of the State or Territory; or

  (b)   for Western Australia--the Health Practitioner Regulation National Law (WA) Act 2010 (WA), so far as that Act corresponds to the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).

"NR-type diagnostic imaging service" means a diagnostic imaging service corresponding to an item of the diagnostic imaging services table that is classified as an NR - type service in the table.

"nurse practitioner" means a person who is registered under the National Law in the nursing profession as a nurse practitioner.

"nursing care" means nursing care given by or under the supervision of a registered nurse.

"nursing-home type patient" , in relation to a hospital, means a patient in the hospital who has been provided with accommodation and nursing care, as an end in itself, for a continuous period exceeding 35 days.

"optometrist" means a person who is registered under the National Law in the optometry profession.

"ordinarily located" :

  (a)   in relation to diagnostic imaging premises--has a meaning affected by subsection   16D(6); and

  (b)   in relation to bases for mobile diagnostic imaging equipment--has a meaning affected by subsection   16D(8); and

  (c)   in relation to radiation oncology premises--has a meaning affected by subsection   16F(8); and

  (d)   in relation to bases for mobile radiation oncology equipment--has a meaning affected by subsection   16F(10).

"organization" means a society, body or group of persons, whether corporate or unincorporate.

"osteopath" means a person who is registered under the National Law in the osteopathy profession.

"out-patient service" , in relation to a hospital, means a health service or procedure provided by the hospital to an eligible person other than a patient of the hospital.

"paid work" means work for financial gain or reward (whether as an employee, a self - employed person or otherwise).

"parent visa" : a person has applied for a parent visa if:

  (a)   the person has applied for a permanent visa included in a class of visas under the Migration Regulations, being a class that has the word "parent" in its title; or

  (b)   before 1   November 1999 the person applied for a Change in Circumstance (Residence) (Class AG) visa, a Family (Residence) (Class AO) visa or a General (Residence) (Class AS) visa under the Migration Regulations and:

  (i)   the person was nominated for the grant of that visa by a child of the person, being a child who was at least 18 years old when the application was made; or

  (ii)   the person was included in an application made by a person covered by subparagraph   (i).

"participating midwife" means:

  (a)   if the Minister has approved a common form of undertaking under section   21A--an eligible midwife in respect of whom there is in force an undertaking given by him or her and accepted by the Minister under section   21B; or

  (b)   otherwise--an eligible midwife;

so far as the eligible midwife renders a service in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations, for the purposes of this definition.

"participating nurse practitioner" means:

  (a)   if the Minister has approved a common form of undertaking under section   22--an eligible nurse practitioner in respect of whom there is in force an undertaking given by him or her and accepted by the Minister under section   22A; or

  (b)   otherwise--an eligible nurse practitioner;

so far as the eligible nurse practitioner renders a service in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations, for the purposes of this definition.

"pathologist-determinable service" means a pathology service specified, or a pathology service included in a class of pathology services specified, in a determination in force under section   4BA.

"pathology service" means a medical service to which an item of the pathology services table relates.

"pathology services table" , means the table prescribed under section   4A.

"patient" , in relation to a hospital, does not include:

  (a)   a member of the staff of the hospital who is receiving treatment in his or her own quarters; or

  (b)   except as provided by subsection   (2), a newly - born child whose mother also occupies a bed in the hospital.

"patient contribution" means:

  (b)   in relation to a nursing - home type patient of a recognized hospital in a State such amount as is determined by the Minister from time to time for the purposes of this paragraph with respect to that State;

  (c)   in relation to a nursing - home type patient of a recognized hospital in an internal Territory, such amount as is determined by the Minister from time to time for the purposes of this paragraph in relation to that Territory; or

  (d)   in relation to a nursing - home type patient of a private hospital in a State or internal Territory, such amount as is determined by the Minister from time to time for the purposes of this paragraph with respect to that State or Territory.

"pecuniary penalty order" means an order made under section   125A.

"permanent visa" has the same meaning as in the Migration Act 1958 .

"physiotherapist" means a person who is registered under the National Law in the physiotherapy profession.

"podiatrist" means a person who is registered under the National Law in the podiatry profession.

"practitioner" means a medical practitioner or a dental practitioner.

"prescribed pathology service" means a pathology service specified, or a pathology service included in a class of pathology services specified, in a determination in force under section   4BB.

"primary information" :

  (a)   for the purposes of Division   4 of Part   IIB--has the meaning given by section   23DZR; and

  (b)   for the purposes of Part   IIC--has the meaning given by section   23DZZQ.

"private health insurer" has the same meaning as in the Private Health Insurance Act 2007 .

"private hospital" means a hospital in respect of which there is in force a statement under subsection   121 - 5(8) of the Private Health Insurance Act 2007 that the hospital is a private hospital.

