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This is a Bill, not an Act. For current law, see the Acts databases.
1996
The Parliament of
the
Commonwealth of
Australia
HOUSE OF
REPRESENTATIVES
Presented and read a first
time
Private Health
Insurance Incentives Bill 1996
No. ,
1996
(Health and Family
Services)
A Bill for an Act to provide
incentives for private health insurance, and for related
purposes
9615221—1,577/12.12.1996—(152/96) Cat.
No. 96 5725
8 ISBN
0644 480020
Contents
9615221—1,577/12.12.1996—(152/96) Cat.
No. 96 5725
8 ISBN
0644 480020
The Parliament of Australia enacts:
This Act may be cited as the Private Health Insurance Incentives Act
1996.
This Act commences on the day on which it receives the Royal
Assent.
Expressions used in this Act (or in a particular provision of this Act)
that are defined in the Dictionary in Schedule 1 have the meanings given to them
in the Dictionary.
This Part is about how people who are covered by private health insurance
policies providing hospital cover, ancillary cover or combined cover can
participate in a scheme under which the premiums payable under those policies
are reduced.
Table of Divisions
2 Introduction
3 Who is eligible to participate in the scheme?
4 How do people participate in the scheme?
5 What effect does the scheme have on insurance premiums?
Note: The incentives scheme is complemented by the private
health insurance tax offset, provided for by Subdivision 61-G of the Income
Tax Assessment Act 1996. People can choose to claim the tax offset instead
of having their premiums reduced.
A person is eligible, in respect of a financial year, to participate in
the incentives scheme in respect of a private health insurance policy
if:
(a) the health fund that issued the policy is, for the year, a
participating fund (see Division 7); and
(b) the person is eligible to apply under Division 4 for registration in
respect of the policy for that year (see section 4-2); and
(c) the policy provides appropriate private health insurance cover (see
section 3-2); and
(d) the income test under section 3-3 or 3-4 (whichever is applicable) is
satisfied in respect of that year; and
(e) the person is, at any time during that year, an eligible person within
the meaning of section 3 of the Health Insurance Act 1973, or is treated
as such a person because of section 6 of that Act.
(1) The policy provides appropriate private health insurance
cover if:
(a) it provides hospital cover (see subsection (2)); or
(b) it provides ancillary cover (see subsection (3)); or
(c) it provides combined cover (see subsection (6)).
(2) The policy provides hospital cover if:
(a) it is an applicable benefits arrangement, within the meaning of
section 5A of the National Health Act 1953, to which paragraph 5A(1)(a)
of that Act applies; and
(b) the annual premium payable for the policy is not less than:
(i) if the policy covers only one person—$250, or such other amount
as the Minister determines in writing; or
(ii) if the policy covers more than one person—$500, or such other
amount as the Minister determines in writing.
(3) The policy provides ancillary cover if:
(a) persons covered by the policy are covered (wholly or partly) for
liability to pay fees and charges in respect of ancillary health benefits within
the meaning of section 67 of the National Health Act 1953; and
(b) the annual premium payable for the policy is not less than:
(i) if the policy covers only one person—$125, or such other amount
as the Minister determines in writing; or
(ii) if the policy covers more than one person—$250, or such other
amount as the Minister determines in writing.
(4) In subsections (2) and (3):
annual premium means the amount of premium payable if the
policy were to apply for one year, whether or not the policy applies, in the
particular case in question, for that period.
(5) Determinations made for the purposes of subparagraph (2)(b)(i) or (ii)
or (3)(b)(i) or (ii) are disallowable instruments for the purposes of section
46A of the Acts Interpretation Act 1901.
(6) The policy provides combined cover if it provides both
hospital cover and ancillary cover.
(1) If the policy covers only one person, the income test is satisfied in
respect of the financial year in question if the sum of the taxable incomes of
all of the persons whose incomes are required by subsection (2) to be taken into
account is less than the maximum amount under subsection (4).
Note: For taxable income, see section
3-5.
(2) The persons whose incomes are to be taken into account are:
(a) if the person covered by the policy is not a dependent child during
the financial year—that person and the partner (if any) of that person; or
(b) if the person covered by the policy is a dependent child at any time
during that year—any parent of that person, and the partner (if any) of
the parent, but only if, in respect of that year:
(i) the parent, or his or her partner, made one or more payments of
premiums in respect of the policy; or
(ii) a person (other than a parent of the dependent child or the partner
(if any) of that parent) made one or more such payments, under an arrangement
entered into with the parent or partner.
