Commonwealth of Australia Bills Commonwealth of Australia Bills[Index] [Search] [Download] [Related Items] [Help]
This is a Bill, not an Act. For current law, see the Acts databases.
2013-2014
The Parliament of the
Commonwealth of Australia
HOUSE OF REPRESENTATIVES
Presented and read a first time
Private Health Insurance Amendment
Bill (No. 2) 2014
No. , 2014
(Health)
A Bill for an Act to amend the Ombudsman Act
1976, and for related purposes
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
i
Contents
1
Short title ........................................................................................... 1
2
Commencement ................................................................................. 1
3
Schedules ........................................................................................... 2
Schedule 1--Private Health Insurance Ombudsman
3
Part 1--Main amendments
3
Ombudsman Act 1976
3
Private Health Insurance Act 2007
32
Part 2--Transitional provisions
35
Schedule 2--Base premium measure
38
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
1
A Bill for an Act to amend the Ombudsman Act
1
1976, and for related purposes
2
The Parliament of Australia enacts:
3
1 Short title
4
This Act may be cited as the Private Health Insurance Amendment
5
Act (No. 2) 2014.
6
2 Commencement
7
(1) Each provision of this Act specified in column 1 of the table
8
commences, or is taken to have commenced, in accordance with
9
column 2 of the table. Any other statement in column 2 has effect
10
according to its terms.
11
12
2
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
Commencement information
Column 1
Column 2
Column 3
Provisions
Commencement
Date/Details
1. Sections 1 to 3
and anything in
this Act not
elsewhere covered
by this table
The day this Act receives the Royal Assent.
2. Schedule 1
As follows:
(a) if this Act receives the Royal Assent
before 1 July 2015--1 July 2015;
(b) if this Act receives the Royal Assent on
or after 1 July 2015--a single day to be
fixed by Proclamation.
However, if this Act receives the Royal
Assent on or after 1 July 2015, and
Schedule 1 does not commence within the
period of 6 months beginning on the day this
Act receives the Royal Assent, it
commences on the day after the end of that
period.
3. Schedule 2
The day this Act receives the Royal Assent.
Note:
This table relates only to the provisions of this Act as originally
1
enacted. It will not be amended to deal with any later amendments of
2
this Act.
3
(2) Any information in column 3 of the table is not part of this Act.
4
Information may be inserted in this column, or information in it
5
may be edited, in any published version of this Act.
6
3 Schedules
7
Legislation that is specified in a Schedule to this Act is amended or
8
repealed as set out in the applicable items in the Schedule
9
concerned, and any other item in a Schedule to this Act has effect
10
according to its terms.
11
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
3
Schedule 1
--Private Health Insurance
1
Ombudsman
2
Part 1
--Main amendments
3
Ombudsman Act 1976
4
1 Title
5
Omit "and an Overseas Students Ombudsman,", substitute ", an
6
Overseas Students Ombudsman and a Private Health Insurance
7
Ombudsman,"
8
2 Subsection 3(1)
9
Insert:
10
adult has the same meaning as in the Private Health Insurance Act
11
2007.
12
Chief Executive Medicare has the same meaning as in the Private
13
Health Insurance Act 2007.
14
complying health insurance policy has the same meaning as in the
15
Private Health Insurance Act 2007.
16
complying health insurance product has the same meaning as in
17
the Private Health Insurance Act 2007.
18
health care provider has the same meaning as in the Private
19
Health Insurance Act 2007.
20
Health Department means the Department administered by the
21
Health Minister.
22
health insurance business has the same meaning as in the Private
23
Health Insurance Act 2007.
24
Health Minister means the Minister administering the Private
25
Health Insurance Act 2007.
26
medical practitioner has the same meaning as in the Private
27
Health Insurance Act 2007.
28
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
4
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
personal information has the same meaning as in the Private
1
Health Insurance Act 2007.
2
PHI records, of a subject of a complaint under Division 3 of
3
Part IID or an investigation under Division 4 of Part IID, includes
4
any of the following documents that are in the possession, or under
5
the control, of the subject:
6
(a) the constitution and rules of the subject, if the subject is a
7
private health insurer;
8
(b) the internal training manuals and related documents of the
9
subject;
10
(c) any documents relevant to a private health insurance
11
arrangement to which the subject is a party or that applies to
12
the subject;
13
(d) to the extent that the complaint or investigation relates to the
14
subject's dealings with a particular person--the subject's
15
documents relating to its dealings with that particular person
16
including correspondence, internal memoranda, emails, and
17
recordings of taped conversations;
18
whenever those documents came into existence.
19
private health insurance arrangement has the same meaning as in
20
the Private Health Insurance Act 2007.
21
private health insurance broker has the same meaning as in the
22
Private Health Insurance Act 2007.
23
Private Health Insurance (Information Disclosure) Rules means
24
rules mentioned in subsection 333-20(1), table item 16, of the
25
Private Health Insurance Act 2007.
26
Private Health Insurance Ombudsman Rules means rules made
27
under section 20ZJ.
28
private health insurance policy has the same meaning as in the
29
Private Health Insurance Act 2007.
30
private health insurer has the same meaning as in the Private
31
Health Insurance Act 2007.
32
product has the same meaning as in the Private Health Insurance
33
Act 2007.
34
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
5
rules, of a private health insurer, has the same meaning as in the
1
Private Health Insurance Act 2007.
2
3 Subsection 3(1) (note at the end of the definition of officer)
3
Repeal the note, substitute:
4
Note:
For the meaning of officer in Parts IIB, IIC and IID, see sections 19G,
5
19ZF and 20A respectively.
6
4 At the end of paragraph 4A(e)
7
Add:
8
; and (v) the functions of the Private Health Insurance
9
Ombudsman referred to in section 20D.
10
5 After Part IIC
11
Insert:
12
Part IID--Private Health Insurance Ombudsman
13
Division 1--Preliminary
14
20 Principal object of this Part
15
The principal object of this Part is to establish the office of, and set
16
out the powers and functions of, the Private Health Insurance
17
Ombudsman so that he or she may protect the interests of people
18
who are covered by private health insurance by:
19
(a) assisting people who have made complaints relating to
20
private health insurance to resolve those complaints; and
21
(b) investigating the practices and procedures of private health
22
insurers, private health insurance brokers and health care
23
providers; and
24
(c) mediating between private health insurers and health care
25
providers; and
26
(d) disseminating information about private health insurance and
27
the rights and obligations of privately insured people.
28
20A Definitions for this Part
29
In this Part:
30
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
6
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
officer, of a private health insurer, has the same meaning as in the
1
Private Health Insurance Act 2007.
2
officer, of a subject of a complaint under Division 3 or an
3
investigation under Division 4, means:
4
(a) if the subject is an individual--the individual; or
5
(b) if the subject is a private health insurer--a person who is an
6
officer of the insurer; or
7
(c) if the subject is a company within the meaning of the
8
Corporations Act 2001--a director of the company; or
9
(d) if the subject is an incorporated association--a member of
10
the management committee of the association; or
11
(e) if the subject is an unincorporated entity--a member of the
12
governing body of the entity; or
13
(f) if the subject is a partnership--a partner in the partnership.