"private patient" , in relation to a hospital, means a patient of the hospital who is not a public patient.

"professional attention" means:

  (a)   medical or surgical treatment by or under the supervision of a medical practitioner; or

  (b)   obstetric treatment by or under the supervision of a medical practitioner or a registered nurse with obstetric qualifications; or

  (c)   dental treatment by or under the supervision of a dental practitioner; or

  (d)   podiatric treatment by an accredited podiatrist.

"professional service" means:

  (a)   a service (other than a diagnostic imaging service) to which an item relates, being a clinically relevant service that is rendered by or on behalf of a medical practitioner; or

  (b)   a prescribed medical service to which an item relates, being a clinically relevant service that is rendered by a dental practitioner approved by the Minister in writing for the purposes of this definition; or

  (c)   a service to which an item relates, being a clinically relevant service that is rendered by an optometrist; or

  (d)   a pathology service that is rendered by or on behalf of an approved pathology practitioner pursuant to a request made in accordance with subsection   16A(4) by:

  (i)   a treating practitioner; or

  (ii)   another approved pathology practitioner who received a request for the service made by the treating practitioner; or

  (e)   a pathology service (other than a service referred to in paragraph   (d)) that is a clinically relevant service rendered by or on behalf of an approved pathology practitioner other than a medical practitioner; or

  (f)   a diagnostic imaging service that is rendered by or on behalf of a medical practitioner pursuant to a subsection   16B(1) request; or

  (g)   a diagnostic imaging service (other than a service referred to in paragraph   (f)) that is a clinically relevant service rendered by or on behalf of a medical practitioner.

Note:   See subsection   (17) for when a service is taken to be rendered on behalf of a medical practitioner.

"proprietor" :

  (a)   in relation to a pathology laboratory--means the person or authority having effective control of:

  (i)   the laboratory premises, whether or not the holder of an estate or interest in the premises; and

  (ii)   the use of equipment used in the laboratory; and

  (iii)   the employment of staff in the laboratory; and

  (b)   in relation to diagnostic imaging premises or a base for mobile diagnostic imaging equipment--has the meaning given by section   23DZO; and

  (c)   in relation to radiation oncology premises or a base for mobile radiation oncology equipment--has the meaning given by section   23DZZN; and

  (d)   in relation to other premises--means the person, authority or body of persons having effective control of the premises, whether or not he or she or it is the holder of an estate or interest in the premises.

"protection visa" means a permanent or temporary visa included in a class of visas under the Migration Regulations, being a class that has the word "protection" in its title.

"public hospital service" means a hospital service provided in:

  (a)   a recognised hospital; or

  (b)   a hospital in respect of which the Commonwealth, or a State, provides funding for the provision of hospital services to public patients.

"public patient" , in relation to a hospital, means a patient in respect of whom the hospital provides comprehensive care, including all necessary medical, nursing and diagnostic services and, if they are available at the hospital, dental and paramedical services, by means of its own staff or by other agreed arrangements.

"radiation oncology equipment" means equipment that is primarily used in rendering a radiation oncology service.

"radiation oncology premises" has the meaning given by section   23DZZL.

"Radiation Oncology Register" means the Register kept under section   23DZZJ.

"radiation oncology service" has the meaning given by subsection   16F(2).

"recognised hospital" means a hospital in respect of which there is in force a statement under subsection   121 - 5(8) of the Private Health Insurance Act 2007 that the hospital is a public hospital.

"registered" :

  (a)   in relation to diagnostic imaging premises--has the meaning given by subsection   16D(2); and

  (b)   in relation to a base for mobile diagnostic imaging equipment--has the meaning given by subsection   16D(3); and

  (c)   in relation to radiation oncology premises--has the meaning given by subsection   16F(4); and

  (d)   in relation to a base for mobile radiation oncology equipment--has the meaning given by subsection   16F(5).

"registered nurse" means a person who is registered under the National Law in the nursing profession as a registered nurse.

"relevant dental benefits offence" means:

  (a)   an offence against section   50, 51, 52, 53 or 54 of the Dental Benefits Act 2008 ; or

  (b)   an offence against:

  (i)   section   6 of the Crimes Act 1914 ; or

  (ii)   section   11.1, 11.4 or 11.5 of the Criminal Code ;

    that relates to an offence referred to in paragraph   (a) of this definition; or

  (c)   an offence against section   134.1, 134.2, 135.1, 135.2, 135.4, 136.1, 137.1, 144.1, 145.1, 145.4 or 145.5 of the Criminal Code that relates to a claim for payment in respect of the rendering of a dental service (within the meaning of the Dental Benefits Act 2008 ).

"return of service obligation" : see section   124ZF.

"RoSO compliance period" means the period referred to in paragraph   124ZF(2)(a).

