PRIVATE HEALTH INSURANCE ACT 2007
Table of Provisions
CHAPTER 1--Introduction
PART 1-1--INTRODUCTION
Division 1--Preliminary
Division 3--Overview of this Act
- 3.1 What this Act is about
- 3.5 Incentives (Chapter 2)
- 3.10 Complying health insurance products (Chapter 3)
- 3.15 Health insurance business, health benefits funds and miscellaneous obligations of private health insurers (Chapter 4)
- 3.20 Enforcement (Chapter 5)
- 3.25 Administration (Chapter 6)
- 3.30 Dictionary (Schedule 1)
Division 5--Constitutional matters
- 5.1 Meaning of insurance
- 5.5 Act not to apply to State insurance within that State
- 5.10 Compensation for acquisition of property
CHAPTER 2--Incentives
PART 2-1--INTRODUCTION
Division 15--Introduction
- 15.1 What this Chapter is about
PART 2-2--PREMIUMS REDUCTION SCHEME
Division 20--Introduction
Division 22--PHIIB, PHII benefit and related concepts
Subdivision 22-A--PHIIB, PHII benefit and related concepts- 22.1 Application of Subdivision
- 22.5 Meaning of PHIIB
- 22.10 Meaning of PHII benefit
- 22.15 Meaning of share of the PHII benefit --single PHIIB
- 22.20 Meaning of share of the PHII benefit --multiple PHIIBs
- 22.25 Application of subsection 22 - 15(1) after a person 65 years or over ceases to be covered by policy Subdivision 22-B--Private health insurance tiers
- 22.30 Private health insurance tiers
- 22.35 Private health insurance singles thresholds
- 22.40 Private health insurance family thresholds
- 22.45 Indexation
Division 23--Premiums reduction scheme
Subdivision 23-A--Amount of reduction- 23.1 Reduction in premiums Subdivision 23-B--Participation in the premiums reduction scheme
- 23.15 Registration as a participant in the premiums reduction scheme
- 23.20 Refusal to register
- 23.30 Participants who want to withdraw from scheme
- 23.35 Revocation of registration
- 23.40 Variation of registration
- 23.45 Retention of applications by private health insurers
PART 2-3--LIFETIME HEALTH COVER
Division 31--Introduction
Division 34--General rules about lifetime health cover
- 34.1 Increased premiums for person who is late in taking out hospital cover
- 34.5 Increased premiums for person who ceases to have hospital cover after his or her lifetime health cover base day
- 34.10 Increased premiums stop after 10 years' continuous cover
- 34.15 Meaning of hospital cover
- 34.20 Meaning of permitted days without hospital cover
- 34.25 Meaning of lifetime health cover base day
- 34.30 When a person is overseas or enters Australia
Division 37--Exceptions to the general rules about lifetime health cover
- 37.1 People born on or before 1 July 1934
- 37.5 People over 31 and overseas on 1 July 2000
- 37.7 Person yet to turn 31
- 37.10 Hardship cases
- 37.15 Increases cannot exceed 70% of base rates
- 37.20 Joint hospital cover
Division 40--Administrative matters relating to lifetime health cover
- 40.1 Notification to insured people etc.
- 40.5 Evidence of having had hospital cover, or of a person's age
PART 2-4--EXCESS LEVELS FOR MEDICARE LEVY AND MEDICARE LEVY SURCHARGE PURPOSES
Division 42--Introduction
- 42.1 What this Part is about
Division 45--Excess levels for medicare levy and medicare levy surcharge purposes
- 45.1 Excess level amounts
CHAPTER 3--Complying health insurance products
PART 3-1--INTRODUCTION
Division 50--Introduction
PART 3-2--COMMUNITY RATING
Division 55--Principle of community rating
- 55.1 What this Part is about
- 55.5 Principle of community rating
- 55.10 Closed products, and terminated products and product subgroups
- 55.15 Pilot projects
PART 3-3--REQUIREMENTS FOR COMPLYING HEALTH INSURANCE PRODUCTS
Division 60--Introduction
- 60.1 What this Part is about
Division 63--Basic rules about complying health insurance products
- 63.1 Obligation to ensure products are complying products
- 63.5 Meaning of complying health insurance product
- 63.10 Meaning of complying health insurance policy
Division 66--Community rating requirements
- 66.1 Community rating requirements
- 66.5 Premium requirement
- 66.10 Minister's approval of premiums
- 66.15 Entitlement to benefits for general treatment
- 66.20 Different amount of benefits depending on where people live
- 66.25 Different amounts of benefits for travel or accommodation
Division 69--Coverage requirements
Division 72--Benefit requirements for policies that cover hospital treatment
- 72.1 Benefit requirements
- 72.5 Rules requirement in relation to provision of benefits
- 72.10 Minimum benefits for medical devices and human tissue products
- 72.11 Meaning of medical device
- 72.12 Meaning of human tissue product
- 72.15 Fees for certain activities
- 72.20 Delisting because of unpaid fees or levy
- 72.25 Minister may direct that activities not be carried out
- 72.27 Matters to have regard to before exercising certain powers
- 72.30 When cost - recovery fee must be paid