14
20B Private Health Insurance Ombudsman Rules
15
Matters relevant to this Part are also dealt with in the Private
16
Health Insurance Ombudsman Rules. The provisions of this Part
17
indicate when a particular matter is or may be dealt with in these
18
Rules.
19
Note:
The Private Health Insurance Ombudsman Rules are made by the
20
Ombudsman under section 20ZJ.
21
Division 2--Establishment and functions of the Private
22
Health Insurance Ombudsman
23
20C Establishment of office of Private Health Insurance
24
Ombudsman
25
(1) For the purposes of this Act, there is to be a Private Health
26
Insurance Ombudsman.
27
(2) The office of Private Health Insurance Ombudsman is to be held
28
by the person who holds the office of Commonwealth
29
Ombudsman.
30
(3) The reference in subsection (2) to the person who holds the office
31
of Commonwealth Ombudsman includes a reference to a person
32
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
7
for the time being acting in that office because of an appointment
1
under section 29 (acting appointments).
2
20D Functions of Private Health Insurance Ombudsman
3
The Private Health Insurance Ombudsman has the following
4
functions:
5
(a) dealing with complaints under Division 3;
6
(b) conducting investigations under Division 4;
7
(c) publishing (in written form and on the Private Health
8
Insurance Ombudsman's website) a report, called the State of
9
the Health Funds Report, as soon as practicable after the end
10
of each financial year providing comparative information on
11
the performance and service delivery of all private health
12
insurers during that financial year;
13
(d) collecting and publishing (in written form and on the
14
internet) information about the complying health insurance
15
products available to people, in order to assist people to
16
understand the entitlements and benefits available under
17
those products;
18
(e) publishing, in aggregate form, information (not personal
19
information) about complaints under Division 3;
20
(f) reporting and making recommendations to the Health
21
Minister under sections 20R and 20V;
22
(g) reporting to the Health Minister or to the Health Department
23
about the practices of particular private health insurers or
24
private health insurance brokers;
25
(h) reporting (as part of reports mentioned in paragraph (g)) to
26
the Health Minister or to the Health Department about the
27
practices of particular health care providers, to the extent to
28
which those practices relate to:
29
(i) the application of private health insurance arrangements
30
or classes of private health insurance arrangements to
31
services or goods provided, or to goods manufactured or
32
supplied, by the health care providers; or
33
(ii) private health insurance arrangements or classes of
34
private health insurance arrangements to which those
35
kinds of health care providers may be party;
36
(i) making recommendations to the Health Minister or the
37
Health Department about regulatory practices or industry
38
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
8
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
practices relating to private health insurers or private health
1
insurance brokers;
2
(j) making recommendations (as part of recommendations
3
mentioned in paragraph (i)) to the Health Minister or to the
4
Health Department about regulatory practices or industry
5
practices relating to health care providers, to the extent to
6
which those practices relate to:
7
(i) the application of private health insurance arrangements
8
or classes of private health insurance arrangements to
9
services or goods provided, or to goods manufactured or
10
supplied, by the health care providers; or
11
(ii) private health insurance arrangements or classes of
12
private health insurance arrangements to which those
13
kinds of health care providers may be party;
14
(k) promoting a knowledge and understanding of the Private
15
Health Insurance Ombudsman's functions;
16
(l) any other functions that are incidental to the performance of
17
any of the preceding functions.
18
Division 3--Complaints
19
Subdivision A--Relevant complaints
20
20E Who may make a complaint
21
(1) A complaint may be made to the Private Health Insurance
22
Ombudsman by any of the following:
23
(a) a person who is, or was at the time of the incident to which
24
the complaint relates, insured or seeking to be insured under
25
a private health insurance policy;
26
(b) a private health insurer;
27
(c) a health care provider;
28
(d) a private health insurance broker.
29
Note:
Section 7 also deals with making complaints. For the application of
30
section 7 to the Private Health Insurance Ombudsman, see
31
section 20ZK.
32
(2) A complaint may be made by a person on behalf of a person
33
mentioned in subsection (1).
34
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
9
20F Persons against whom complaints may be made
1
A complaint may be made to the Private Health Insurance
2
Ombudsman against any of the following:
3
(a) a private health insurer;
4
(b) a health care provider;
5
(c) a private health insurance broker.
6
20G Grounds for complaint
7
(1) The complaint may be about:
8
(a) any matter arising out of or connected with a private health
9
insurance arrangement; or
10
(b) any matter arising out of or connected with Chapter 2 of the
11
Private Health Insurance Act 2007.
12
(2) A complaint against a health care provider must, in addition to
13
being about a matter in subsection (1), also:
14
(a) be about either or both of the following:
15
(i) the application of a private health insurance
16
arrangement to goods or a service provided, or goods
17
manufactured or supplied, by the health care provider;
18
(ii) a private health insurance arrangement to which the
19
health care provider is, or was at the time of the incident
20
to which the complaint relates, a party; and
21
(b) satisfy at least one of the following:
22
(i) the complaint must also be made against a private health
23
insurer;
24
(ii) the complainant must be a private health insurer or a
25
person insured under a private health insurance policy;
26
(iii) if the complainant is another health care provider or a
27
private health insurance broker--a private health insurer
28
or a person insured under a private health insurance
29
policy must also be a complainant in relation to the
30
complaint.
31
(3) The Private Health Insurance Ombudsman Rules may prescribe
32
matters about which complaints cannot be made.
33
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
10
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
Subdivision B--Dealing with complaints
1
20H Initial receipt of complaint
2
On receiving a complaint, the Private Health Insurance
3
Ombudsman may:
4
(a) inform the subject of the complaint of the nature of the
5
complaint; and
6
(b) request or require information from the subject under
7
Division 6.
8
20J Ways of dealing with complaints
9
(1) The Private Health Insurance Ombudsman may deal with a
10
complaint by:
11
(a) conducting mediation under Division 5; or
12
(b) referring the complaint to the subject of the complaint under
13
Subdivision C; or
14
(c) if section 20P applies--investigating the complaint under
15
Subdivision D.
16
(2) The Private Health Insurance Ombudsman must not take any
17
action mentioned in subsection (1) unless the complainant agrees
18
to the action being taken.
19
(3) The Private Health Insurance Ombudsman must not take, or
20
continue to take, any action mentioned in paragraph (1)(a) or (c) if
21
the complainant withdraws the complaint.
22
(4) The Private Health Insurance Ombudsman must not take any
23
action mentioned in subsection (1) if the complaint is about a
24
matter prescribed by the Private Health Insurance Ombudsman
25
Rules for the purposes of subsection 20G(3).
26
20K Referral to the Australian Competition and Consumer
27
Commission
28
(1) If, in the Private Health Insurance Ombudsman's opinion, a
29
complaint raises a matter that could be dealt with more effectively
30
or conveniently by the Australian Competition and Consumer
31
Commission, the Private Health Insurance Ombudsman must,
32
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
11
subject to subsections (2) and (3), refer the matter to the Australian
1
Competition and Consumer Commission.
2
(2) The Private Health Insurance Ombudsman must not refer the
3
matter to the Australian Competition and Consumer Commission
4
unless the complainant agrees to the referral.
5
(3) The Private Health Insurance Ombudsman must not refer the
6
matter to the Australian Competition and Consumer Commission if
7
the complainant withdraws the complaint.
