Commonwealth Numbered Acts Commonwealth Numbered Acts
No. 31, 2007
Contents
Part 1‑1--Introduction 2
Division 1--Preliminary 2
1‑1......... Short title............................................................................................ 2
1‑5......... Commencement.................................................................................. 2
1‑10....... Identifying defined terms.................................................................... 2
Division 3--Overview of this Act 4
3‑1......... What this Act is about........................................................................ 4
3‑5......... Incentives (Chapter 2)........................................................................ 4
3‑10....... Complying health insurance products (Chapter 3)............................ 4
3‑15....... Private health insurers (Chapter 4)..................................................... 4
3‑20....... Enforcement (Chapter 5).................................................................... 5
3‑25....... Administration (Chapter 6)................................................................ 5
3‑30....... Dictionary (Schedule 1)...................................................................... 5
Division 5--Constitutional matters 6
5‑1......... Meaning of insurance......................................................................... 6
5‑5......... Act not to apply to State insurance within that State........................ 6
5‑10....... Compensation for acquisition of property......................................... 6
Chapter 2--Incentives 7
Part 2‑1--Introduction 7
Division 15--Introduction 7
15‑1....... What this Chapter is about................................................................. 7
Part 2‑2--Premiums reduction and incentive payments schemes 8
Division 20--Introduction 8
20‑1....... What this Part is about....................................................................... 8
20‑5....... Private Health Insurance (Incentives) Rules....................................... 8
Division 23--Premiums reduction scheme 9
Subdivision 23‑A--Amount of reduction 9
23‑1....... Reduction in premiums....................................................................... 9
23‑5....... Meaning of incentive amount............................................................ 10
23‑10..... Reduction after a person 65 years or over ceases to be covered by policy 11
Subdivision 23‑B--Participation in the premiums reduction scheme 12
23‑15..... Registration as a participant in the premiums reduction scheme..... 12
23‑20..... Refusal to register............................................................................. 13
23‑25..... Pre‑1999 participants must keep information up to date................ 13
23‑30..... Participants who want to withdraw from scheme............................ 14
23‑35..... Revocation of registration................................................................. 14
23‑40..... Variation of registration.................................................................... 15
23‑45..... Retention of applications by private health insurers....................... 15
Division 26--The incentive payments scheme 16
Subdivision 26‑A--Amount of incentive payment 16
26‑1....... Payment in relation to premiums..................................................... 16
26‑5....... Payment after a person 65 years or over ceases to be covered by policy 17
Subdivision 26‑B--Claiming payments under the incentive payments scheme 18
26‑10..... Claim for payment under incentive payments scheme..................... 18
26‑15..... Withdrawal of claim.......................................................................... 18
26‑20..... Determination of claim and payment of amount.............................. 19
26‑25..... Reconsideration of decision refusing a claim.................................... 19
26‑30..... Claimants to keep information up to date........................................ 20
Part 2‑3--Lifetime health cover 21
Division 31--Introduction 21
31‑1....... What this Part is about..................................................................... 21
31‑5....... Private Health Insurance (Lifetime Health Cover) Rules................. 21
Division 34--General rules about lifetime health cover 22
34‑1....... Increased premiums for person who is late in taking out hospital cover 22
34‑5....... Increased premiums for person who ceases to have hospital cover after his or her lifetime health cover base day.......................................................................................................... 22
34‑10..... Increased premiums stop after 10 years' continuous cover............. 23
34‑15..... Meaning of hospital cover................................................................ 24
34‑20..... Meaning of permitted days without hospital cover........................... 25
34‑25..... Meaning of lifetime health cover base day........................................ 25
34‑30..... When a person is overseas................................................................ 27
Division 37--Exceptions to the general rules about lifetime health cover 28
37‑1....... People born on or before 1 July 1934.............................................. 28
37‑5....... People over 31 and overseas on 1 July 2000.................................... 28
37‑10..... Hardship cases.................................................................................. 28
37‑15..... Increases cannot exceed 70% of base rates....................................... 28
37‑20..... Joint hospital cover.......................................................................... 29
Division 40--Administrative matters relating to lifetime health cover 30