- 72.35 Payment of cost - recovery fee
- 72.40 Recovery of fee
- 72.45 Other matters
Division 75--Waiting period requirements
- 75.1 Waiting period requirements
- 75.5 Meaning of waiting period
- 75.10 Meaning of transfers
- 75.15 Meaning of pre - existing condition
Division 78--Portability requirements
- 78.1 Portability requirements
Division 81--Quality assurance requirements
- 81.1 Quality assurance requirements
Division 84--Enforcement of this Part
- 84.1 Offence: advertising, offering or insuring under non - complying policies
- 84.5 Offence: directors and chief executive officers liable if systems not in place to prevent breaches
- 84.10 Injunction in relation to non - complying policies
- 84.15 Remedies for people affected by non - complying policies
PART 3-4--OBLIGATIONS RELATING TO COMPLYING HEALTH INSURANCE PRODUCTS
Division 90--Introduction
- 90.1 What this Part is about
Division 93--Giving information to consumers
- 93.1 Maintaining up to date private health information statements
- 93.5 Meaning of private health information statement
- 93.10 Making private health information statements available
- 93.15 Giving information to newly insured people
- 93.20 Keeping insured people up to date
- 93.25 Giving advance notice of detrimental changes to rules
- 93.30 Failure to give information to consumers
Division 96--Giving information to the Department and the Private Health Insurance Ombudsman
- 96.1 Giving private health information statements on request
- 96.5 Giving private health information statements for new products
- 96.10 Giving updated private health information statements
- 96.15 Giving additional information on request
- 96.20 Failure to give information to Department or Private Health Insurance Ombudsman
- 96.25 Giving information required by the Private Health Insurance (Complying Product) Rules
Division 99--Transfer certificates
- 99.1 Transfer certificates
Division 102--Private health insurers to offer cover for hospital treatment
- 102.1 Private health insurers to offer cover for hospital treatment
CHAPTER 4--Health insurance business, health benefits funds and miscellaneous obligations of private health insurers
PART 4-1--INTRODUCTION
Division 110--Introduction
- 110.1 What this Chapter is about
PART 4-2--HEALTH INSURANCE BUSINESS
Division 115--Introduction
- 115.1 What this Part is about
- 115.5 Private Health Insurance (Health Insurance Business) Rules
- 115.10 Whether a business etc. is health insurance business
Division 121--What is health insurance business?
- 121.1 Meaning of health insurance business
- 121.5 Meaning of hospital treatment
- 121.7 Conditions on declarations of hospitals
- 121.8 Application for inclusion of hospital in a class
- 121.8A Minister to decide application
- 121.8B Period of inclusion of hospital in a class
- 121.8C Revocation of inclusion of hospital in a class
- 121.8D Private Health Insurance (Health Insurance Business) Rules
- 121.10 Meaning of general treatment
- 121.15 Extension to employee health benefits schemes
- 121.20 Exception: accident and sickness insurance business
- 121.25 Exception: liability insurance business
- 121.30 Exception: insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules
PART 4-4--HEALTH BENEFITS FUNDS
Division 131--Health benefits funds
- 131.1 What this Part is about
- 131.5 Private Health Insurance (Health Benefits Fund Policy) Rules
- 131.10 Meaning of health benefits fund
- 131.15 Meaning of health - related business
- 131.20 Risk equalisation jurisdictions
- 131.25 Operation of health - related businesses through health benefits funds
PART 4-5--MISCELLANEOUS OBLIGATIONS OF PRIVATE HEALTH INSURERS
Division 157--Introduction
Division 169--Notification obligations
- 169.10 Private health insurers to notify any changes to rules
Division 172--Other obligations
- 172.5 Agreements with medical practitioners
- 172.10 Private health insurers to give information to Secretary
- 172.15 Restrictions on payment of pecuniary penalties etc.
CHAPTER 5--Enforcement
PART 5-1--INTRODUCTION
Division 180--Introduction
- 180.1 What this Chapter is about
PART 5-2--GENERAL ENFORCEMENT METHODS
Division 185--What this Part is about
Division 188--Performance indicators
- 188.1 Performance indicators
Division 191--Explanation of private health insurer's operations
- 191.1 Minister may seek an explanation from a private health insurer
- 191.5 Minister must respond to insurer's explanation
Division 194--Investigation of private health insurer's operations
- 194.1A Purposes for which powers may be exercised etc.
- 194.1 Minister may investigate a private health insurer
- 194.5 Notice to give information
- 194.10 Notice to produce documents
- 194.15 Notice to give evidence
- 194.20 Offences in relation to investigation notices
- 194.25 Authorisation to examine books and records etc.
