New Assignment of Benefit Requirements from 1/7/2026

New Assignment of Benefit Requirements from 1/7/2026

UPDATE: This article has been updated with revised information based on the June 18th announcement from The Department of Health, Disability and Ageing. Please check back from time-to-time for further updates.

Background

Under the Health Insurance Act 1973, the Australian Government subsidises the cost of health services. For bulk-billed services, patients direct their Medicare benefit payment to their healthcare provider as payment in full. For most types of inpatient medical claims (IMC - also known as ECLIPSE claims) the Medicare benefit is paid via the Health Fund and unless the claim was fully paid, the Medicare and fund rebate will be paid to the provider. 

In the past assignment was given on specific forms, signed by the patient after the consultation or service. It was the patient's responsibility to keep the Assignment of Benefit (AoB) form. During the COVID-19 pandemic, the Department of Health, Disability and Ageing issued temporary guidelines where in certain situations, patients could consent verbally, as opposed to signing an agreement.

This arrangement was due to cease from 1/7/2026, however on 18/6/2026 the government announced that the rollout of the Bulk Bill component will now be subject to a 12-month transition period. Verbal assignment of benefit for all Bulk-Billed patients, in all settings will still be valid until 1/7/2027. See https://www.health.gov.au/our-work/improving-the-assignment-of-benefit-process#status

NOTE: The new requirements for AoB with Simplified billing, i.e. some ECLIPSE (Inpatient Medical Claims) will still commence as planned from 1/7/2026.

Under the new regulations, the provider is required to obtain an AoB where appropriate and retain a copy for at least 2 years.

Managing Assignment of Benefit (AoB) in CESoft

From 1/7/2026, you must comply with the AoB regulations to obtain an assignment prior to submitting a claim.
To facilitate this we are introducing a new AoB workflow into CESoft.

Which claims do not need AoB?

  1. Medicare Claims - There is no need to collect AoB on Medicare Claims, as benefit is never assigned.
  2. Paid In Full Claims - There is no need to collect AoB on any claim that is paid in full as the benefit goes to the patient.
  3. No Gap/Known Gap/Gap Cover IMC claims - AoB is implied through the insurance arrangements, so there is no need to request AoB from the patient if working under the funds rules (but see below)

When do I need to collect AoB?

  1. When required, AoB must be collected prior to submitting a claim. It can be collected before or after the service is provided, but must accurately reflect the service(s) given.
  2. Bulk Bill Claims - You are still required to obtain AoB for all Bulk Bill claims. However, this can continue to be done verbally until 1/7/2027 if you wish. You may collect it electronically before then if you wish.
  3. ECLIPSE Claims (IMC) - If you exceed the allowed maximum gap, or charge a gap on a No Gap arrangement, then you're no longer operating under the insurers' rules. In this case you will need to obtain AoB.
  4. If AoB is collected prior to a service and the service changes, a new AoB must be obtained prior to submitting a claim.

How to collect AoB?

When submitting claims you will get a prompt to obtain AoB when one is required. You will see an AoB button adjacent to the Submit button to initiate the Assignment process. This will send a link by email or by SMS to the person assigning the benefit - usually the patient, but see 'Who is able to assign benefits' below.

When the Assignor opens the link they will be instructed to view the AoB form using a code. They will then read and accept the AoB. Their acceptance and a copy of the form are saved in the Invoice History tab, fulfilling the legal requirements.

You may then submit the claim for processing.

Who is able to assign benefits?

Usually this is the patient. An assignment can also be made by a parent, guardian, or carer, however it is not limited to these relationships. Assignment can be made by anyone who would otherwise be responsible for the cost of the medical service if it were not being bulk billed.

What if a patient is unable to sign?

If a patient is unable to sign an AoB agreement, an assignor (i.e. parent, partner, carer, relative, person with power of attorney or friend) could be asked to sign the agreement.

Staff employed by the medical practitioner rendering the medical service cannot be the ‘assignor’ as there is a perceived financial conflict of interest, unless they are the parents or carers of the patient, when it would be acceptable for them to assign on the child’s behalf.
Without a patient or assignor’s signature, an AoB agreement is not complete, and you should not make a bulk-bill claim.

What if the patient does not agree to assign their Medicare benefit?

If the patient does not agree to assign their Medicare benefit, they should be privately billed and provided with an invoice to enable them to claim their Medicare benefit from Services Australia. You must not bulk-bill without an AoB.

What is 'Implied' assignment?

According the the new legislation, where a patient has an existing arrangement with an insurer, there are no requirements for signatures or approvals from the assignor or patient if services are provided under that arrangement. 

Implied AoB would apply when an inpatient medical claim is submitted to an insurer under a No Gap/Known Gap/Gap Cover arrangement (i.e. most ECLIPSE claims).

However if you work outside these arrangements, eg by charging more than the allowed gap on a Known Gap claim, or charging any gap on a No Gap arrangement, then you must specifically request AoB prior to submitting a claim.

Do I need AoB for Medicare Claims?

No, with Medicare claims (as distinct from Bulk Bill claims) the benefit never goes directly to the provider. Therefore no AoB is required.

Do I need AoB for Workcover or other third-party Claims?

No, only claims with a Medicare benefit require AoB.

How does AoB work in aged care and nursing home settings?

An AoB for bulk billed services is required in aged care settings. Where a patient lacks mental or physical capacity to make their own financial or health decisions, an assignor can do so on their behalf. Under the Health Insurance Act 1973, an assignor is a person who would otherwise meet the cost of medical expenses. In practical terms this is usually a carer, partner, parent, or a person with Power of Attorney.

The department is working to finalise regulations to support enduring AoB for patients who are registered in MyMedicare or receive services from an Aboriginal Community Controlled Health Organisation (ACCHS) or Aboriginal Medical Service (AMS). Enduring AoB will require an agreement to be signed once (by a patient or their assignor), for ongoing and future services from a preferred clinic/practice. The use of an enduring assignment will have a post-service notification requirement. This will require providers to send a notification to patients after a related service. Enduring assignment will commence in 2027. 

Important Notes

  1. There is no requirement for the provider to physically or electronically sign the agreement.
  2. There is a requirement to record that the patient or person responsible (the Assignor) has agreed to assign the benefit. CE manages this for you.
  3. You can also send a copy of the assignment by email to the patient or assignor if desired.
  4. Providers are required to keep a copy of the completed AoB agreements for 2 years and must provide a copy to the patient upon request. These can be accessed on the Invoice History tab.

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