(3) For the purposes of subsection (2), a person is the
partner of another person only if, on the last day of the
financial year, the person is the partner of that person.
(4) The maximum amount is:
(a) if at all times during the financial year the person covered by the
policy is not a dependent child and is not the partner of another
person—$35,000; or
(b) if at any time during the financial year the person covered by the
policy is not a dependent child and is the partner of another
person—$70,000; or
(c) if at any time during the financial year the person covered by the
policy is a dependent child—$70,000.
Note: For dependent child, parent
and partner, see the Dictionary.
(1) If the policy covers more than one person, the income test is
satisfied in respect of the financial year in question if the sum of the taxable
incomes of all of the persons whose incomes are required by subsection (2) to be
taken into account is less than the maximum amount under subsection
(4).
Note: For taxable income, see section
3-5.
(2) The persons whose incomes are to be taken into account are:
(a) each person covered by the policy who is not a dependent child during
the financial year; and
(b) the partner (if any) of each such person; and
(c) if all of the persons covered by the policy are dependent children at
any time during that year—any parent of any of the persons covered,
and the partner (if any) of the parent, but only if, in respect of that
year:
(i) the parent, or his or her partner, made one or more payments of
premiums in respect of the policy; or
(ii) a person (other than a parent of the dependent child or the partner
(if any) of that parent) made one or more such payments, under an arrangement
entered into with the parent or partner.
(3) For the purposes of subsection (2), a person is the
partner of another person only if, on the last day of the
financial year, the person is the partner of that person.
(4) The maximum amount is:
(a) if the persons covered by the policy do not include 2 or more
dependent children at any time during the financial year
concerned—$70,000; or
(b) if, at any time during the financial year, 2 or more dependent
children are covered by the policy—the amount worked out as
follows:
Example: If the policy covers the members of a family that
has 3 dependent children, the maximum amount under subsection (4)
is:
Note: For dependent child, parent
and partner, see the Dictionary.
In section 3-3 or 3-4:
taxable income, in relation to a person, means the
person’s taxable income, within the meaning of the Income Tax
Assessment Act 1936, for the financial year in question, and includes any
share in the net income of a trust estate:
(a) to which the person is presently entitled as a beneficiary;
and
(b) in respect of which the trustee of the trust estate in that capacity
is liable to be assessed under section 98 of that Act; and
(c) that is attributable to that financial year.
(1) A person who is eligible to apply for registration in respect of a
private health insurance policy for a financial year (see section 4-2) may
apply under section 4-3, to the health fund that issued the policy, to be
registered by the Commission in respect of the policy for that year.
(2) If the health fund receives such an application, it must notify the
Commission of the application (see section 4-4).
(3) On receiving a notice under subsection (2), the Commission must
register the person in respect of the policy for that financial year,
unless the Commission is satisfied that:
(a) the person is not eligible to participate in the incentives scheme;
or
(b) the notice contains information that is incorrect.
Note: Refusals
to register are reviewable under section 13-1.
(1) Any person who is covered by the policy (other than a dependent child)
is eligible to apply for registration in respect of the policy for the financial
year. If every person covered by the policy is a dependent child at any time
during that year, any parent of any of them is eligible to apply.
Note: For dependent child and
parent, see the Dictionary.
(2) A person is not eligible to apply for registration in respect of the
policy for the financial year if:
(a) another person has already applied for registration in respect of the
policy for that year; and
(b) the Commission:
(i) has not refused to register that person; or
(ii) has not revoked that person’s registration.
(1) An application under this section must be in a form approved by the
Minister, and must include a statutory declaration by the applicant to the
effect that:
(a) the applicant has estimated the sum of the taxable incomes, for the
financial year in question, of each person whose income must be taken into
account under section 3-3 or 3-4 in respect of the policy for that
financial year; and
(b) the applicant believes that he or she will be eligible to participate
in the incentives scheme for that financial year.
(2) An estimate under paragraph (1)(a) must be made in the way determined
by the Minister in writing.
