Commonwealth Consolidated Acts Commonwealth Consolidated ActsAct No. 31 of 2007 as amended
This compilation was prepared on 15 July 2009
taking into account amendments up to Act No. 66 of 2009
The text of any of those amendments not in force
on that date is appended in the Notes section
The operation of amendments that have been incorporated may
be
affected by application provisions that are set out in the Notes section
Prepared by the Office of Legislative Drafting and
Publishing,
Attorney‑General's Department, Canberra
Contents
Chapter 1--Introduction 1
Part 1‑1--Introduction 1
Division 1--Preliminary 1
1‑1......... Short title [see Note 1] ....................................................................... 1
1‑5......... Commencement .................................................................................. 1
1‑10....... Identifying defined terms .................................................................... 1
Division 3--Overview of this Act 3
3‑1......... What this Act is about ........................................................................ 3
3‑5......... Incentives (Chapter 2) ........................................................................ 3
3‑10....... Complying health insurance products (Chapter 3) ............................ 3
3‑15....... Private health insurers (Chapter 4) ..................................................... 3
3‑20....... Enforcement (Chapter 5) .................................................................... 4
3‑25....... Administration (Chapter 6) ................................................................ 4
3‑30....... Dictionary (Schedule 1) ...................................................................... 4
Division 5--Constitutional matters 5
5‑1......... Meaning of insurance ......................................................................... 5
5‑5......... Act not to apply to State insurance within that State ........................ 5
5‑10....... Compensation for acquisition of property ......................................... 5
Chapter 2--Incentives 6
Part 2‑1--Introduction 6
Division 15--Introduction 6
15‑1....... What this Chapter is about ................................................................. 6
Part 2‑2--Premiums reduction and incentive payments schemes 7
Division 20--Introduction 7
20‑1....... What this Part is about ....................................................................... 7
20‑5....... Private Health Insurance (Incentives) Rules ....................................... 7
Division 23--Premiums reduction scheme 8
Subdivision 23‑A--Amount of reduction 8
23‑1....... Reduction in premiums ....................................................................... 8
23‑5....... Meaning of incentive amount .............................................................. 9
23‑10..... Reduction after a person 65 years or over ceases to be covered by policy 10
Subdivision 23‑B--Participation in the premiums reduction scheme 11
23‑15..... Registration as a participant in the premiums reduction scheme ..... 11
23‑20..... Refusal to register ............................................................................. 11
23‑25..... Pre‑1999 participants must keep information up to date ................ 12
23‑30..... Participants who want to withdraw from scheme ............................ 13
23‑35..... Revocation of registration ................................................................. 13
23‑40..... Variation of registration .................................................................... 13
23‑45..... Retention of applications by private health insurers ....................... 14
Division 26--The incentive payments scheme 15
Subdivision 26‑A--Amount of incentive payment 15
26‑1....... Payment in relation to premiums ..................................................... 15
26‑5....... Payment after a person 65 years or over ceases to be covered by policy 16
Subdivision 26‑B--Claiming payments under the incentive payments scheme 17
26‑10..... Claim for payment under incentive payments scheme ..................... 17
26‑15..... Withdrawal of claim .......................................................................... 17
26‑20..... Determination of claim and payment of amount .............................. 17
26‑25..... Reconsideration of decision refusing a claim .................................... 18
26‑30..... Claimants to keep information up to date ........................................ 19
Part 2‑3--Lifetime health cover 20
Division 31--Introduction 20
31‑1....... What this Part is about ..................................................................... 20
31‑5....... Private Health Insurance (Lifetime Health Cover) Rules ................. 20
Division 34--General rules about lifetime health cover 21
34‑1....... Increased premiums for person who is late in taking out hospital cover 21
34‑5....... Increased premiums for person who ceases to have hospital cover after his or her lifetime health cover base day .......................................................................................................... 21
34‑10..... Increased premiums stop after 10 years' continuous cover ............. 22
34‑15..... Meaning of hospital cover ................................................................ 23
34‑20..... Meaning of permitted days without hospital cover ........................... 23
34‑25..... Meaning of lifetime health cover base day ........................................ 24
34‑30..... When a person is overseas ................................................................ 26
Division 37--Exceptions to the general rules about lifetime health cover 27
37‑1....... People born on or before 1 July 1934 .............................................. 27
37‑5....... People over 31 and overseas on 1 July 2000 .................................... 27
37‑10..... Hardship cases .................................................................................. 27
37‑15..... Increases cannot exceed 70% of base rates ....................................... 27
37‑20..... Joint hospital cover .......................................................................... 28
Division 40--Administrative matters relating to lifetime health cover 29
40‑1....... Notification to insured people etc. ................................................... 29
40‑5....... Evidence of having had hospital cover, or of a person's age ............ 30
Chapter 3--Complying health insurance products 31
Part 3‑1--Introduction 31
Division 50--Introduction 31
50‑1....... What this Chapter is about ............................................................... 31
50‑5....... Private Health Insurance Rules relevant to this Chapter .................. 31
Part 3‑2--Community rating 32
Division 55--Principle of community rating 32
55‑1....... What this Part is about ..................................................................... 32
55‑5....... Principle of community rating .......................................................... 32
