{"id":"F2023L01272","name":"Private Health Insurance (Complaints Levy) Rules 2023","slug":"private-health-insurance-complaints-levy-rules-2023","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":442096,"registerId":"F2023L01272-fast-fetch-1775957195827","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Private Health Insurance (Complaints Levy) Rules 2023","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![Commonwealth Coat of Arms of Australia](image.001.jpeg)\n\n \n\nPrivate Health Insurance (Complaints Levy) Rules 2023\n\nI, MARK BUTLER, Minister for Health and Aged Care, make the following Rules under section 8 of the Private Health Insurance (Complaints Levy) Act 1995.\n\nDated 4 September 2023   \n\nMark Butler\n\nMinister for Health and Aged Care\n\n \n\n \n\n \n\nContents\n\n1  Name\n\n2  Commencement\n\n3  Authority\n\n4  Definitions\n\n5  Schedules\n\n6  Census day\n\n7  Complaints levy day\n\n8  Rate of levy for a single policy\n\n9  Rate of levy for a joint policy\n\nSchedule 1—Repeals\n\nPrivate Health Insurance (Complaints Levy) Rules 2022\n\n \n\n1  Name\n\n  This instrument is the Private Health Insurance (Complaints Levy) Rules 2023.\n\n2  Commencement\n\n  (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provisions Commencement Date/Details\n- 1. The whole of this instrument The day after this instrument is registered.\n\n\nNote: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.\n\n3  Authority\n\n  This instrument is made under section 8 of the Private Health Insurance (Complaints Levy) Act 1995.\n\n4  Definitions\n\n (1) In this instrument:\n\nAct means the Private Health Insurance (Complaints Levy) Act 1995.\n\ncensus day means the day specified in rule 6.\n\ncomplaints levy day means the day or days specified in rule 7.\n\njoint policy means a policy under which two or more persons are insured.\n\npolicy means a complying health insurance policy as defined in section 63-10 of the Private Health Insurance Act 2007.\n\nsingle policy means a policy under which only one person is insured.\n\ntotal number of single policies means the number of single policies on issue from all private health insurers on the census day.\n\ntotal number of joint policies means the number of joint policies on issue from all private health insurers on the census day.\n\nNote: The number of single policies and joint policies on issue from private health insurers used is taken from data held by the Australian Prudential Regulation Authority.\n\n (2) Other expressions used in this instrument have the same meanings in this instrument as in the Private Health Insurance Act 2007.\n\n5  Schedules\n\n  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.\n\n6  Census day\n\n  For the purposes of subparagraph 6(2)(a)(i) of the Act, the census day is the   30 June last occurring before the day on which the levy is payable.\n\nNote 1: The rate of levy is based on the number of complying health insurance policies on issue from a private health insurer on the census day.\n\nNote 2: The Private Health Insurance (Levy Administration) Rules 2015 specify the payment day.\n\n7  Complaints levy day\n\n  For the purposes of paragraph 5(1)(a) of the Act, the complaints levy day is   1 October each year.\n\nNote: The complaints levy day is the day the complaints levy is imposed on the conduct of health insurance business by private health insurers. The complaints levy day is an imposition day for section 307-1 of the Private Health Insurance Act 2007.\n\n8  Rate of levy for a single policy\n\n (1) For the purposes of item 1 of the table in subsection 6(1) of the Act, the rate of complaints levy for each single policy on issue from a private health insurer on the census day is the rate calculated using the formula:\n\n| $ 2,964,000.00 |\n| --- |\n| total number of single policies + (2 x total number of joint policies) |\n\n\n (2) If the rate of levy calculated under subrule (1) for a single policy on issue from an insurer is more than $0.50, the rate for a single policy is $0.50.\n\n9  Rate of levy for a joint policy\n\n (1) For the purposes of item 1 of the table in subsection 6(1) of the Act, the rate of complaints levy for each joint policy on issue from a private health insurer on the census day is the rate calculated using the formula:\n\n- 2 x $ 2,964,000.00\n- total number of single policies + (2 x total number of joint policies)\n\n\n (2) If the rate of levy calculated under subrule (1) for a joint policy on issue from an insurer is more than $1.00, the rate for the policy is $1.00.\n\n \n\n\n\n\nSchedule 1—Repeals\n\nPrivate Health Insurance (Complaints Levy) Rules 2022\n\n1  The whole of the instrument\n\nRepeal the instrument.\n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":2,"scope_assessment":{"changed":false,"description":"The legislation maintains its original narrow purpose: setting the annual dollar amount and calculation method for the complaints levy. The 2023 version updates the total levy pool to $2,964,000 (presumably adjusted from previous years) but does not expand beyond the original scope of funding the Ombudsman through insurer contributions."},"complexity_factors":["Short instrument: only 9 substantive rules plus a repeal schedule","Minimal defined terms: only 8 definitions in rule 4, mostly straightforward (single policy, joint policy, census day, etc.)","Simple mathematical formula: basic division with a cap (maximum $0.50/$1.00)","Single cross-reference: only refers back to the parent Act (Private Health Insurance (Complaints Levy) Act 1995) and the Private Health Insurance Act 2007 for definitions","No nested exceptions or conditional logic beyond the simple cap provisions in rules 8(2) and 9(2)","Annual sunsetting mechanism: this is a 2023 instrument that repeals the 2022 version, suggesting a pattern of yearly remaking with updated dollar amounts"],"plain_english_summary":"This instrument requires private health insurers to pay an annual levy (due 1 Oct) to fund the Private Health Insurance Ombudsman, using policy counts as at 30 June. The industry must raise $2,964,000 each year, apportioned by insurers’ market share: a per‑person “single” rate (joint policies count as two) capped at $0.50 per single and $1.00 per joint policy. It secures stable, proportionate funding for consumer dispute resolution without using general taxation."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"This instrument repeals the Private Health Insurance (Complaints Levy) Rules 2022 (Schedule 1) and restates the operational mechanics: it specifies census day (rule 6), levy day (rule 7), per-policy levy formulas and caps (rules 8–9) and relies on APRA policy counts (rule 4 note). It does not amend the underlying Act; it replaces prior operational detail rather than expanding the statutory scope."},"complexity_factors":["Simple numerical formulas determine per-policy levies (rules 8–9).","Use of aggregated APRA policy counts to allocate the pool requires external data (rule 4 note; rule 6).","Fixed per-policy caps limit exposure but require enforcement and rounding rules (rules 8(2), 9(2)).","Timing dependencies: census day (rule 6) and complaints levy day/payment timing (rule 7; note referencing Levy Administration Rules 2015).","Repeals prior instrument and replaces operational details (Schedule 1), so administrators must transition to new rules."],"plain_english_summary":"These Rules set how the annual Private Health Insurance complaints levy is calculated and when it is imposed. They fix the census day (30 June) and levy day (1 October), provide formulas that spread a $2,964,000 pool across single and joint policies using APRA policy counts, and cap charges at $0.50 (single) and $1.00 (joint). The payer is the private health insurer; the instrument repeals the 2022 Rules and replaces operational details for levying complaints funding."},"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"}},"importantCases":[],"_links":{"self":"/api/acts/private-health-insurance-complaints-levy-rules-2023","history":"/api/acts/private-health-insurance-complaints-levy-rules-2023/history","analysis":"/api/acts/private-health-insurance-complaints-levy-rules-2023/analysis","conflicts":"/api/acts/private-health-insurance-complaints-levy-rules-2023/conflicts","importantCases":"/api/acts/private-health-insurance-complaints-levy-rules-2023/important-cases","documents":"/api/acts/private-health-insurance-complaints-levy-rules-2023/documents"}}