(3) The application must state the following details:
(a) the applicant’s full name;
(b) the applicant’s date of birth;
(c) the applicant’s address;
(d) the applicant’s Medicare card number;
(e) whether the policy in respect of which the applicant has applied to be
registered covers only one person or covers more than one person;
(f) the full name and date of birth of each person covered by the policy
(other than the applicant);
(g) whether any of those persons are dependent children;
(h) the full name and date of birth of each person (other than a person
covered by the policy) whose income must be taken into account under section 3-3
or 3-4 in respect of the policy for the financial year in question;
(i) any other information determined in writing by the Minister.
(4) For the purposes of paragraph (3)(i), the Minister must not determine
that an applicant must provide:
(a) the tax file number of any person; or
(b) any information about the applicant’s income, or the income of
any other person, other than that the applicant believes that the income test is
satisfied in respect of the policy for the financial year in question.
(5) Determinations under subsections (2) and (3) are disallowable
instruments for the purposes of section 46A of the Acts Interpretation Act
1901.
(6) An application under this section may be made at any time before or
during the financial year concerned.
(1) A health fund must notify the Commission of an application given to
the health fund under section 4-3 no later than whichever of the following days
is applicable:
(a) if the health fund receives the application on a day that is on or
before the 21st day of a month—the first business day of the following
month; or
(b) if the health fund receives the application on a day that is on or
after the 22nd day of a month—the first business day of the second month
after that day.
(2) The notice must be in such a form, and contain such details, as the
Managing Director determines in writing.
(3) The details referred to in subsection (2) may include, but are not
limited to, the following:
(a) the applicant’s full name;
(b) the applicant’s date of birth;
(c) the applicant’s address;
(d) the applicant’s Medicare card number;
(e) whether the policy in respect of which the applicant has
applied to be registered covers only one person or covers more than one
person;
(f) the full name and date of birth of any person covered by the policy
(other than the applicant);
(g) whether any of those persons are dependent children;
(h) the full name and date of birth of any person (other than a person
covered by the policy) whose income must be taken into account under section 3-3
or 3-4 in respect of the policy for the financial year in question;
(i) whether the policy provides hospital cover, ancillary cover or
combined cover.
(4) For the purposes of subsection (2), the Managing Director must not
determine that the participating fund must provide:
(a) the tax file number of any person; or
(b) any information about the applicant’s income, or the income of
any other person, other than that the applicant believes the income test is
satisfied in respect of the policy for the financial year in question;
or
(c) information about the physical, psychological or emotional health of
any person.
(5) The details determined by the Managing Director for the purposes of
subsection (2) must not relate to any person other than:
(a) the applicant; or
(b) persons covered by the policy; or
(c) persons whose income must be taken into account under section
3-3 or 3-4 in respect of the policy for the financial year in
question.
(6) Determinations under subsection (2) are disallowable instruments for
the purposes of section 46A of the Acts Interpretation Act
1901.
(1) If the Commission refuses to register the applicant, it must give
written notice of the refusal, together with reasons for the refusal,
to:
(a) the applicant; and
(b) the health fund that issued the policy.
(2) The
applicant is taken, for the purposes of this Act, to be registered in respect of
the policy for the financial year in question if the Commission does not give
notice of refusal within 14 days after being notified under section 4-4 of the
application in question.
(1) The Commission must revoke a person’s registration in respect of
a private health insurance policy for a financial year if:
(a) the person becomes registered in respect of another policy for that
year; or
(b) the Commission is given a notice under section 4-8 in respect of the
person; or
(c) the Commission is satisfied that the person is not eligible to
participate in the incentives scheme for that year.
(2) Revocation of registration under subsection (1) does not affect a
person’s right to make another application for registration under section
4-3.
Note: Revocations
of registration are reviewable under section 13-1.
(1) A person who is registered in respect of a private health insurance
policy for a financial year (the registered person) must give
written notice to the health fund in question if:
(a) the estimated sum of the taxable incomes of persons whose income must
be taken into account under section 3-3 or 3-4 in respect of the policy for that
year changes; and
(b) the sum changes in such a way that the registered person knows or
ought reasonably to expect that the income test in respect of the policy will
not be satisfied for that year.
(2) The registered person must also give written notice to the health fund
if a detail:
(a) stated in the person’s application under section 4-3;
and
(b) relating to the number of people covered by the policy or to whether
any of those people are dependent children;
changes in such a way that the person ought reasonably to expect that the
annual incentive amount for the policy for the year will change.
(3) The registered person may notify the health fund in writing if he or
she no longer wishes to be registered in respect of the policy for that
year.