40‑1....... Notification to insured people etc.................................................... 30
40‑5....... Evidence of having had hospital cover, or of a person's age............ 31
Chapter 3--Complying health insurance products 32
Part 3‑1--Introduction 32
Division 50--Introduction 32
50‑1....... What this Chapter is about............................................................... 32
50‑5....... Private Health Insurance Rules relevant to this Chapter.................. 32
Part 3‑2--Community rating 33
Division 55--Principle of community rating 33
55‑1....... What this Part is about..................................................................... 33
55‑5....... Principle of community rating.......................................................... 33
55‑10..... Closed products................................................................................ 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.................................................................................... 49
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 60
Division 90--Introduction 60
90‑1....... What this Part is about..................................................................... 60
Division 93--Giving information to consumers 61
93‑1....... Maintaining up to date standard information statements................. 61
93‑5....... Meaning of standard information statement..................................... 62
93‑10..... Making standard information statements available.......................... 62
93‑15..... Giving information to newly insured people.................................... 62
93‑20..... Keeping insured people up to date................................................... 63
93‑25..... Giving advance notice of detrimental changes to rules..................... 64
93‑30..... Failure to give information to consumers......................................... 64
Division 96--Giving information to the Department, the Council and the Private Health Insurance Ombudsman 65
96‑1....... Giving standard information statements on request......................... 65
96‑5....... Giving standard information statements for new products.............. 65
96‑10..... Giving updated standard information statements............................. 65
96‑15..... Giving additional information on request......................................... 66
96‑20..... Failure to give information to Department, Council or Private Health Insurance Ombudsman 66
96‑25..... Giving information required by the Private Health Insurance (Complying Product) Rules 67
Division 99--Transfer certificates 68
99‑1....... Transfer certificates.......................................................................... 68
Division 102--Private health insurers to offer cover for hospital treatment 70
102‑1..... Private health insurers to offer cover for hospital treatment............ 70
Chapter 4--Private health insurers 71
Part 4‑1--Introduction 71
Division 110--Introduction 71
110‑1..... What this Chapter is about............................................................... 71
Part 4‑2--Carrying on health insurance business 72
Division 115--Introduction 72
115‑1..... What this Part is about..................................................................... 72
115‑5..... The Private Health Insurance (Health Insurance Business) Rules... 72
115‑10... Whether a business etc. is health insurance business....................... 72
Division 118--Prohibition of carrying on health insurance business without registration 74
118‑1..... Carrying on health insurance business without registration............. 74
118‑5..... Injunctions........................................................................................ 74
Division 121--What is health insurance business? 76
121‑1..... Meaning of health insurance business.............................................. 76
121‑5..... Meaning of hospital treatment.......................................................... 77
121‑7..... Conditions on declarations of hospitals........................................... 78
121‑10... Meaning of general treatment........................................................... 79
121‑15... Extension to employee health benefits schemes................................ 80
121‑20... Exception: accident and sickness insurance business....................... 81
121‑25... Exception: liability insurance business............................................. 82
121‑30... Exception: insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules 82
Part 4‑3--Registration 83
Division 126--Registration 83
126‑1..... What this Part is about..................................................................... 83
126‑5..... The Private Health Insurance (Registration) Rules.......................... 83
126‑10... Applying for registration.................................................................. 83
126‑15... Requesting further information......................................................... 84
126‑20... Deciding the application................................................................... 84
126‑25... Notifying the decision...................................................................... 86
126‑30... Council can be taken to refuse application....................................... 86
126‑35... Council to maintain record of registrations etc................................. 87
126‑40... Changing registration status.............................................................. 87
126‑42... Conversion to for profit status......................................................... 89
126‑45... Cancellation of registration............................................................... 90
Part 4‑4--Health benefits funds 91
Division 131--Introduction 91
