{"id":"C2004A04893","name":"Private Health Insurance (Complaints Levy) Act 1995","slug":"private-health-insurance-complaints-levy-act-1995","collection":"act","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":"40 of 1995","makingDate":null,"administeringDepartment":null,"currentVersion":{"id":38801,"registerId":"commonwealth-C2004A04893-current","compilationNumber":null,"startDate":"2026-04-01","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Short title [see Note 1]","content":"#### 1 Short title \\[see Note 1\\]\n\n This Act may be cited as the Private Health Insurance (Complaints Levy) Act 1995.","sortOrder":0},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"#### 2 Commencement\n\n This Act commences on 1 July 1995.","sortOrder":1},{"sectionNumber":"3","sectionType":"section","heading":"Interpretation","content":"#### 3 Interpretation\n\n (1) In this Act:\n\n> complaints levy day means the day specified as the complaints levy day in Private Health Insurance (Complaints Levy) Rules made for the purposes of subsection 5(2).\n\n> health insurance business has the same meaning as in the Private Health Insurance Act 2007.\n\n> quarter means a period of 3 months commencing on 1 January, 1 April, 1 July or 1 October in any year.\n\n> supplementary complaints levy day means a supplementary complaints levy day specified in a determination by the Minister under section 5.\n\n (2) Other expressions used in this Act have the same meanings in this Act as in the Private Health Insurance Act 2007.","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Act binds the Crown","content":"#### 4 Act binds the Crown\n\n This Act binds the Crown in each of its capacities.","sortOrder":3},{"sectionNumber":"5","sectionType":"section","heading":"Imposition of levy","content":"#### 5 Imposition of levy\n\n (1) Levy is imposed on the conduct of health insurance business by private health insurers:\n (a) on each day specified in the Private Health Insurance (Complaints Levy) Rules as a complaints levy day for a financial year; and\n (b) on each day (if any) determined by the Minister, by legislative instrument, as a supplementary complaints levy day for a financial year.\n (2) The Private Health Insurance (Complaints Levy) Rules must not specify more than 4 complaints levy days for a financial year.\n (3) The determination by the Minister must not specify more than 2 supplementary complaints levy days for a financial year.","sortOrder":4},{"sectionNumber":"6","sectionType":"section","heading":"Rate of levy","content":"#### 6 Rate of levy\n\n (1) The rate of complaints levy imposed on a particular day is worked out using the following table:\n\n```html\n

Rate of complaints levy

Item

The rate of levy imposed on a …

is the rate that …

1

complaints levy day

(a) is specified in the Private Health Insurance (Complaints Levy) Rules; and

(b) applies on that day.

2

supplementary complaints levy day

(a) is determined by the Minister by legislative instrument; and

(b) applies on that day.

