Schedule 8

The last day of the last policy year of a person’s pre-existing MediShield cover is taken to be 31 October 2015.(2) Sub-paragraph (1) does not apply for the purpose of determining the first insurance period under regulation 20(1).Cross implementation claim2.—

Regulation 14 does not apply to a cross implementation claim.(2) Subject to sub-paragraph (3), the amount of an insured person’s cross implementation claim that may be paid in respect of each period of the cross implementation claim referred to in sub-paragraph (a), or (b)(i) or (ii)(A) or (B), or (c) is an amount not exceeding the excess limit determined in accordance with the formula in sub-paragraph (a), or (b)(i) or (ii)(A) or (B), or (c), as the case may be —

for any relevant policy year of the person’s cross implementation claim before the last policy year of the person’s pre-existing MediShield cover to which the cross implementation claim relates:L − A,where Lis the policy year limit under regulation 10(5) of the revoked MediShield Regulations for the initial policy year of the cross implementation claim; andAis the total amount of claims which were —

paid under the person’s pre-existing MediShield cover to which the cross implementation claim relates in respect of the relevant policy year of that pre-existing MediShield cover; and

received before the Board received the cross implementation claim;

if —

regulation 20(1)(a) applies to the first insurance period of the insured person’s MediShield Life cover, for the cross implementation period of the insured person’s cross implementation claim:L – B − C,where Lis as defined in sub-paragraph (a);Bis the total amount of claims which were —

paid under the person’s pre-existing MediShield cover to which the cross implementation claim relates in respect of the last policy year of that pre-existing MediShield cover; and

received before the Board received the cross implementation claim; andCis the total amount of claims which were —

paid under the person’s MediShield Life cover to which the cross implementation claim relates in respect of the first insurance period of that MediShield Life cover; and

received before the Board received the cross implementation claim;

regulation 20(1)(b) applies to the first insurance period of the insured person’s MediShield Life cover —

for the last policy year of the insured person’s pre‑existing MediShield cover:L − B,where Lis as defined in sub-paragraph (a); andBis as defined in sub-paragraph (b)(i);

for the first insurance period of the insured person’s MediShield Life cover:L − C,where Lis as defined in sub-paragraph (a); andCis as defined in sub-paragraph (b)(i);

for any relevant insurance period of the person’s cross implementation claim after the first insurance period of the person’s MediShield Life cover:L − D,where Lis as defined in sub-paragraph (a); andDis the total amount of claims which were —

paid under the person’s MediShield Life cover to which the cross implementation claim relates in respect of the relevant insurance period of that MediShield Life cover; and

received before the Board received the cross implementation claim.(3) For the purposes of sub-paragraph (2), if the Minister approves an insured person’s application to apply a higher value of L in relation to the insured person’s cross implementation claim in respect of any relevant insurance period of the insured person’s MediShield Life cover, the value of L in respect of any insurance period to which the insured person’s cross implementation claim relates —

is a value specified by the Minister for that insurance period; and

must not exceed —

for the cross implementation period of the insured person’s cross implementation claim, $100,000; and

for any other relevant insurance period, the insurance period limit under regulation 13(1) for that insurance period.(4) The Board may pay cross implementation claims from the Fund.(5) In relation to a person’s cross implementation claim —“cross implementation period”, in relation to an insured person’s cross implementation claim, means the last policy year of the insured person’s pre-existing MediShield cover and the first insurance period of the insured person’s MediShield Life cover;“final insurance period” means the insurance period in which the date of discharge of the approved medical treatment or services to which the person’s cross implementation claim relates falls;“initial policy year” means the policy year in which the admission date of the approved medical treatment or services to which the person’s cross implementation claim relates falls;“relevant insurance period”, in relation to an insured person’s cross implementation claim, means each insurance period between the first insurance period and the final insurance period (both inclusive) of the insured person’s MediShield Life cover to which the cross implementation claim relates;“relevant policy year”, in relation to an insured person’s cross implementation claim, means each policy year between the initial policy year and the last policy year (both inclusive) of the insured person’s pre-existing MediShield cover to which the cross implementation claim relates.