HEALTH LEGISLATION AMENDMENT ACT (NO. 3) 1999 NO. 159, 1999 - SCHEDULE 3

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HEALTH LEGISLATION AMENDMENT ACT (NO. 3) 1999 NO. 159, 1999 - SCHEDULE 3

- Private health insurance incentives Part 1— Private Health Insurance Incentives Act 1998

1 Subsection 4-5(1)

Repeal the subsection, substitute:

(1): You are entitled to a payment under this Chapter if:

(a): you have paid, or your employer has paid as a ^*fringe benefit for you, 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; and
(b): the policy was issued by a ^*health fund.

2 After section 4-5

Insert:

4-6 Receipt for payment of premiums

(1): Subject to subsection (2), a ^*health fund to which a premium has been paid as mentioned in subsection 4-5(1) must, if requested to do so by the person who made the payment, give to the person a receipt for the payment in such form, and containing such information, as are determined in writing by the Managing Director.
(2): Subsection (1) does not apply if the premium to which the payment relates has been reduced under Chapter 3.

3 Subsection 6-20(1)

Repeal the subsection (including the note), substitute:

(1): The HIC must make a decision granting or refusing the claim within 14 days after the day on which the claim is made.

4 At the end of Division 6

Add:

6-25 Application for reconsideration of decision refusing a claim

(1): If the claim is refused, you may apply to the HIC for the HIC to reconsider the decision.
(2): The application must:

(a): be in writing; and
(b): set out the reasons for the application.

(3): The application must be made within:

(a): 28 days after the day on which you are notified of the decision; or
(b): if, either before or after the end of that period of 28 days, the HIC extends the period within which the application may be made—the extended period for making the application.

6-30 Reconsideration by HIC

(1): Upon receiving such an application, the HIC must:

(a): reconsider the decision; and
(b): either affirm or revoke the decision.

(2): If the HIC revokes the decision, the revocation is taken to be a decision granting the claim.
(3): The HIC must give to you a notice stating its decision on the reconsideration together with a statement of the reasons for its decision.

6-35 Deadline for reconsiderations

(1): The HIC must make its decision on reconsideration of a decision within 28 days after the day on which it received an application for reconsideration.
(2): The HIC is taken, for the purposes of this Division, to have made a decision confirming the original decision if it has not told the applicant of its decision on the reconsideration before the end of the period of 28 days.

: Note: A decision confirming the original decision is reviewable under section 19-10.

5 Subsection 8-5(1)

Omit "written".

6 Section 8-10

Repeal the section.

7 Section 10-5

Omit "for a financial year".

8 Paragraph 10-5(b)

Omit ", for that year,".

9 Paragraph 10-5(c)

Omit "for that year".

10 Subsection 11-5(1)

Omit "for a financial year".

11 Subsection 11-5(1)

Omit "for that year".

12 Subsection 11-5(3)

Repeal the subsection, substitute:

(3): On receiving a notice under subsection (2), the HIC must register the applicant in respect of the policy if the HIC is satisfied that the applicant is eligible to participate in the ^*premiums reduction scheme in respect of the policy.
(3A): If a person who is registered in respect of an ^*appropriate private health insurance policy becomes eligible to apply for registration under this Division in respect of another appropriate private health insurance policy issued by the ^*health fund that issued the first-mentioned policy, the person is taken, by this subsection, to be registered in respect of the other policy.

13 Subsection 11-5(4)

Omit "for a financial year".

14 Section 11-10

Repeal the section, substitute:

11-10 Eligibility to apply for registration

You are eligible to apply for registration under this Division in respect of an ^*appropriate private health insurance policy if:

(a): you have paid, or your employer as a ^*fringe benefit for you has paid, a premium under the policy for the whole or a part of the financial year that began on 1 July 1998 or a later financial year; or
(b): you are covered by the policy (otherwise than as a ^*dependent child); or
(c): every person covered by the policy is a dependent child and you are a ^*parent of any one or more of them.

15 Subsection 11-15(4)

Repeal the subsection.

16 Subsection 11-20(1)

Repeal the subsection, substitute:

(1): A ^*health fund that has issued an ^*appropriate private health insurance policy must notify the HIC, within a period determined by the ^*Managing Director, if:

(a): an application is given by a person to the fund under section 11-15 in respect of the policy; or
(b): a person who is registered under this Division in respect of the policy becomes eligible to apply for registration under this Division in respect of another appropriate private health insurance policy issued by the fund.

