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This is a Bill, not an Act. For current law, see the Acts databases.
2016-2017-2018
The Parliament of the
Commonwealth of Australia
HOUSE OF REPRESENTATIVES
Presented and read a first time
Private Health Insurance Legislation
Amendment Bill 2018
No. , 2018
(Health)
A Bill for an Act to amend laws relating to private
health insurance, and for other purposes
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
i
Contents
1
Short title ........................................................................................... 1
2
Commencement ................................................................................. 1
3
Schedules ........................................................................................... 2
Schedule 1--Increasing maximum excess levels
3
Private Health Insurance Act 2007
3
Schedule 2--Age-based discounts for hospital cover
5
Part 1--Main amendments
5
Private Health Insurance Act 2007
5
Part 2--Consequential amendments
6
Age Discrimination Act 2004
6
Schedule 3--Private Health Insurance Ombudsman's powers
7
Ombudsman Act 1976
7
Schedule 4--Transitional provisions relating to the treatment
of certain health insurance policies
13
Schedule 5--Miscellaneous
19
Part 1--Benefits for travel and accommodation
19
Private Health Insurance Act 2007
19
Part 2--Information requirements
21
Private Health Insurance Act 2007
21
Part 3--Benefit requirements according to class of hospital
24
Private Health Insurance Act 2007
24
Part 4--Closed and terminated products
27
Private Health Insurance Act 2007
27
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
1
A Bill for an Act to amend laws relating to private
1
health insurance, and for other purposes
2
The Parliament of Australia enacts:
3
1 Short title
4
This Act is the Private Health Insurance Legislation Amendment
5
Act 2018.
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 Legislation Amendment Bill 2018
No. , 2018
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. Schedules 1
and 2
1 April 2019.
1 April 2019
3. Schedule 3
1 July 2018.
1 July 2018
4. Schedule 4
The day after this Act receives the Royal
Assent.
5. Schedule 5,
Parts 1 and 2
1 April 2019.
1 April 2019
6. Schedule 5,
Part 3
1 January 2019.
1 January 2019
7. Schedule 5,
Part 4
The day after 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
Increasing maximum excess levels Schedule 1
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
3
Schedule 1--Increasing maximum excess
1
levels
2
3
Private Health Insurance Act 2007
4
1 At the end of Chapter 2
5
Add:
6
Part 2-4--Excess levels for medicare levy and
7
medicare levy surcharge purposes
8
Division 42--Introduction
9
42-1 What this Part is about
10
This Part sets out the excess levels for complying health insurance
11
products that relate to whether a person is liable to pay medicare
12
levy or medicare levy surcharge.
13
Division 45--Excess levels for medicare levy and medicare
14
levy surcharge purposes
15
45-1 Excess level amounts
16
For the purposes of the A New Tax System (Medicare Levy
17
Surcharge--Fringe Benefits) Act 1999 and the Medicare Levy Act
18
1986, any excess payable in respect of benefits under a
*
complying
19
health insurance policy that provides
*
hospital cover must not be
20
more than:
21
(a) $750 in any 12 month period, in relation to a policy under
22
which only one person is insured; and
23
(b) $1,500 in any 12 month period, in relation to any other
24
policy.
25
Schedule 1 Increasing maximum excess levels
4
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
2 Application
1
The amendment made by item 1 of this Schedule applies in relation to
2
the 2018-19 income year and later income years.