55‑10..... Closed products ................................................................................ 34
55‑15..... Pilot projects .................................................................................... 34
Part 3‑3--Requirements for complying health insurance products 35
Division 60--Introduction 35
60‑1....... What this Part is about ..................................................................... 35
Division 63--Basic rules about complying health insurance products 36
63‑1....... Obligation to ensure products are complying products ................... 36
63‑5....... Meaning of complying health insurance product .............................. 36
63‑10..... Meaning of complying health insurance policy ................................. 37
Division 66--Community rating requirements 38
66‑1....... Community rating requirements ....................................................... 38
66‑5....... Premium requirement ........................................................................ 38
66‑10..... Minister's approval of premiums .................................................... 40
66‑15..... Entitlement to benefits for general treatment ................................... 40
66‑20..... Different amount of benefits depending on where people live ......... 41
Division 69--Coverage requirements 42
69‑1....... Coverage requirements ...................................................................... 42
69‑5....... Meaning of cover .............................................................................. 42
69‑10..... Meaning of hospital‑substitute treatment .......................................... 43
Division 72--Benefit requirements for policies that cover hospital treatment 44
72‑1....... Benefit requirements ......................................................................... 44
72‑5....... Rules requirement in relation to provision of benefits ..................... 46
72‑10..... Minimum benefits for prostheses .................................................... 47
72‑15..... Ongoing listing fee for prostheses .................................................... 48
72‑20..... Other matters .................................................................................... 48
Division 75--Waiting period requirements 50
75‑1....... Waiting period requirements ............................................................. 50
75‑5....... Meaning of waiting period ................................................................ 50
75‑10..... Meaning of transfers ........................................................................ 51
75‑15..... Meaning of pre‑existing condition .................................................... 51
Division 78--Portability requirements 53
78‑1....... Portability requirements ................................................................... 53
Division 81--Quality assurance requirements 55
81‑1....... Quality assurance requirements ........................................................ 55
Division 84--Enforcement of this Part 56
84‑1....... Offence: advertising, offering or insuring under non‑complying policies 56
84‑5....... Offence: directors and chief executive officers liable if systems not in place to prevent breaches 56
84‑10..... Injunction in relation to non‑complying policies .............................. 57
84‑15..... Remedies for people affected by non‑complying policies ............... 58
Part 3‑4--Obligations relating to complying health insurance products 59
Division 90--Introduction 59
90‑1....... What this Part is about ..................................................................... 59
Division 93--Giving information to consumers 60
93‑1....... Maintaining up to date standard information statements ................. 60
93‑5....... Meaning of standard information statement ..................................... 61
93‑10..... Making standard information statements available .......................... 61
93‑15..... Giving information to newly insured people .................................... 61
93‑20..... Keeping insured people up to date ................................................... 62
93‑25..... Giving advance notice of detrimental changes to rules ..................... 63
93‑30..... Failure to give information to consumers ......................................... 63
Division 96--Giving information to the Department, the Council and the Private Health Insurance Ombudsman 64
96‑1....... Giving standard information statements on request ......................... 64
96‑5....... Giving standard information statements for new products .............. 64
96‑10..... Giving updated standard information statements ............................. 64
96‑15..... Giving additional information on request ......................................... 65
96‑20..... Failure to give information to Department, Council or Private Health Insurance Ombudsman 65
96‑25..... Giving information required by the Private Health Insurance (Complying Product) Rules 66
Division 99--Transfer certificates 67
99‑1....... Transfer certificates .......................................................................... 67
Division 102--Private health insurers to offer cover for hospital treatment 69
102‑1..... Private health insurers to offer cover for hospital treatment ............ 69
Chapter 4--Private health insurers 70
Part 4‑1--Introduction 70
Division 110--Introduction 70
110‑1..... What this Chapter is about ............................................................... 70
Part 4‑2--Carrying on health insurance business 71
Division 115--Introduction 71
115‑1..... What this Part is about ..................................................................... 71
115‑5..... The Private Health Insurance (Health Insurance Business) Rules ... 71
115‑10... Whether a business etc. is health insurance business ....................... 71
Division 118--Prohibition of carrying on health insurance business without registration 73
118‑1..... Carrying on health insurance business without registration ............. 73
118‑5..... Injunctions ........................................................................................ 73
Division 121--What is health insurance business? 75
121‑1..... Meaning of health insurance business .............................................. 75
121‑5..... Meaning of hospital treatment .......................................................... 76
121‑7..... Conditions on declarations of hospitals ........................................... 77
121‑10... Meaning of general treatment ........................................................... 78
121‑15... Extension to employee health benefits schemes ................................ 79
121‑20... Exception: accident and sickness insurance business ....................... 80
121‑25... Exception: liability insurance business ............................................. 80
121‑30... Exception: insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules 81
Part 4‑3--Registration 82