8
(4) If the Private Health Insurance Ombudsman refers the matter to the
9
Australian Competition and Consumer Commission, the Private
10
Health Insurance Ombudsman must:
11
(a) tell the complainant of the matter's referral; and
12
(b) give the Australian Competition and Consumer Commission
13
any information or documents that relate to the complaint and
14
that are in the Private Health Insurance Ombudsman's
15
possession or under his or her control.
16
(5) The Australian Competition and Consumer Commission may
17
investigate the matter. If it does, it must, within 30 days after the
18
referral, report to the Private Health Insurance Ombudsman on:
19
(a) the conduct of the investigation; and
20
(b) any findings that it has made as a result of the investigation.
21
(6) If the Australian Competition and Consumer Commission decides
22
not to investigate the matter, it must, within 30 days after the
23
referral, give the Private Health Insurance Ombudsman a written
24
notice informing the Private Health Insurance Ombudsman of its
25
decision and of the reasons for its decision.
26
20L Referral to other bodies
27
(1) If, in the Private Health Insurance Ombudsman's opinion, a
28
complaint raises a matter that could be dealt with more effectively
29
or conveniently by another body, the Private Health Insurance
30
Ombudsman must, subject to this section, refer the matter to that
31
body.
32
(2) The Private Health Insurance Ombudsman must not refer the
33
matter to the other body unless the complainant agrees to the
34
referral.
35
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
12
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(3) The Private Health Insurance Ombudsman must not refer the
1
matter to the other body if the complainant withdraws the
2
complaint.
3
(4) If the Private Health Insurance Ombudsman refers the matter to the
4
other body, the Private Health Insurance Ombudsman must:
5
(a) tell the complainant of the matter's referral; and
6
(b) give the other body any information or documents that relate
7
to the complaint and that are in the Private Health Insurance
8
Ombudsman's possession or under his or her control.
9
20M Deciding not to deal with a complaint
10
(1) The Private Health Insurance Ombudsman may decide not to deal,
11
or not to continue to deal, with a complaint in accordance with this
12
section. If the Private Health Insurance Ombudsman so decides, he
13
or she must:
14
(a) tell the complainant of the decision and the reasons for the
15
decision; and
16
(b) if requested by the complainant--give the complainant
17
written notice of the decision and the reasons for the
18
decision.
19
(2) The Private Health Insurance Ombudsman may decide not to take
20
any action in relation to a complaint if the incident to which the
21
complaint relates occurred more than 12 months before the
22
complaint is made.
23
(3) The Private Health Insurance Ombudsman may decide not to deal
24
with a complaint if he or she is satisfied that the complainant has
25
not taken reasonable steps to negotiate a settlement of the
26
complaint with the subject of the complaint.
27
(4) The Private Health Insurance Ombudsman may decide not to deal,
28
or not to continue to deal, with a complaint if the complainant does
29
not agree to a matter relating to the complaint being referred to
30
another body under section 20L.
31
(5) The Private Health Insurance Ombudsman may decide not to deal,
32
or not to continue to deal, with a complaint, if he or she believes
33
that:
34
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
13
(a) the subject of the complaint has dealt, or is dealing,
1
adequately with the complaint, or has not yet had an adequate
2
opportunity to do so; or
3
(b) the Private Health Insurance Ombudsman has dealt
4
adequately with the complaint; or
5
(c) the complainant is capable of assisting the Private Health
6
Insurance Ombudsman in dealing with the complaint but
7
does not do so on request; or
8
(d) the complainant does not have a sufficient interest in the
9
subject matter of the complaint; or
10
(e) the matter is trivial; or
11
(f) the complaint is frivolous or vexatious or was not made in
12
good faith; or
13
(g) the complaint is mainly about commercial negotiations and,
14
having regard to the object of this Part, it is not appropriate to
15
deal, or to continue to deal, with the complaint; or
16
(h) the complaint is mainly about clinical matters and, having
17
regard to the object of this Part, it is not appropriate to deal,
18
or continue to deal, with the complaint; or
19
(i) the complainant has exercised, or exercises, a right to have
20
the matter to which the complaint relates reviewed by a court
21
or tribunal constituted by or under a law of the
22
Commonwealth or of a State or Territory; or
23
(j) both:
24
(i) the complainant has, or had, a right to have the matter to
25
which the complaint relates reviewed by a court or by a
26
tribunal constituted by or under a law of the
27
Commonwealth or of a State or Territory, but has not
28
exercised that right; and
29
(ii) it is, or would have been, reasonable for the
30
complainant to exercise that right; or
31
(k) to deal, or continue to deal, with the complaint is not
32
warranted having regard to all the circumstances.
33
Subdivision C--Referral to subjects of complaints
34
20N Referral to the subject of the complaint
35
The Private Health Insurance Ombudsman may, at any time and
36
whether or not mediation has been conducted under Division 5,
37
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
14
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
refer a complaint to the subject of the complaint and request the
1
subject:
2
(a) to investigate the complaint; and
3
(b) to report to the Private Health Insurance Ombudsman on the
4
outcome of the investigation and any action that the subject
5
proposes to take as a result, before the end of the period
6
specified in the request.
7
Note:
The Private Health Insurance Ombudsman must have the
8
complainant's agreement to act under this section (see
9
subsection 20J(2)).
10
Subdivision D--Investigation of complaints
11
20P Investigation of complaint
12
The Private Health Insurance Ombudsman may investigate a
13
complaint if:
14
(a) the complaint is not resolved to the complainant's
15
satisfaction by mediation under Division 5; or
16
(b) the Private Health Insurance Ombudsman is not satisfied
17
with the outcome of a referral under Subdivision C.
18
Note:
The Private Health Insurance Ombudsman must have the
19
complainant's agreement to act under this section and cannot continue
20
if the complaint is withdrawn (see subsections 20J(2) and (3)).
21
Subdivision E--Recommendations and reports
22
20Q Recommendations as a result of referral or investigation
23
(1) The Private Health Insurance Ombudsman may make
24
recommendations under this section after:
25
(a) receiving a report from the subject of a complaint after
26
referral under Subdivision C; or
27
(b) investigating a complaint under Subdivision D.
28
(2) The Private Health Insurance Ombudsman may recommend any or
29
all of the following:
30
(a) to a private health insurer, that the insurer take a specific
31
course of action in relation to the complaint or make changes
32
to its rules, or both;
33
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
15
(b) to a private health insurer, that the insurer request a health
1
care provider or private health insurance broker to take a
2
specific course of action in relation to the complaint;
3
(c) to a health care provider or private health insurance broker,
4
that the provider or broker take a specific course of action in
5
relation to the complaint.
6
(3) The Private Health Insurance Ombudsman may, by written notice
7
given to the person to whom the recommendation was made, or an
8
officer of that person, require the person to report to the Private
9
Health Insurance Ombudsman, before action is taken to give effect
10
to the recommendation, on the action proposed to be taken. The
11
notice must specify the period within which the report is to be
12
given.
13
20R Report to Health Minister on outcome of investigation under
14
Subdivision D
15
(1) The Private Health Insurance Ombudsman may report and make
16
recommendations under this section after completing an
17
investigation of a complaint against a particular subject under
18
Subdivision D.