3
Age-based discounts for hospital cover Schedule 2
Main amendments Part 1
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
5
Schedule 2--Age-based discounts for hospital
1
cover
2
Part 1--Main amendments
3
Private Health Insurance Act 2007
4
1 Paragraph 55-5(2)(c)
5
Repeal the paragraph, substitute:
6
(c) the age of a person, except to the extent allowed under:
7
(i) Part 2-3 (lifetime health cover); or
8
(ii) subsection 63-5(4); or
9
(iii) section 66-5, because of the reason mentioned in
10
paragraph 66-5(3)(ea); or
11
2 After paragraph 66-5(3)(e)
12
Insert:
13
(ea) because a person insured under the policy is entitled to an
14
age-based discount in the circumstances set out in the Private
15
Health Insurance (Complying Product) Rules;
16
Schedule 2 Age-based discounts for hospital cover
Part 2 Consequential amendments
6
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
Part 2--Consequential amendments
1
Age Discrimination Act 2004
2
3 Schedule 2 (table item
9A, column headed "Provision(s)")
3
Omit "Part 2-3 and subsection 63-5(4)", substitute "Part 2-3,
4
subsection 63-5(4) and paragraph 66-5(2)(a), because of the reason
5
mentioned in paragraph 66-5(3)(ea)".
6
4 Schedule 2 (after table item 9A)
7
Insert:
8
9
10
Private Health Insurance (Complying Product) Rules
made under the Private Health Insurance Act 2007
rules made for the
purposes of the
reason mentioned
in paragraph
66-5(3)(ea) of the
Private Health
Insurance Act 2007
10
Private Health Insurance Ombudsman's powers Schedule 3
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
7
Schedule 3--Private Health Insurance
1
Ombudsman's powers
2
3
Ombudsman Act 1976
4
1 After Division 3 of Part IID
5
Insert:
6
Division 3A--Inspection and audit
7
Subdivision A--Inspection and audit
8
20SA Powers to conduct inspections and audits
9
The Private Health Insurance Ombudsman may:
10
(a) at any reasonable time of the day, enter:
11
(i) a place occupied by a private health insurer or private
12
health insurance broker; or
13
(ii) a place occupied by a person predominantly for the
14
purpose of performing services for, or on behalf of, a
15
private health insurer or private health insurance broker;
16
or
17
(iii) a place where documents or other records relating to a
18
private health insurer, a private health insurance broker
19
or the carrying on of health insurance business are kept;
20
and
21
(b) may exercise the following powers in relation to the place:
22
(i) the power to inspect any documents or other records to
23
verify evidence provided in relation to a complaint
24
made under Division 3;
25
(ii) the power to take extracts from, or make copies of, any
26
such document or other record.
27
Note:
See also sections 20ZHA and 20ZHB.
28
Schedule 3 Private Health Insurance Ombudsman's powers
8
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
Subdivision B--Recommendations and reports
1
20SB Recommendation and reporting powers as a result of
2
inspection or audit
3
Recommendations to insurers or brokers
4
(1) After exercising powers under section 20SA, the Private Health
5
Insurance Ombudsman may make recommendations under this
6
section.
7
(2) The Private Health Insurance Ombudsman may recommend either
8
or both of the following:
9
(a) to a private health insurer, that the insurer take a specific
10
course of action or make changes to its rules, or both;
11
(b) to a health care provider or private health insurance broker,
12
that the provider or broker take a specific course of action.
13
(3) The Private Health Insurance Ombudsman may, by written notice
14
given to the person to whom the recommendation was made, or an
15
officer of that person, require the person to report to the Private
16
Health Insurance Ombudsman, before action is taken to give effect
17
to the recommendation, on the action proposed to be taken. The
18
notice must specify the period within which the report is to be
19
given.
20
Reports to the Health Minister
21
(4) After exercising powers under section 20SA, the Private Health
22
Insurance Ombudsman may:
23
(a) report to the Health Minister on any recommendations made
24
to a private health insurer or private health insurance broker
25
and any responses to those recommendations; or
26
(b) report to the Health Minister on any recommendations to
27
general changes in regulatory practice or industry practices
28
relating to the kind of issues raised as a result of the exercise
29
of those powers.
30
(5) If the Private Health Insurance Ombudsman provides a report to
31
the Health Minister, as mentioned in subsection (4):
32
(a) the report must refer to the Private Health Insurance
33
Ombudsman's exercise of powers under section 20SA; and
34
Private Health Insurance Ombudsman's powers Schedule 3
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
9
(b) the Private Health Insurance Ombudsman must notify any
1
private health insurer or private health insurance broker
2
named in a report provided to the Health Minister of that fact,
3
unless doing so would, or could be reasonably expected to,
4
prejudice the conduct of a current or pending investigation.
