Legislation has been introduced to update the Assignment of Medicare Benefits (AOB) process, effective from 1 July 2026. AOB applies where a patient’s Medicare benefit is paid to another party, such as a private health fund or an approved billing agent.
Types of assignment
For services provided from 1 July 2026, simplified billing will recognise two types of assignment of Medicare benefits:
- Implied (“I”) assignment
- Requested (“R”) assignment
Implied assignment
An implied assignment applies by default where a medical provider or hospital has an arrangement with a fund that covers the service and fee. This includes AGC, MPPAs, and HPPA/PAs.
Where a provider meets the relevant terms and conditions, the assignment is treated as implied. As a provider declaration of assignment must be made with a medical claim under implied assignment changes have been made to the Account Summary Form (batch header) for paper claims.
AGC forms must only be used where AGC applies. These claims are designated as “I”.
AGC and agreement claims
All valid AGC/agreement claims should be flagged as “I” when submitted via ECLIPSE to Medicare by the fund.
Manual AGC/Agreement claims require a AOB declaration to be provided.
Non-valid AGC and agreement claims
AGC/agreement claims that breach the rules (for example, where charge limits are exceeded) cannot be treated as an implied assignment. These claims will be rejected.
Requested assignment
A requested assignment applies where no fund arrangement covers the service.
Requested assignment must be obtained in writing by the provider. There is no prescribed form. The request may be incorporated into existing documents such as a patient election, admission form or patient claim form. Copies of the requested assignment do not need to be provided to the fund or billing agent.
A requested assignment can apply to all medical services within the same episode of care. Where no fund arrangement exists (Non-AGC/Agreement), these claims should be flagged as “R” claims when submitted via ECLIPSE to Medicare by the fund.
Provider responsibilities
The responsibility for obtaining the appropriate assignment of benefit rests with the provider (doctor, hospital, or medical organisation).
When a claim is lodged, the fund or billing agent may assume the provider has properly obtained the assignment. No responsibility rests with the fund or billing agent if the provider has failed to do so.
A provider declaration of assignment must be provided with the medical claim.
Additional information
Implied or Requested assignment may occur in public, private, or day hospital settings.
AOB applies only to the medical service component that attracts a Medicare benefit. Hospital accommodation and facility charges are out of scope.
The legislation applies to medical claims with a date of service from 1 July 2026.
References
Legislation
- Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Act 2024
- Health Legislation Amendment (Miscellaneous Measures No. 1) Act 2025
- Health Insurance Amendment (Assignment of Medicare Benefits and Other Measures) Regulations 2025
Presentation by the Department
Further information can also be found in the slides presented by the Department on 11 February 2026.
Frequently asked questions by the Department
Further information can also be found in Frequently asked questions document provided by the Department on 15 May 2026.
General enquiries about legislation
For general enquiries about the legislation, contact the Australian Government Department of Health, Disability and Ageing at AssignmentofBenefit@health.gov.au