131‑1..... What this Part is about..................................................................... 91
131‑5..... The Private Health Insurance (Health Benefits Fund) Rules........... 91
131‑10... Meaning of health benefits fund........................................................ 91
131‑15... Meaning of health‑related business.................................................. 92
Division 134--The requirement to have health benefits funds 93
134‑1..... Private health insurers must have health benefits funds................... 93
134‑5..... Notifying the Council when health benefits funds are established... 94
134‑10... Inclusion of health‑related businesses in health benefits funds........ 94
Division 137--The operation of health benefits funds 95
137‑1..... Assets of health benefits funds........................................................ 95
137‑5..... Payments to health benefits funds................................................... 96
137‑10... Expenditure and application of health benefits funds...................... 97
137‑15... Effect of non‑compliance with section 137‑10................................. 98
137‑20... Investment of health benefits funds................................................. 99
137‑25... Restriction on restructure, merger, acquisition or termination of health benefits funds 100
137‑30... Operation of health‑related businesses through health benefits funds 100
Division 140--The solvency standard for health benefits funds 101
140‑1..... Purpose of Division........................................................................ 101
140‑5..... Council to establish solvency standard.......................................... 101
140‑10... Purpose of solvency standard........................................................ 101
140‑15... Compliance with solvency standard............................................... 102
140‑20... Solvency directions......................................................................... 103
Division 143--The capital adequacy standard for health benefits funds 106
143‑1..... Purpose of Division........................................................................ 106
143‑5..... Council to establish capital adequacy standard.............................. 106
143‑10... Purpose of capital adequacy standard............................................ 106
143‑15... Compliance with capital adequacy standard.................................. 107
143‑20... Capital adequacy directions............................................................ 108
Division 146--Restructure, merger and acquisition of health benefits funds 111
146‑1..... Restructure of health benefits funds............................................... 111
146‑5..... Merger and acquisition of health benefits funds............................. 113
146‑10... Consent of policy holders not required.......................................... 115
146‑15... Other laws not overridden.............................................................. 116
Division 149--Termination of health benefits funds 117
Subdivision 149‑A--Approving the termination of health benefits funds 117
149‑1..... Applying for termination............................................................... 117
149‑5..... Requesting further information....................................................... 117
149‑10... Deciding the application................................................................. 117
149‑15... Council can be taken to refuse application..................................... 118
Subdivision 149‑B--Conducting the termination of health benefits funds 118
149‑20... Conduct of funds during termination process................................ 118
149‑25... Insurers etc. to give reports to Council.......................................... 119
149‑30... Terminating managers displace management of funds.................... 120
Subdivision 149‑C--Ending the termination of health benefits funds 120
149‑35... Power to end termination............................................................... 120
Subdivision 149‑D--Completing the termination of health benefits funds 121
149‑40... Completion of the termination process.......................................... 121
149‑45... Distribution of remaining assets after completion of the termination process 121
149‑50... Liability of officers of insurers for loss to terminated funds.......... 121
149‑55... Report of terminating manager....................................................... 122
149‑60... Applying for winding up................................................................ 122
Division 152--Duties and liabilities of directors etc. 124
152‑5..... Notices to remedy contraventions.................................................. 124
152‑10... Liability of directors in relation to non‑compliance with notices... 124
152‑15... Council may sue in the name of private health insurers................. 125
Part 4‑5--Other obligations of private health insurers 126
Division 157--Introduction 126
157‑1..... What this Part is about................................................................... 126
157‑5..... The Private Health Insurance (Insurer Obligations) Rules............. 126
Division 160--Appointed actuaries 127
160‑1..... Appointment.................................................................................. 127
160‑5..... Eligibility for appointment............................................................. 127
160‑10... Notification of appointment etc..................................................... 128
160‑15... Cessation of appointment.............................................................. 128
160‑20... Compliance with the Private Health Insurance (Insurer Obligations) Rules 128
160‑25... Powers of appointed actuary......................................................... 128