(1) A health fund must notify the Commission, in a form determined by the
Managing Director, of each notice given to the health fund under section
4-7.
(2) The health fund must so notify the Commission on or before whichever
of the following days is applicable:
(a) if the health fund receives the notice on a day that is on or before
the 21st day of a month—the first business day of the following month;
or
(b) if the health fund receives the notice on a day that is on or after
the 22nd day of a month—the first business day of the second month after
that day.
(1) A health fund must notify the Commission if the type of cover provided
by a private health insurance policy, issued by the health fund and in respect
of which a person is registered, is varied.
Note: For type of cover, see the
Dictionary.
(2) On receiving such a notice, the Commission must vary the details of
the registration accordingly.
(1) A health fund must retain an application made to it under
section 4-3 for the period of 5 years beginning on the day the application
was made.
(2) The health fund may retain the application in any form (including an
electronic form) approved in writing by the Managing Director.
(3) An application retained in such a form must be received in all courts
and tribunals as evidence as if it were the original.
(1) The amount of premium that, apart from this section, would be payable
under a private health insurance policy in respect of which a person is a
participant in the incentives scheme for a financial year (see section 5-2) is
to be reduced by:
(a) if the premium is paid in respect of the whole of the financial
year—the annual incentive amount for the policy under section 5-3;
or
(b) if the premium is paid in respect of a part of the financial
year—the amount worked out using the formula:
(2) Subsection (1) does not apply to:
(a) the payment of a premium that is made after the policy has ceased,
during the financial year in question, to be a dependent child policy (see
section 5-4); or
(b) the payment of a premium that is made in respect of a period that ends
before 1 July 1997; or
(c) if the payment of a premium is made in respect of a period that starts
before 1 July 1997 and ends on or after that day but on or before 31 July
1997—the part of the payment that relates to the part of the period before
1 July 1997; or
(d) the payment of a premium that is made in respect of a period that
starts on or before 1 July 1997 and ends after 31 July 1997.
(1) A person is a participant in the incentives scheme for a financial
year in respect of a private health insurance policy if:
(a) the person is registered under Division 4 in respect of the policy for
the year; or
(b) the person has applied to be registered in respect of the policy for
the year and the registration has not been refused.
(2) For the purposes of this Act, a person is taken, in respect of a
payment of premium during July in a financial year, to be a participant in the
incentives scheme if:
(a) the person has not, at the time the payment is made, applied to be
registered in respect of the private health insurance policy in question;
and
(b) on 30 June in the previous financial year, the person was registered
under Division 4 in respect of the policy for that year.
(1) The annual incentive amount for a private health insurance policy
is:
(a) the amount set out in the following table; or
(b) such other amount as is determined in writing by the
Minister.
|
Annual Incentive Amounts |
||||
|---|---|---|---|---|
|
|
|
|
Policy provides hospital cover but not ancillary
cover |
|
|
1 |
Policy covers 3 or more people |
$450 |
$350 |
$100 |
|
2 |
Policy covers one dependent child and one other person |
$450 |
$350 |
$100 |
|
3 |
Policy covers 2 people neither of whom are dependent children |
$250 |
$200 |
$50 |
|
4 |
Policy covers one person |
$125 |
$100 |
$25 |
Note: For combined cover, hospital
cover and ancillary cover, see
section 3-2.
(2) Determinations under paragraph (1)(b) are disallowable instruments for
the purposes of section 46A of the Acts Interpretation Act
1901.
For the purposes of paragraph 5-1(2)(a), if:
(a) at the time an application was made under section 4-3 for registration
of a private health insurance policy for a financial year, the policy did not
cover any person who was not a dependent child; and
(b) on any day during that year, the person, or one or more of the
persons, who was at that time covered by the policy ceases to be a dependent
child but remains covered by the policy;
the policy ceases to be a dependent child policy on that day.
Note: For dependent child, see the
Dictionary.
If, on one or more days during a financial year, a person:
(a) is not an eligible person within the meaning of section 3 of the
Health Insurance Act 1973; or
(b) is not treated as an eligible person under section 6 of that Act;
for the purposes of section 5-1, any premium payable under a private health
insurance policy that has been paid (or would, apart from this section, be taken
to have been paid) in respect of the whole or part of the financial year by the
person is taken not to have been paid in respect of those days.