19
(2) The Private Health Insurance Ombudsman may report to the
20
Health Minister on the outcome of the investigation (including any
21
recommendations made to the subject of the complaint and any
22
responses to those recommendations).
23
(3) The Private Health Insurance Ombudsman may recommend to the
24
Health Minister either or both of the following:
25
(a) general changes in regulatory practice or industry practices
26
relating to the kind of subject of complaint;
27
(b) possible means of dealing with specific problems arising in
28
relation to the particular subject of the complaint.
29
(4) The Private Health Insurance Ombudsman may make
30
recommendations under paragraph (3)(b) concerning health care
31
providers or a particular health care provider only to the extent to
32
which the recommendations relate to:
33
(a) the application of a private health insurance arrangement or a
34
class of private health insurance arrangements to services or
35
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
16
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
goods provided, or goods manufactured or supplied, by that
1
kind of health care provider; or
2
(b) a private health insurance arrangement or a class of private
3
health insurance arrangements to which that kind of health
4
care provider may be party.
5
(5) Before reporting to the Health Minister under this section, the
6
Private Health Insurance Ombudsman must:
7
(a) inform the subject of the complaint that the Private Health
8
Insurance Ombudsman proposes to make the report and of
9
the nature of any criticism of the subject's conduct that will
10
appear in the report; and
11
(b) invite the subject to comment on such criticism, before the
12
end of the period specified in the invitation.
13
The Private Health Insurance Ombudsman must include in the
14
report any comments made by the subject.
15
Subdivision F--Miscellaneous
16
20S Complainant to be kept informed
17
(1) The Private Health Insurance Ombudsman must keep the
18
complainant informed about the Private Health Insurance
19
Ombudsman's handling of the complaint.
20
(2) The Private Health Insurance Ombudsman must inform the
21
complainant in writing of:
22
(a) any action taken by a private health insurer, a health care
23
provider or private health insurance broker as a result of the
24
Private Health Insurance Ombudsman's handling of the
25
complaint; and
26
(b) any recommendations made by the Private Health Insurance
27
Ombudsman under section 20Q;
28
and the reasons for the action or recommendation.
29
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
17
Division 4--Investigations
1
Subdivision A--Investigations
2
20T Initiating investigations
3
(1) The Private Health Insurance Ombudsman may, on his or her own
4
initiative, investigate the practices and procedures of a private
5
health insurer or a private health insurance broker.
6
(2) The Private Health Insurance Ombudsman may, on his or her own
7
initiative, investigate the practices and procedures of a health care
8
provider together with an investigation of a private health insurer
9
under subsection (1), if:
10
(a) the investigation relates to a matter arising out of or
11
connected with a private health insurance arrangement; and
12
(b) the practices and procedures relate to either or both of the
13
following:
14
(i) the application of a private health insurance
15
arrangement to services or goods provided, or to goods
16
manufactured or supplied, by the health care provider;
17
(ii) a private health insurance arrangement to which the
18
health care provider is, or was in the period to be
19
investigated, a party; and
20
(c) the Private Health Insurance Ombudsman considers, having
21
regard to the object of this Part, that investigation of the
22
health care provider together with the private health insurer is
23
necessary or appropriate in order to consider the matter
24
effectively.
25
Note:
An investigation may include mediation (see section 20X).
26
Subdivision B--Recommendations and reports
27
20U Recommendations as a result of investigation
28
(1) The Private Health Insurance Ombudsman may make
29
recommendations under this section after conducting an
30
investigation under this Division.
31
(2) The Private Health Insurance Ombudsman may recommend either
32
or both of the following:
33
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
18
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(a) to a private health insurer, that the insurer take a specific
1
course of action or make changes to its rules, or both;
2
(b) to a health care provider or private health insurance broker,
3
that the provider or broker take a specific course of action.
4
(3) The Private Health Insurance Ombudsman may, by written notice
5
given to the person to whom the recommendation was made, or an
6
officer of that person, require the person to report to the Private
7
Health Insurance Ombudsman, before action is taken to give effect
8
to the recommendation, on the action proposed to be taken. The
9
notice must specify the period within which the report is to be
10
given.
11
20V Report to Health Minister on outcome of investigations under
12
this Division
13
(1) The Private Health Insurance Ombudsman may, after completing
14
an investigation under section 20T:
15
(a) report to the Health Minister on the outcome of the
16
investigation and any mediation conducted as part of the
17
investigation (including any recommendations made to the
18
subject of the investigation); and
19
(b) make recommendations to the Health Minister:
20
(i) concerning general changes in regulatory practice or
21
industry practices relating to that kind of subject of
22
investigation; or
23
(ii) concerning possible means of dealing with specific
24
problems arising in relation to the particular subject of
25
the investigation.
26
(2) The Private Health Insurance Ombudsman may make
27
recommendations under paragraph (1)(b) concerning health care
28
providers or a particular health care provider only to the extent to
29
which the recommendations relate to:
30
(a) the application of a private health insurance arrangement or a
31
class of private health insurance arrangements to services or
32
goods provided, or to goods manufactured or supplied, by
33
that kind of health care provider; or
34
(b) a private health insurance arrangement or a class of private
35
health insurance arrangements to which that kind of health
36
care provider may be party.
37
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
19
(3) Before reporting to the Health Minister under this section, the
1
Private Health Insurance Ombudsman must:
2
(a) inform the subject of the investigation that the Private Health
3
Insurance Ombudsman proposes to make the report and of
4
the nature of any criticism of the conduct of the subject that
5
will appear in the report; and
6
(b) invite the subject to comment on such criticism, before the
7
end of the period specified in the invitation.
8
The Private Health Insurance Ombudsman must include in the
9
report any comments made by the subject.
10
20W Consultation with Australian Competition and Consumer
11
Commission
12
If the Private Health Insurance Ombudsman considers, as a result
13
of an investigation under this Division, that there might have been
14
conduct in the nature of a restrictive trade practice for the purposes
15
of the Competition and Consumer Act 2010, the Private Health
16
Insurance Ombudsman must, before reporting on the matter under
17
section 20V:
18
(a) consult with the Australian Competition and Consumer
19
Commission; and
20
(b) have regard to the advice of the Australian Competition and
21
Consumer Commission on the matter.
22
Division 5--Mediation
23
20X Conducting mediation
24
(1) The Private Health Insurance Ombudsman may, at any time, try to
25
settle a complaint made under Division 3 by mediating between the
26
complainant and the subject of the complaint.
27
(2) The Private Health Insurance Ombudsman may, if he or she
28
considers it appropriate and consistent with the object of this Part,
29
try to resolve a matter being investigated under Division 4 by
30
mediating between a private health insurer and a health care
31
provider.
32
(3) A party's participation in the mediation may be:
33
(a) voluntary; or
34
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
20
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(b) required by a direction given to the party by the Private
1
Health Insurance Ombudsman under section 20Y.
2
Note:
If mediating a complaint, the Private Health Insurance Ombudsman
3
must have the complainant's agreement to act under this section and
4
cannot continue if the complaint is withdrawn (see subsections 20J(2)
5
and (3)).
6
20Y Participation in mediation may be compulsory
7
(1) The Private Health Insurance Ombudsman may direct:
8
(a) the subject of a complaint made under Division 3; or
9
(b) a private health insurer that is the subject of an investigation
10
under Division 4; or
11
(c) a health care provider that is the subject of an investigation
12
under Division 4;
13
to participate in mediation under section 20X.