Division 126--Registration 82
126‑1..... What this Part is about ..................................................................... 82
126‑5..... The Private Health Insurance (Registration) Rules .......................... 82
126‑10... Applying for registration .................................................................. 82
126‑15... Requesting further information ......................................................... 83
126‑20... Deciding the application ................................................................... 83
126‑25... Notifying the decision ...................................................................... 85
126‑30... Council can be taken to refuse application ....................................... 85
126‑35... Council to maintain record of registrations etc. ................................ 86
126‑40... Changing registration status .............................................................. 86
126‑42... Conversion to for profit status ......................................................... 87
126‑45... Cancellation of registration ............................................................... 89
Part 4‑4--Health benefits funds 90
Division 131--Introduction 90
131‑1..... What this Part is about ..................................................................... 90
131‑5..... The Private Health Insurance (Health Benefits Fund) Rules ........... 90
131‑10... Meaning of health benefits fund ........................................................ 90
131‑15... Meaning of health‑related business .................................................. 91
Division 134--The requirement to have health benefits funds 92
134‑1..... Private health insurers must have health benefits funds ................... 92
134‑5..... Notifying the Council when health benefits funds are established ... 92
134‑10... Inclusion of health‑related businesses in health benefits funds ........ 93
Division 137--The operation of health benefits funds 94
137‑1..... Assets of health benefits funds ........................................................ 94
137‑5..... Payments to health benefits funds ................................................... 95
137‑10... Expenditure and application of health benefits funds ...................... 96
137‑15... Effect of non‑compliance with section 137‑10 ................................. 97
137‑20... Investment of health benefits funds ................................................. 98
137‑25... Restriction on restructure, merger, acquisition or termination of health benefits funds 99
137‑30... Operation of health‑related businesses through health benefits funds 99
Division 140--The solvency standard for health benefits funds 100
140‑1..... Purpose of Division ........................................................................ 100
140‑5..... Council to establish solvency standard .......................................... 100
140‑10... Purpose of solvency standard ........................................................ 100
140‑15... Compliance with solvency standard ............................................... 100
140‑20... Solvency directions ......................................................................... 102
Division 143--The capital adequacy standard for health benefits funds 105
143‑1..... Purpose of Division ........................................................................ 105
143‑5..... Council to establish capital adequacy standard .............................. 105
143‑10... Purpose of capital adequacy standard ............................................ 105
143‑15... Compliance with capital adequacy standard .................................. 106
143‑20... Capital adequacy directions ............................................................ 107
Division 146--Restructure, merger and acquisition of health benefits funds 110
146‑1..... Restructure of health benefits funds ............................................... 110
146‑5..... Merger and acquisition of health benefits funds ............................. 112
146‑10... Consent of policy holders not required .......................................... 114
146‑15... Other laws not overridden .............................................................. 114
Division 149--Termination of health benefits funds 116
Subdivision 149‑A--Approving the termination of health benefits funds 116
149‑1..... Applying for termination ............................................................... 116
149‑5..... Requesting further information ....................................................... 116
149‑10... Deciding the application ................................................................. 116
149‑15... Council can be taken to refuse application ..................................... 117
Subdivision 149‑B--Conducting the termination of health benefits funds 117
149‑20... Conduct of funds during termination process ................................ 117
149‑25... Insurers etc. to give reports to Council .......................................... 118
149‑30... Terminating managers displace management of funds .................... 118
Subdivision 149‑C--Ending the termination of health benefits funds 119
149‑35... Power to end termination ............................................................... 119
Subdivision 149‑D--Completing the termination of health benefits funds 119
149‑40... Completion of the termination process .......................................... 119
149‑45... Distribution of remaining assets after completion of the termination process 120
149‑50... Liability of officers of insurers for loss to terminated funds .......... 120
149‑55... Report of terminating manager ....................................................... 121
149‑60... Applying for winding up ................................................................ 121
Division 152--Duties and liabilities of directors etc. 122
152‑5..... Notices to remedy contraventions .................................................. 122
152‑10... Liability of directors in relation to non‑compliance with notices ... 122
152‑15... Council may sue in the name of private health insurers ................. 123
Part 4‑5--Other obligations of private health insurers 124
Division 157--Introduction 124
157‑1..... What this Part is about ................................................................... 124
157‑5..... The Private Health Insurance (Insurer Obligations) Rules ............. 124
Division 160--Appointed actuaries 125
160‑1..... Appointment .................................................................................. 125
160‑5..... Eligibility for appointment ............................................................. 125
160‑10... Notification of appointment etc. .................................................... 126
160‑15... Cessation of appointment .............................................................. 126
160‑20... Compliance with the Private Health Insurance (Insurer Obligations) Rules 126
