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Appendix 1: Context and relevant provisions - Standard 26 - Arrangement for payments to Medicare Australia

StandardContext
Standard 26 - Arrangement for payments to Medicare Australia

Proactive advice to Medicare and correct attribution of the payment of medical costs, allows insurers to make prompt payment of entitlements and reduces the risk that a worker is inadvertently subject to recovery action from Medicare Australia.

The Health and Other Services (Compensation) Act 1995, applies when a person receives eligible benefits provided through Australian Government programs, including Medicare benefits

A Medicare request for notice of past benefits is required when a payment greater than $5,000 is likely and medical services for a work-related injury may have been paid by Medicare Australia.

The Health and Other Services (Compensation) Act 1995, applies when a person receives eligible benefits provided through Australian Government programs, including Medicare benefits.

In accordance with this Act, the compensation payer (usually the insurer) must tell the Department of Human Services:

  • within 28 days from the date of a judgment or settlement
  • when settlement fixes the value of compensation awarded at more than $5,000 including all costs, or

when a reimbursement arrangement is made more than six months from the date the claim was made.