14
(2) The Private Health Insurance Ombudsman Rules may prescribe
15
matters to which the Private Health Insurance Ombudsman is to
16
have regard when deciding whether or not to give a direction under
17
subsection (1).
18
(3) The direction must:
19
(a) be in writing; and
20
(b) name either or both of the following:
21
(i) the subject of the complaint or investigation;
22
(ii) an officer, or officers, of that subject; and
23
(c) be given to those named in it; and
24
(d) specify the time of the mediation, which must not be earlier
25
than 14 days after the day the direction is given; and
26
(e) specify the place of the mediation.
27
Note:
Subsection 33(3) of the Acts Interpretation Act 1901 has the effect that
28
the direction may be varied or revoked.
29
(4) A person commits an offence if:
30
(a) the person is directed under subsection (1) to participate in
31
mediation; and
32
(b) the other party to the mediation attends, or was willing to
33
attend, the mediation; and
34
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
21
(c) the person, or, if the person is a medical practitioner who has
1
appointed a representative in relation to the mediation under
2
section 20Z, the person's representative, fails to participate in
3
part or all of the mediation.
4
Penalty: 10 penalty units.
5
20Z Medical practitioners may appoint representatives
6
(1) If the Private Health Insurance Ombudsman directs a medical
7
practitioner under subsection 20Y(1) to participate in mediation,
8
the medical practitioner may appoint an individual to participate in
9
the mediation on the practitioner's behalf.
10
(2) The appointment must be:
11
(a) in writing; and
12
(b) signed by the medical practitioner; and
13
(c) made before the mediation starts.
14
20ZA Conduct of compulsory mediation
15
(1) If the Private Health Insurance Ombudsman directs a party to
16
participate in mediation, the mediation may be conducted by:
17
(a) the Private Health Insurance Ombudsman; or
18
(b) a person appointed by the Private Health Insurance
19
Ombudsman under section 20ZC.
20
(2) Mediation in which a party is directed to participate ceases:
21
(a) if the parties agree to settle the matter; or
22
(b) if the Private Health Insurance Ombudsman concludes that
23
the matter cannot be settled by mediation.
24
(3) The Private Health Insurance Ombudsman Rules may prescribe
25
matters to which the Private Health Insurance Ombudsman is to
26
have regard before concluding that a matter cannot be settled by
27
mediation.
28
(4) A person appointed by the Private Health Insurance Ombudsman
29
under section 20ZC to conduct mediation must, as soon as
30
practicable after the mediation is conducted or should have been
31
conducted, report to the Private Health Insurance Ombudsman
32
about:
33
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
22
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(a) whether the mediation was conducted; and
1
(b) if the mediation failed--the reasons for the failure; and
2
(c) if the parties agreed to settle the complaint--the terms of the
3
settlement, including any action to be taken.
4
20ZB Admissibility of things said in mediation
5
(1) Evidence of anything said, or any admission made, during
6
participation in mediation under section 20X is not admissible:
7
(a) in any court (whether exercising federal jurisdiction or not);
8
or
9
(b) in any proceedings before a person authorised by a law of the
10
Commonwealth or of a State or Territory, or by the consent
11
of the parties, to hear evidence.
12
(2) This section applies whether or not a party is directed to participate
13
in the mediation.
14
20ZC Appointment of mediators
15
(1) The Private Health Insurance Ombudsman may appoint a person to
16
conduct mediation in which a person is or will be directed to
17
participate under section 20Y.
18
(2) The Private Health Insurance Ombudsman Rules may prescribe
19
matters to which the Private Health Insurance Ombudsman is to
20
have regard when appointing a person under this section.
21
(3) The person is appointed for the period specified by the Private
22
Health Insurance Ombudsman in the instrument of appointment.
23
(4) Subject to section 35, the person is not personally liable to an
24
action or other proceeding for damages in relation to anything done
25
or omitted to be done, reasonably and in good faith, in or in
26
relation to the conduct of the mediation.
27
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
23
Division 6--Information-gathering
1
20ZD Information-gathering--requests for PHI records and
2
information
3
(1) The Private Health Insurance Ombudsman may, in accordance
4
with this section, obtain such information, and make such inquiries,
5
as he or she thinks fit.
6
(2) The Private Health Insurance Ombudsman may request a person to
7
give the Private Health Insurance Ombudsman a PHI record or
8
information under this section only if the Private Health Insurance
9
Ombudsman could require the person to give the PHI record or
10
information to the Private Health Insurance Ombudsman under
11
section 20ZE.
12
Note:
Section 20ZF deals with matters such as the person's exposure to
13
penalty and the admissibility of such information or PHI records.
14
20ZE Information-gathering--notices requiring PHI records and
15
information
16
(1) If the Private Health Insurance Ombudsman reasonably believes
17
that a person is capable of giving information or PHI records
18
relevant to:
19
(a) deciding if, and how, to deal with a complaint made under
20
Division 3; or
21
(b) mediating a complaint made under Division 3; or
22
(c) investigating a complaint made under Division 3; or
23
(d) evaluating action proposed by the subject of a complaint after
24
referral of the complaint to the subject under Subdivision C
25
of Division 3; or
26
(e) an investigation under Division 4 (including mediating as
27
part of the investigation under Division 5);
28
the Private Health Insurance Ombudsman may, by notice in writing
29
given to the person, require the person to give the Private Health
30
Insurance Ombudsman the information or the PHI records (relating
31
to the complaint or the practices and procedures being
32
investigated) that are specified in the notice, before the end of the
33
period specified in the notice.
34
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
24
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(2) The Private Health Insurance Ombudsman may give one or more
1
notices under subsection (1) in relation to a complaint or
2
investigation, at any time while the Private Health Insurance
3
Ombudsman is dealing with the complaint or investigation.
4
Self-incrimination
5
(3) A person is not excused from giving information or a PHI record
6
when required to do so under subsection (1) on the ground that the
7
information or PHI record might tend to incriminate the person or
8
expose the person to a penalty.
9
Note:
Section 20ZF deals with matters such as the person's exposure to
10
penalty and the admissibility of such information or PHI records.
11
20ZF Information-gathering--compliance with requests and notices
12
(1) This section applies if a person gives information or a PHI record
13
to the Private Health Insurance Ombudsman:
14
(a) in compliance with a request under section 20ZD or a notice
15
under section 20ZE; or
16
(b) reasonably believing that this would assist the Private Health
17
Insurance Ombudsman in:
18
(i) mediating a complaint under Division 5 or otherwise
19
dealing with it under Subdivision B or D of Division 3;
20
or
21
(ii) referring a complaint under section 20K or 20L; or
22
(iii) making a decision under section 20M not to deal, or not
23
to continue to deal, with a complaint; or
24
(iv) investigating a matter under section 20T.
25
(2) The person is not liable to any penalty under the provisions of any
26
other enactment by reason of his or her giving the information or
27
PHI record to the Private Health Insurance Ombudsman.
28
(3) For the purposes of:
29
(a) the Privacy Act 1988; and
30
(b) any provision of a law of a State or Territory that provides
31
that personal information contained in a record or
32
information may be disclosed if the disclosure is authorised
33
by law;
34
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
25
the giving of the information or PHI record to the Private Health
1
Insurance Ombudsman is taken to be authorised by this Act.