\n```\n\n (2) The rate of levy:\n (a) must be based on the number of complying health insurance policies on issue on:\n (i) for levy imposed on a complaints levy day—the day specified in the Private Health Insurance (Complaints Levy) Rules as the census day for the levy day; and\n (ii) for levy imposed on a supplementary complaints levy day—the day determined by the Minister, by legislative instrument, as the census day for the levy day; and\n (b) may be different for complying health insurance policies under which different numbers of people are insured; and\n (c) may be set at zero; and\n (d) must not exceed:\n (i) in respect of complying health insurance policies under which only one person is insured—50 cents a quarter; and\n (ii) otherwise—$1 a quarter.","sortOrder":5},{"sectionNumber":"7","sectionType":"section","heading":"By whom is levy payable?","content":"#### 7 By whom is levy payable?\n\n Levy is payable by each private health insurer conducting health insurance business.","sortOrder":6},{"sectionNumber":"8","sectionType":"section","heading":"Private Health Insurance (Complaints Levy) Rules","content":"#### 8 Private Health Insurance (Complaints Levy) Rules\n\n The Minister may, by legislative instrument, make Private Health Insurance (Complaints Levy) Rules providing for matters:\n (a) required or permitted by this Act to be provided; or\n (b) necessary or convenient to be provided in order to carry out or give effect to this Act.","sortOrder":7},{"sectionNumber":"9","sectionType":"section","heading":"Regulations","content":"#### 9 Regulations\n\n The Governor‑General may make regulations prescribing matters required or permitted by this Act to be prescribed.","sortOrder":8}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"The legislation remains tightly focused on its original purpose: imposing a levy on private health insurers to fund the complaints resolution scheme. The 2007 reference update (from earlier legislation) was a technical consolidation, not an expansion of scope."},"complexity_factors":["Only 4 defined terms in the interpretation section (complaints levy day, health insurance business, quarter, supplementary complaints levy day)","Simple two-tier rate structure with clear caps (50c/$1)","Minimal cross-referencing — only refers to the Private Health Insurance Act 2007 for definitions","Straightforward procedural mechanism: Rules set the days and rates, Minister can add supplementary days","No nested exceptions or conditional logic beyond the basic distinction between regular and supplementary levy days","Short length (9 sections) with clear, sequential structure"],"plain_english_summary":"This law creates a **complaints levy** — essentially a tax — that private health insurers must pay to fund the operation of the Private Health Insurance Ombudsman (the government body that handles complaints about health insurance).\n\n**Who it affects:**\n- **Private health insurers** (companies like Bupa, Medibank, etc.) — they must pay the levy\n- **Health insurance customers** — indirectly, since insurers may pass costs through to premiums\n\n**How it works:**\n- The levy is charged on specific days each financial year called \"complaints levy days\" (up to 4 per year) and optionally on up to 2 extra \"supplementary complaints levy days\" if the Minister decides\n- The amount is calculated based on how many health insurance policies the insurer has on a particular \"census day\" — roughly, how many customers they have\n- The rate varies depending on policy type:\n - **Single policies:** maximum 50 cents per quarter\n - **Family/couples policies:** maximum $1 per quarter\n - The rate can be set to zero if no funding is needed\n\n**Why it matters:**\nThis ensures the complaints handling system for private health insurance is **industry-funded** rather than coming from general taxpayer revenue. It creates a direct link between the industry being regulated and the cost of resolving disputes about that industry."},"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":false,"description":"The text establishes a levy framework on private health insurers; it does not itself expand or narrow the statutory definition of health insurance business. No amendments or scope-expanding provisions are included in the Act text supplied."},"complexity_factors":["Multiple timing mechanisms: up to 4 complaints levy days set by Rules and up to 2 supplementary days set by Ministerial determination (s5(1)–(3)).","Rate computation tied to a census day for each levy day, requiring insurers to report counts on specific dates (s6(2)(a)).","Differentiated rates allowed by policy size (single-person vs multi-person) and an ability to set rate to zero, plus statutory caps (s6(2)(b)–(d)).","Delegated law and discretion: Rule-making power for detailed implementation (s8) and Ministerial legislative-instrument determinations for supplementary days and census days (s5(1)(b), s6(2)(a)).","Cross-reference to external statute for key definitions (health insurance business and other terms drawn from the Private Health Insurance Act 2007) increases interpretive linkage (s3(1)–(2)).","Universal payer and binding Crown status means all insurers (and the Crown) must comply, concentrating compliance burden on regulated entities (s4, s7).","Low textual volume but operational complexity: short Act delegates many operational details to Rules/instruments, creating administrative implementation risk and reliance on subordinate instruments (s8, s9)."],"plain_english_summary":"This Act imposes a complaints levy on private health insurers. Rules and the Minister set up to four scheduled levy days (plus up to two supplementary days). Rates are calculated per complying policy using a census day, may vary by how many people a policy covers, can be set to zero, and are capped at 50¢ (single-person) or $1 (other) per quarter.\n\nAll private health insurers pay; the measure creates administrative tasks to count policies and comply with rule and ministerial determinations."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"issue_detection":{"absurdities":[{"type":"circular_definition","section":"3 (definition of 'complaints levy day') and 8","severity":"high","reasoning":"Section 5(1)(a) imposes levy on complaints levy days, which depend on Rules being made under section 8. Section 8 says the Minister 'may' make Rules. If the Minister never exercises this discretion, levy is never imposed on complaints levy days. The entire primary levy-imposition mechanism is therefore contingent on a discretionary power, creating a structural absurdity where the Act imposes a levy that may never practically arise.","confidence":0.82,"description":"Circular definition: 'complaints levy day' is defined as the day specified in Rules made for the purposes of subsection 5(2), but subsection 5(2) merely limits the number of days that can be specified in those Rules. The Rules themselves are not mandated to be made — they are merely permissive under section 8. If no Rules are ever made, the core operative mechanism of the Act (levy imposition) cannot function, yet there is no obligation on the Minister to make them."