5
2 After section 20T
6
Insert:
7
20TA Powers to inspect documents etc.
8
For the purposes of conducting an investigation under this
9
Division, the Private Health Insurance Ombudsman may:
10
(a) at any reasonable time of the day, enter:
11
(i) a place occupied by a private health insurer or private
12
health insurance broker; or
13
(ii) a place occupied by a person predominantly for the
14
purpose of performing services for, or on behalf of, a
15
private health insurer or private health insurance broker;
16
or
17
(iii) a place where documents or other records relating to a
18
private health insurer, a private health insurance broker
19
or the carrying on of health insurance business are kept;
20
and
21
(b) exercise the following powers:
22
(i) the power to inspect any documents or other records;
23
(ii) the power to take extracts from, or make copies of, any
24
such document or other record.
25
Note:
See also sections 20ZHA and 20ZHB.
26
3 After paragraph 20ZG(6)(c)
27
Insert:
28
(ca) a summary of the exercise of powers during the period by the
29
Private Health Insurance Ombudsman under section 20SA;
30
4 After section 20ZH
31
Insert:
32
Schedule 3 Private Health Insurance Ombudsman's powers
10
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
20ZHA Announcement before entry
1
(1) This section applies if the Private Health Insurance Ombudsman:
2
(a) enters a place mentioned in paragraph 20SA(a) for the
3
purposes of conducting an inspection and audit; or
4
(b) enters a place mentioned in paragraph 20TA(a) for the
5
purposes of conducting an investigation under section 20T.
6
(2) Before entering the place, the Private Health Insurance
7
Ombudsman must show the Private Health Insurance
8
Ombudsman's identity card to the occupier of the place, or to
9
another person who apparently represents the occupier, if the
10
occupier or other person is present at the place.
11
Note:
See also section 20ZIA.
12
20ZHB Responsibility to provide facilities and assistance
13
(1) A person commits an offence if:
14
(a) the person is the occupier of, or is in charge of, a place
15
mentioned in paragraph 20SA(a); and
16
(b) the Private Health Insurance Ombudsman exercises, or
17
purports to exercise, the powers mentioned in
18
paragraph 20SA(b) in relation to the place; and
19
(c) the person does not provide the Private Health Insurance
20
Ombudsman with reasonable facilities and assistance for the
21
effective exercise of those powers.
22
Penalty: 30 penalty units.
23
(2) A person commits an offence if:
24
(a) the person is the occupier of, or is in charge of, a place
25
entered mentioned in paragraph 20TA(a); and
26
(b) the Private Health Insurance Ombudsman exercises, or
27
purports to exercise, the powers mentioned in
28
paragraph 20TA(b) in relation to the place; and
29
(c) the person does not provide the Private Health Insurance
30
Ombudsman with reasonable facilities and assistance for the
31
effective exercise of those powers.
32
Penalty: 30 penalty units.
33
Private Health Insurance Ombudsman's powers Schedule 3
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
11
5 After section 20ZI
1
Insert:
2
20ZIA Identity cards
3
(1) The Private Health Insurance Ombudsman must issue an identity
4
card to a person who exercises the powers mentioned in
5
paragraph 20SA(b) or 20TA(b).
6
(2) The identity card must:
7
(a) be in the form approved by the Private Health Insurance
8
Ombudsman; and
9
(b) contain a photograph that is no more than 5 years old of the
10
person to whom it is issued.
11
(3) A person must carry an identity card at all times when exercising
12
powers under section 20SA or 20TA.
13
(4) A person commits an offence of strict liability if:
14
(a) the person ceases to be:
15
(i) a member of staff mentioned in section 31; or
16
(ii) a person to whom the Private Health Insurance
17
Ombudsman has delegated powers under section 34 in
18
relation to section 20SA or 20TA; and
19
(b) the person does not, within 14 days of so ceasing, return the
20
person's identity card to the Private Health Insurance
21
Ombudsman.