(1) If:
(a) a person has applied before 1 July 1997 to a health fund for
registration under Division 4 in respect of a private health insurance policy
for the financial year commencing on that day; and
(b) the person has paid an amount of premium payable under the policy in
respect of a period starting on or before 1 July 1997 and ending on a day (the
expiry day) after 31 July 1997;
the health fund must, on or before 31 August 1997, either:
(c) pay to the person an amount equal to the amount that is payable to the
health fund under Division 8 in respect of the policy during the current policy
period; or
(d) offset that amount against amounts of premium that the person would be
liable to pay to the health fund after the expiry day if the policy were to
continue in force after that day.
(2) In this section:
current policy period means the period starting on 1 July
1997 and ending on the expiry day.
This Part is about how health funds become part of the incentives scheme,
and how the government reimburses them for the reductions to premiums they make
under the scheme.
Table of Divisions
6 Introduction
7 How do health funds become participating funds?
8 How are participating funds reimbursed?
(1) A health fund may apply under section 7-2 to the Minister to become a
participating fund for a financial year.
(2) If the Minister approves the application for the financial year (see
section 7-3), the health fund is a participating fund for that financial
year.
Note: Rejections
of applications are reviewable under section 13-1.
(1) The application must:
(a) be in a form approved by the Minister; and
(b) include such information as is determined in writing by the
Minister; and
(c) be signed by the public officer of the applicant; and
(d) include an undertaking signed by the public officer of the applicant
that the applicant will participate in the scheme until the end of the financial
year in question.
(2) The application must be made:
(a) no later than 2 months, or such shorter period as the Minister
determines in writing, before the start of the financial year in question;
or
(b) if the health fund becomes registered under Part VI of the National
Health Act 1953 during a financial year—as soon as practicable after
its registration.
(3) In this section:
public officer means the person who is appointed the public
officer of a health fund for the purposes of the National Health Act
1953.
(1) The Minister must approve the application unless the health fund is
subject to Part VIA of the National Health Act 1953. However, even if the
health fund is subject to that Part, the Minister may approve the application if
the Minister is satisfied that it is in the public interest to do so.
(2) A health fund is subject to Part VIA of the National Health Act
1953 if:
(a) the Minister has served a notice under subsection 82R(1) of that Act
on the health fund and the Minister has not decided whether an inspector should
be appointed to investigate the affairs of the health fund; or
(b) the Minister has appointed under subsection 82R(2) of that Act an
inspector to investigate the affairs of the health fund and the investigation
has been neither completed nor terminated; or
(c) the Minister is considering a report in relation to the health fund
prepared under paragraph 82W(1)(b) of that Act and the Minister has not decided,
having regard to the report, whether to make an application under section 82Z of
that Act; or
(d) the Minister has made such an application, and the application has not
been finally determined; or
(e) an application has been made by the health fund under
section 82ZG of that Act, and the application has not been finally
determined; or
(f) an order for judicial management, made on the Minister’s
application under section 82Z of that Act, is in force; or
(g) an order for winding up, made on the Minister’s application
under section 82Z of that Act or the application of the health fund under
section 82ZG of that Act, has been made.
(1) The Minister must notify the applicant in writing, within 28 days of
the decision, whether the application has been approved or rejected.
(2) The notice must set out the Minister’s reasons for rejecting the
application if it has been rejected.
(1) A health fund may, in accordance with section 8-2, claim reimbursement
from the Commission for each month during a financial year for which it is a
participating fund.
(2) The Commission must pay to the health fund, in accordance with section
8-3, the amount payable under that section in respect of the month to which the
claim relates.
(1) A claim by a health fund in respect of a month must be made to the
Commission:
(a) on the day of the month (not being later than the seventh day of the
month) determined by the Managing Director in writing, or, if the day so
determined is not a business day, the first business day after that day;
or
(b) if a day has not been so determined—on the first business day of
that month.
(2) The claim must contain such details as the Managing Director
determines in writing.
(3) The details may include, but are not limited to, details about any or
all of the following private health insurance policies issued by the health
fund:
(a) policies that were, on the first day of the month, policies in respect
of which persons were participants in the incentives scheme;
(b) policies that had been, at any time before that day, policies in
respect of which persons were participants in the incentives scheme.
(4) The Managing Director must not determine under subsection (2) that the
health fund must provide:
(a) the tax file number of any person; or
(b) any information about the income of a person who is a participant in
the incentives scheme, or the income of any other person, other than that each
participant in the incentives scheme has made a statutory declaration under
section 4-3, and has not given a notice under subsection 4-7(1); or
(c) information about the physical, psychological or emotional health of
any person.
(5) Determinations under subsection (1) or (2) are disallowable
instruments for the purposes of section 46A of the Acts Interpretation Act
1901.
(6) A claim under this section must be in a form approved by the Managing
Director.
(1) Subject to subsection (2), the amount payable to the health fund in
respect of the month is
1/12 of the sum of the
annual incentive amount (see section 5-3) for each private health insurance
policy that:
(a) was issued by the health fund; and
(b) on the first day of that month, covers a person who is, on that day, a
participant in the incentives scheme in respect of that policy (see section
5-2).
(2) Subject to subsection (3), the annual incentive amount for a private
health insurance policy in respect of which a person is a participant in the
incentives scheme is taken, for the purposes of subsection (1), to be the amount
that would be the annual incentive amount if:
(a) the number of persons covered by the policy; and
(b) the number of such persons who are dependent children;
were as stated in the most recent application under section 4-3 made by the
person in respect of the policy.
(3) Subsection (2) only applies if the amount worked out under that
subsection is less than the annual incentive amount under
section 5-3.
(4) The amount must be paid to the health fund on or before the 15th day
of the month (or, if that day is not a business day, the first business day
after that day).
(5) The amount must be paid in the way determined, in writing, by the
Managing Director.
(1) The Commission must notify a health fund if it decides that an amount
is not payable in respect of a private health insurance policy included in a
claim under section 8-2.
(2) A notice under subsection (1) must include reasons for the
decision.
(3) The Commission is taken, for the purposes of this Act, to have decided
that the amount is payable if the Commission does not give notice of its
decision that the amount is not payable on or before the day under subsection
8-3(4) on which, if it had been payable, it would have to have been
paid.
(1) A health fund that has been given a notice under subsection 8-4(1) may
request the Commission to reconsider the decision.
(2) The request must:
(a) be in writing; and
(b) set out the reasons for the request; and
(c) be made on or before the first day of the month following the month
during which the Commission gave the notice (or, if that day is not a business
day, the first business day after that day).
(3) As soon as practicable after receiving the request, the Commission
must:
(a) reconsider the decision; and
(b) affirm, vary or revoke the decision.
Note: Decisions on reconsideration are reviewable under
section 13-1.
(4) If the Commission revokes the decision, revocation is taken to be a
decision that the amount in question is payable.
(5) If the Commission varies the decision, the decision has effect, and is
taken always to have had effect, accordingly.
(6) The Commission must notify the health fund stating its decision on the
reconsideration together with a statement of its reasons for its
decision.
(7) The Commission is taken, for the purposes of this Act, to have revoked
the decision if the Commission does not notify the health fund of its decision
on the reconsideration within 28 days after receiving the request.
The Consolidated Revenue Fund is appropriated for the purposes of making
payments under this Division.
This Part is about the administration of the incentives scheme. In
particular, it deals with how the government checks the way in which the scheme
is operating, and when and how it recovers payments.
Table of Divisions
9 Introduction
10 How is the scheme administered?
11 When and how does the government recover payments?
12 How is information protected?
The Commission has the general administration of this Act.
(1) The Commission may, at any time, audit the accounts and records of a
health fund that is, or has been, a participating fund.
(2) An audit under subsection (1) must relate only to the accounts and
records of the health fund to the extent that they deal with:
(a) participation by persons in the incentives scheme; or
(b) reductions of premium payable under private health insurance policies
under the incentives scheme; or
(c) receipt of money from the Commission under Part 3.
(3) The Commission must give notice in writing to the health fund
concerned that an audit is to be carried out.
(4) The health fund must ensure that the Commission has full and free
access to all accounts, records, documents and papers of the health fund that
are relevant to the audit.
(5) The person carrying out the audit may take copies of, or extracts
from, such accounts, records, documents and papers for use in the
audit.
(6) In considering whether or not to conduct an audit under this section,
the Commission may take into account a report under section 82PA of the
National Health Act 1953.
(1) The Commission may, by written notice given to a health fund, require
the health fund:
(a) to produce to the Commission, within the period and in the manner
specified in the notice, applications retained under section 4-10; or
(b) to make copies of any such applications and to give them to the
Commission within the period and in the manner specified in the
notice.
(2) A period specified under subsection (1) must not be less than one
month.
