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This is a Bill, not an Act. For current law, see the Acts databases.
1998
The Parliament of
the
Commonwealth of
Australia
HOUSE OF
REPRESENTATIVES
Presented and read a first
time
Private Health
Insurance Incentives Bill 1998
No. ,
1998
(Health and Aged
Care)
A Bill for an Act to provide
incentives for private health insurance, and for related
purposes
ISBN: 0642 377677
Contents
A Bill for an Act to provide incentives for private
health insurance, and for related purposes
The Parliament of Australia enacts:
This Act may be cited as the Private Health Insurance Incentives Act
1998.
This Act commences on the day on which it receives the Royal
Assent.
(1) Some of the expressions used in this Act are defined in the Dictionary
of defined expressions in Part 8.
(2) Most defined expressions are identified by an asterisk appearing at
the start of the expression. The footnote that goes with the asterisk contains a
signpost to the definitions in the Dictionary.
Note: The expressions you and
HIC are not asterisked.
(3) Once a defined expression has been identified by an asterisk, later
occurrences of the expression in the same subsection are not usually
asterisked.
(4) Expressions are not asterisked in Guides and notes contained in this
Act.
(5) In this Act, you means an individual but does not
include an individual in the capacity of a trustee or the capacity of an
employer.
Chapter 1 deals with some preliminary matters.
Chapter 2 establishes a scheme under which people who, or whose employers
on their behalf, pay premiums under certain private health insurance policies
can obtain payments from the Commonwealth in return for the payment of the
premiums.
Chapter 3 establishes an alternative scheme under which people who are
covered by such private health insurance policies can have the premiums payable
under those policies reduced.
If, under Chapter 3, a premium is reduced, no payment can be received under
Chapter 2 in respect of the premium (see subsection 4-5(2)).
If, under Chapter 2, a payment is received in respect of a premium, no
reduction is allowed in respect of the premium under Chapter 3 (see subsection
12-5(4)).
Chapter 4 deals with matters that are relevant to both Chapter 2 and
Chapter 3.
Note: The incentive payments scheme and the premiums
reduction scheme are complemented by the private health insurance offset
provided for by Subdivision 61-H of the Income Tax Assessment Act
1997.
This Part explains who is entitled to payments under the scheme and how the
amounts payable are calculated
Table
of Divisions in this Part
3 Introduction
4 Entitlement to, and calculation of,
payments
(1) You are entitled to a payment under this Chapter if you have paid, or
your employer as a *fringe benefit for you has
paid, a premium under an *appropriate private
health insurance policy for the whole or a part of the financial year that began
on 1 July 1998 or a later financial year.
(2) You
are not entitled to a payment under this Chapter in respect of a payment of
premium if the premium is less than it would otherwise have been because of the
operation of Chapter 3.
Financial Year 1998-99
(1) The amount payable under this Chapter for an amount of premium paid
under a policy for the financial year that began on 1 July 1998 depends upon
whether or not a person was registered, or eligible to apply for registration,
before 1 January 1999 under the Private Health Insurance Incentives Act
1997 in respect of the policy for the financial year.
If no-one registered or eligible for registration
(2) If no person was so registered or eligible to apply for registration,
the amount payable is 30% of the amount of the premium paid by you, or by your
employer as a *fringe benefit for you, under
the policy for the financial year.
If someone registered or eligible for registration
(3) If a person was so registered or eligible to apply for registration,
the amount payable is the greater of the amount worked out under paragraph (a)
and the amount worked out under paragraph (b):
(a) 30% of:
(i) the amount of the premium paid by you, or by your employer as a
*fringe benefit for you, under the policy for
the financial year; or
(ii) if, because of the operation of the Private Health Insurance
Incentives Act 1997, that amount of premium was less than the amount of
premium that would otherwise have been payable—the amount of premium that
would otherwise have been payable; and
(b) the *incentive amount for the policy
for the financial year.