160‑25... Powers of appointed actuary ......................................................... 126
160‑30... Actuary's obligations to report ...................................................... 127
160‑35... Qualified privilege of appointed actuary ........................................ 128
Division 163--Prudential standards 130
163‑1..... Private Health Insurance (Insurer Obligations) Rules to establish prudential standards 130
163‑5..... Compliance with prudential standards ........................................... 131
163‑10... Notice of breaches of prudential standards etc. .............................. 131
163‑15... Directions to comply with standards ............................................. 131
163‑20... Failure to comply with directions .................................................. 132
Division 166--Disqualified persons 133
166‑1..... Private health insurers not to allow disqualified persons to act as directors 133
166‑5..... Disqualified persons must not act for private health insurers ........ 133
166‑10... Effect of non‑compliance ................................................................ 133
166‑15... Who is a disqualified person? ......................................................... 133
166‑20... Council may disqualify persons ..................................................... 134
166‑25... Council may determine that persons are not disqualified ............... 135
Division 169--Reporting and notification requirements 137
169‑1..... Copies of reports to policy holders ............................................... 137
169‑5..... Information to be given to the Council annually ............................ 137
169‑10... Private health insurers to notify any changes to rules .................... 137
169‑15... Private health insurers to notify Department and Council about current chief executive officer 138
Division 172--Miscellaneous 139
172‑1..... Private health insurers to comply with Council's requirements .... 139
172-5..... Agreements with medical practitioners .......................................... 139
172‑10... Private health insurers to give information to Secretary ................. 139
172‑15... Restrictions on payment of pecuniary penalties etc. ..................... 140
Chapter 5--Enforcement 141
Part 5‑1--Introduction 141
Division 180--Introduction 141
180‑1..... What this Chapter is about ............................................................. 141
Part 5‑2--General enforcement methods 142
Division 185--What this Part is about 142
185‑1..... Introduction .................................................................................... 142
185‑5..... Meaning of enforceable obligation ................................................. 142
185‑10... Meaning of Council‑supervised obligation ..................................... 143
Division 188--Performance indicators 144
188‑1..... Performance indicators ................................................................... 144
Division 191--Explanation of private health insurer's operations 145
191‑1..... Minister or Council may seek an explanation from a private health insurer 145
191‑5..... Writer must respond to insurer's explanation ................................ 145
Division 194--Investigation of private health insurer's operations 147
194‑1..... Minister or Council may investigate a private health insurer ......... 147
194‑5..... Notice to give information .............................................................. 147
194‑10... Notice to produce documents ......................................................... 148
194‑15... Notice to give evidence ................................................................... 148
194‑20... Offences in relation to investigation notices ................................... 149
194‑25... Authorisation to examine books and records etc. ........................... 150
194‑30... Minister may consult Council ........................................................ 150
194‑35... Minister or Council must notify outcome of investigation ............ 150
Division 197--Enforceable undertakings 151
197‑1..... Minister or Council may accept written undertakings given by a private health insurer 151
197‑5..... Enforcement of undertakings .......................................................... 151
Division 200--Ministerial and Council directions 152
200‑1..... Minister or Council may give directions ........................................ 152
200‑5..... Direction requirements ................................................................... 153
Division 203--Remedies in the Federal Court 154
203‑1..... Minister or Council may apply to the Federal Court .................... 154
203‑5..... Declarations of contravention ......................................................... 154
203‑10... Pecuniary penalty order ................................................................. 155
203‑15... Compensation order ....................................................................... 155
203‑20... Adverse publicity order .................................................................. 156
203‑25... Other order ..................................................................................... 156
203‑30... Time limit for declarations and orders ............................................ 156
203‑35... Civil evidence and procedure rules for declarations and orders ...... 156
203‑40... Civil proceedings after criminal proceedings .................................. 156
203‑45... Criminal proceedings during civil proceedings ................................ 157
203‑50... Criminal proceedings after civil proceedings .................................. 157
203‑55... Evidence given in proceedings for penalty not admissible in criminal proceedings 157
203‑60... Minister or Council may require person to assist .......................... 158
203‑65... Relief from liability for contravening an enforceable obligation ..... 160
203‑70... Powers of Federal Court ................................................................. 160
Division 206--Revoking entitlement to offer rebate as a premium reduction 161
206‑1..... Revocation of status of participating insurer ................................. 161
Part 5‑3--Enforcement of health benefits fund requirements 162
Division 211--Introduction 162
211‑1..... What this Part is about ................................................................... 162
211‑5..... Purpose of this Part ........................................................................ 162
211‑10... The Private Health Insurance (Health Benefits Fund Enforcement) Rules 163
211‑15... Limitation on external management and termination of health benefits funds 163
Division 214--Investigations into affairs of private health insurers 164
214‑1..... Investigation of private health insurers by inspectors ................... 164
214‑5..... Powers of inspectors ...................................................................... 164
214‑10... Person may be represented by lawyer ........................................... 165
214‑15... Compliance with requirements of inspectors ................................. 165
214‑20... Access to premises ......................................................................... 166
214‑25... Reports of inspectors ..................................................................... 167
214‑30... Dissemination of reports ................................................................ 168
214‑35... Liability for publishing reports etc. ................................................ 169
214‑40... Delegation by inspectors ................................................................ 169
214‑45... Records not to be concealed etc. ..................................................... 170
Division 217--External management of health benefits funds 171
Subdivision 217‑A--Preliminary 171
217‑1..... Purpose of Division ........................................................................ 171
217‑5..... The basis of the law relating to external management ..................... 171
Subdivision 217‑B--Appointment of external managers 172
217‑10... Council may appoint external managers ......................................... 172
217‑15... Grounds of appointment of external managers ............................... 172
217‑20... External managers to displace management of funds ...................... 173
Subdivision 217‑C--Duties and powers of external managers 174
217‑25... Duties of external managers ............................................................ 174
217‑30... Additional powers of external managers ......................................... 174
217‑35... Protection of property during external management ...................... 175
217‑40... Rights of chargee, owner or lessor of property of fund under external management 175
Subdivision 217‑D--Procedure relating to voluntary deeds of arrangement 176
217‑45... Matters that may be included in the Private Health Insurance (Health Benefits Fund Enforcement) Rules 176
Subdivision 217‑E--External managers' reports to Council 177
217‑50... External managers to give reports to Council ................................. 177
217‑55... Dealing with reports given to the Council ...................................... 178
217‑60... Court orders in respect of schemes of arrangement ........................ 179
Subdivision 217‑F--Miscellaneous 180
217‑65... When an external management begins and ends .............................. 180
217‑70... Effect of things done during external management of health benefits funds 180
217‑75... Disclaimer of onerous property ..................................................... 181
217‑80... Application of provisions of Corporations Act ............................. 181
Division 220--Ordering the termination of health benefits funds 184
220‑1..... Applications by external managers to the Federal Court ............... 184
220‑5..... Orders made on applications for appointments of terminating managers 184
220‑10... Binding nature of Court orders ....................................................... 184
220‑15... Notice of appointments .................................................................. 184
Chapter 6--Administration 185
Part 6‑1--Introduction 185
Division 230--Introduction 185
230‑1..... What this Chapter is about ............................................................. 185
Part 6‑2--Private Health Insurance Ombudsman 187
Division 235--Introduction 187
235‑1..... Principal object of this Part ............................................................ 187
235‑5..... Private Health Insurance (Ombudsman) Rules ............................... 187
Division 238--Establishment and functions 188
238‑1..... Establishment of office of Private Health Insurance Ombudsman . 188
238‑5..... Functions of Private Health Insurance Ombudsman ...................... 188
Division 241--Complaints 190
Subdivision 241‑A--Relevant complaints 190
241‑1..... Who may make a complaint ........................................................... 190
241‑5..... Persons against whom complaints may be made ............................ 190
241‑10... Grounds for complaint ................................................................... 190
Subdivision 241‑B--Dealing with complaints 191
241‑15... Initial receipt of complaint ............................................................. 191
241‑20... Ways of dealing with complaints ................................................... 191
241‑25... Referral to the Australian Competition and Consumer Commission 192
241‑30... Referral to other bodies .................................................................. 193
241‑35... Deciding not to deal with a complaint ............................................ 193
Subdivision 241‑C--Referral to subjects of complaints 195
241‑40... Referral to the subject of the complaint ......................................... 195
Subdivision 241‑D--Investigation of complaints 196
241‑45... Investigation of complaint .............................................................. 196
241‑50... Minister may direct Private Health Insurance Ombudsman to investigate, or to continue to investigate, a complaint ........................................................................................................ 196
Subdivision 241‑E--Recommendations and reports 196
241‑55... Recommendations as a result of referral or investigation ............... 196
241‑60... Report to Minister on outcome of investigation under Subdivision 241‑D 197
Subdivision 241‑F--Miscellaneous 198
241‑65... Complainant to be kept informed ................................................... 198
Division 244--Investigations 200
Subdivision 244‑A--Investigations 200
244‑1..... Initiating investigations ................................................................... 200
244‑5..... Investigations at Minister's request ............................................... 200
Subdivision 244‑B--Recommendations and reports 201
244‑10... Recommendations as a result of investigation ................................ 201
244‑15... Report to Minister on outcome of investigations under this Division 202
244‑20... Consultation with Australian Competition and Consumer Commission 203
Division 247--Mediation 204
247‑1..... Conducting mediation ..................................................................... 204
247‑5..... Participation in mediation may be compulsory .............................. 204
247‑10... Medical practitioners may appoint representatives ....................... 205
247‑15... Conduct of compulsory mediation ................................................. 206
247‑20... Admissibility of things said in mediation ....................................... 206
247‑25... Appointment of mediators ............................................................. 207
Division 250--Information‑gathering 208
250‑1..... Information‑gathering ..................................................................... 208
250‑5..... Limits on information‑gathering ..................................................... 210