(3) A health fund is entitled to be paid by the Commission reasonable
compensation for complying with paragraph (1)(b).
The Commission must, within 60 days of the end of each financial year,
give the following information to the Commissioner of Taxation:
(a) the name, date of birth and address of each person who was a
participant in the incentives scheme for that financial year;
(b) the name of the health fund that issued the health insurance policy
in respect of which the person was a participant in the incentives
scheme;
(c) the type of cover provided by the policy;
(d) the total amount of payments to a health fund in respect of the
policy;
(e) the number of months in respect of which those payments were
made;
(f) the name and date of birth of any other person covered by the policy
in respect of which those payments were made;
(g) whether any person covered by the policy was a dependent child at any
time during that financial year;
(h) the name and date of birth of any person whose income was taken into
account in determining whether the income test was satisfied in respect of that
policy for that financial year.
(1) The following amounts are recoverable as debts due to the
Commonwealth:
(a) so much of a payment made under section 8-1 as relates to a private
health insurance policy that covers a person who was, for the financial year in
question:
(i) a participant in the incentives scheme (see section 5-2);
and
(ii) not eligible to participate in the incentives scheme (see Division
3);
(b) 150% of so much of a payment made under section 8-1 as:
(i) is not reflected in reductions in premiums payable under private
health insurance policies issued by the health fund in question; or
(ii) relates to a financial year and to a person whose application under
section 4-3 in respect of that financial year has not been retained by the
health fund as required by section 4-10; or
(iii) relates to a financial year and to a person whose application under
section 4-3 has been so retained, but has not been produced to the Commission by
the health fund in accordance with a requirement by the Commission under section
10-3; or
(c) so much of a payment purportedly made under section 8-1 as was not
payable under that section.
(2) The amounts are recoverable from:
(a) if paragraph (1)(a) applies—the person referred to in that
paragraph, or the estate of that person; or
(b) if paragraph (1)(b) or (c) applies—the health fund to which the
payment in question was made.
(3) An amount recoverable under subsection (1) is recoverable whether or
not any person has been convicted of an offence relating to the
payment.
(1) If the Managing Director has served a notice on a person from whom an
amount is recoverable under subsection 11-1(1), or on the person’s estate,
claiming an amount as a debt due to the Commonwealth, and:
(a) within the period referred to in subsection (4), an arrangement has
been entered into between the Managing Director and the person or estate for the
repayment, and there has been a default in payment of an amount required to pay
under the arrangements; or
(b) at the end of that period, such an arrangement has not been entered
into and all or part of the amount remains unpaid;
then, from the day after the end of the period, interest becomes payable on
so much of the amount as from time to time remains unpaid.
(2) Interest is payable:
(a) at the rate specified in the regulations; or
(b) if the regulations do not specify a rate—at the rate of 15% per
annum.
(3) The interest so payable is recoverable as a debt due to the
Commonwealth from the person or the person’s estate.
(4) The period for entering into an arrangement under paragraph (1)(a) is
a period of 3 months following the service of the notice under subsection (1),
or such longer period as the Managing Director allows.
(5) Despite subsections (1) and (3), in any proceedings instituted by the
Commonwealth for the recovery of an amount due under subsection (3), the court
may order that the interest payable under that subsection is, and is taken to
have been, so payable from a day later than the day referred to in subsection
(1).
(1) The Managing Director may, on behalf of the Commonwealth, by
instrument in writing:
(a) write off an amount that a person has been required to pay to the
Commonwealth under section 11-1; or
(b) waive the right of the Commonwealth to recover from a person the whole
or part of an amount that the person has been required to pay to the
Commonwealth under that section; or
(c) allow a person who has been required to pay an amount to the
Commonwealth under that section to pay that amount by such instalments as are
specified in the instrument.
(2) A decision under subsection (1) takes effect:
(a) on the day specified in the notice, being the day on which the
decision is made or any day before or after that day; or
(b) if no day is so specified—on the day on which the decision is
made.
Note: Decisions not to exercise the powers under this
section are reviewable under section 13-1.
(1) The Minister may, in writing, make principles relating to:
(a) the acquiring of personal information under or for the purposes of
this Act; and
(b) the storage of, security of, access to, correction of, use of and
disclosure of such personal information.
(2) A health fund must comply with the principles.
(3) The principles are disallowable instruments for the purposes of
section 46A of the Acts Interpretation Act 1901.