Financial year 1999-2000 or later financial year
(4) The amount payable under this Chapter for an amount of premium paid
under a policy for a later financial year depends upon whether or not a person
was registered, or eligible to apply for registration, before 1 January 1999
under the Private Health Insurance Incentives Act 1997 in respect of the
policy for the financial year that began on 1 July 1998.
If no-one registered or eligible for registration
(5) If no person was so registered or eligible to apply for registration,
the amount payable is 30% of the amount of the premium paid by you, or by your
employer as a *fringe benefit for you, under
the policy for the later financial year.
If someone registered or eligible for registration
(6) If a person was so registered or eligible to apply for registration,
the amount payable is the greater of:
(a) 30% of the amount of the premium paid by you, or by your employer as a
*fringe benefit for you, under the policy for
the later financial year; and
(b) the *incentive amount for the policy
for the later financial year.
Amount payable to be reduced by any tax offset
(7) The total amount payable under this Chapter for a policy for a
financial year is reduced by the amount of any tax offset received under
Subdivision 61-H of the Income Tax Assessment Act 1997 for the total
amount of the premium paid by you, or by your employer as a
*fringe benefit for you, under the policy for
that financial year.
Disregard premium that relates to period before 1 January
1999
(8) In working out an amount payable under this Chapter for an amount of
premium paid by you, or by your employer as a
*fringe benefit for you, under a policy,
disregard any part of the amount of the premium paid that relates to a period
before 1 January 1999.
Amount payable reduced if premium reduced under 1997 Act
(9) If, because of the operation of the Private Health Insurance
Incentives Act 1997, the amount of a premium paid by you, or by your
employer as a *fringe benefit for you, under a
policy for a period after 31 December 1998 was less than the amount that would
otherwise have been payable, the amount payable under this Chapter in respect of
the premium is reduced by the amount of the difference.
To get the payment, you must make a claim for it.
Note: See Division 6 in Part 3 for rules about
claims.
This Part explains how claims may be made for payments under the scheme and
how claims are determined.
Table of Divisions in this Part
5 Introduction
6 Claims for payments
If you want to be paid an amount to which you are entitled under section
4-5, you must make a proper claim for payment of the amount.
(1) To be a proper claim, a claim must:
(a) be in a form (including an electronic form) approved by the HIC;
and
(b) provide all the information, and be accompanied by any documents,
required by the form; and
(c) be sent to or lodged at an office of, or a place approved by, the HIC;
and
(d) be so sent or lodged in the financial year in which the payment of the
premium to which the claim relates was made or the next financial
year.
(2) The HIC must not approve a form under paragraph (1)(b) that requires
you to provide the *tax file number of any
person.
You may at any time, by writing sent to or lodged at an office of, or a
place approved by, the HIC, withdraw a claim.
(1) The HIC must grant or refuse the claim.
Note: Refusals of claims are reviewable under section
19-10.
(2) If the claim is granted, the HIC must pay to you the amount to which
you are entitled.
(3) If the claim is refused, the HIC must cause to be served on you a
notice stating that the claim has been refused and setting out the reasons for
the refusal.
This Part is about the obtaining of information by the HIC for the purposes
of this Chapter.
Table of Divisions in this Part
7 Introduction
8 Notification requirements
(1) If you have made a claim under section 6-5 for a payment of an amount
and:
(a) a matter, event or circumstance occurs that affects your entitlement
to a payment for which the claim is made; or
(b) a change occurs in the premium, or in the amounts or frequency of the
payments in respect of the premium, under the policy;
you must, within 30 days after the occurrence of the matter, event,
circumstance or change, give written notice to the HIC containing particulars of
it.
(2) You are guilty of an offence if:
(a) you are required by subsection (1) to give a notice to the HIC
containing particulars of a matter, event, circumstance or change referred to in
that subsection; and
(b) you fail to comply with the requirement.
Maximum penalty: 60 penalty units.
Note: Chapter 2 of the Criminal Code sets out the
general principles of criminal responsibility.
