Commonwealth Numbered Regulations - Explanatory Statements Commonwealth Numbered Regulations - Explanatory Statements[Index] [Search] [Download] [Related Items] [Help]
NATIONAL HEALTH (LIFETIME HEALTH COVER) REGULATIONS 2000 2000 NO. 106
EXPLANATORY STATEMENTSTATUTORY RULES 2000 No. 106
Issued by the Authority of the Minister for Health and Aged Care
National Health Act 1953
National Health (Lifetime Health Cover) Regulations 2000
Section 140 of the National Health Act 1953 (the Act) allows the Governor-General to make regulations prescribing matters that are required or permitted by the Act to be prescribed, or that are necessary and convenient to be prescribed for carrying out or giving effect to the Act.
Schedule 2 of the Act contains rules relating to a new system of private health insurance called Lifetime Health Cover. Under Lifetime Health Cover, registered organizations (health funds) are able to set different premiums depending on the age when a member first takes out hospital cover with a registered health fund. Schedule 2 of the Act commences on 1 July 2000.
The purpose of the regulations is to specify the administrative arrangements needed to account for exceptions to the general rules and to ensure that Lifetime Health Cover is applied and administered consistently by health funds.
The regulations will:
- specify, for the purposes of paragraph 3(1)(b) and subparagraph 3(2)(b)(ii) of Schedule 2 of the Act, the obligations of health funds regarding the suspension of an adult beneficiary's membership (proposed regulations 4 and 5);
- specify, for the purposes of subclause 4(2) of Schedule 2 of the Act, the classes of persons who will be taken to have hospital cover (proposed regulation 6);
- specify, for the purposes of paragraphs 10(1)(b) and 10(2)(b) of Schedule 2 of the Act, the circumstances in which the Minister must determine that an applicant is to be treated as having had hospital cover on 1 July 2000 and 30 June 1999 respectively (proposed regulations 7, 8 and 9);
- specify, for the purposes of subclause 12(1) of Schedule 2 of the Act, the obligations of health funds regarding the provision of information to adult beneficiaries (proposed regulation 10);
- specify, for the purposes of subclause 12(1) of Schedule 2 of the Act, the obligations of health funds regarding the provision of information to persons who apply, or inquire about becoming an adult beneficiary (proposed regulation 11);
- specify, for the purposes of subclause 12(2) of the Act, the obligations of health funds regarding the provision of information to other health funds about a particular adult beneficiary (proposed regulation 12);
- specify, for the purposes of paragraph 13 (a) of Schedule 2 of the Act, the evidence that health funds must accept as proof of a person having had hospital cover at a particular time, or during a particular period (proposed subregulation 13(1));and
- specify, for the purposes of paragraph 13(b) of Schedule 2 of the Act, the evidence that health funds must accept as proof of a person's age (proposed subregulation 13(2)).
Details of the regulations are set out in the Attachment.
The regulations commence on 1 July 2000.
ATTACHMENT
PART 1: Introductory
Regulation 1: Name of Regulations
Regulation 1 provides that the Regulations may be cited as the National Health (Lifetime Health Cover) Regulations 2000.
Regulation 2: Commencement
Regulation 2 provides that the Regulations commence on 1 July 2000.
Regulation 3: Definition
Regulation 3 provides that in these regulations Act means the National Health Act 1953.
Part 2: Lifetime Health Cover
Division 1: General Rules
Regulation 4: Permitted days - suspended hospital cover
Regulation 4 provides that..
- an adult beneficiary's hospital cover may be suspended in accordance with the
rules of the adult beneficiary's health fund;
- the days on which an adult beneficiary's membership is suspended does not
include any of their 730 permitted days without hospital cover under paragraph
3 )(1)(a) of Schedule 2 to the Act. and
- anyone who did not have hospital cover on 30 June 1999 but did have hospital
cover on 1 July 2000 (that is, took out hospital cover during the Lifetime Health
Cover grace period) and who has suspended hospital cover on or after 1 July
2000 but before 2 July 2001 needs to maintain their hospital cover for at least 366
days. These '366 days can occur before and after the period of suspension, but
must occur after 30 June 2000.