"R-type diagnostic imaging service" means a diagnostic imaging service corresponding to an item of the diagnostic imaging services table that is classified as an R - type service in the table.

"Rural Health Minister" means the Minister responsible for health in rural, regional or remote areas.

"Secretary" means the Secretary of the Department.

"specialist" , in relation to a particular specialty (other than general practice), means a medical practitioner in relation to whom there is in force a determination under section   3DB or 3E that the medical practitioner is recognised for the purposes of this Act as a specialist in that specialty, or a medical practitioner who is taken to be so recognised under section   3D.

" subsection 16B(1) request" means a request of a kind referred to in subsection   16B(1).

"table" means the table consisting of:

  (a)   the general medical services table; and

  (b)   the pathology services table; and

  (c)   the diagnostic imaging services table.

"Veterans' Affairs Department" means the Department administered by the Veterans' Affairs Minister.

"Veterans' Affairs Minister" means the Minister administering the Veterans' Entitlements Act 1986 .

  (1A)   In this Act, unless the contrary intention appears, a word or phrase defined for the purposes of the National Health Act 1953 has the meaning that it would have if used in that Act.

  (2)   For the purposes of this Act:

  (a)   a newly - born child who occupies an approved bed in an intensive care facility in a hospital, being a facility approved by the Minister for the purposes of this subsection, for the purpose of the provision of special care shall be deemed to be a patient of the hospital; and

  (b)   where there are two or more newly born children of the same mother in a hospital and those children are not in - patients of the hospital by virtue of paragraph   (a)--each such child in excess of 1 shall be deemed to be a patient of the hospital.

  (3)   Where an anaesthetic is administered to a patient:

  (a)   pre - medication of the patient in preparation for the administration of the anaesthetic; and

  (b)   pre - operative examination of the patient in preparation for the administration of the anaesthetic, being an examination carried out during the attendance at which the anaesthetic is administered;

shall, for the purposes of this Act, be deemed to form part of the professional service constituted by the administration of the anaesthetic.

  (4)   Unless the contrary intention appears, a reference in this Act to a professional attendance or to an attendance is a reference to an attendance by a medical practitioner on a patient, including an attendance at the medical practitioner's rooms or surgery.

  (5)   Unless the Minister otherwise directs, a professional service, not being a service specified in an item in the general medical services table that is expressed to relate to a professional attendance by a medical practitioner (however described), a dental practitioner, an optometrist, a participating midwife or a participating nurse practitioner, shall be deemed to include all professional attendances necessary for the purposes of post - operative treatment of the person to whom the professional service is rendered.

  (5A)   For the purposes of this Act, a pathology service shall be deemed to include any necessary interpretation, analysis or reporting.

  (5B)   For the purposes of this Act, a diagnostic imaging service is taken to include any necessary interpretation, analysis or reporting.

  (5C)   For the purposes of this Act, if the descriptions of 2 diagnostic imaging services in the diagnostic imaging services table differ from each other only so far as one service is indicated to be an R - type diagnostic imaging service and the other is indicated to be an NR - type diagnostic imaging service, the first - mentioned service is taken to be an R - type diagnostic imaging service for which there is a corresponding NR - type diagnostic imaging service.

  (6)   Where a professional service rendered to a person includes a medical procedure that would, but for this subsection, itself be a professional service, that procedure shall, in respect of that person, be deemed not to be a professional service.

  (14)   For the purposes of the definition of patient contribution in subsection   (1), Norfolk Island is taken to form part of the State of New South Wales.

  (15)   For the purposes of the definition of recognized hospital in subsection   (1), State includes the Northern Territory.

  (16)   In approving a form for the purposes of the definition of approved form in subsection   (1), the Minister may specify a disc, tape, film or other medium as the means by which the information to be contained in the form is to be or may be set out.

  (17)   For the purposes of this Act and the regulations, a service is taken to be rendered on behalf of a medical practitioner if, and only if:

  (a)   it is rendered by another person who is not a medical practitioner, and who provides the service, in accordance with accepted medical practice, under the supervision of the medical practitioner; and

  (b)   it is not a service of a kind specified in regulations made for the purposes of this paragraph.

  (18)   If:

  (a)   a professional service prescribed by the regulations for the purposes of this paragraph is rendered by a medical practitioner who is a specialist trainee (see subsection   (20)); and

  (b)   the specialist trainee renders the service under the supervision of another medical practitioner who is present at all times while the specialist trainee renders the service;

then, for the purposes of this Act and the regulations:

  (c)   the service is taken to have been rendered by the other medical practitioner; and

  (d)   the service is taken not to have been rendered by the specialist trainee.

  (19)   The regulations may prescribe provisions of this Act and of the regulations to which subsection   (18) does not apply.

  (20)   In subsection   (18):

"specialist trainee" has the meaning given by regulations made for the purposes of this subsection.

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