1. for a single membership - the contributor;

2. for a couples membership - both members of the couple;

3. for a single parent membership - the single parent and one other member only;

4. for a family membership - 2 members only.

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Note Some expressions used in this Determination are defined in the Act (see s 4) or in the Health Insurance Act 1973 (see s 3), including:

• applicable benefits arrangement

• contributor

• Council

• dependant

• professional service

• registered health benefits organisation

• registered organisation.

(2) In this Determination:

1. the Northern Territory is taken to be a State; and

2. the Australian Capital Territory is taken to be part of New South Wales.

1.4 Notification by Council

As soon as possible after receiving from all registered health benefits organisations carrying on health insurance business in a State the information required under the Reinsurance Records Determination, the Council must give each organisation written notice of the amount payable by, or to, the organisation, under section 73BC of the Act, for the quarter for the State to which the information relates.

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Part 2 Payments into the Fund

2.1 Purpose of Part

The purpose of this Part is to set out principles for determining the method of, and the matters to be taken into account in, calculating the amounts to be paid into the Fund by registered health benefits organisations, and related matters.

2.2 Matters to be taken into account

(1) The following matters are to be taken into account in calculating the amounts to be paid into the Fund, for a particular quarter, by a registered organisation:

1. the reinsurable patient days that have been claimed against the organisation in the quarter for hospital treatment, including patient days for hospital treatment outside Australia, if the rules of the registered organisation accommodate such claims;

2. for each of those claims, the amount of the benefit payable by the organisation;

3. in relation to each of those claims, the amount of the benefit payable by the organisation for professional services, to the extent of:

   1. the difference between the medicare benefit for the service and the fee charged for the service, up to the amount of the Medicare Benefit Schedule fee for a service of that kind; and

   2. if the professional service is subject to a Division 4 agreement, and the amount payable under the agreement exceeds the amount of the Medicare Benefit Schedule fee for a service of that kind - the amount of that excess, up to 16% more than the amount of the Medicare Benefit Schedule fee;

4. the median number, for the quarter, of single equivalent units with whom the health benefits fund conducted by the organisation has entered into an applicable benefits arrangement (that is, the number determined by adding the number of such units at the beginning of the quarter and the number at the end, and halving the result).

(2) The matters mentioned in subsection (1) are to be taken into account on a State by State basis consistently with the organisation of information presented for the quarter by the registered organisation under the Reinsurance Records Determination.

(3) For this section, the Council may make a correction to information received from a registered organisation if it considers the information to be inaccurate in a way that would produce an incorrect calculation.

(4) For this section, Division 4 agreement means a medical purchaser provider agreement under section 73BDA of the Act or a practitioner agreement under section 73BDAA of the Act.