17 Subsection 11-25(1)

Repeal the subsection, substitute:

(1): If the HIC refuses to register you in respect of a policy, it must, within 28 days after the day on which the refusal occurs, give to you, and to the ^*health fund that issued the policy, notice of the refusal together with reasons for the refusal.

18 Subsection 11-25(2)

Omit "for the financial year".

19 Paragraph 11-30(1)(a)

Omit "for a financial year".

20 Paragraph 11-30(1)(b)

Omit "for the year", substitute "for a financial year".

21 Subsection 11-30(1)

Omit "written".

22 Subsection 11-30(4)

Repeal the subsection, substitute:

(4): You must notify the ^*health fund if you no longer wish to be registered in respect of the policy.

23 Subsection 11-40(1)

Omit "for a financial year".

24 Subsection 11-40(1)

Omit "for that year".

25 At the end of section 11-40

Add:

(3): The HIC must give notice of the revocation of a person's registration in respect of an ^*appropriate private health insurance policy to the person, and to the fund that issued the policy, within 28 days after the day on which the revocation occurs.

26 Subsection 12-5(1)

After "scheme", insert "for that year".

27 After subsection 12-5(3)

Insert:

(3A): If a premium that, apart from this section, would be payable under an ^*appropriate private health insurance policy in respect of which a person is a ^*participant in the premiums reduction scheme is payable for part only of a financial year, the amount of the reduction is the amount worked out using the formula:

where:

part of year means the number of days in the part of the financial year.

whole year reduction means the amount that would have been the amount of the reduction if the premium had been payable for the whole of the financial year.

28 Section 12-10

Repeal the section, substitute:

12-10 Participant in the premiums reduction scheme

(1): A person is a ^*participant in the premiums reduction scheme for the financial year that began on 1 July 1998 in respect of an ^*appropriate private health insurance policy if:

(a): 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): the person is registered under Division 11 in respect of the policy; or
(c): the person has applied to be registered under Division 11 in respect of the policy and the registration has not been refused.

(2): A person is a ^*participant in the premiums reduction scheme for the financial year beginning on 1 July 1999 or a later financial year in respect of an ^*appropriate private health insurance policy if:

(a): the person is registered under Division 11 in respect of the policy; or
(b): the person has applied to be registered under Division 11 in respect of the policy and the registration has not been refused.

29 Subsection 14-5(1)

Omit "for that financial year".

30 Subsection 14-5(2)

Omit "for the financial year beginning on 1 July 1998 or a later financial year", substitute "for the purposes of this Act".

31 Subsection 14-5(3)

Repeal the subsection, substitute:

(3): If the Minister approves the application, the ^*health fund is a participating fund .

32 Paragraph 14-10(1)(d)

Omit "until the end of the financial year concerned".

33 After subsection 14-10(1)

Insert:

(1A): An undertaking given under paragraph 14-10(1)(d) of the Private Health Insurance Incentives Act 1998 as in force before the day on which Schedule 3 to the Health Legislation Amendment Act (No. 3) 1999 received the Royal Assent is taken to comply with paragraph (1)(d) of this section even if it is expressed to apply only until the end of a financial year.

34 Subsection 14-10(2)

Repeal the subsection.

35 Subsection 14-15(1)

Omit "subsections (2) and (3)", substitute "subsection (2)".

36 Subsections 14-15(2) and (3)

Repeal the subsections, substitute:

(2): The Minister must not approve an application by a ^*health fund made on or after 1 July 2000 unless the health fund provides its members with a choice of one or more of the following types of policies:

(a): a ^*no gap policy;
(b): a ^*known gap policy.

37 Subsection 14-20

Omit "in writing".

38 After Division 14

Insert:

Division 14A—Revocation of status of health fund as a participating fund 14A-1 Revocation of status of participating fund

(1): If a ^*participating fund:

(a): has failed to comply with section 4-6; or
(b): has failed to comply with a condition of participation in the premiums reduction scheme that is prescribed by the regulations; or
(c): does not, on and after 1 July 2000, provide its members with a choice of one or more of the following types of policies:

(i): a ^*no gap policy;
(ii): a ^*known gap policy;

the Minister may, by notice given to the fund, revoke the fund's status as a participating fund.