160‑30... Actuary's obligations to report...................................................... 129
160‑35... Qualified privilege of appointed actuary........................................ 131
Division 163--Prudential standards 132
163‑1..... Private Health Insurance (Insurer Obligations) Rules to establish prudential standards 132
163‑5..... Compliance with prudential standards........................................... 133
163‑10... Notice of breaches of prudential standards etc............................... 133
163‑15... Directions to comply with standards............................................. 133
163‑20... Failure to comply with directions.................................................. 134
Division 166--Disqualified persons 135
166‑1..... Private health insurers not to allow disqualified persons to act as directors 135
166‑5..... Disqualified persons must not act for private health insurers........ 135
166‑10... Effect of non‑compliance................................................................ 135
166‑15... Who is a disqualified person?......................................................... 135
166‑20... Council may disqualify persons..................................................... 136
166‑25... Council may determine that persons are not disqualified............... 137
Division 169--Reporting and notification requirements 139
169‑1..... Copies of reports to policy holders............................................... 139
169‑5..... Information to be given to the Council annually............................ 139
169‑10... Private health insurers to notify any changes to rules.................... 140
169‑15... Private health insurers to notify Department and Council about current chief executive officer 140
Division 172--Miscellaneous 142
172‑1..... Private health insurers to comply with Council's requirements.... 142
172-5..... Agreements with medical practitioners.......................................... 142
172‑10... Private health insurers to give information to Secretary................. 142
172‑15... Restrictions on payment of pecuniary penalties etc...................... 143
Chapter 5--Enforcement 144
Part 5‑1--Introduction 144
Division 180--Introduction 144
180‑1..... What this Chapter is about............................................................. 144
Part 5‑2--General enforcement methods 145
Division 185--What this Part is about 145
185‑1..... Introduction.................................................................................... 145
185‑5..... Meaning of enforceable obligation................................................. 145
185‑10... Meaning of Council‑supervised obligation..................................... 146
Division 188--Performance indicators 147
188‑1..... Performance indicators................................................................... 147
Division 191--Explanation of private health insurer's operations 148
191‑1..... Minister or Council may seek an explanation from a private health insurer 148
191‑5..... Writer must respond to insurer's explanation................................ 149
Division 194--Investigation of private health insurer's operations 150
194‑1..... Minister or Council may investigate a private health insurer......... 150
194‑5..... Notice to give information.............................................................. 150
194‑10... Notice to produce documents......................................................... 151
194‑15... Notice to give evidence................................................................... 152
194‑20... Offences in relation to investigation notices................................... 152
194‑25... Authorisation to examine books and records etc............................ 153
194‑30... Minister may consult Council........................................................ 153
194‑35... Minister or Council must notify outcome of investigation............ 154
Division 197--Enforceable undertakings 155
197‑1..... Minister or Council may accept written undertakings given by a private health insurer 155
197‑5..... Enforcement of undertakings.......................................................... 155
Division 200--Ministerial and Council directions 157
200‑1..... Minister or Council may give directions........................................ 157
200‑5..... Direction requirements................................................................... 158
Division 203--Remedies in the Federal Court 159
203‑1..... Minister or Council may apply to the Federal Court.................... 159
203‑5..... Declarations of contravention......................................................... 159
203‑10... Pecuniary penalty order................................................................. 160
203‑15... Compensation order....................................................................... 160
203‑20... Adverse publicity order.................................................................. 161
203‑25... Other order..................................................................................... 161
203‑30... Time limit for declarations and orders............................................ 161
203‑35... Civil evidence and procedure rules for declarations and orders...... 161
203‑40... Civil proceedings after criminal proceedings.................................. 162
203‑45... Criminal proceedings during civil proceedings................................ 162
203‑50... Criminal proceedings after civil proceedings.................................. 162
203‑55... Evidence given in proceedings for penalty not admissible in criminal proceedings 163
203‑60... Minister or Council may require person to assist.......................... 163