- 194.35 Minister must notify outcome of investigation
Division 197--Enforceable undertakings
- 197.1 Minister may accept written undertakings given by a private health insurer
- 197.5 Enforcement of undertakings
Division 200--Ministerial directions
Division 203--Remedies in the Federal Court
- 203.1 Minister may apply to the Federal Court
- 203.5 Declarations of contravention
- 203.10 Pecuniary penalty order
- 203.15 Compensation order
- 203.20 Adverse publicity order
- 203.25 Other order
- 203.30 Time limit for declarations and orders
- 203.35 Civil evidence and procedure rules for declarations and orders
- 203.40 Civil proceedings after criminal proceedings
- 203.45 Criminal proceedings during civil proceedings
- 203.50 Criminal proceedings after civil proceedings
- 203.55 Evidence given in proceedings for penalty not admissible in criminal proceedings
- 203.60 Minister may require person to assist
- 203.65 Relief from liability for contravening an enforceable obligation
- 203.70 Powers of Federal Court
Division 206--Revoking entitlement to offer rebate as a premium reduction
- 206.1 Revocation of status of participating insurer
CHAPTER 6--Administration
PART 6-1--INTRODUCTION
Division 230--Introduction
- 230.1 What this Chapter is about
PART 6-4--ADMINISTRATION OF PREMIUMS REDUCTION SCHEME
Division 276--Introduction
- 276.1 What this Part is about
Division 279--Reimbursement of participating insurers and powers of Chief Executive Medicare
Subdivision 279-A--Reimbursement of private health insurers for premiums reduced under scheme- 279.1 Participating insurers may claim reimbursement
- 279.5 Participating insurers
- 279.10 Requirements for claims
- 279.15 Amounts payable to the private health insurer
- 279.20 Notifying private health insurers if amount is not payable
- 279.25 Additional payment if insurer claims less than entitlement
- 279.30 Additional payment if insurer makes a late claim
- 279.35 Content and timing of application
- 279.40 Decision on application
- 279.45 Reconsideration of decisions Subdivision 279-B--Powers of Chief Executive Medicare in relation to participating insurers
- 279.50 Audits by Chief Executive Medicare
- 279.55 Chief Executive Medicare may require production of applications
Division 282--Recovery of amounts and other matters
Subdivision 282-A--When and how payments can be recovered- 282.1 Recovery of payments
- 282.5 Interest on amounts recoverable
- 282.10 Chief Executive Medicare may set off debts against amounts payable
- 282.15 Reconsideration of certain decisions under this Division Subdivision 282-AA--Recovery of certain amounts by Commissioner of Taxation
- 282.16 Administration of this Subdivision by Commissioner of Taxation
- 282.17 Subdivision operates in addition to Subdivision 282 - A
- 282.18 Liability for excess private health insurance premium reduction or refund
- 282.19 When general interest charge payable Subdivision 282-B--Miscellaneous
- 282.20 Notification requirements--private health insurers
- 282.25 Use etc. of information relating to another person
- 282.30 Information to be provided to the Commissioner of Taxation
- 282.35 Delegation
- 282.40 Appropriation
PART 6-6--PRIVATE HEALTH INSURANCE LEVIES
Division 304--Introduction
- 304.1 What this Part is about
- 304.5 Private Health Insurance (Levy Administration) Rules
- 304.10 Meaning of private health insurance levy
Division 307--Collection and recovery of private health insurance levies
- 307.1 When private health insurance levy must be paid
- 307.5 Late payment penalty
- 307.10 Payment of levy and late payment penalty
- 307.15 Recovery of levy and late payment penalty
- 307.20 Waiver of late payment penalty
- 307.30 Other matters
Division 310--Returns, requesting information and keeping records: private health insurers
- 310.1 Returns relating to complaints levy
- 310.5 Insurer must keep records
- 310.10 Power to request information from insurer
Division 313--Power to enter premises and search for documents related to complaints levy
- 313.1 Authorised officer may enter premises with consent
- 313.5 Authorised officer may enter premises under warrant
- 313.10 Announcement before entry
- 313.15 Executing a warrant to enter premises
- 313.20 Identity cards
PART 6-7--PRIVATE HEALTH INSURANCE RISK EQUALISATION SPECIAL ACCOUNT
Division 318--Private Health Insurance Risk Equalisation Special Account
- 318.1 Private Health Insurance Risk Equalisation Special Account
- 318.5 Credits to the Risk Equalisation Special Account
- 318.10 Purpose of the Risk Equalisation Special Account
- 318.15 Record keeping
PART 6-8--DISCLOSURE OF INFORMATION
Division 323--Disclosure of information
- 323.1 Prohibition on disclosure of information
- 323.5 Authorised disclosure: official duties
- 323.10 Authorised disclosure: sharing information about insurers among agencies
- 323.15 Authorised disclosure: sharing information about insurers other than among agencies
- 323.20 Authorised disclosure: public interest
- 323.25 Authorised disclosure: by the Secretary if authorised by affected person
- 323.30 Authorised disclosure: court proceedings
- 323.40 Offence: disclosure of information obtained by certain authorised disclosures
- 323.45 Offence: soliciting disclosure of information
- 323.50 Offence: use etc. of unauthorised information
- 323.55 Offence: offering to supply protected information