(4) In this section:
personal information has the same meaning as in the
Privacy Act 1988.
(1) A person who uses, makes a record of, or discloses or communicates to
any person, any information that relates to the affairs of another person and
that was acquired under or for the purposes of this Act is guilty of an
offence.
Penalty: 5 penalty units.
Note: Chapter 2 of the Criminal Code sets out the
general principles of criminal responsibility.
(2) This section does not apply to conduct carried out in the performance
of a function or obligation under this Act or the exercise of a power under this
Act.
Note: A defendant bears an evidential burden in relation to
the matters in subsection (2) (see subsection 13.3(3) of the Criminal
Code).
Application may be made to the Administrative Appeals Tribunal for review
of the following decisions:
(a) a decision by the Commission refusing to register a person under
subsection 4-1(3) in respect of a private health insurance policy;
(b) a decision by the Commission under subsection 4-6(1) to revoke a
person’s registration in respect of a private health insurance
policy;
(c) a decision by the Minister to reject an application under subsection
7-1(1) by a health fund to become a participating fund;
(d) a decision by the Commission under subsection 8-5(3) on
reconsideration of a decision that an amount is not payable in respect of a
private health insurance policy included in a claim under section 8-2;
(e) a decision by the Managing Director not to exercise his or her powers
under section 11-3 in relation to an amount.
Note: Under section 27A of the Administrative Appeals
Tribunal Act 1975, the decision-maker must notify persons whose interests
are affected by the making of the decision and of their right to have the
decision reviewed. In notifying such persons, the decision-maker must have
regard to the Code of Practice determined under section 27B of that
Act.
This Act does not apply with respect to State insurance that does not
extend beyond the limits of the State concerned.
Chapter 2 of the Criminal Code applies to all offences against
this Act.
The Governor-General may make regulations, not inconsistent with this
Act, prescribing matters:
(a) required or permitted by this Act to be prescribed; or
(b) necessary or convenient to be prescribed for carrying out or giving
effect to this Act.
In this Act, unless the contrary intention appears:
ancillary cover, in relation to a private
health insurance policy, has the meaning given in subsection 3-2(3).
business day means a day other than a Saturday, a Sunday or a
public holiday in the place concerned.
combined cover, in relation to a private health
insurance policy, has the meaning given in subsection 3-2(6).
Commission means the Health Insurance Commission.
dependent child, in relation to a private health insurance
policy, means a person:
(a) who is covered by the policy; and
(b) whom the health fund that issued the policy accepts as a dependent
child for the purposes of the policy;
but does not include:
(c) a person who is the partner of another person; or
(d) a person (other than a full-time student) who is 18 years of age or
older; or
(e) a full-time student who is 25 years of age or older.
health fund means a registered organization within the
meaning of Part VI of the National Health Act 1953.
hospital cover, in relation to a private health
insurance policy, has the meaning given in subsection 3-2(2).
incentives scheme means the scheme provided for under this
Act for the reduction of premiums paid in respect of certain private health
insurance policies.
Managing Director means the Managing Director of the Health
Insurance Commission within the meaning of the Health Insurance Act
1973.
parent, in relation to a dependent child, means:
(a) unless the dependent child is a full-time student who is 18 years of
age or older—a person who has the right (whether alone or jointly with
another person):
(i) to have the daily care and control of the child; and
(ii) to make decisions about the daily care and control of the child;
or
(b) if the dependent child is a full-time student who is 18 years of age
or older—a person who is primarily responsible (whether alone or jointly
with another person) for the maintenance and support of the student.
participant in the incentives scheme has the meaning given by
section 5-2.
participating fund, in relation to a financial year, means a
health fund referred to in subsection 7-1(2) in respect of that year.
partner, in relation to another person, means:
(a) a person who is legally married to the other person and is not living
separately and apart from the other person on a permanent basis; or
(b) a person who, although not legally married to the other person, lives
with the other person on a bona fide domestic basis as the husband or wife of
the other person.
private health insurance policy means a contract of insurance
that was entered into by a health fund in the course of carrying on a health
insurance business within the meaning of section 67 of the National Health
Act 1953.
tax file number means a tax file number as defined in
section 202A of the Income Tax Assessment Act 1936.
type of cover, in relation to a private health insurance
policy, means:
(a) combined cover; or
(b) hospital cover; or
(c) ancillary cover.