(3) Section 4K of the Crimes Act 1914 does not apply to the
obligation to provide information pursuant to subsection (1).
(1) The HIC may, by notice in writing, require a
*health fund to provide information relevant to
the operation of this Chapter about a person who:
(a) is covered at any time during a financial year specified in the notice
by an *appropriate private health insurance
policy issued by the fund; or
(b) paid premiums under such a policy.
(2) The information that the HIC may require the
*health fund to provide includes the
following:
(a) the name, residential address and date of birth of each such
person;
(b) the fund membership number of the policy;
(c) the name, residential address and date of birth of the person covered
by the policy whom the health fund treats as the contributor in respect of the
policy;
(d) the name, residential address and date of birth of any person who is a
*partner of a person covered by the
policy;
(e) whether the policy provides *hospital
cover, *ancillary cover or
*combined cover;
(f) the date on which the policy was issued;
(g) whether the policy has terminated or been suspended, and, if it has,
the date on which it terminated or was suspended;
(h) the amount of the premium under the policy;
(i) the period to which the premium relates;
(j) any increase or decrease in the premium;
(k) whether a payment in respect of a premium that was due within a period
specified by the HIC was not paid.
(3) The information required by a notice under subsection (1) is to be
provided:
(a) in a form (including an electronic form) approved by the HIC;
and
(b) within the period specified in the notice.
(4) A *health fund is guilty of an
offence if:
(a) the fund is required by a notice under subsection (1) to provide
information within a specified period about a person or matter; and
(b) the fund fails to comply with the requirement.
Maximum penalty: 20 penalty units.
Note 1: Chapter 2 of the Criminal Code sets out the
general principles of criminal responsibility.
Note 2: The obligation to provide information pursuant to a
notice under subsection (1) is a continuing obligation and a health fund is
guilty of an offence for each day, after the period specified in the notice,
until the information is provided (see section 4K of the Crimes Act
1914).
This Part explains when a reduction in premium can be obtained and how the
premiums are reduced.
Table of Divisions in this Part
9 Introduction
10 Who is eligible to participate in the premiums reduction
scheme
11 How people participate in the premiums reduction scheme
12 What effect the premiums reduction scheme has on insurance
premiums
You are eligible for a financial year to participate in the
*premiums reduction scheme in respect of a
*private health insurance policy if:
(a) the policy is an *appropriate private
health insurance policy; and
(b) the *health fund that issued the
policy is, for that year, a *participating
fund; and
(c) you are eligible to apply under Division 11 for registration in
respect of the policy for that year.
(1) If you are eligible to apply for registration in respect of an
*appropriate private health insurance policy
for a financial year, you may apply under section 11-15, to the
*health fund that issued the policy, to be
registered by the HIC in respect of the policy for that year.
(2) If the *health fund receives such an
application, it must notify the HIC of the application.
(3) On receiving a notice under subsection (2), the HIC must register the
applicant in respect of the policy for that financial year if the HIC is
satisfied that the applicant is eligible for that year to participate in the
*premiums reduction scheme.
(4) When the HIC registers an applicant in respect of an
*appropriate private health insurance policy
for a financial year, the HIC must give notice of the registration to the
*health fund that issued the policy.
(1) Subject to subsection (2), if you are covered by the policy (otherwise
than as a *dependent child), you are eligible
to apply for registration under this Division 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 for registration.
(2) You are not eligible to apply for registration under this Division in
respect of the policy for the financial year if:
(a) another person has already applied for registration under this
Division in respect of the policy for the financial year; and
(b) the HIC:
(i) has not refused to register the other person; or
(ii) has not revoked the other person’s registration.
(1) An application by you under this section must be in a form approved by
the Minister and must state the following details:
(a) the name of the *health fund to which
the application is made;
(b) your full name;
(c) your date of birth;
(d) your residential address;
(e) your Medicare card number;
(f) the fund membership number of the policy;
(g) whether the policy in respect of which you have applied to be
registered covers only one person or covers more than one person;
(h) the full name and date of birth of each person covered by the policy
(other than yourself);
(i) whether any of those persons are
*dependent children;
(j) any other information determined in writing by the Minister.