(2): Upon the giving of the notice, the fund ceases to be a participating fund.

39 Subsection 15-5(1)

Omit "a financial year for".

40 Subsection 15-5(2)

Omit "The HIC must pay to a ^*health fund", substitute "If a ^*health fund makes a claim that the HIC decides is correct, the HIC must pay to the fund".

41 Subsection 15-20(1)

Repeal the subsection, substitute:

(1): If the HIC considers that a claim is incorrect, it may either refuse the claim or pay only such part of the claim as it is satisfied is correct.
(1A): The HIC must notify a ^*health fund if the HIC makes a decision referred to in subsection (1).

42 Subsection 15-20(2)

Omit "(1)", substitute "(1A)".

43 Subsection 15-20(3)

Repeal the subsection, substitute:

(3): The HIC is taken, for the purposes of this Act, to have decided that a claim is correct if the HIC does not give notice of its decision that the claim is incorrect on or before the day under subsection 15-15(2) on or before which, if the claim were correct, it would have been required to have been paid.

44 Subsection 15-25(1)

Omit "(1)", substitute "(1A)".

45 Paragraph 15-25(2)(a)

Repeal the paragraph.

46 Subsections 15-25(3), (4) and (5)

Repeal the subsections, substitute:

(3): As soon as practicable after receiving the request, the HIC must reconsider the decision and:

(a): affirm it; or
(b): vary it; or
(c): revoke it and make a fresh decision.

: Note: Decisions on reconsideration are reviewable under section 19-10.

(4): If the HIC varies the decision or revokes the decision and makes a fresh decision, the decision as varied, or the fresh decision, as the case may be, has effect according to its terms and is taken always to have had that effect from the time when the original decision was made.

47 Subsection 16-5(3)

Omit "in writing".

48 At the end of section 16-5

Add:

(7): Without limiting the powers of the HIC under the preceding provisions of this section, the HIC may, by notice given to a ^*health fund, require the fund to give to the HIC, within a period specified in the notice beginning at the end of a financial year, a certificate in writing by a registered company auditor as to the correctness of the accounts and records of the fund for that year to the extent that those accounts and records deal with matters mentioned in paragraphs (2)(a), (b) and (c).

49 Subsection 16-10(1)

Omit "written".

50 After paragraph 18-5(1)(b)

Insert:

(ba): a payment made to a person under Part 3 in respect of a claim that has been withdrawn under section 6-15;

51 Paragraph 18-5(1)(c)

Repeal the paragraph, substitute:

(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:

(i): a ^*participant in the premiums reduction scheme for the financial year concerned in respect of the policy; and
(ii): not eligible to participate in that scheme in respect of that policy;

(ca): so much of a payment made under section 15-5 as relates to a premium for which a reduction was not allowable under section 12-5;

52 Subparagraph 18-5(1)(d)(ii)

Repeal the subparagraph, substitute:

(ii): relates to a person whose application under section 11-15 has not been retained by the health fund as required by section 11-50; or

53 Subparagraph 18-5(1)(d)(iii)

Omit "to a financial year and".

54 Paragraph 18-5(2)(a)

Omit "or (b)", substitute ", (b) or (ba)".

55 Paragraph 18-5(2)(b)

After "(1)(c),", insert "(ca),".

56 After subsection 18-15(1)

Insert:

(1A): Without limiting subsection (1), the *Managing Director may make a determination under paragraph (1)(b) if the Managing Director is of the opinion that information given by or on behalf of:

(a): the Commonwealth; or
(b): a *health fund;

to a person from whom an amount is recoverable about that person's entitlements under this Act was incorrect or misleading in a material particular.

57 At the end of Division 18

Add:

18-20 HIC may set off debts against amounts payable

(1): Despite any other provision of this Act, if:

(a): except for this section, an amount would be payable by the HIC to a person or his or her estate, or to a ^*health fund, under this Act; and
(b): an amount is recoverable under section 18-5 by the Commonwealth from the person or his or her estate, or from the fund, as the case may be;

(b): against the amount referred to in paragraph (a).

(2): If the HIC decides to make such a set-off in respect of a person or his or her estate, the *Managing Director must serve on the person or his or her legal personal representative or the legal personal representative of his or her estate a notice of the decision.
(3): If the HIC makes such a set-off:

(a): it is liable to pay to the person or his or her estate, or to the fund, only the amount remaining after the set-off; and
(b): the amount referred to in paragraph (1)(b) is reduced by the amount set off.

58 At the end of Division 18

Add:

18-25 Reconsideration of certain decisions under this Division

(1): You may apply to the HIC for the HIC to reconsider the following decisions:

(a): a decision that an amount is recoverable as a debt due to the Commonwealth under:

(i): paragraph 18-5(1)(a) or (b); or
(ii): paragraph 18-5(1)(f) in respect of a payment made to an individual; or

(b): a decision under subsection 18-20(1) to set off a debt against an amount otherwise payable to a person or his or her estate.

(2): The application must:

(a): be in writing; and
(b): set out the reasons for the application.

(3): The application must be made within:

(a): 28 days after the day on which you are notified of the decision; or
(b): if, either before or after the end of that period of 28 days, the HIC extends the period within which the application may be made—the extended period for making the application.

(4): Upon receiving such an application, the HIC must:

(a): reconsider the decision; and
(b): either affirm or revoke the decision.

(5): If the HIC revokes the decision, the revocation is taken to be a decision:

(a): in the case of a decision mentioned in paragraph (1)(a)—to waive the debt; or
(b): in the case of a decision mentioned in paragraph (1)(b)—not to set off a debt against an otherwise payable amount.

(6): The HIC must give you a notice stating its decision on the reconsideration together with a statement of the reasons for its decision.
(7): The HIC must make its decision on reconsideration of a decision within 28 days after the day on which it received an application for reconsideration.
(8): The HIC is taken, for the purposes of this Division, to have made a decision confirming the original decision if it has not told the applicant of its decision on the reconsideration before the end of the period of 28 days.

59 Before section 19-5

Insert in Division 19:

19-1 Notification requirements—health funds

(1): The HIC may, by notice given to a ^*health fund, require the fund to provide information specified in the notice 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 is information relating to any of 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;
(l): any other information relevant to the operation of Chapter 2 or 3 that is determined in writing by the ^*Managing Director.

(3): For the purposes of paragraph (2)(l), the ^*Managing Director must not make a determination 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.

(4): Determinations under paragraph (2)(l) are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901 .
(5): 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.

(6): 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.

19-2 Form of notices

(1): A notice under this Act by the Minister or the HIC to a ^*health fund or a notice, request or application by a health fund to the Minister or the HIC may be given, served or made in writing or in an electronic form.
(2): A notice under this Act by the HIC to a person other than a ^*health fund or a notice, request or application by a person other than a health fund to the HIC must be in writing.

19-3 Use of information to determine whether persons covered by private health insurance policies are eligible for medicare benefits

In determining for the purposes of this Act whether a person covered by a ^*private health insurance policy 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 or 7 of that Act, the HIC may use any information that it has obtained under that Act in determining whether the person was eligible to receive medicare benefits.

60 After section 19-5

Insert:

19-6 Principles relating to personal information

(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 .

61 Paragraph 19-10(a)

Repeal the paragraph, substitute:

(a): a decision by the HIC under section 6-30 confirming a decision under section 6-20 refusing a claim;

62 Paragraph 19-10(b)

Omit "for a financial year".

63 Paragraph 19-10(e)

Repeal the paragraph, substitute:

(da): a decision by the Minister under section 14A to revoke a health fund's status as a participating fund;
(e): a decision by the HIC under subsection 15-25(3) on reconsideration of a decision that a claim under section 15-10 is incorrect;

64 At the end of section 19-10

Add:

; (g) a decision by the HIC under section 18-25 on reconsideration of a decision:

(i): that an amount is recoverable as a debt due to the Commonwealth under:

(A) paragraph 18-5(1)(a) or (b); or
(B) paragraph 18-5(1)(f) in respect of a payment made to an individual; or

(ii): under subsection 18-20(1) to set off a debt against an amount otherwise payable to a person or his or her estate.

65 After paragraph 19-15(b)

Insert:

(ba): the fund membership number of the policy;
(bb): the identification code of the fund that issued the policy;
(bc): the type of membership provided by the fund in respect of the policy;
(bd): whether the policy has been terminated or is suspended;
(be): if the policy has been terminated or is suspended, the date of the termination or suspension;

66 At the end of section 19-15

Add:

(i): any other information that the Commissioner determines in writing.

(2): For the purposes of paragraph (1)(i), the ^*Commissioner must not make a determination requiring the HIC to provide:

(a): the ^*tax file number of any person; or
(b): information about the physical, psychological or emotional health of any person.

(3): Determinations under paragraph (1)(i) are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901 .

67 After section 19-15

Insert:

19-16 Delegation

(1): The Minister may, by writing, delegate all or any of his or her powers under this Act to:

(a): the Secretary to the Department; or
(b): the Managing Director; or
(c): an officer of, or person employed in, the Department; or
(d): a member of the staff of the HIC.

(2): The HIC may, by writing, delegate all or any of its powers under this Act to the Managing Director or to a member of its staff.
(3): The Managing Director may, by writing, delegate all or any of his or her powers under this Act to a member of the staff of the HIC.

68 Section 20-5 (paragraph (b) of the definition of appropriate private health insurance policy )

After "6", insert "or 7".

69 Section 20-5 (definition of participating fund )

Repeal the definition, substitute:

participating fund means a ^*health fund referred to in subsection 14-5(1) or (3) other than such a fund whose status as a participating fund has been revoked under subsection 14A- 1(1).

Part 2— Health Insurance Commission Act 1973

70 Section 8DA

Repeal the section, substitute:

8DA Administration of the private health insurance incentives legislation

The functions of the Commission include administering the Private Health Insurance Incentives Act 1997 and the Private Health Insurance Incentives Act 1998 .

Part 3— National Health Act 1953

71 Section 73ABB

Repeal the section, substitute:

73ABB Registered health benefits organization to comply with requirements of health insurance incentives legislation

It is a condition of registration of a registered organization that it must not contravene a requirement imposed on it by or under the Private Health Insurance Incentives Act 1997 or the Private Health Insurance Incentives Act 1998 .

72 Paragraph 82G(1)(bb)

After " 1997 ", insert "or the incentive payments scheme, or the premiums reduction scheme, within the meaning of the Private Health Insurance Incentives Act 1998 ".

73 Paragraph 82L(3)(a)

Repeal the paragraph, substitute:

(a): if that year was the year that commenced on 1 July 1997—persons in respect of whom private health insurance policies issued by the registered organization were in force during that year and who were participants in the incentives scheme for that year;
(aa): if that year was the year that commenced on 1 July 1998 or a later year—persons in respect of whom appropriate private health insurance policies issued by the registered organization were in force during that year;

74 Paragraph 82L(3)(c)

After " 1997 ", insert ", or the Private Health Insurance Incentives Act 1998 ,".

75 Subsection 82L(4)

After " 1997 ", insert ", or the Private Health Insurance Incentives Act 1998 ,".

76 Subsection 82L(5)

Repeal the subsection, substitute:

(5): In this section:

appropriate private health insurance policy means an appropriate private health insurance policy within the meaning of the Private Health Insurance Incentives Act 1998 .

participant in the incentives scheme has the same meaning as in the Private Health Insurance Incentives Act 1997 .

participant in the premiums reduction scheme has the same meaning as in the Private Health Insurance Incentives Act 1998 .

participating fund means a participating fund within the meaning of the Private Health Insurance Incentives Act 1997 or the Private Health Insurance Incentives Act 1998 , as the case may be.

private health insurance policy means a private health insurance policy within the meaning of the Private Health Insurance Incentives Act 1997 .

77 At the end of subsection 82PA(2A)

Add "or the incentive payments scheme, or the premiums reduction scheme, within the meaning of the Private Health Insurance Incentives Act 1998 ".

78 Subsection 82PA(2B)

After " 1997 ", insert ", or the Private Health Insurance Incentives Act 1998 ,".

79 At the end of paragraph 82R(1)(c)

Add "or the Private Health Insurance Incentives Act 1998 ".

80 At the end of section 82ZSA

Add:

; or (c) any matter arising out of or connected with the incentive payments scheme, or the premiums reduction scheme, within the meaning of the Private Health Insurance Incentives Act 1998 ".

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