Commonwealth Consolidated Acts

PRIVATE HEALTH INSURANCE ACT 2007 - SECT 26.25

             (1)  If a claim is refused, the claimant may apply to the Medicare Australia CEO for the Medicare Australia CEO to reconsider the decision.

             (2)  The application must:

                     (a)  be in writing; and

                     (b)  set out the reasons for the application.

             (3)  The application must be made within:

                     (a)  28 days after the day on which the claimant was notified of the decision; or

                     (b)  if, either before or after the end of that period of 28 days, the Medicare Australia CEO extends the period within which the application may be made--the extended period for making the application.

             (4)  The Medicare Australia CEO must:

                     (a)  reconsider the decision; and

                     (b)  either affirm or revoke the decision;

within 28 days after receiving the application for reconsideration.

Note:          Decisions affirming original decisions are reviewable under Part 6‑9.

             (5)  If the Medicare Australia CEO revokes the decision, the revocation is taken to be a decision granting the claim.

             (6)  The Medicare Australia CEO must give the claimant a notice stating his or her decision on the reconsideration together with a statement of his or her reasons for the decision.

             (7)  The Medicare Australia CEO is taken, for the purposes of this Subdivision, to have made a decision affirming the original decision if the Medicare Australia CEO has not told the claimant of the decision on the reconsideration before the end of the period of 28 days.