Regulation 5: Suspended hospital cover to be recognised
Regulation 5 provides that a health fund must recognise the suspension of membership of an adult beneficiary who transfers to their health fund during a period of suspension from another health fund. That is, the health fund must recognise that the period of the adult beneficiary's suspension is permitted days without hospital cover under paragraph 3(1)(b) of Schedule 2 to the Act and must not apply any additional loadings to the adult beneficiary's premium.
Health funds are only required to recognise a maximum of two years suspended membership for an adult beneficiary wishing to transfer while on suspension from another health fund, however, health funds have the discretion to recognise a period of suspension of longer than two years.
Regulation 6: Persons taken to have hospital cover
Subregulation 6(1) provides that following groups of people are taken to have hospital cover:
- people who have their health services provided by the Australian Antarctic
Division of the Department of the Environment and Heritage;
- members of the Australian Defence Force on continuous full-time service who
have their health services provided by the Australian Defence Force and their
dependants, who also have their health services provided by the Australian
Defence Force; or
- people who are Australian citizens or holders of a permanent visa (within the
meaning of the Migration Act 1958) who are overseas on 1 July 2000 and who
have not subsequently returned to Australia for more than 90 days.
Subregulation 6(2) ensures that the anti-avoidance measures contained in paragraph 1(1)(b) of Schedule 2 to the Act do not operate to disadvantage a person referred to in proposed subregulation 6(1) who is taken to have hospital cover on 1 July 2000. Paragraph 1(1)(b) of Schedule 2 to the Act increases premiums in respect of any person who takes out hospital cover during the grace period but discontinues his or her policy in the first year after the commencement of Lifetime Health Cover.
Division 2: Exceptions to general rules
Regulation 7: Hardship cases
Regulation 7 provides that in order for the Minister to determine that a person is to be treated, for the purposes of Schedule 2 to the Act, as having had hospital cover on 1 July 2000 and 30 June 1999 the Minister must be satisfied either that:
- the person was in receipt of an income support payment (as defined in the Social
Security Act 1991) or was the holder of a Health Care Card at any time during the
period 1 July 1999 to 30 June 2000 inclusive; and
- the person has had hospital cover or ancillary cover with a health fund for at least
three years in total in the past or for at least 12 months in total during the period
1 July 1997 to 30 June 2000 inclusive.
Regulation 8: Hardship cases - migrants
Regulation 8 provides for migrants who were ineligible for Medicare on 1 July 2000 and who were either residing in Australia on 30 September 1999 or who had applied to migrate to Australia before 30 September 1999.
Regulation 8 specifies that in order for the Minister to determine that a person is to be treated, for the purposes of Schedule 2 to the Act, as having had hospital cover on 1 July 2000 and 30 June 1999 the Minister must be satisfied that on 1 July 2000 the person is not entitled to Medicare benefits, and is either:
- a person who on 3 0 September 1999 was an Australian resident and the holder of a permanent visa;
- or a person to whom an item in Schedule 1 of the proposed regulations applies.
Regulation 9: Hardship cases - exceptional circumstances
Regulation 9 provides that in order for the Minister to determine that a person is to be treated, for the purposes of Schedule 2 to the Act, as having had hospital cover on 1 July 2000 and 30 June 1999 the Minister must be satisfied that, by reasons of exceptional circumstances, it would be unreasonable to expect the person to have had hospital cover on 1 July 2000. However, to qualify for a determination on the grounds of exceptional circumstances, the person must have had hospital cover or ancillary cover with a health fund for at least three years in total in the past or for at least 12 months in total during the period 1 July 1997 to 30 June 2000 inclusive.
Cases where it might have been unreasonable to expect a person to have had hospital cover on 1 July 2000 could be that the person was in hospital in the period leading up to and including 1 July 2000, or that the person was waiting for the proceeds of the sale of an asset and therefore did not have money available to purchase hospital cover.
Regulation 10: Notification of information about membership status (Act, Schedule 2, cl 12)
Regulation 10 provides that an adult beneficiary requesting information from his or her health fund about his or her hospital cover must be given the information within 14 days of the health fund receiving the request.
Regulation 10 also provides that health funds must provide adult beneficiaries (except those for whom no contributions have been paid for the immediately preceding 12 months) information every year that is clearly expressed in writing about the adult beneficiary's hospital cover. The information must include the following:
- details of the type and level of cover the adult beneficiary has, including information regarding any election the adult beneficiary has made to contribute for lesser benefits under paragraph (ba) of Schedule 2 to the Act, front-end-deductibles, co-payments and exclusions;
- details of any loadings that are applied to the adult beneficiary's premium and details of the number of days absence the adult beneficiary has had from hospital cover since his or her Schedule 2 application day, other than days during which the adult beneficiary's hospital cover was suspended. This information may be expressed, as the adult beneficiary's certified age at entry (an age notionally attributed to the adult beneficiary as the age from which he or she is treated as having had continuous hospital cover).
This information may be given to the adult beneficiary as a separate notice or may accompany other information sent to the adult beneficiary, such as a statement issued under paragraph 4(1)(a) of the Private Health Insurance Incentives Regulations 1998.
In the case of joint hospital cover the information must set out the details of the hospital cover as it applies to each adult beneficiary. The information must be sent to each adult beneficiary covered by the hospital cover unless any adult beneficiaries share an address, in which case the information may be sent as a single notice to the beneficiaries at that address.
Regulation 11: Notification of information about new membership (Act, Schedule 2, cl 12)
Regulation 11 provides that health funds must inform a person who applies to become, or inquires about becoming, an adult beneficiary about any loadings that they may be required to pay on top of their premium under clause 1 of Schedule 2 to the Act because they are late in taking out hospital cover. Health funds must also inform these people of the effect of ceasing their hospital cover under clause 2 of Schedule 2 to the Act.
Regulation 12: Information given by one registered organization to another
Regulation 12 provides that a health fund can only give information to another health fund with the permission of the adult beneficiary, or in the case of joint hospital cover, with the permission of the joint adult beneficiary who is the contributor. This information may be expressed as the adult beneficiary's certified age at entry (an age notionally attributed to the adult beneficiary as the age from which he or she is treated as having had continuous hospital cover).
Regulation 13: Conclusive evidence of hospital cover, or age
Subregulation 13(1) provides that health funds must accept the following as proof of a person having had hospital cover at a particular time or for a particular period:
- the annual statement issued to the adult beneficiary by his or her health fund
under proposed regulation 10;
- a determination that a person is to be treated as having had hospital cover on
1 July 2000 and/or 3 0 June 1999 under clause 10 of Schedule 2 to the Act;
- a written statement issued by the Australian Antarctic Division of the Department
of the Environment and Heritage, that the person had health services provided by
the Australian Antarctic Division at the particular time or during the particular
period; or
- a written statement issued by the Australian Defence Force that the person had
health services provided by the Australian Defence Force at the particular time or
during the particular period;
however, health funds have the discretion to accept any other form of evidence as proof of a
person having had hospital cover at a particular time or for a particular period.
Subregulation 13(2) provides that health funds must accept the following as proof of a person's age:
- the person's original birth certificate;
- the person's current driver's license; or
- the person's current passport;
however, health funds have the discretion to accept any other form of evidence as proof of a
person's age.
Schedule 1: Hardship Cases - recent migrants
Schedule 1 provides that in order for the Minister to determine that a person is to be treated, for the purposes of Schedule 2 to the Act, as having had hospital cover on 1 July 2000 and 1 July 1999 the Minister must be satisfied that on 1 July 2000 the person is not entitled to Medicare benefits, and is a person to whom any of the following circumstances apply:
(a) the person has applied for a permanent visa, or permanent entry permit, before
30 September 1999 and, as a result of the application:
(i) is granted a permanent visa, or a transitional (permanent) visa, before
1 July 2002-, and
(ii) if granted the visa outside Australia, enters Australia as holder of that visa before 1 July 2002-,
(b) the person has applied for an Extended Eligibility (Temporary) (Class TK) visa and General (Residence) (Class AS) visa on or after 1 September 1994 and before 30 September 1999, and:
(i) is _granted an Extended Eligibility (Temporary) (Class TK) visa, before
1 July 2002; and
(ii) remains an applicant for a General (Residence) (Class AS) visa;
(c) the person has applied for a Spouse (Provisional) (Class UF) visa and Spouse (Migrant) (Class BC) visa on or after 1 September 1994 and before 30 September 1999, and:
(i) enters Australia as holder of a Spouse (Provisional) (Class UF) visa. before 1 July 2002; and
(ii) remains an applicant for a Spouse (Migrant) (Class BC) visa;
(d) the person has applied for an Interdependency (Provisional) (Class UG) visa and Interdependency (Migrant) (Class BI) visa on or after 1 September 1994 and before 310 September 1999, and:
(i) enters Australia as holder of an Interdependency (Provisional) (Class UG) visa, before 1 July 2002. and
(ii) remains an applicant for an Interdependency (Migrant) (Class BI) visa;
(e) the person has applied for a Resolution of Status (Temporary) (Class UH) visa and Resolution of Status (Residence) (Class BL) visa before J30 September 1999; and:
(i) enters Australia as holder of a Resolution of Status (Temporary) (Class UH) visa, before 1 July 2002 or, being in Australia, is granted a visa of that class before that date; and
(ii) remains an applicant for a Resolution of Status (Residence) (Class BL) visa;
the person:
(i) before 1 July 2002, is granted a transitional (temporary) visa because he or she has applied, under the Migration (1993) Regulations, for a Class 820 (Extended Eligibility (Spouse)) visa or entry permit; and
(ii) is an applicant for a transitional (permanent) visa because he or she is an applicant, under those Regulations, for a Class 801 (Spouse (After Entry)) entry permit;
(g) the person:
(i) before 1 July 2002, is granted, under the Migration (1993) Regulations, a Class 820 (Extended Eligibility (Spouse)) visa or entry permit that continues in effect, under the Migration Reform (Transitional Provisions) Regulations, as a transitional (temporary) visa; and
(ii) is an applicant for a transitional (permanent) visa because he or she is an applicant, under the Migration (1993) Regulations, for a Class 801 (Spouse (After Entry)) entry permit;
(h) the person:
(i) before 1 July 2002, is granted a transitional (temporary) visa because he or she has applied, under the Migration (1993) Regulations, for a Class 826 (Extended Eligibility (Interdependency)) visa or entry permit; and
(ii) is an applicant for a transitional (permanent) visa because he or she is an applicant, under those Regulations, for a Class 814 (Interdependency (Permanent)) entry permit;
(i) the person:
(i) before 1 July 2002, is granted, under the Migration (1993) Regulations, a Class 826 (Extended Eligibility (Interdependency)) visa or entry permit that continues in effect, under the Migration Reform (Transitional Provisions) Regulations, as a transitional (temporary) visa; and
(ii) is an applicant for a transitional (permanent) visa because he or she is an applicant, under the Migration (1993) Regulations, for a Class 814 (Interdependency (Permanent)) entry permit;
the person:
(i) before 1 July 2002, is granted a transitional (temporary) visa because he or she has applied, under the Migration (1989) Regulations, for an extended eligibility (spouse) entry permit or visa; and
(ii) is an applicant for a transitional (permanent) visa because he or she is an applicant, under those Regulations, for a spouse (after entry) entry permit;
(k) the person:
(i) before 1 July 2002, is granted, under the Migration (1989) Regulations, an extended eligibility (spouse) entry permit or visa that continues in effect, under the Migration Reform (Transitional Provisions) Regulations, as a transitional (temporary) visa; and
(ii) is an applicant for a transitional (permanent) visa because he or she is an applicant, under the Migration (1993) Regulations, for a spouse (after entry) entry permit;
(1) the person:
(i) before 1 July 2002, is granted a transitional (temporary) visa because he or she has applied, under the Migration (1989) Regulations, for an extended eligibility (interdependency) entry permit or visa; and
(ii) is an applicant for a transitional (permanent) visa because he or she is an applicant, under those Regulations, for an interdependency (permanent) entry permit;
(m) the person:
(iii) before 1 July 2002, is granted, under the Migration (1989) Regulations, an extended eligibility (interdependency) entry permit or visa that continues in effect, under the Migration Reform (Transitional Provisions) Regulations, as a transitional (temporary) visa; and
(iv) is an applicant for a transitional (permanent) visa because he or she is an applicant, under the Migration (1989) Regulations, for an interdependency (permanent) entry permit.