(2) For the purposes of paragraph (1)(j), the Minister must not make a
determination requiring you to provide the *tax
file number of any person.
(3) Determinations under paragraph (1)(j) are disallowable instruments for
the purposes of section 46A of the Acts Interpretation Act
1901.
(4) An application for registration in respect of a policy for a financial
year may be made at any time before or during that financial year.
(1) A *health fund must notify the HIC,
within a period determined by the *Managing
Director, of an application given by a person to the health fund under section
11-15.
(2) The notice must be in such form, and contain such details, as the
*Managing Director determines in
writing.
(3) For the purposes of subsection (2), the
*Managing Director must not make a
determination requiring the *participating fund
to provide:
(a) the tax file number of any person; or
(b) information about the physical, psychological or emotional health of
any person.
(4) 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.
(5) Determinations under subsection (2) are disallowable instruments for
the purposes of section 46A of the Acts Interpretation Act
1901.
(1) If the HIC refuses to register you, it must give written notice of the
refusal, together with the reasons for the refusal, to you.
(2) You are taken, for the purposes of this Act, to be registered in
respect of the policy for the financial year if the HIC does not give notice of
refusal within 14 days after receiving the notice under section 11-20 from the
*health fund to which you applied for
registration.
Note: Refusals
to register are reviewable under section 19-10.
(1) If:
(a) you are a registered person in respect of an
*appropriate private health insurance policy
for a financial year; and
(b) a detail:
(i) stated in your application under section 11-15; and
(ii) 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 you ought reasonably to expect that the
incentive amount for the policy for the year will change;
you must, within 30 days after the change occurs, give written notice of
the change to the health fund that issued the policy.
(2) You are guilty of an offence if:
(a) you are required by subsection (1) to give a notice to a
*health fund if a detail referred to in that
subsection changes as mentioned in that subsection; and
(b) you fail to comply with the requirement.
Maximum penalty: 60 penalty units.
Note: Chapter 2 of the Criminal Code sets out the
general principles of criminal responsibility.
(3) Section 4K of the Crimes Act 1914 does not apply to the
obligation to provide information pursuant to subsection (1).
(4) You may notify the *health fund in
writing if you no longer wish to be registered in respect of the policy for the
financial year.
A *health fund must notify the HIC, in a
form and within a period determined by the
*Managing Director, of each notice given to the
health fund under section 11-30.
(1) The HIC must revoke a person’s registration in respect of an
*appropriate private health insurance policy
for a financial year if the HIC is satisfied that the person is not eligible to
participate in the *premiums reduction 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
11-15.
Note: Revocations of registration are reviewable under
section 19-10.
(1) A *health fund must notify the HIC if
the *type of cover provided by an
*appropriate private health insurance policy,
issued by the health fund and in respect of which a person is registered, is
varied.
(2) On receiving such a notice, the HIC must vary the details of the
registration accordingly and give notice of the variation to the
*health fund.
(1) A *health fund must retain an
application made to it under section 11-15 for the period of 5 years beginning
on the day on which 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
or tribunals as evidence as if it were the original.
(1) The amount of premium that, apart from this section, would be payable
for a financial year under an *appropriate
private health insurance policy in respect of which a person is a
*participant in the premiums reduction scheme
is to be reduced in accordance with this section.
(2) If the financial year is the financial year that began on 1 July 1998,
the amount of the reduction is the greater of the amount worked out under
paragraph (a) and the amount worked out under paragraph (b):
(a) 30% of:
(i) the amount of the premium payable under the policy for the financial
year; or
(ii) if, because of the operation of the Private Health Insurance
Incentives Act 1997, that amount of premium is less than the amount of
premium that would otherwise have been payable—the amount of premium that
would otherwise have been payable; and
(b) the *incentive amount for the policy
for the financial year.