203‑65... Relief from liability for contravening an enforceable obligation..... 165
203‑70... Powers of Federal Court................................................................. 166
Division 206--Revoking entitlement to offer rebate as a premium reduction 167
206‑1..... Revocation of status of participating insurer................................. 167
Part 5‑3--Enforcement of health benefits fund requirements 168
Division 211--Introduction 168
211‑1..... What this Part is about................................................................... 168
211‑5..... Purpose of this Part........................................................................ 168
211‑10... The Private Health Insurance (Health Benefits Fund Enforcement) Rules 169
211‑15... Limitation on external management and termination of health benefits funds 169
Division 214--Investigations into affairs of private health insurers 170
214‑1..... Investigation of private health insurers by inspectors................... 170
214‑5..... Powers of inspectors...................................................................... 170
214‑10... Person may be represented by lawyer........................................... 171
214‑15... Compliance with requirements of inspectors................................. 171
214‑20... Access to premises......................................................................... 172
214‑25... Reports of inspectors..................................................................... 173
214‑30... Dissemination of reports................................................................ 175
214‑35... Liability for publishing reports etc................................................. 175
214‑40... Delegation by inspectors................................................................ 176
214‑45... Records not to be concealed etc...................................................... 176
Division 217--External management of health benefits funds 177
Subdivision 217‑A--Preliminary 177
217‑1..... Purpose of Division........................................................................ 177
217‑5..... The basis of the law relating to external management..................... 177
Subdivision 217‑B--Appointment of external managers 178
217‑10... Council may appoint external managers......................................... 178
217‑15... Grounds of appointment of external managers............................... 179
217‑20... External managers to displace management of funds...................... 179
Subdivision 217‑C--Duties and powers of external managers 180
217‑25... Duties of external managers............................................................ 180
217‑30... Additional powers of external managers......................................... 180
217‑35... Protection of property during external management...................... 181
217‑40... Rights of chargee, owner or lessor of property of fund under external management 181
Subdivision 217‑D--Procedure relating to voluntary deeds of arrangement 182
217‑45... Matters that may be included in the Private Health Insurance (Health Benefits Fund Enforcement) Rules 182
Subdivision 217‑E--External managers' reports to Council 183
217‑50... External managers to give reports to Council................................. 183
217‑55... Dealing with reports given to the Council...................................... 184
217‑60... Court orders in respect of schemes of arrangement........................ 185
Subdivision 217‑F--Miscellaneous 186
217‑65... When an external management begins and ends.............................. 186
217‑70... Effect of things done during external management of health benefits funds 187
217‑75... Disclaimer of onerous property..................................................... 187
217‑80... Application of provisions of Corporations Act............................. 187
Division 220--Ordering the termination of health benefits funds 190
220‑1..... Applications by external managers to the Federal Court............... 190
220‑5..... Orders made on applications for appointments of terminating managers 190
220‑10... Binding nature of Court orders....................................................... 190
220‑15... Notice of appointments.................................................................. 190
Chapter 6--Administration 192
Part 6‑1--Introduction 192
Division 230--Introduction 192
230‑1..... What this Chapter is about............................................................. 192
Part 6‑2--Private Health Insurance Ombudsman 194
Division 235--Introduction 194
235‑1..... Principal object of this Part............................................................ 194
235‑5..... Private Health Insurance (Ombudsman) Rules............................... 194
Division 238--Establishment and functions 195
238‑1..... Establishment of office of Private Health Insurance Ombudsman. 195
238‑5..... Functions of Private Health Insurance Ombudsman...................... 195
Division 241--Complaints 197
Subdivision 241‑A--Relevant complaints 197
241‑1..... Who may make a complaint........................................................... 197
241‑5..... Persons against whom complaints may be made............................ 197
241‑10... Grounds for complaint................................................................... 197
Subdivision 241‑B--Dealing with complaints 198
241‑15... Initial receipt of complaint............................................................. 198
241‑20... Ways of dealing with complaints................................................... 198
241‑25... Referral to the Australian Competition and Consumer Commission 199
241‑30... Referral to other bodies.................................................................. 200