22
Penalty: 1 penalty unit.
23
(5) Subsection (4) does not apply if the identity card was lost or
24
destroyed.
25
Note:
A defendant bears an evidential burden in relation to the matter in
26
subsection (5) (see subsection 13.3(3) of the Criminal Code).
27
6 Subsection 34(2C)
28
Omit "a member of staff mentioned in section 31", substitute "a
29
person".
30
7 Subsection 34(2C)
31
Omit "and 20V", substitute ", paragraph 20SB(4)(b) and section 20V".
32
Schedule 3 Private Health Insurance Ombudsman's powers
12
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
8 Application
1
The amendments made by this Schedule apply in relation to a complaint
2
made under Division 3 of Part IID of the Ombudsman Act 1976 on or
3
after 1 July 2018.
4
9 Delegation
5
A delegation in force under subsection 34(2C) of the Ombudsman Act
6
1976 immediately before 1 July 2018 has effect on and after that day as
7
if it were a delegation made under subsection 34(2C) of that Act as
8
amended by this Schedule.
9
Transitional provisions relating to the treatment of certain health insurance policies
Schedule 4
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
13
Schedule 4--Transitional provisions relating
1
to the treatment of certain health
2
insurance policies
3
4
1 Simplified outline of this Schedule
5
•
An irregular health insurance policy is to be treated as a
6
complying health insurance policy during the period:
7
(a)
beginning at the start of 1 April 2007; and
8
(b)
ending at the end of 30 June 2018.
9
•
An irregular health insurance policy is a health insurance
10
policy that includes one or more benefit limitation periods.
11
•
If an amount paid by the Commonwealth to a private health
12
insurer has become repayable because a health insurance
13
policy was an irregular health insurance policy, the repayment
14
of the amount is waived.
15
•
If an amount paid by the Commonwealth to a person by way
16
of an incentive payment has become repayable because a
17
health insurance policy was an irregular health insurance
18
policy, the repayment of the amount is waived.
19
2 Definitions
20
In this Schedule:
21
benefit limitation periods has the meaning generally accepted within
22
the health insurance industry.
23
hospital-substitute treatment has the same meaning as in the Private
24
Health Insurance Act 2007.
25
hospital treatment has the same meaning as in the Private Health
26
Insurance Act 2007.
27
irregular health insurance policy has the meaning given by item 3.
28
private health insurer means:
29
Schedule 4 Transitional provisions relating to the treatment of certain health insurance
policies
14
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
(a) a body that is or was registered under Division 3 of Part 2 of
1
the Private Health Insurance (Prudential Supervision) Act
2
2015; or
3
(b) a person who was registered under repealed Part 4-3 of the
4
Private Health Insurance Act 2007; or
5
(c) an organisation that was covered by subsection 18(1) of the
6
Private Health Insurance (Transitional Provisions and
7
Consequential Amendments) Act 2007.
8
3 Irregular health insurance policy
9
(1)
For the purposes of this Schedule, an insurance policy is an irregular
10
health insurance policy at a particular time during the period:
11
(a) beginning at the start of 1 April 2007; and
12
(b) ending at the end of 30 June 2018;
13
if, at that time (apart from item 4):
14
(c) the insurance policy includes one or more benefit limitation
15
periods; and
16
(d) the insurance policy is not a complying health insurance
17
policy (within the meaning of the Private Health Insurance
18
Act 2007); and
19
(e) the insurance policy would be a complying health insurance
20
policy (within the meaning of that Act), if:
21
(i) the waiting period requirements in Division 75 of that
22
Act; and
23
(ii) the portability requirements in Division 78 of that Act;
24
did not prevent the policy from including those benefit
25
limitation periods.
26
(2)
Subitem (1) has effect subject to subitem (3).
27
(3)
For the purposes of this Schedule, if (apart from item 4):
28
(a) at a particular time during the period:
29
(i) beginning at the start of 1 April 2018; and
30
(ii) ending at the end of 30 June 2018;
31
an insurance policy included one or more benefit limitation
32
periods that relate to:
33
(iii) hospital treatment that is psychiatric care; or
34
(iv) hospital-substitute treatment that is psychiatric care; and
35
Transitional provisions relating to the treatment of certain health insurance policies
Schedule 4
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
15
(b) as a result, the policy is not a complying health insurance
1
policy (within the meaning of the Private Health Insurance
2
Act 2007) at that time;
3
the policy is not an irregular health insurance policy at that time.
4
4 Irregular health insurance policy to be treated as a
5
complying health insurance policy
6
(1)
The provisions of:
7
(a) the Private Health Insurance Act 2007; and
8
(b) any other law of the Commonwealth;
9
have effect, and are taken always to have had effect, as if section 63-10
10
of that Act had always provided that an insurance policy that was an
11
irregular health insurance policy at a time during the period:
12
(c) beginning at the start of 1 April 2007; and
13
(d) ending at the end of 30 June 2018;
14
is taken, for the purposes of that Act, to be a complying health
15
insurance policy at that time.
16
(2)
Subitem (1) does not apply:
17
(a) in determining whether a person has committed an offence
18
against section 84-1 of the Private Health Insurance Act
19
2007; or
20
(b) in determining the obligation of a court under
21
subsection 84-1(2) of that Act; or
22
(c) in determining, for the purposes of subsection 84-10(1) of
23
that Act, whether a private health insurer has engaged, is
24
engaging, or is proposing to engage, in conduct:
25
(i) that contravenes or would contravene section 63-1 of
26
that Act; or
27
(ii) that is or that would be an offence against section 84-1
28
of that Act; or
29
(d) in determining, for the purposes of subsection 84-10(2) of
30
that Act, whether a refusal or failure:
31
(i) contravenes or would contravene section 63-1 of that
32
Act; or
33
(ii) is or would be an offence against section 84-1 of that
34
Act; or
35
Schedule 4 Transitional provisions relating to the treatment of certain health insurance
policies
16
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
(e) in determining, for the purposes of paragraph 84-15(a) of that
1
Act, whether a private health insurer has engaged in conduct
2
that contravenes section 63-1 of that Act or is an offence
3
against section 84-1 of that Act; or
4
(f) in determining, for the purposes of paragraph 84-15(b) of that
5
Act, whether a refusal or failure contravenes section 63-1 of
6
that Act or is an offence against section 84-1 of that Act; or
7
(g) in determining the scope of a jurisdiction or power conferred
8
on the Federal Court by section 84-10 or 84-15 of that Act.
9
(3)
Subitem (1) does not apply:
10
(a) in determining, for the purposes of Chapter 5 of the Private
11
Health Insurance Act 2007, whether a private health insurer
12
may have, or has, contravened an enforceable obligation
13
(within the meaning of that Act); or
14
(b) in determining the scope of a power conferred on the
15
Minister by Chapter 5 of that Act; or
16
(c) in determining the scope of a jurisdiction or power conferred
17
on the Federal Court by Chapter 5 of that Act.
18
(4)
Subitem (1) does not apply so as to preclude any common law action
19
that could (apart from that subitem) have been brought by the holder of
20
an irregular health insurance policy against a private health insurer.
21
(5)
This item has effect subject to subitems 5(3) and 6(3).
22
5 Waiver
--reimbursement of private health insurer
23
Scope
24
(1)
This item applies if (apart from item 4):
25
(a) before the commencement of this item, an amount (the
26
relevant amount) was paid to a private health insurer under,
27
or purportedly under, Subdivision 279-A of the Private
28
Health Insurance Act 2007; and
29
(b) the private health insurer was not entitled to receive the
30
whole, or a part, of the relevant amount because, during the
31
whole or a part of the period:
32
(i) beginning at the start of 1 April 2007; and
33
(ii) ending at the end of 30 June 2018;
34
Transitional provisions relating to the treatment of certain health insurance policies
Schedule 4
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
17
one or more insurance policies were irregular health
1
insurance policies; and
2
(c) as a result, the whole, or the part, as the case may be, of the
3
relevant amount became repayable to the Commonwealth.
4
Waiver
5
(2)
The repayment of the whole, or the part, as the case may be, of the
6
relevant amount is waived.
7
Non-validation
8
(3)
Item 4 does not operate to validate the whole, or the part, as the case
9
may be, of the relevant amount.
10
6 Waiver
--incentive payment
11
Scope
12
(1)
This item applies if (apart from item 4):
13
(a) before the commencement of this item, an amount (the
14
relevant amount) was paid to a person under, or purportedly
15
under, repealed Division 26 of the Private Health Insurance
16
Act 2007; and
17
(b) the person was not entitled to receive the whole, or a part, of
18
the relevant amount because, during the whole or a part of
19
the period:
20
(i) beginning at the start of 1 April 2007; and
21
(ii) ending at the end of 30 June 2013;
22
one or more insurance policies were irregular health
23
insurance policies; and
24
(c) as a result, the whole, or the part, as the case may be, of the
25
relevant amount became repayable to the Commonwealth.
26
Waiver
27
(2)
The repayment of the whole, or the part, as the case may be, of the
28
relevant amount is waived.
29
Schedule 4 Transitional provisions relating to the treatment of certain health insurance
policies
18
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
Non-validation
1
(3)
Item 4 does not operate to validate the whole, or the part, as the case
2
may be, of the relevant amount.
3
Miscellaneous Schedule 5
Benefits for travel and accommodation Part 1
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
19
Schedule 5--Miscellaneous
1
Part 1--Benefits for travel and accommodation
2
Private Health Insurance Act 2007
3
1 Paragraph 55-5(2)(d)
4
Repeal the paragraph, substitute:
5
(d) where a person lives, except to the extent allowed under
6
subsection 66-10(2) or section 66-20 or 66-25; or
7
2 At the end of Division 66
8
Add:
9
66-25 Different amounts of benefits for travel or accommodation
10
Neither:
11
(a) the community rating principle in section 55-5; nor
12
(b) the community rating requirements in section 66-1;
13
prevents a private health insurer from determining a person's
14
entitlement under a
*
complying health insurance policy to a benefit
15
for travel or accommodation in respect of
*
hospital treatment or
16
*
general treatment based on the distance between the person's
17
principal place of residence and the facility where treatment is
18
provided.
19
3 After subsection 121-5(2)
20
Insert:
21
(2A) Without limiting subsection (1) or (2), hospital treatment also
22
includes benefits for travel or accommodation relating to treatment
23
covered by subsection (1) or (2).
24
4 Subsection 121-5(4)
25
Omit "and (2)", substitute ", (2) and (2A)".
26
5 After subsection 121-10(2)
27
Insert:
28
Schedule 5 Miscellaneous
Part 1 Benefits for travel and accommodation
20
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
(2A) Despite paragraph (1)(b), general treatment also includes benefits
1
for travel or accommodation relating to hospital treatment.
2
6 Subsection 121-10(3)
3
Omit "and (2)", substitute ", (2) and (2A)".
4
Miscellaneous Schedule 5
Information requirements Part 2
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
21
Part 2--Information requirements
1
Private Health Insurance Act 2007
2
7 Section 93-1 (heading)
3
Omit "standard information statements", substitute "private health
4
information statements".
5
8 Subsection 93-1(1)
6
Omit "
*
standard information statement", substitute "
*
private health
7
information statement".
8
9 Subsection 93-1(1A)
9
Omit "
*
standard information statement may be the standard information
10
statement", substitute "
*
private health information statement may be the
11
private health information statement".
12
10 Subsections 93-1(2) and (3)
13
Omit "
*
standard information statement", substitute "
*
private health
14
information statement".
15
11 Paragraph 93-1(4)(a)
16
Omit "
*
standard information statement", substitute "
*
private health
17
information statement".
18
12 Paragraph 93-1(4)(b)
19
Omit "standard information statement", substitute "private health
20
information statement".