(3) If the financial year is a later financial year, the amount of the
reduction is the greater of:
(a) 30% of the amount of the premium payable under the policy for the
later financial year; and
(b) the *incentive amount for the policy
for the later financial year.
(4) A reduction is not allowable under this section for an amount of
premium payable under a policy if an amount has been received under Chapter 2 in
respect of the payment.
(5) In working out the reduction under this section for an amount of
premium payable under a policy, any part of the amount of the premium payable
that relates to a period before 1 January 1999 is to be disregarded.
(6) If, because of the operation of the Private Health Insurance
Incentives Act 1997, the amount of a premium payable under a policy for a
period after 31 December 1998 is less than the amount that would otherwise have
been payable, the amount of the reduction under this section in respect of the
premium is reduced by the amount of the difference.
(1) A person is a *participant in the
premiums reduction scheme for a financial year in respect of an
*appropriate private health insurance policy
if:
(a) where the financial year is the financial year that began on 1 July
1998—the person was, immediately before 1 January 1999, registered under
Division 4 of the Private Health Insurance Incentives Act 1997 in respect
of the policy for the year; or
(b) where the financial year is the financial year that began on 1 July
1998 or a later financial year:
(i) the person was registered under Division 11 in respect of the policy
for the year; or
(ii) the person 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 premiums reduction scheme
if:
(a) the person has not, at the time when the payment is made, applied to
be registered for that financial year in respect of the
*appropriate private health insurance policy
concerned; and
(b) on 30 June in the previous financial year the person was registered
under Division 11 in respect of the policy for that year.
This Part is about how health funds participate in the premiums reduction
scheme, and how the Commonwealth reimburses them for the reductions in premiums
that they make under the scheme.
Table of Divisions in this Part
13 Introduction
14 How health funds become participating funds
15 How participating funds are reimbursed
16 Administrative provisions
(1) A *health fund that was, for the
financial year that began on 1 July 1998, a participating fund for the purposes
of the Private Health Insurance Incentives Act 1997 is taken to be a
participating fund for that financial year for the purposes of this
Act.
(2) A *health fund may apply under
section 14-10 to the Minister to become a participating fund for the financial
year beginning on 1 July 1998 or a later financial year.
(3) If the Minister approves the application for the financial year, the
*health fund is a participating
fund for that financial year.
(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 person who is the public officer of the
*health fund for the purposes of the
National Heath Act 1953; and
(d) include an undertaking, signed by the person referred to in paragraph
(c), stating that the applicant will participate in the premiums reduction
scheme until the end of the financial year concerned.
(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; or
(b) if the *health fund becomes
registered under Part VI of the National Health Act 1953 during the
financial year—as soon as practicable after its registration.
(1) Subject to subsection (2), the Minister must approve the
application.
Note: Rejections of applications are reviewable under
section 19-10.
(2) The Minister must not approve an application by a
*health fund for a financial year if the health
fund failed to comply in the previous financial year with any of the conditions
of participation in the premiums reduction scheme that are prescribed by the
regulations.
(1) The Minister must notify the applicant in writing, within 28 days
after the date of the decision, whether the application has been approved or
rejected.
(2) If the application is rejected, the Minister must cause the
Minister’s reasons for rejecting the application to be included in the
notice.
Note: Rejections of applications are reviewable under
section 19-10.
(1) A *health fund may, in accordance
with section 15-10, claim reimbursement from the HIC for each month during a
financial year for which it is a *participating
fund.
(2) The HIC must pay to the *health fund,
in accordance with section 15-15, 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 HIC on or before the last day of the
*notification period for the following
month.
(2) The claim must be in a form approved by the
*Managing Director and 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
premiums reduction scheme;
(b) policies that had been, at any time before that day, policies in
respect of which persons were *participants in
the premiums reduction scheme.