241‑35... Deciding not to deal with a complaint............................................ 200
Subdivision 241‑C--Referral to subjects of complaints 202
241‑40... Referral to the subject of the complaint......................................... 202
Subdivision 241‑D--Investigation of complaints 203
241‑45... Investigation of complaint.............................................................. 203
241‑50... Minister may direct Private Health Insurance Ombudsman to investigate, or to continue to investigate, a complaint........................................................................................................ 203
Subdivision 241‑E--Recommendations and reports 204
241‑55... Recommendations as a result of referral or investigation............... 204
241‑60... Report to Minister on outcome of investigation under Subdivision 241‑D 205
Subdivision 241‑F--Miscellaneous 206
241‑65... Complainant to be kept informed................................................... 206
Division 244--Investigations 207
Subdivision 244‑A--Investigations 207
244‑1..... Initiating investigations................................................................... 207
244‑5..... Investigations at Minister's request............................................... 207
Subdivision 244‑B--Recommendations and reports 208
244‑10... Recommendations as a result of investigation................................ 208
244‑15... Report to Minister on outcome of investigations under this Division 209
244‑20... Consultation with Australian Competition and Consumer Commission 210
Division 247--Mediation 211
247‑1..... Conducting mediation..................................................................... 211
247‑5..... Participation in mediation may be compulsory.............................. 211
247‑10... Medical practitioners may appoint representatives....................... 212
247‑15... Conduct of compulsory mediation................................................. 213
247‑20... Admissibility of things said in mediation....................................... 213
247‑25... Appointment of mediators............................................................. 214
Division 250--Information‑gathering 215
250‑1..... Information‑gathering..................................................................... 215
250‑5..... Limits on information‑gathering..................................................... 217
250‑10... Disclosure of personal information................................................ 217
Division 253--Provisions relating to the Private Health Insurance Ombudsman 219
253‑1..... Appointment of the Private Health Insurance Ombudsman.......... 219
253‑5..... Validity of appointments............................................................... 219
253‑10... Acting appointments...................................................................... 219
253‑15... Remuneration and allowances......................................................... 220
253‑20... Outside employment...................................................................... 220
253‑25... Leave of absence............................................................................. 220
253‑30... Resignation..................................................................................... 221
253‑35... Termination of appointment.......................................................... 221
253‑40... Disclosure of interest by Private Health Insurance Ombudsman... 222
253‑45... Statutory agency etc. for purposes of Public Service Act.............. 222
253‑50... Annual report................................................................................. 222
253‑55... Delegation....................................................................................... 223
253‑60... Private Health Insurance Ombudsman and staff not personally liable 223
Division 256--Miscellaneous 224
256‑1..... Protection from civil actions........................................................... 224
256‑5..... Victimisation................................................................................... 224
256‑10... Giving information about the Private Health Insurance Ombudsman 224
Part 6‑3--Private Health Insurance Administration Council 226
Division 261--Introduction 226
261‑1..... What this Part is about................................................................... 226
261‑5..... The Private Health Insurance (Council) Rules............................... 226
Division 264--Continuation, purposes, functions and powers 227
264‑1..... Continuation of the Council........................................................... 227
264‑5..... Objectives of the Council............................................................... 227
264‑10... Functions of the Council................................................................ 228
264‑15... Report on private health insurers................................................... 230
264‑20... Powers............................................................................................ 231
264‑25... Directions by Minister................................................................... 231
Division 267--Constitution and administration 232
267‑1..... Constitution of the Council............................................................ 232
267‑5..... Appointment of members.............................................................. 232
267‑10... Meetings of the Council................................................................. 232
267‑15... Delegation by the Council.............................................................. 233
267‑20... Modification of the Commonwealth Authorities and Companies Act 1997 233
Division 270--Members 234
270‑1..... Terms and conditions etc................................................................ 234