250‑10... Disclosure of personal information ................................................ 210
Division 253--Provisions relating to the Private Health Insurance Ombudsman 212
253‑1..... Appointment of the Private Health Insurance Ombudsman .......... 212
253‑5..... Validity of appointments ............................................................... 212
253‑10... Acting appointments ...................................................................... 212
253‑15... Remuneration and allowances ......................................................... 213
253‑20... Outside employment ...................................................................... 213
253‑25... Leave of absence ............................................................................. 213
253‑30... Resignation ..................................................................................... 214
253‑35... Termination of appointment .......................................................... 214
253‑40... Disclosure of interest by Private Health Insurance Ombudsman ... 214
253‑45... Statutory agency etc. for purposes of Public Service Act .............. 215
253‑50... Annual report ................................................................................. 215
253‑55... Delegation ....................................................................................... 216
253‑60... Private Health Insurance Ombudsman and staff not personally liable 216
Division 256--Miscellaneous 217
256‑1..... Protection from civil actions ........................................................... 217
256‑5..... Victimisation ................................................................................... 217
256‑10... Giving information about the Private Health Insurance Ombudsman 217
Part 6‑3--Private Health Insurance Administration Council 219
Division 261--Introduction 219
261‑1..... What this Part is about ................................................................... 219
261‑5..... The Private Health Insurance (Council) Rules ............................... 219
Division 264--Continuation, purposes, functions and powers 220
264‑1..... Continuation of the Council ........................................................... 220
264‑5..... Objectives of the Council ............................................................... 220
264‑10... Functions of the Council ................................................................ 221
264‑15... Report on private health insurers ................................................... 223
264‑20... Powers ............................................................................................ 224
264‑25... Directions by Minister ................................................................... 224
Division 267--Constitution and administration 225
267‑1..... Constitution of the Council ............................................................ 225
267‑5..... Appointment of members .............................................................. 225
267‑10... Meetings of the Council ................................................................. 225
267‑15... Delegation by the Council .............................................................. 226
267‑20... Modification of the Commonwealth Authorities and Companies Act 1997 226
Division 270--Members 227
270‑1..... Terms and conditions etc. ............................................................... 227
270‑5..... Validity of appointments ............................................................... 227
270‑10... Acting Commissioner ..................................................................... 227
270‑15... Deputy Commissioner to act as Commissioner in certain circumstances 228
270‑20... Powers and duties of persons acting as Commissioner .................. 228
270‑25... Remuneration and allowances of members ..................................... 229
270‑30... Leave of absence ............................................................................. 229
270‑35... Resignation ..................................................................................... 230
270‑40... Termination of appointment .......................................................... 230
270‑45... Disclosure of interests .................................................................... 230
Division 273--Chief Executive Officer and staff 232
273‑1..... Chief Executive Officer ................................................................... 232
273‑5..... Duties of Chief Executive Officer ................................................... 232
273‑10... Conflict of interests ........................................................................ 232
273‑15... Staff and consultants ...................................................................... 233
273‑20... Remuneration and allowances of Chief Executive Officer .............. 233
273‑25... Leave of absence of Chief Executive Officer .................................. 233
Part 6‑4--Administration of premiums reduction and incentive payments schemes 235
Division 276--Introduction 235
276‑1..... What this Part is about ................................................................... 235
Division 279--Provisions applying only to premiums reduction scheme 236
Subdivision 279‑A--Reimbursement of private health insurers for premiums reduced under scheme 236
279‑1..... Participating insurers may claim reimbursement ............................ 236
279‑5..... Participating insurers ...................................................................... 236
279‑10... Requirements for claims ................................................................. 237
279‑15... Amounts payable to the private health insurer .............................. 237
279‑20... Notifying private health insurers if amount is not payable ............ 237
279‑25... Additional payment if insurer claims less than entitlement ........... 238
279‑30... Additional payment if insurer makes a late claim ........................... 238
279‑35... Content and timing of application .................................................. 239
279‑40... Decision on application .................................................................. 239
279‑45... Reconsideration of decisions .......................................................... 240
Subdivision 279‑B--Powers of Medicare Australia CEO in relation to participating insurers 241
279‑50... Audits by Medicare Australia CEO ............................................... 241
279‑55... Medicare Australia CEO may require production of applications . 242
Division 282--Provisions applying to premiums reduction scheme and incentive payments scheme 243
Subdivision 282‑A--When and how payments can be recovered 243
282‑1..... Recovery of payments ................................................................... 243
282‑5..... Interest on amounts recoverable ..................................................... 244
282‑10... Medicare Australia CEO may set off debts against amounts payable 245
282‑15... Reconsideration of certain decisions under this Division ............... 246
Subdivision 282‑B--Miscellaneous 247
282‑20... Notification requirements--private health insurers ....................... 247
282‑25... Use etc. of information relating to another person ......................... 248
282‑30... Information to be provided to the Commissioner of Taxation ....... 248
282‑35... Delegation ....................................................................................... 249
282‑40... Appropriation ................................................................................ 249
Part 6‑5--External managers and terminating managers 250
Division 287--Introduction 250
287‑1..... What this Part is about ................................................................... 250
287‑5..... The Private Health Insurance (Management) Rules ....................... 250
Division 290--Powers of managers 251
290‑1..... Powers of managers ........................................................................ 251
290‑5..... Officers etc. not to perform functions etc. while fund is under management 251
290‑10... Managers act as agents of private health insurers .......................... 252
Division 293--Information concerning, and records and property of, health benefits funds 253
293‑1..... Directors etc. to help managers ...................................................... 253
293‑5..... Managers' rights to certain records ................................................ 254
293‑10... Only manager can deal with property of fund under management . 254
293‑15... Order for compensation where officer involved in void transaction 256
Division 296--Provisions incidental to appointment of managers 258
296‑1..... Remuneration of managers .............................................................. 258
296‑5..... Council may give directions to managers ........................................ 258
296‑10... Termination of appointments of managers ..................................... 258
296‑15... Acts of managers valid etc. ............................................................. 259
296‑20... Indemnity ....................................................................................... 260
296‑25... Qualified privilege ........................................................................... 260
Division 299--Miscellaneous 261
299‑1..... Time for doing act does not run while act prevented by this Division 261
299‑5..... Continued application of other provisions of Act ......................... 261
299‑10... Modifications of this Act in relation to health benefits funds under management 261
299‑15... Order of Court to be binding on all persons ................................... 262
299‑20... Jurisdiction of Federal Court .......................................................... 262
299‑25... Private Health Insurance (Management) Rules dealing with various matters 262
Part 6‑6--Private health insurance levies 264
Division 304--Introduction 264
304‑1..... What this Part is about ................................................................... 264
304‑5..... Private Health Insurance (Levy Administration) Rules ................. 264
304‑10... Meaning of private health insurance levy ....................................... 264
Division 307--Collection and recovery of private health insurance levies 265
307‑1..... When private health insurance levy must be paid .......................... 265
307‑5..... Late payment penalty .................................................................... 266
307‑10... Payment of levy and late payment penalty ................................... 266
307‑15... Recovery of levy and late payment penalty .................................. 267
307‑20... Waiver of late payment penalty for levies other than collapsed insurer levy 268
307‑25... Waiver of collapsed insurer levy and late payment penalty for that levy 268
307‑30... Other matters .................................................................................. 269
Division 310--Returns, requesting information and keeping records: private health insurers 270
310‑1..... Returns must be lodged with Council and Department .................. 270
310‑5..... Insurer must keep records .............................................................. 270
310‑10... Council may request information from insurer ............................... 271
Division 313--Power to enter premises and search for documents: private health insurers 273
313‑1..... Authorised officer may enter premises with consent ..................... 273
313‑5..... Authorised officer may enter premises under warrant ................... 273
313‑10... Announcement before entry ........................................................... 274
313‑15... Executing a warrant to enter premises ............................................ 274
313‑20... Identity cards .................................................................................. 275
Part 6‑7--Private Health Insurance Risk Equalisation Trust Fund 277
Division 318--Private Health Insurance Risk Equalisation Trust Fund 277
318‑1..... Private Health Insurance Risk Equalisation Trust Fund ................ 277
318‑5..... Amounts to be paid into the Risk Equalisation Trust Fund .......... 277
318‑10... Operation of the Risk Equalisation Trust Fund ............................. 278
318‑15... Administration of the Risk Equalisation Trust Fund ..................... 278
Part 6‑8--Disclosure of information 279
Division 323--Disclosure of information 279
323‑1..... Prohibition on disclosure of information ........................................ 279
323‑5..... Authorised disclosure: official duties ............................................. 279
323‑10... Authorised disclosure: sharing information about insurers among agencies 280
323‑15... Authorised disclosure: sharing information about insurers other than among agencies 281
323‑20... Authorised disclosure: public interest ............................................ 281
323‑25... Authorised disclosure: by the Secretary or Council if authorised by affected person 282
323‑30... Authorised disclosure: court proceedings ....................................... 282
323‑35... Authorised disclosure: Council's public information and agency cooperation functions 282
323‑40... Offence: disclosure of information obtained by certain authorised disclosures 283
323‑45... Offence: soliciting disclosure of information .................................. 283
323‑50... Offence: use etc. of unauthorised information ................................ 283
323‑55... Offence: offering to supply protected information ........................ 284
Part 6‑9--Review of decisions 285
Division 328--Review of decisions 285
328‑1..... What this Part is about ................................................................... 285
328‑5..... AAT review of decisions ................................................................ 285