2
(4) This section does not otherwise affect a claim of legal professional
3
privilege that anyone may make in relation to the information or
4
PHI record.
5
Self-incrimination etc.
6
(5) If the information or PHI record is given by an individual and, by
7
giving the information or the PHI record, the individual:
8
(a) contravenes any other enactment; or
9
(b) might tend to incriminate himself or herself or make himself
10
or herself liable to a penalty; or
11
(c) discloses a legal advice given to the subject of a complaint
12
made under Division 3 or an investigation under Division 4;
13
or
14
(d) if the subject of a complaint made under Division 3 or an
15
investigation under Division 4 is an individual--discloses a
16
privileged communication between the subject and another
17
person or body; or
18
(e) if the subject of a complaint made under Division 3 or an
19
investigation under Division 4 is not an individual--discloses
20
a privileged communication between:
21
(i) an officer of the subject and another person or body; or
22
(ii) a person who is employed in the service of, or engaged
23
to provide services to, the subject, and another person or
24
body; or
25
(f) otherwise acts contrary to the public interest;
26
then none of the following are admissible in evidence against the
27
individual in any proceedings, other than proceedings for an
28
offence against section 137.1, 137.2 or 149.1 of the Criminal Code
29
that relates to this Act:
30
(g) the information or PHI record given;
31
(h) giving the information or PHI record;
32
(i) any information, document or thing obtained as a direct or
33
indirect consequence of giving the information or PHI record.
34
(6) In this section:
35
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
26
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
privileged communication means a communication protected
1
against disclosure by legal professional privilege.
2
Division 7--Provisions relating to the Private Health
3
Insurance Ombudsman
4
20ZG Reports of the Private Health Insurance Ombudsman
5
Annual reports
6
(1) As soon as practicable after the end of each financial year, the
7
Private Health Insurance Ombudsman must give an annual report
8
to the Minister, for presentation to the Parliament, on the
9
operations of the Private Health Insurance Ombudsman during the
10
financial year.
11
Additional reports
12
(2) The Private Health Insurance Ombudsman may, from time to time,
13
give the Minister, for presentation to the Parliament, a report:
14
(a) on the operations of the Private Health Insurance
15
Ombudsman during a part of a year; or
16
(b) in relation to any matter relating to, or arising in connection
17
with, the exercise of the powers, or the performance of the
18
functions, of the Private Health Insurance Ombudsman.
19
(3) Subsections (1) and (2) do not affect the powers and duties of the
20
Private Health Insurance Ombudsman under paragraph 20D(c) or
21
(g) or section 20R or 20V.
22
Tabling and inclusion in other reports
23
(4) If the Private Health Insurance Ombudsman gives a report to the
24
Minister under subsection (1) or (2), the Minister must cause the
25
report to be laid before each House of the Parliament within 15
26
sitting days of that House after the Minister receives the report.
27
(5) A report relating to the operations of the Private Health Insurance
28
Ombudsman during a period may be included in a report under:
29
(a) section 19; or
30
(b) section 46 of the Public Governance, Performance and
31
Accountability Act 2013;
32
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
27
relating to the operations of the Ombudsman during that period.
1
Content of report
2
(6) A report relating to the operations of the Private Health Insurance
3
Ombudsman during a period must include the following:
4
(a) the number and nature of complaints received under
5
section 20E;
6
(b) the outcomes of any actions taken, recommendations made or
7
investigations conducted in relation to such complaints;
8
(c) the outcomes in relation to complaints referred to another
9
body under section 20L;
10
(d) the number and nature of investigations (if any) conducted by
11
the Private Health Insurance Ombudsman under section 20T;
12
(e) the outcomes of investigations conducted under section 20T.
13
Division 8--Miscellaneous
14
20ZH Victimisation
15
A person commits an offence if:
16
(a) the person subjects, or threatens to subject, another person to
17
detriment; and
18
(b) the person does so because the other person has made, or
19
proposes to make, a complaint under this Part.
20
Penalty: Imprisonment for 6 months.
21
20ZI Giving information about the Private Health Insurance
22
Ombudsman
23
(1) The Private Health Insurance Ombudsman may, by written notice
24
given to private health insurers, require private health insurers:
25
(a) to give adults insured under the insurers' products the
26
information specified in the notice, in the manner specified in
27
the notice; or
28
(b) to publish the information specified in the notice, in the
29
manner specified in the notice.
30
(2) A notice must only specify information that relates to the functions
31
of the Private Health Insurance Ombudsman.
32
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
28
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(3) If more than one adult is insured under a single complying health
1
insurance policy of a private health insurer, the insurer is taken to
2
comply with a notice if the insurer complies with the notice in
3
relation to only one of those adults.
4
20ZJ Private Health Insurance Ombudsman Rules
5
(1) The Ombudsman may, by legislative instrument (and subject to
6
subsection (2)), make rules prescribing matters:
7
(a) required or permitted by this Part to be prescribed by the
8
rules; or
9
(b) necessary or convenient to be prescribed for carrying out or
10
giving effect to this Part.
11
(2) To avoid doubt, the rules may not do the following:
12
(a) create an offence or civil penalty provision;
13
(b) provide:
14
(i) powers of arrest or detention; or
15
(ii) powers relating to entry, search or seizure;
16
(c) impose a tax;
17
(d) set an amount to be appropriated from the Consolidated
18
Revenue Fund under an appropriation in this Act;
19
(e) amend this Act.
20
20ZK Application of certain provisions of the Act
21
(1) Subject to this section, the following provisions apply in relation to
22
the Private Health Insurance Ombudsman as if a reference in any
23
of those provisions to the Ombudsman were a reference to the
24
Private Health Insurance Ombudsman:
25
(a) the definition of authorized person in subsection 3(1);
26
(b) section 7 (complaints);
27
(c) section 11A (powers of Federal Court of Australia);
28
(d) subsection 31(1) (staff);
29
(e) section 33 (Ombudsman not to be sued);
30
(f) subsection 34(7) (delegation from State Ombudsman);
31
(g) section 35 (officers to observe confidentiality);
32
(h) section 35AA (disclosure of information and documents to
33
Integrity Commissioner);
34
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
29
(i) section 35A (disclosure of information by Ombudsman);
1
(j) section 35B (disclosure of ACC information);
2
(k) section 35C (disclosure of ACLEI information);
3
(l) section 36 (offences);
4
(m) section 37 (protection from civil actions).
5
(2) The following provisions apply in accordance with this subsection:
6
(a) section 7 applies as if a reference to investigating a complaint
7
were a reference to dealing with a complaint as mentioned in
8
subsection 20J(1);
9
(b) section 11A applies as if:
10
(i) the reference to a requirement made by the Ombudsman
11
by notice under section 9 to furnish information, to
12
produce documents or other records or to attend before
13
the Ombudsman to answer questions in relation to an
14
investigation under this Act were a reference to a
15
requirement made by the Private Health Insurance
16
Ombudsman by notice under section 20ZE to give
17
information or PHI records in relation to a complaint
18
made under Division 3 of Part IID or an investigation
19
under Division 4 of Part IID; and
20
(ii) the reference to an order directing the person to furnish
21
the information, produce the documents or attend before
22
the Ombudsman to answer questions were a reference to
23
an order directing the person to give the information or
24
PHI records to the Private Health Insurance
25
Ombudsman;
26
(c) subparagraph 35(3)(b)(i) applies, in relation to information
27
relating to a complaint made under Division 3 of Part IID or
28
an investigation under Division 4 of Part IID the subject of
29
which is not an individual, as if:
30
(i) the reference to information given by an officer of a
31
Department or prescribed authority in the performance
32
of his or her duties were a reference to information
33
given by an officer of the subject or a person employed
34
in the service of, or engaged to provide services to, the
35
subject; and
36
(ii) the reference to the principal officer of the Department
37
or authority or the responsible Minister were a reference
38
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
30
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
to the individual primarily responsible for the
1
management of the subject;
2
(d) subsection 35(6A) applies as if the reference to
3
paragraph 6(4D)(e) or 6(18)(d) were a reference to
4
paragraph 20K(4)(b) or 20L(4)(b) or section 20W;
5
(e) section 35AA applies as if the reference to the investigation
6
of an action as mentioned in paragraph 5(1)(b) were a
7
reference to an investigation under Division 4 of Part IID or
8
mediation undertaken to try to resolve a matter being
9
investigated under Division 4 of Part IID;
10
(f) section 35A applies as if a reference to an investigation were
11
a reference to:
12
(i) dealing with a complaint as mentioned in
13
subsection 20J(1); or
14
(ii) an investigation under Division 4 of Part IID or
15
mediation undertaken to try to resolve a matter being
16
investigated under Division 4 of Part IID;
17
(g) the definition of listed disclosure method in
18
subsections 35B(2) and 35C(2) applies as if:
19
(i) a reference to Division 2 of Part II were a reference to
20
section 20R, 20V or 20ZG; and
21
(ii) a reference to section 6 or 6A were a reference to
22
section 20K or 20L;
23
(h) section 37 applies as if the reference to a requirement under
24
section 9 were a reference to a requirement under
25
section 20ZE.
26
6 Section 20
27
Renumber as section 20ZL.
28
7 Paragraph 34(1)(a)
29
Omit "17 and 19", substitute "17, 19 and 20ZJ".
30
8 After subsection 34(2B)
31
Insert:
32
(2C) The Private Health Insurance Ombudsman may, either generally or
33
as otherwise provided by the instrument of delegation, by
34
instrument in writing, delegate to a member of staff mentioned in
35
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
31
section 31 all or any of his or her powers or functions under this
1
Act, other than his or her powers under section 20R and 20V.
2
9 At the end of subsection 35(1)
3
Add:
4
; or (f) a person appointed by the Private Health Insurance
5
Ombudsman under section 20ZC (appointment of mediators).
6
10 After subsection 35(6A)
7
Insert:
8
Sharing information about private health insurers among agencies
9
(6B) Subsections (2) and (5) do not prevent an officer, in the
10
performance of his or her duties as an officer, from disclosing
11
information mentioned in subsection (6C) in accordance with
12
subsection (6D).
13
(6C) For subsection (6B), the information is information that:
14
(a) relates to any or all of the following:
15
(i) a private health insurer;
16
(ii) an applicant to become a private health insurer;
17
(iii) a person carrying on health insurance business;
18
(iv) a director or officer of a person mentioned in
19
subparagraph (i), (ii) or (iii); and
20
(b) is not information of a kind specified in the Private Health
21
Insurance (Information Disclosure) Rules as information that
22
must not be disclosed under section 323-10 of the Private
23
Health Insurance Act 2007.
24
(6D) For subsection (6B), the officer may disclose the information to the
25
following:
26
(a) the Health Minister;
27
(b) the Secretary of the Health Department;
28
(c) an APS employee in, or a person holding or performing the
29
duties of an office in, the Health Department;
30
(d) a member of the Council (within the meaning of the Private
31
Health Insurance Act 2007);
32
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
32
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(e) a person employed, or a consultant engaged, by the Council
1
(within the meaning of the Private Health Insurance Act
2
2007);
3
(f) the Chief Executive Medicare;
4
(g) a Departmental employee (within the meaning of the Human
5
Services (Medicare) Act 1973);
6
if the disclosure is made in accordance with any requirements in
7
the Private Health Insurance (Information Disclosure) Rules.
8
11 Subsection 35C(2) (paragraph (a) of the definition of listed
9
disclosure method)
10
Omit "Part 2", substitute "Part II".
11
12 Paragraph 36(1)(ba)
12
After "furnish", insert "or publish".
13
13 After paragraph 36(1)(c)
14
Insert:
15
or (d) to give a report;
16
Private Health Insurance Act 2007
17
14 Paragraph 230-1(a)
18
Repeal the paragraph.
19
15 Part 6-2
20
Repeal the Part.
21
16 At the end of section 323-5
22
Add:
23
; or (d) for the purpose of enabling a person to perform functions
24
under Part IID of the Ombudsman Act 1976.
25
17 Subsection 323-10(1)
26
Repeal the subsection, substitute:
27
(1) This section applies to information if the information:
28
(a) relates to any or all of the following:
29
Private Health Insurance Ombudsman Schedule 1
Main amendments Part 1
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
33
(i) a private health insurer;
1
(ii) an applicant to become a private health insurer;
2
(iii) a person carrying on
*
health insurance business;
3
(iv) a
*
director or
*
officer of a person mentioned in
4
subparagraph (i), (ii) or (iii); and
5
(b) is not information of a kind specified in the Private Health
6
Insurance (Information Disclosure) Rules as information that
7
must not be disclosed under this section.
8
(1A) For the purposes of subsection 323-1(3), a person to whom
9
subsection (2) applies may disclose the information to:
10
(a) another person to whom subsection (2) applies; or
11
(b) the Private Health Insurance Ombudsman; or
12
(c) an APS employee in, or a person holding or performing the
13
duties of an office in, the Statutory Agency of the
14
Commonwealth Ombudsman;
15
if the disclosure is made in accordance with any requirements in
16
the Private Health Insurance (Information Disclosure) Rules.
17
18 Paragraphs 323-10(2)(f) and (g)
18
Repeal the paragraphs.
19
19 Section 328-1
20
Omit "the Council, the Minister and the Private Health Insurance
21
Ombudsman", substitute "the Council and the Minister".
22
20 Section 328-5, table items 36 and 37
23
Repeal the items.
24
21 Subsection 333-20(1), table item 11
25
Repeal the item.
26
22 Clause 1 of Schedule 1 (definition of officer, second
27
occurring)
28
Repeal the definition.
29
23 Clause 1 of Schedule 1 (definition of Private Health
30
Insurance Ombudsman)
31
Repeal the definition, substitute:
32
Schedule 1 Private Health Insurance Ombudsman
Part 1 Main amendments
34
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
Private Health Insurance Ombudsman means the Private Health
1
Insurance Ombudsman established by section 20C of the
2
Ombudsman Act 1976.
3
24 Clause 1 of Schedule 1 (definition of records)
4
Repeal the definition.
5
Private Health Insurance Ombudsman Schedule 1
Transitional provisions Part 2
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
35
Part 2
--Transitional provisions
1
25 Definitions
2
In this Part:
3
commencement day means the day this item commences.