},{"type":"other","section":"6(2)(d)","severity":"medium","reasoning":"A financial year has 4 quarters. With up to 4 complaints levy days plus 2 supplementary days, multiple levy days could fall within a single quarter. If the cap is per levy day, multiple impositions in one quarter could cumulatively exceed the 'per quarter' cap. If the cap is per quarter in aggregate, there is no mechanism in the Act to enforce or calculate this. The mismatch between the 'per day' imposition mechanism and the 'per quarter' rate ceiling is logically unresolved.","confidence":0.75,"description":"The levy rate cap is expressed 'a quarter' (50 cents or $1 per quarter), but levy is imposed on specific days (up to 4 complaints levy days and 2 supplementary days per financial year — potentially 6 days). There is no mechanism connecting the per-quarter cap to the per-day levy, creating ambiguity about whether the cap applies per levy day, per quarter (regardless of how many levy days fall in that quarter), or in aggregate across the year."},{"type":"other","section":"5(1) and 5(2)","severity":"low","reasoning":"The Act imposes a ceiling of 4 days but no floor. Specifying zero days is technically compliant. The Act would then impose no levy, defeating its own purpose. This is logically absurd though administratively possible.","confidence":0.7,"description":"Section 5(2) restricts the Rules to specifying 'not more than 4 complaints levy days for a financial year', but section 5(1)(a) imposes levy 'on each day specified... as a complaints levy day for a financial year' without any floor requirement. Combined with the permissive nature of section 8, zero levy days can be specified, meaning levy may be imposed on no days at all — rendering the Act inoperative without any breach of its terms."},{"type":"retroactive_impossibility","section":"2 and 3 (definition of 'health insurance business')","severity":"medium","reasoning":"At commencement in 1995, 'health insurance business' and other expressions in subsection 3(2) were defined by reference to a 2007 Act. The 1995 Act must have originally referenced predecessor legislation (e.g., the National Health Act 1953 or the Private Health Insurance Incentives Act 1997). The current form of the Act creates an apparent retroactive impossibility — it purports to have commenced with definitions sourced from legislation enacted 12 years later. This reflects legislative amendment history but as presented is logically incoherent.","confidence":0.85,"description":"The Act commenced on 1 July 1995 but incorporates definitions by reference to the Private Health Insurance Act 2007, which did not exist at commencement. The Act therefore commenced with definitions it could not legally incorporate, creating a 12-year definitional gap."}],"contradictions":[{"severity":"low","section_a":"5(1)(b) and 5(3)","section_b":"3 (definition of 'supplementary complaints levy day')","confidence":0.6,"description":"Section 5(1)(b) refers to days 'determined by the Minister, by legislative instrument' while section 5(3) refers to 'the determination by the Minister'. However, the definition of 'supplementary complaints levy day' in section 3 says it means a day 'specified in a determination by the Minister under section 5', without specifying it must be a legislative instrument. Section 6(2)(a)(ii) and table item 2 in section 6(1) both confirm it must be a legislative instrument. The definition in section 3 is therefore narrower than the operative provisions, creating a minor inconsistency in the characterisation of the Minister's determination."},{"severity":"medium","section_a":"6(2)(a)(i)","section_b":"6(2)(a)(ii)","confidence":0.72,"description":"For complaints levy days, the census day is specified in the Private Health Insurance (Complaints Levy) Rules (a legislative instrument made by the Minister under section 8). For supplementary complaints levy days, the census day is determined by the Minister by legislative instrument under section 5. There is no requirement that the census day precede the levy day in either case. A census day specified after the levy day would make compliance retroactively impossible, as insurers could not know the number of policies on issue on a future census day at the time levy is imposed."},{"severity":"medium","section_a":"8","section_b":"9","confidence":0.68,"description":"Section 8 empowers the Minister to make Rules by legislative instrument covering matters 'required or permitted by this Act to be provided'. Section 9 separately empowers the Governor-General to make regulations for matters 'required or permitted by this Act to be prescribed'. The Act does not clearly delineate which matters fall within each power, and the broad general terms of both provisions create overlapping jurisdiction. Both powers could potentially cover the same subject matter, leading to potential conflicts between Rules and Regulations with no hierarchy of precedence established within the Act."}]},"summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"The Act originally commenced in 1995 and has been amended to reference the Private Health Insurance Act 2007 (replacing earlier legislation), reflecting a broader legislative overhaul of the private health insurance framework. The introduction of 'supplementary complaints levy days' via ministerial determination also added flexibility beyond the original fixed levy day structure, slightly expanding the Minister's discretionary power compared to what a purely rules-based approach would suggest was the original intent."},"complexity_factors":["Cross-references to another Act (Private Health Insurance Act 2007) for key definitions, requiring readers to consult multiple documents","Multiple levy day types (standard and supplementary) with different rate-setting mechanisms","Rate calculation tied to a 'census day' concept that itself requires consulting subordinate rules or ministerial determinations","Layered regulatory structure: the Act itself sets caps, but actual rates and days are set in separate Rules and ministerial instruments","HTML table in the source text adds minor presentation complexity"],"plain_english_summary":"This law makes private health insurers pay a small, industry-funded levy to support the independent complaints-handling system for private health insurance. Insurers are charged on specified “levy days” (up to four per year, plus up to two supplementary days) based on the number and type of policies they hold, with rates capped at 50¢ per quarter for single policies and $1 per quarter for family/multi-person policies. It shifts complaint-system funding to insurers rather than taxpayers, protecting consumers’ access to independent review."}},"importantCases":[],"_links":{"self":"/api/acts/private-health-insurance-complaints-levy-act-1995","history":"/api/acts/private-health-insurance-complaints-levy-act-1995/history","analysis":"/api/acts/private-health-insurance-complaints-levy-act-1995/analysis","conflicts":"/api/acts/private-health-insurance-complaints-levy-act-1995/conflicts","importantCases":"/api/acts/private-health-insurance-complaints-levy-act-1995/important-cases","documents":"/api/acts/private-health-insurance-complaints-levy-act-1995/documents"}}