270‑5..... Validity of appointments............................................................... 234
270‑10... Acting Commissioner..................................................................... 234
270‑15... Deputy Commissioner to act as Commissioner in certain circumstances 235
270‑20... Powers and duties of persons acting as Commissioner.................. 235
270‑25... Remuneration and allowances of members..................................... 236
270‑30... Leave of absence............................................................................. 236
270‑35... Resignation..................................................................................... 237
270‑40... Termination of appointment.......................................................... 237
270‑45... Disclosure of interests.................................................................... 238
Division 273--Chief Executive Officer and staff 239
273‑1..... Chief Executive Officer................................................................... 239
273‑5..... Duties of Chief Executive Officer................................................... 239
273‑10... Conflict of interests........................................................................ 239
273‑15... Staff and consultants...................................................................... 240
273‑20... Remuneration and allowances of Chief Executive Officer.............. 240
273‑25... Leave of absence of Chief Executive Officer.................................. 241
Part 6‑4--Administration of premiums reduction and incentive payments schemes 242
Division 276--Introduction 242
276‑1..... What this Part is about................................................................... 242
Division 279--Provisions applying only to premiums reduction scheme 243
Subdivision 279‑A--Reimbursement of private health insurers for premiums reduced under scheme 243
279‑1..... Participating insurers may claim reimbursement............................ 243
279‑5..... Participating insurers...................................................................... 243
279‑10... Requirements for claims................................................................. 244
279‑15... Amounts payable to the private health insurer.............................. 244
279‑20... Notifying private health insurers if amount is not payable............ 244
279‑25... Additional payment if insurer claims less than entitlement........... 245
279‑30... Additional payment if insurer makes a late claim........................... 245
279‑35... Content and timing of application.................................................. 246
279‑40... Decision on application.................................................................. 246
279‑45... Reconsideration of decisions.......................................................... 247
Subdivision 279‑B--Powers of Medicare Australia CEO in relation to participating insurers 248
279‑50... Audits by Medicare Australia CEO............................................... 248
279‑55... Medicare Australia CEO may require production of applications. 249
Division 282--Provisions applying to premiums reduction scheme and incentive payments scheme 251
Subdivision 282‑A--When and how payments can be recovered 251
282‑1..... Recovery of payments................................................................... 251
282‑5..... Interest on amounts recoverable..................................................... 252
282‑10... Medicare Australia CEO may set off debts against amounts payable 253
282‑15... Reconsideration of certain decisions under this Division............... 254
Subdivision 282‑B--Miscellaneous 255
282‑20... Notification requirements--private health insurers....................... 255
282‑25... Use etc. of information relating to another person......................... 256
282‑30... Information to be provided to the Commissioner of Taxation....... 256
282‑35... Delegation....................................................................................... 257
282‑40... Appropriation................................................................................ 257
Part 6‑5--External managers and terminating managers 258
Division 287--Introduction 258
287‑1..... What this Part is about................................................................... 258
287‑5..... The Private Health Insurance (Management) Rules....................... 258
Division 290--Powers of managers 259
290‑1..... Powers of managers........................................................................ 259
290‑5..... Officers etc. not to perform functions etc. while fund is under management 259
290‑10... Managers act as agents of private health insurers.......................... 260
Division 293--Information concerning, and records and property of, health benefits funds 261
293‑1..... Directors etc. to help managers...................................................... 261
293‑5..... Managers' rights to certain records................................................ 262
293‑10... Only manager can deal with property of fund under management. 263
293‑15... Order for compensation where officer involved in void transaction 264
Division 296--Provisions incidental to appointment of managers 266
296‑1..... Remuneration of managers.............................................................. 266
296‑5..... Council may give directions to managers........................................ 266
296‑10... Termination of appointments of managers..................................... 266
296‑15... Acts of managers valid etc.............................................................. 267
296‑20... Indemnity....................................................................................... 268
296‑25... Qualified privilege........................................................................... 268
Division 299--Miscellaneous 269
299‑1..... Time for doing act does not run while act prevented by this Division 269
299‑5..... Continued application of other provisions of Act......................... 269
299‑10... Modifications of this Act in relation to health benefits funds under management 270
299‑15... Order of Court to be binding on all persons................................... 270
299‑20... Jurisdiction of Federal Court.......................................................... 270
299‑25... Private Health Insurance (Management) Rules dealing with various matters 270
Part 6‑6--Private health insurance levies 272
Division 304--Introduction 272
304‑1..... What this Part is about................................................................... 272
304‑5..... Private Health Insurance (Levy Administration) Rules................. 272
304‑10... Meaning of private health insurance levy....................................... 272
Division 307--Collection and recovery of private health insurance levies 273
307‑1..... When private health insurance levy must be paid.......................... 273
307‑5..... Late payment penalty.................................................................... 274
307‑10... Payment of levy and late payment penalty................................... 274
307‑15... Recovery of levy and late payment penalty.................................. 275
307‑20... Waiver of late payment penalty for levies other than collapsed insurer levy 275
307‑25... Waiver of collapsed insurer levy and late payment penalty for that levy 276
307‑30... Other matters.................................................................................. 277
Division 310--Returns, requesting information and keeping records 278
310‑1..... Returns must be lodged with Council and Department.................. 278
310‑5..... Insurer must keep records.............................................................. 278
310‑10... Council may request information from insurer............................... 279
Division 313--Power to enter premises and search for documents 281
313‑1..... Authorised officer may enter premises with consent..................... 281
313‑5..... Authorised officer may enter premises under warrant................... 281
313‑10... Announcement before entry........................................................... 282
313‑15... Executing a warrant to enter premises............................................ 282
313‑20... Identity cards.................................................................................. 283
Part 6‑7--Private Health Insurance Risk Equalisation Trust Fund 285
Division 318--Private Health Insurance Risk Equalisation Trust Fund 285
318‑1..... Private Health Insurance Risk Equalisation Trust Fund................ 285
318‑5..... Amounts to be paid into the Risk Equalisation Trust Fund.......... 285
318‑10... Operation of the Risk Equalisation Trust Fund............................. 286
318‑15... Administration of the Risk Equalisation Trust Fund..................... 286
Part 6‑8--Disclosure of information 287
Division 323--Disclosure of information 287
323‑1..... Prohibition on disclosure of information........................................ 287
323‑5..... Authorised disclosure: official duties............................................. 287
323‑10... Authorised disclosure: sharing information about insurers among agencies 288
323‑15... Authorised disclosure: sharing information about insurers other than among agencies 289
323‑20... Authorised disclosure: public interest............................................ 289
323‑25... Authorised disclosure: by the Secretary or Council if authorised by affected person 290
323‑30... Authorised disclosure: court proceedings....................................... 290
323‑35... Authorised disclosure: Council's public information and agency cooperation functions 291
323‑40... Offence: disclosure of information obtained by certain authorised disclosures 291
323‑45... Offence: soliciting disclosure of information.................................. 291
323‑50... Offence: use etc. of unauthorised information................................ 291
323‑55... Offence: offering to supply protected information........................ 292
Part 6‑9--Review of decisions 293
Division 328--Review of decisions 293
328‑1..... What this Part is about................................................................... 293
328‑5..... AAT review of decisions................................................................ 293
Part 6‑10--Miscellaneous 298
Division 333--Miscellaneous 298
333‑1..... Delegation by Minister................................................................... 298
333‑5..... Delegation by Secretary.................................................................. 298
333‑10... Approved forms............................................................................. 298
333‑15... Signing approved forms.................................................................. 300
333‑20... Private Health Insurance Rules made by the Minister................... 300
333‑25... Private Health Insurance Rules made by the Council..................... 301
333‑30... Regulations..................................................................................... 302
Schedule 1--Dictionary 303
1............ Dictionary....................................................................................... 303
Private Health Insurance Act 2007
No. 31, 2007
An Act to regulate private health insurance, and for related purposes
[Assented to 30 March 2007]
The Parliament of Australia enacts: