522 Obligation on authorised insurers

An authorised health insurer is obliged, where a claim under a contract of insurance has been submitted and accepted, to discharge that claim, in so far as it relates to a practitioner’s fees from professional services in respect of relevant medical expenses by paying the practitioner directly unless section 529A applies on a payment to a partnership.

Where the medical practitioner was providing the services as an employee, rather than on his or her own account, then the authorised health insurer should discharge the claim directly to the employer.

This obligation facilitates a health insurer in deducting the withholding tax from such payments.

The subscriber or member is indemnified against any breach of contract by a practitioner where the health insurer pays that practitioner directly.

Relevant Date: Finance Act 2021