Part 6‑10--Miscellaneous 290
Division 333--Miscellaneous 290
333‑1..... Delegation by Minister ................................................................... 290
333‑5..... Delegation by Secretary .................................................................. 290
333‑10... Approved forms ............................................................................. 290
333‑15... Signing approved forms .................................................................. 292
333‑20... Private Health Insurance Rules made by the Minister ................... 292
333‑25... Private Health Insurance Rules made by the Council ..................... 293
333‑30... Regulations ..................................................................................... 294
Schedule 1--Dictionary 295
1............ Dictionary ....................................................................................... 295
Notes 307
Notes to
the
Private Health Insurance Act 2007 Note 1 The Private Health Insurance Act 2007 as shown in this
compilation comprises Act No. 31, 2007 amended as indicated in the Tables
below. For application, saving or transitional provisions made by the
Private Health Insurance (Transitional Provisions and Consequential
Amendments) Act 2007, see Act No. 32, 2007. For all other relevant information pertaining to application,
saving or transitional provisions see Table A. Table of Acts
|
Act |
Number |
Date |
Date of commencement |
Application, saving or transitional provisions |
|
31, 2007 |
30 Mar 2007 |
1 Apr 2007 |
|
|
|
Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 |
32, 2007 |
30 Mar 2007 |
Schedule 3 (items 9D, 9E): 1 July 2007 |
[see Note 1] |
|
180, 2007 |
28 Sept 2007 |
Schedule 1 (items 1-3, 5): 1 Apr 2007 Schedule 1 (items 4-4B, 6): 29 Sept 2007 |
Sch. 1 (items 5, 6) |
|
|
54, 2008 |
25 June 2008 |
25 June 2008 |
Sch. 3 (items 3, 4) |
|
|
Private Health Insurance Legislation Amendment Act 2009 |
66, 2009 |
1 July 2009 |
Schedule 1 (items 2-14): 1 July 2009 (see s. 2(1)) |
-- |
Table of Amendments
|
ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted |
|
|
Provision affected |
How affected |
|
Chapter 2 |
|
|
Part 2-2 |
|
|
Division 20 |
|
|
Note to s. 20-1 .................... |
am. No. 32, 2007 |
|
Division 26 |
|
|
Subdivision 26-A |
|
|
S. 26-1 ................................ |
am. No. 32, 2007 |
|
Chapter 3 |
|
|
Part 3-2 |
|
|
Division 55 |
|
|
S. 55-5................................. |
am. No. 54, 2008; No. 66, 2009 |
|
S. 55-15............................... |
am. No. 54, 2008 |
|
Part 3-3 |
|
|
Division 63 |
|
|
S. 63-5................................. |
am. No. 66, 2009 |
|
Division 84 |
|
|
S. 84-1................................. |
am. No. 180, 2007 |
|
Chapter 4 |
|
|
Part 4-3 |
|
|
Division 126 |
|
|
S. 126-10............................. |
am. No. 54, 2008 |
|
S. 126-20............................. |
am. No. 180, 2007; No. 54, 2008 |
|
S. 126-45............................. |
am. No. 54, 2008 |
|
Chapter 5 |
|
|
Part 5-2 |
|
|
Division 185 |
|
|
S. 185-5............................... |
am. No. 54, 2008 |
|
Division 200 |
|
|
S. 200-1............................... |
am. No. 54, 2008 |
|
Chapter 6 |
|
|
Part 6-3 |
|
|
Division 270 |
|
|
S. 270-45............................. |
am. No. 180, 2007 |
|
Part 6-6 |
|
|
Division 304 |
|
|
S. 304-10............................. |
am. No. 66, 2009 |
|
Division 307 |
|
|
S. 307-1............................... |
am. No. 66, 2009 |
|
S. 307-5............................... |
am. No. 66, 2009 |
|
S. 307-10............................. |
am. No. 66, 2009 |
|
S. 307-20............................. |
am. No. 66, 2009 |
|
Division 310 |
|
|
Heading to Div. 310 ............ |
rs. No. 66, 2009 |
|
Division 313 |
|
|
Heading to Div. 313............. |
rs. No. 66, 2009 |
|
Schedule 1 |
|
|
Schedule 1.......................... |
am. No. 66, 2009 |
Table A
Application, saving or transitional provisions
Health Legislation Amendment Act 2007 (No. 180, 2007)
Schedule 1
5 Transitional provision in relation to health cover for overseas visitors
(1) This item applies in relation to business that, at any time in the period starting on 1 April 2007 and ending on 30 June 2008 (the transition period), is covered by subrule 17(2) of the Private Health Insurance (Health Insurance Business) Rules made under the Private Health Insurance Act 2007.
(2) During the transition period, sections 63‑1 and 84‑1 of the Private Health Insurance Act 2007 do not apply in relation to insurance that is that kind of business.
6 Certain business taken to be health insurance business for certain purposes during transition period
For the purposes of:
(a) paragraphs 12BAA(7)(d) and (8)(b) of the Australian Securities and Investments Commission Act 2001; and
(b) paragraph 765A(1)(c) of the Corporations Act 2001; and
(c) paragraph (k) of the definition of insurance business in subsection 3(1) of the Insurance Act 1973; and
(d) paragraph 9(1)(b) of the Insurance Contracts Act 1984;
business that, at any time during the period starting on the day this item commences and ending on 30 June 2008, is covered by rule 18 of the Private Health Insurance (Health Insurance Business) Rules made under the Private Health Insurance Act 2007 is, during that period, taken to be health insurance business.
Private Health Insurance Legislation Amendment Act 2008 (No. 54, 2008)
Schedule 3
3 Applications for registration for which decisions are pending
An application made before the commencement of this item for registration as a private health insurer is taken, on that commencement, not to be a valid application under section 126‑10 of the Private Health Insurance Act 2007 if, as at that commencement:
(a) the applicant was not a company within the meaning of the Corporations Act 2001; and
(b) the Council had not decided the application under section 126‑20 of the Private Health Insurance Act 2007.
4 Exemption from stamp duty etc. relating to certain private health insurers becoming companies
(1) Stamp duty, or any other tax, imposed under a law of a State or Territory is not payable in relation to a thing done (including, for example, a transaction entered into or an instrument or document made, executed, lodged or given) for the purpose of, because of or as a result of the registration of a body as a company if:
(a) the thing is done after the commencement of this item and before 1 January 2010; and
(b) at the time the thing is done, the body is a private health insurer; and
(c) the registration as a company is solely for the purpose of avoiding the body's registration as a private health insurer being cancelled under paragraph 126‑45(1)(c) of the Private Health Insurance Act 2007.
(2) In this item:
company means a company within the meaning of the Corporations Act 2001.
private health insurer means a person registered under Part 4‑3 of the Private Health Insurance Act 2007, and includes a body that is taken to be a private health insurer because of section 18 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007.