21
13 Section 93-5 (heading)
22
Omit "standard information statement", substitute "private health
23
information statement".
24
14 Subsection 93-5(1)
25
Omit "standard information statement", substitute "private health
26
information statement".
27
Schedule 5 Miscellaneous
Part 2 Information requirements
22
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
15 Subsection 93-5(2)
1
Omit "
*
standard information statements", substitute "
*
private health
2
information statements".
3
16 Section 93-10 (heading)
4
Omit "standard information statements", substitute "private health
5
information statements".
6
17 Paragraph 93-10(a)
7
Omit "
*
standard information statement", substitute "
*
private health
8
information statement".
9
18 Paragraph 93-15(1)(a)
10
Omit "
*
standard information statement", substitute "
*
private health
11
information statement".
12
19 Subsection 93-20(1)
13
Omit "
*
standard information statement", substitute "
*
private health
14
information statement".
15
20 Paragraph 93-20(2)(b)
16
Omit "
*
standard information statements", substitute "
*
private health
17
information statements".
18
21 Paragraph 93-20(2)(d)
19
Omit "standard information statement", substitute "private health
20
information statement".
21
22 Section 96-1 (heading)
22
Omit "standard information statements", substitute "private health
23
information statements".
24
23 Section 96-1
25
Omit "
*
standard information statements", substitute "
*
private health
26
information statements".
27
24 Section 96-5 (heading)
28
Omit "standard information statements", substitute "private health
29
information statements".
30
Miscellaneous Schedule 5
Information requirements Part 2
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
23
25 Section 96-5
1
Omit "
*
standard information statements", substitute "
*
private health
2
information statements".
3
26 Section 96-10 (heading)
4
Omit "standard information statements", substitute "private health
5
information statements".
6
27 Section 96-10
7
Omit "
*
standard information statements", substitute "
*
private health
8
information statements".
9
28 Clause 1 of Schedule 1
10
Insert:
11
private health information statement is defined in section 93-5.
12
29 Clause 1 of Schedule 1 (definition of standard information
13
statement)
14
Repeal the definition.
15
30 Clause 1 of Schedule 1 (definition of up to date)
16
Repeal the definition, substitute:
17
up to date, in relation to a
*
private health information statement, is
18
defined in subsection 93-1(2).
19
Schedule 5 Miscellaneous
Part 3 Benefit requirements according to class of hospital
24
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
Part 3--Benefit requirements according to class of
1
hospital
2
Private Health Insurance Act 2007
3
31 After section 121-7
4
Insert:
5
121-8 Application for inclusion of hospital in a class
6
(1) A person may apply to the Minister for a
*
hospital to be included in
7
a class set out in the Private Health Insurance (Health Insurance
8
Business) Rules.
9
(2) The application must be:
10
(a) in the
*
approved form; and
11
(b) accompanied by any application fee imposed under the
12
Private Health Insurance (Health Insurance Business) Rules.
13
121-8A Minister to decide application
14
(1) The Minister must consider whether a
*
hospital to which an
15
application relates satisfies the assessment criteria set out in the
16
Private Health Insurance (Health Insurance Business) Rules.
17
(2) If the
*
hospital satisfies the assessment criteria, the Minister must,
18
within 60 days after the day the application is made:
19
(a) include the hospital in a class set out in the Private Health
20
Insurance (Health Insurance Business) Rules; and
21
(b) notify the person, in writing, of:
22
(i) the hospital's inclusion in a class set out in the Rules;
23
and
24
(ii) the day that the hospital is included in that class and the
25
day that the hospital's inclusion in that class ends.
26
(3) If the
*
hospital does not satisfy the assessment criteria, the Minister
27
must, within 60 days after the day the application is made:
28
(a) notify the person, in writing, of that fact; and
29
(b) provide reasons for the decision.
30
Miscellaneous Schedule 5
Benefit requirements according to class of hospital Part 3
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
25
Note:
A decision that a hospital does not satisfy the assessment criteria set
1
out in the Private Health Insurance (Health Insurance Business) Rules
2
is reviewable under Part 6-9.
3
121-8B Period of inclusion of hospital in a class
4
The inclusion of a
*
hospital in a class set out in the Private Health
5
Insurance (Health Insurance Business) Rules:
6
(a) comes into force on the day specified in the notice referred to
7
in subparagraph 121-8A(2)(b)(ii); and
8
(b) expires on the day specified in that notice, unless it is
9
revoked earlier.
10
121-8C Revocation of inclusion of hospital in a class
11
The Minister may revoke the inclusion of a
*
hospital in a class set
12
out in the Private Health Insurance (Health Insurance Business)
13
Rules if the Minister considers that the hospital ceases to satisfy
14
the assessment criteria set out in the Rules.
15
Note:
A decision to revoke the inclusion of a hospital in a class set out in the
16
Private Health Insurance (Health Insurance Business) Rules is
17
reviewable under Part 6-9.
18
121-8D Private Health Insurance (Health Insurance Business) Rules
19
The Private Health Insurance (Health Insurance Business) Rules
20
may provide for all or any of the following:
21
(a) for the purposes of this Part and Division 72--set out one or
22
more classes of
*
hospital;
23
(b) impose an application fee for the purposes of section 121-8;
24
(c) set out assessment criteria for including a hospital in a
25
particular class;
26
(d) set out matters of a transitional nature relating to the current
27
arrangements for hospitals and the new application process
28
provided for by section 121-8.
29
32 Section 328-5 (after table item 4A)
30
Insert:
31
32
5
To decide that a
*
hospital does not satisfy
the assessment criteria set out in the Private
section 121-8A
Schedule 5 Miscellaneous
Part 3 Benefit requirements according to class of hospital
26
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
Health Insurance (Health Insurance
Business) Rules
6
To decide to revoke a
*
hospital's inclusion
in a class set out in the Private Health
Insurance (Health Insurance Business) Rules
section 121-8C
1
Miscellaneous Schedule 5
Closed and terminated products Part 4
No. , 2018
Private Health Insurance Legislation Amendment Bill 2018
27
Part 4--Closed and terminated products
1
Private Health Insurance Act 2007
2
33 Section 55-10
3
Repeal the section, substitute:
4
55-10 Closed products, and terminated products and product
5
subgroups
6
The principle of community rating in section 55-5 does not:
7
(a) prevent a private health insurer from closing a
*
complying
8
health insurance product, such that the
*
product will not be
9
available to anyone except those persons, who at the time of
10
closing, are insured under a policy forming part of the
11
product; or
12
(b) prevent a private health insurer from terminating a complying
13
health insurance product or a
*
product subgroup of a
14
complying health insurance product, such that:
15
(i) in the case of a product--the product will not be
16
available to any person insured under a policy forming
17
part of the product; and
18
(ii) in the case of a product subgroup--the product
19
subgroup will not be available to any person insured
20
under a policy that belongs to the product subgroup.
21
34 Subsection 78-1(1)
22
Omit "and (4)", substitute ", (4) and (5A)".
23
35 After subsection 78-1(5)
24
Insert:
25
(5A) An insurance policy meets the requirement in this subsection if:
26
(a) the policy forms part of a
*
complying health insurance
27
product or belongs to a
*
product subgroup of a complying
28
health insurance product; and
29
(b) the
*
product or product subgroup is being terminated by the
30
private health insurer, and as a consequence, an
*
adult
31
Schedule 5 Miscellaneous
Part 4 Closed and terminated products
28
Private Health Insurance Legislation Amendment Bill 2018
No. , 2018
insured under the policy is to be transferred to a new policy;
1
and
2
(c) the insurer informs the adult insured under the policy, in
3
writing, of the matters set out in the Private Health Insurance
4
(Complying Product) Rules; and
5
(d) the adult insured under the policy is informed of those
6
matters a reasonable time before the transfer to the new
7
policy is to take effect.
8
Note:
See also section 55-10.
9