12. Benefits

Benefits may be claimed under the Scheme, in accordance with these Regulations, only for claimable medical treatment or services received by the insured person —

from an approved medical practitioner employed or engaged by an approved medical institution; and

during the period when the insured person is insured under the Scheme.

No benefits may be claimed under the Scheme —

for any treatment, service or item specified in the Third Schedule; or

for any treatment, service or item assessed, by the Council or a committee appointed under section 8(4) of the Act, to be inappropriate in the circumstances of a particular case.

An approved medical institution may submit claims directly to the Board, in the manner and subject to any terms and conditions required by the Board, for claimable medical treatment or services provided by the approved medical institution to the insured person.

Claims under the Scheme may be paid from the Fund.

Benefits may be claimed under the Scheme, in accordance with these Regulations, only for claimable medical treatment or services received by the insured person —

from an approved medical practitioner employed or engaged by an approved medical institution; and

during the period when the insured person is insured under the Scheme.

No benefits may be claimed under the Scheme —

for any treatment, service or item specified in the Third Schedule; or

for any treatment, service or item assessed, by the Council or a committee appointed under section 8(4) of the Act, to be inappropriate in the circumstances of a particular case.

An approved medical institution may submit claims directly to the Board, in the manner and subject to any terms and conditions required by the Board, for claimable medical treatment or services provided by the approved medical institution to the insured person.

Claims under the Scheme may be paid from the Fund.