4
Health Minister means the Minister administering the Private Health
5
Insurance Act 2007.
6
26 Things done by, or in relation to, the Private Health
7
Insurance Ombudsman before the commencement day
8
(1)
If, before the commencement day, a thing was done by, or in relation to,
9
the Private Health Insurance Ombudsman under the Private Health
10
Insurance Act 2007, then the thing is taken, on and after that day, to
11
have been done by, or in relation to, the Private Health Insurance
12
Ombudsman under the Ombudsman Act 1976.
13
(2)
The Health Minister may, by writing, determine that subitem (1) does
14
not apply in relation to a specified thing done by, or in relation to, the
15
Private Health Insurance Ombudsman before the commencement day.
16
(3)
A determination made under subitem (2) is not a legislative instrument.
17
27 Things started but not finished by the Private Health
18
Insurance Ombudsman before the commencement day
19
(1)
This item applies if:
20
(a) before the commencement day, the Private Health Insurance
21
Ombudsman started doing a thing under the Private Health
22
Insurance Act 2007; and
23
(b) immediately before that day, the Private Health Insurance
24
Ombudsman had not finished doing that thing.
25
(2)
The Private Health Insurance Ombudsman may, on and after the
26
commencement day, finish doing the thing under the Ombudsman Act
27
1976.
28
(3)
The Health Minister may, by writing, determine that subitem (2) does
29
not apply in relation to a specified thing started by the Private Health
30
Insurance Ombudsman before the commencement day.
31
Schedule 1 Private Health Insurance Ombudsman
Part 2 Transitional provisions
36
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
(4)
A determination made under subitem (3) is not a legislative instrument.
1
28 Application of the Safety, Rehabilitation and
2
Compensation Act 1988
3
(1)
This item applies if, before the commencement day, an employee of the
4
Private Health Insurance Ombudsman suffered an injury resulting in an
5
incapacity for work or an impairment.
6
(2)
Sections 36, 37, 38, 39, 41 and 41A of the Safety, Rehabilitation and
7
Compensation Act 1988 apply on and after the commencement day, in
8
relation to the injury, as if the employee were employed by the Office of
9
the Commonwealth Ombudsman.
10
Note:
The main effect of subitem (2) is that sections 36, 37, 38, 39, 41 and 41A of the Safety,
11
Rehabilitation and Compensation Act 1988 apply in relation to the employee's injury as
12
if the Commonwealth Ombudsman were the rehabilitation authority.
13
(3)
On and after the commencement day, the Office of the Commonwealth
14
Ombudsman is, for the purposes of section 40 of the Safety,
15
Rehabilitation and Compensation Act 1988, taken to be the relevant
16
employer of the employee.
17
(4)
For the purposes of this item, employee of the Private Health
18
Insurance Ombudsman means a member of the staff assisting the
19
Private Health Insurance Ombudsman referred to in
20
subsection 253-45(1) of the Private Health Insurance Act 2007.
21
29 Transfer of records
22
(1)
This item applies to any records or documents that, immediately before
23
the commencement day, were in the possession of the Private Health
24
Insurance Ombudsman or a member of the staff assisting the Private
25
Health Insurance Ombudsman referred to in subsection 253-45(1) of the
26
Private Health Insurance Act 2007.
27
(2)
The records and documents are to be transferred to the Office of the
28
Commonwealth Ombudsman on or after the commencement day.
29
Note:
The records and documents are Commonwealth records for the purposes of the Archives
30
Act 1983.
31
Private Health Insurance Ombudsman Schedule 1
Transitional provisions Part 2
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
37
30 Disclosure of information
1
For sections 323-1 and 323-40 of the Private Health Insurance Act
2
2007, a disclosure of information is an authorised disclosure if the
3
disclosure is:
4
(a) made in the course of performing a duty or function, or
5
exercising a power, under Part IID of the Ombudsman Act
6
1976; or
7
(b) one that the person would have been able to make under the
8
Ombudsman Act 1976, had the information been obtained in
9
the course of performing a duty or function, or exercising a
10
power, under the Ombudsman Act 1976.
11
31 Transitional rules
12
(1)
The Health Minister may, by legislative instrument (and subject to
13
subitem (2)), make rules prescribing matters of a transitional nature
14
(including prescribing any saving or application provisions) relating to
15
the amendments or repeals made by this Act.
16
(2)
To avoid doubt, the rules may not do the following:
17
(a) create an offence or civil penalty provision;
18
(b) provide:
19
(i) powers of arrest or detention; or
20
(ii) powers relating to entry, search or seizure;
21
(c) impose a tax;
22
(d) set an amount to be appropriated from the Consolidated
23
Revenue Fund under an appropriation in this Act;
24
(e) amend this Act.
25
(3)
This Act (other than subitem (2)) does not limit the rules that may be
26
made for the purposes of subitem (1).
27
Schedule 2 Base premium measure
38
Private Health Insurance Amendment Bill (No. 2) 2014
No. , 2014
Schedule 2
--Base premium measure
1
2
1 Non-commencement of certain items
3
Items 1, 2, 3, 6 and 13 of Schedule 1 to the Private Health Insurance
4
Legislation Amendment (Base Premium) Act 2013 are taken never to
5
have commenced.
6
Note:
The items are superseded by the amendments made by the Private Health Insurance
7
Legislation Amendment Act 2014.
8
2 Validation of certain payments
9
Scope
10
(1)
This item applies if:
11
(a) during the period starting on 1 April 2014 and ending
12
immediately before the commencement of this item, an
13
amount was purportedly paid to a private health insurer under
14
a provision (the payment provision) of Part 6-4 of the Private
15
Health Insurance Act 2007; and
16
(b) the amount paid exceeded the amount that, disregarding
17
item 1, was payable to the private health insurer under the
18
payment provision; and
19
(c) the amount paid equalled the amount that, taking account of
20
item 1, was payable to the private health insurer under the
21
payment provision.
22
Recovery of excess
23
(2)
The excess referred to in paragraph (1)(b):
24
(a) is a debt due to the Commonwealth by the private health
25
insurer; and
26
(b) may be recovered by action in a court of competent
27
jurisdiction.
28
Substitute payment
29
(3)
There is payable to the private health insurer an amount equal to the
30
excess referred to in paragraph (1)(b).
31
(4)
The payment under subitem (3) is taken to be a payment to which
32
section 282-40 of the Private Health Insurance Act 2007 applies.
33
Base premium measure Schedule 2
No. , 2014
Private Health Insurance Amendment Bill (No. 2) 2014
39
(5)
The payment under subitem (3) is taken to satisfy any obligation to
1
make a payment to the same private health insurer of the amount that
2
was payable as described in paragraph (1)(c).
3
Set-off
4
(6)
The amount payable by the private health insurer under subitem (2) may
5
be recovered by deduction from the amount payable to the private
6
health insurer under subitem (3).
7
3 Application of amendments made by the Private Health
8
Insurance Legislation Amendment Act 2014 to
9
adjustment year starting on 1 April 2014
10
Despite the fact that the Private Health Insurance Legislation
11
Amendment Act 2014 commenced on 9 April 2014, the amendments
12
made by that Act apply to the whole of the adjustment year (within the
13
meaning of the Private Health Insurance Act 2007) starting on 1 April
14
2014.
15