(4) The *Managing Director must not make
a determination under subsection (2) requiring the
*health fund to provide:
(a) the *tax file number of any person;
or
(b) information about the physical, psychological or emotional health of
any person.
(5) Determinations under subsection (2) are disallowable instruments for
the purposes of section 46A of the Acts Interpretation Act
1901.
(1) Subject to subsection (2), the amount payable to the
*health fund in respect of the month is the sum
of the amounts by which premiums in respect of that month under the
*appropriate private health insurance policies
issued by the health fund were reduced because of the operation of this
Chapter.
(2) The amount must be paid to the
*health fund on or before the 15th day of the
following month (or, if that day is not a business day, the first business day
after that day).
(3) The amount must be paid in the way determined, in writing, by the
*Managing Director.
(1) The HIC must notify a *health fund if
it decides that an amount is not payable in respect of an
*appropriate private health insurance policy
included in a claim under section 15-10.
(2) A notice under subsection (1) must include reasons for the
decision.
(3) The HIC is taken, for the purposes of this Act, to have decided that
the amount is payable if the HIC does not give notice of its decision that the
amount is not payable on or before the day under subsection 15-15(2) on or
before which, if it had been payable, it would have been required to have been
paid.
(1) A *health fund that has been given a
notice under subsection 15-20(1) may request the HIC 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 HIC 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 HIC
must:
(a) reconsider the decision; and
(b) affirm, vary or revoke the decision.
Note: Decisions on reconsideration are reviewable under
section 19-10.
(4) If the HIC revokes the decision, revocation is taken to be a decision
that the amount in question is payable.
(5) If the HIC varies the decision, the decision has effect, and is taken
always to have had effect, accordingly.
(6) The HIC must notify the *health fund
stating its decision on the reconsideration together with a statement of its
reasons for its decision.
(7) The HIC is taken, for the purposes of this Act, to have revoked the
decision if the HIC does not notify the *health
fund of its decision on the reconsideration within 28 days after receiving the
request.
(1) The HIC 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
*premiums reduction scheme; or
(b) reductions of premium payable under
*appropriate private health insurance policies
under the premiums reduction scheme; or
(c) receipt of money from the HIC under this Part.
(3) The HIC must not carry out an audit unless it has given notice in
writing to the *health fund concerned stating
that an audit is to be carried out.
(4) The *health fund must ensure that the
HIC 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 make copies of, or take extracts
from, such accounts, records, documents or papers for use in the
audit.
(6) In considering whether or not to conduct an audit under this section,
the HIC may take into account a report under section 82PA of the National
Health Act 1953.
(1) The HIC may, by written notice given to a
*health fund, require the health
fund:
(a) to produce to the HIC, within the period and in the manner specified
in the notice, applications retained under section 11-50; or
(b) to make copies of any such applications and give them to the HIC
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 HIC reasonable compensation for complying with paragraph
(1)(b).
This Part contains general provisions that relate to both Chapters 2 and
3.
Table of Divisions in this Part
17 Introduction
18 When and how payments can be recovered
19 Miscellaneous
(1) The following amounts are recoverable as debts due to the
Commonwealth:
(a) a payment made to a person under Part 3 to which the person was not
entitled;
(b) a payment made to a person under Part 3 in respect of a premium that
was afterwards refunded;
(c) so much of a payment made under section 15-5 as relates to an
*appropriate private health insurance policy
that covers a person who was, for the financial year concerned:
(i) a *participant in the premiums
reduction scheme; and
(ii) not eligible to participate in that scheme;
(d) 150% of so much of a payment made under section 15-5 as:
(i) is not reflected in reductions in premiums payable under
*appropriate private health insurance policies
issued by the *health fund concerned;
or
(ii) relates to a financial year and to a person whose application under
section 11-15 in respect of that financial year has not been retained by the
health fund as required by section 11-50; or
(iii) relates to a financial year and to a person whose application under
section 11-15 has been so retained, but has not been produced to the HIC by the
health fund in accordance with a requirement made by the HIC under section
16-10;
(e) so much of a payment purportedly made under section 15-5 as was not
payable under that section;
(f) interest payable under subsection 18-10(2).
(2) The amounts are recoverable from:
(a) if paragraph (1)(a) or (b) applies—the person referred to in
that paragraph or that person’s estate; or
(b) if paragraph (1)(c), (d) or (e) applies—the
*health fund to which the payment concerned was
made; or
(c) if paragraph (1)(f) applies:
(i) if the payment was made to a health fund—that fund; or
(ii) if the payment was made to an individual—the individual or his
or her estate.
(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
on an individual from whom an amount is recoverable or the legal personal
representative of such an individual, or on a
*health fund from which an amount is
recoverable, under subsection 18-5(1) a notice claiming an amount as a debt due
to the Commonwealth and:
(a) an arrangement for the repayment of the amount has been entered into
between the Managing Director and the individual or the individual’s legal
personal representative, or the health fund, as the case may be, within the
period referred to in subsection (3), and there has been a default in payment of
an amount required to be paid under the arrangement; or
(b) at the end of the period such an arrangement has not been entered into
and all or part of the amount remains unpaid;
then, from and including 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 no rate is so specified—at the rate of 15% per
annum.
(3) The period for entering into an arrangement under paragraph (1)(a) is
the period of 3 months following the service of the notice under subsection (1),
or such longer period as the *Managing Director
allows.
(4) Despite subsection (1), in any proceedings instituted by the
Commonwealth for the recovery of an amount due under paragraph 18-5(1)(f), the
court may order that the interest payable under that paragraph is, and is taken
to have been, so payable from and including a day later than the day referred to
in subsection (1).
(1) The *Managing Director may, on behalf
of the Commonwealth, make a written determination:
(a) writing off an amount that a person or
*health fund is required to pay to the
Commonwealth under section 18-5; or
(b) waiving the right of the Commonwealth to recover from a person or
health fund the whole or a part of an amount that the person or fund is required
to pay to the Commonwealth under that section; or
(c) allowing a person who, or health fund which, is required to pay an
amount to the Commonwealth under that section to pay that amount by such
instalments as are specified in the determination.
(2) A determination under subsection (1) takes effect according to its
terms:
(a) on the day specified in the determination, being the day on which the
determination is made or any day before or after that day; or
(b) if no day is so specified—on the day on which the determination
is made.
(3) If a determination is made under subsection (1) in relation to a
person or *health fund, the
*Managing Director must cause notice of the
determination to be served on the person or fund.
Note: Decisions not to make determinations under this
section are reviewable under section 19-10.
A person is guilty of an offence if:
(a) the person uses, makes a record of, or discloses or communicates to
any person, any information that relates to the affairs of another person and
was acquired under or for the purposes of this Act; and
(b) the use, making of the record, disclosure or communication was not
carried out in the performance of a function or obligation, or the exercise of a
power, under this Act.
Maximum penalty: Imprisonment for 2 years.
Note: Chapter 2 of the Criminal Code sets out the
general principles of criminal responsibility.
Application may be made to the Administrative Appeals Tribunal for review
of the following decisions:
(a) a decision by the HIC under section 6-20 refusing a claim;
(b) a decision by the HIC refusing to register a person under section
11-25 in respect of an *appropriate private
health insurance policy for a financial year;
(c) a decision by the HIC under subsection 11-40(1) to revoke a
person’s registration in respect of an appropriate private health
insurance policy (other than a decision made as a result of a notice given by
the person under subsection 11-30(4));
(d) a decision by the Minister under section 14-15 to reject an
application by a *health fund to become a
*participating fund;
(e) a decision by the HIC under subsection 15-25(3) on reconsideration of
a decision that an amount is not payable in respect of an appropriate private
health insurance policy included in a claim under section 15-10;
(f) a decision by the *Managing Director
not to make a determination under section 18-15 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 any such persons, the decision-maker must have
regard to the Code of Practice determined under section 27B of that
Act.
The HIC must, within 90 days after the end of each financial year, give
the following information to the Commissioner:
(a) the name, date of birth and residential address of each person
who:
(i) paid a premium under an *appropriate
private health insurance policy for that financial year; or
(ii) received a payment under Chapter 2 in respect of such a premium;
or
(iii) was a *participant in the premiums
reduction scheme in respect of an appropriate private health insurance policy
for that financial year;
(b) the name of the *health fund that
issued the policy;
(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 period 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.
This Act does not apply with respect to State insurance that does not
extend beyond the limits of the State concerned.
A person is guilty of an offence if the person gives to the HIC or to a
*health fund under this Act any information
that the person knows to be false or misleading in a material
particular.
Maximum penalty: Imprisonment for 12 months.
Note: Chapter 2 of the Criminal Code sets out the
general principles of criminal responsibility.
Chapter 2 of the Criminal Code applies to all offences under this
Act.
The Consolidated Revenue Fund is appropriated for the purpose of making
payments under this Act.
The Governor-General may make regulations 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: a *private
health insurance policy provides ancillary cover if people covered by the policy
are covered (wholly or partly) for liability to pay fees and charges for
ancillary health benefits within the meaning of section 67 of the National
Health Act 1953.
appropriate private health insurance policy means a
*private health insurance policy that satisfies
the following conditions:
(a) it provides *hospital cover,
*ancillary cover or
*combined cover;
(b) the person, or each of the persons, covered by it is 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.
business day means a day other than a Saturday, a Sunday or a
public holiday in the place concerned.
combined cover: a *private
health insurance policy provides combined cover if it provides both
*hospital cover and
*ancillary cover.
Commissioner means the Commissioner of Taxation.
dependent child, in relation to an
*appropriate 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.
fringe benefit means:
(a) a fringe benefit as defined by subsection 136(1) of the Fringe
Benefits Tax Assessment Act 1986; and
(b) a benefit that would be a fringe benefit (as defined by subsection
136(1) of that Act) if paragraphs (d) and (e) of the definition of
employer in that subsection of that Act were omitted.
health fund means a registered organisation within the
meaning of Part VI of the National Health Act 1953.
HIC means the Health Insurance Commission.
hospital cover: a *private
health insurance policy provides hospital cover if 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.
incentive amount has the meaning given by section
20-10.
incentive payments scheme means the scheme provided for by
Chapter 2.
Managing Director means the Managing Director of the Health
Insurance Commission within the meaning of the Health Insurance Act
1973.
notification period, in relation to a month, means the period
starting on the first day of the month and finishing on the seventh day of the
month.
parent of 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 premiums reduction scheme has the meaning
given by section 12-10.
participating fund for a financial year means a health fund
referred to in subsection 14-5(3) 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.
pay a premium includes make a payment in respect of a
premium.
premiums reduction scheme means the scheme provided for by
Chapter 3.
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) *hospital cover; or
(b) *ancillary cover; or
(c) *combined cover.
you: see subsection 1-15(5).
(1) For the purposes of this Act, the incentive amount for
an *appropriate private health insurance policy
for a financial year is worked out in accordance with the following
table:
|
Incentive amounts |
||||
|---|---|---|---|---|
|
Item |
Number and kinds of people covered by the
policy |
Policy provides
*hospital cover but not
*ancillary cover |
Policy provides
*ancillary cover but not
*hospital cover |
Policy provides
*combined cover |
|
1 |
3 or more people |
$350 |
$100 |
$450 |
|
2 |
One dependent child and one other person |
$350 |
$100 |
$450 |
|
3 |
2 people neither of whom is a dependent child |
$200 |
$50 |
$250 |
|
4 |
One person |
$100 |
$25 |
$125 |
(2) If the amount of the premium paid by a person, or by a person’s
employer as a *fringe benefit for the person,
under the *appropriate private health insurance
policy is for part only of the financial year, the incentive
amount is worked out using the following formula: