{"id":"F2017L00670","name":"Private Health Insurance (Registration) Rules 2017(No 2)","slug":"private-health-insurance-registration-rules-2017-no-2","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":439207,"registerId":"F2017L00670-fast-fetch-1775955317155","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Private Health Insurance (Registration) Rules 2017(No 2)","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\nmeta-generator: Aspose.Words for .NET 20.2\nmeta-keywords: \"[SEC=UNCLASSIFIED]\"\ntitle: Private Health Insurance (Registration) Rules 2017 (No 2)\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![](image.001.png)\n\nPrivate Health Insurance (Registration) Rules 2017 (No 2)\n\nI, Pat Brennan, a delegate of APRA, under subsection 174(1) of the Private Health Insurance (Prudential Supervision) Act 2015 REVOKE Private Health Insurance (Registration) Rules 2017 and MAKE the  Private Health Insurance (Registration) Rules 2017 (No 2).\n\n \n\nThese Rules commence on the day after registration on the Federal Register of Legislation.\n\n \n\nDated: 13 June 2017 \n\n \n\n \n\n[Signed]\n\n \n\n \n\n \n\nPat Brennan\n\n \n\nContents\n\n[1. Name of Rules](#_Toc458155480)\n\n[2. Revocation](#_Toc458155481)\n\n[3. Commencement](#_Toc458155482)\n\n[4. Application](#_Toc458155483)\n\n[5. Definitions](#_Toc458155484)\n\n[6. Criteria for registration](#_Toc458155485)\n\n[7. Description of groups who can be offered insurance products by restricted access insurers](#_Toc458155486)\n\n[8. Limits on insurance provided by restricted access insurers](#_Toc458155487)\n\n[9. Transition arrangements](#_Toc458155488)\n\n## 1.             Name of Rules\n\nThese Rules are the Private Health Insurance (Registration) Rules 2017(No 2).\n\n## 2.             Revocation\n\nThese Rules replace the Private Health Insurance (Registration) Rules 2017.\n\n## 3.             Commencement\n\nThese Rules commence on the day after registration on the Federal Register of Legislation.\n\n## 4.             Application\n\nThese Rules apply to restricted access insurers and companies seeking registration as private health insurers under Division 3 of Part 2 of the Act.\n\n## 5.             Definitions\n\nNote: Terms used in these Rules have the same meaning as in the Act – see section 13 of the Legislative Instruments Act 2003. These terms are:\n\nAPRA  Chief Executive Officer\n\ncomplying health insurance policy\n\nhealth benefits fund\n\nimproper discrimination  private health insurer\n\nrestricted access insurer\n\n \n\nIn these Rules:\n\nAct means the Private Health Insurance (Prudential Supervision) Act 2015.\n\nPHI Act means the Private Health Insurance Act 2007.\n\nPHIAC means the Private Health Insurance Administration Council.\n\nPrincipal Insureds means the persons described in paragraphs 7 (a) to 7 (e) of these Rules.\n\nSecretary of the Department has the same meaning as in the PHI Act.\n\n## 6.             Criteria for registration\n\nThe following criteria apply under section 14 of the Act to the registration of bodies as private health insurers:\n\n(a)          APRA must be satisfied that the applicant will be able to comply with the obligations imposed by or under the Act, the PHI Act and the Financial Sector (Collection of Data) Act 2001 on private health insurers[[1]](#_ftn1);\n\n(b)          APRA must be satisfied that the applicant has notified APRA of the name and contact details of its Chief Executive Officer;\n\n(c)          APRA must be satisfied that the private health insurer satisfies the conditions in subsection 12(1) of the Act;\n\n(d)          APRA must be satisfied that the application meets the requirements of subsection 12(2) of the Act;\n\n(e)          APRA must be satisfied that the rules of the applicant do not permit improper discrimination in relation to the applicant’s complying health insurance policies[[2]](#_ftn2);\n\n(f)           in relation to the health benefits fund, or each of the health benefits funds, proposed to be conducted by the applicant, APRA must be satisfied that the application includes the ratio that the likely amount of management and administrative expenses in respect of the conduct of the fund or funds bears to the likely amount of premiums to be obtained by the private health insurer in respect of each fund; and\n\n(g)          in relation to the health benefits fund, or each of the health benefits funds, proposed to be conducted by the applicant, APRA must be satisfied that the application includes the number of persons who will contribute, or are likely to contribute, to any of the funds proposed to be conducted by the applicant and the proposed premiums to be charged these persons.\n\n## 7.             Description of groups who can be offered insurance products by restricted access insurers\n\nFor the purposes of paragraph 15(4)(e) of the Act a restricted access group to whom a restricted access insurer may make its complying health insurance products available may comprise any or all of the following:\n\n(a)          persons who belong to a group of persons based on whether they are or were a member of one or more groups specified in paragraph (a), (b), (c) or (d) of subsection 15(4) of the Act and/or one or more other groups;\n\n(b)          persons who were already insured with the restricted access insurer immediately before the commencement of these Rules;\n\n(c)          persons who are, or become, officers or employees (including contractors) of the restricted access insurer;\n\n(d)          an employee of a contractor who is, or was, involved in supplying goods or services to the employer referred to in subsection 15(4) of the Act;\n\n(e)          an employee of a franchisee of a subsidiary company of the employer referred to in subsection 15(4) of the Act;\n\n(f)           the former partners and adult children of Principal Insureds of the restricted access insurer;\n\n(g)          the siblings, grandchildren and parents of Principal Insureds of the restricted access insurer;\n\n(h)          the partners and dependent children of persons who are the adult children of Principal Insureds of the restricted access insurer; and\n\n(i)            the partners and dependent children of persons who are the siblings or grandchildren of Principal Insureds of the restricted access insurer.\n\nNotes:\n\nThe purpose of Rule 7 is to ensure that, on and from the commencement of these Rules, restricted access insurers are able to make complying health insurance products available to limited classes of persons who might not otherwise form part of a restricted access group for the purposes of subsection 15(4) of the Act.\n\nThe partners and dependent children of principal insureds who belong to a particular restricted access group are also taken to belong to that group – see subsection 15(4) of the Act.\n\n## 8.             Limits on insurance provided by restricted access insurers\n\nFor the avoidance of doubt, this Rule confirms that:\n\n(a)          a restricted access insurer’s constitution or rules may only specify one restricted access group to whom the insurer’s complying health insurance products are, or will be, available;\n\n(b)          a restricted access insurer may not add new persons to this restricted access group in addition to the persons included in that group by the operation of the Act and these Rules; and\n\n(c)          paragraphs 7 (f), (g), (h) and (i) of these Rules modify the operation of subsection 15(4) of the Act in relation to the partners, siblings, parents, children and grandchildren of people who belong to a restricted access group.\n\n## 9.             Transition arrangements\n\nAny approval, determination or other exercise of discretion by APRA under Private Health Insurance (Registration) Rules 2017 or the Private Health Insurance (Registration) Rules 2015 or by PHIAC under Private Health Insurance (Registration) Rules 2009 (No. 2) will continue to have effect as though exercised pursuant to a corresponding power under these Rules.\n\n---\n\n\n[[1]](#_ftnref1)  In assessing this criterion, APRA will consult with the Secretary of the Department.\n\n[[2]](#_ftnref2)  In assessing this criterion, APRA will consult with the Secretary of the Department.\n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":4,"scope_assessment":{"changed":true,"description":"These Rules expressly revoke and replace the earlier 2017 Rules (s2) and modify the scope of who may be covered by restricted access insurers by adding specified family-, employee- and contractor-related categories (s7), while simultaneously clarifying and limiting insurers to a single restricted access group and barring further additions (s8)."},"complexity_factors":["Cross-references to multiple statutes (Private Health Insurance (Prudential Supervision) Act 2015, Private Health Insurance Act 2007, Financial Sector (Collection of Data) Act 2001) increasing legal interdependence (s5, s6(a)).","APRA’s evaluative discretion to be ‘satisfied’ on multiple criteria, creating case-by-case administrative decision-making (s6(a)–(g)).","Quantitative application requirements: applicants must provide projected management/administration expense-to-premium ratios and likely numbers of contributors, which requires financial forecasting and judgment (s6(f)–(g)).","Definitions and expanded eligibility classes for restricted access groups introduce relationship-based membership rules (family, employees, contractors, franchise arrangements) that require factual assessment of ties (s7).","Restrictive limits on group composition (single restricted access group and prohibition on adding persons) require insurers to align constitutional rules and membership practices with the instrument (s8(a)–(b)).","Consultation points with the Department Secretary referenced in assessment of discrimination and compliance create inter-agency input into registration decisions (footnotes to s6 and s6(e)).","Transition clause preserving prior approvals requires mapping earlier administrative decisions onto the new instrument (s9)."],"plain_english_summary":"These Rules revoke earlier registration rules and set the criteria APRA will apply when registering private health insurers, requiring evidence of compliance capacity, CEO contact details, statutory conditions, and projected expense-to-premium ratios and likely numbers of contributors (s2, s6). They also specify who restricted access insurers may insure — adding certain family, employee and contractor-related categories — while limiting each restricted access insurer to a single named restricted access group and preventing additional enrolments beyond the listed classes (ss7–8)."},"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"},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"The legislation remains focused on its original purpose: setting registration criteria for private health insurers and defining the permissible scope of restricted access insurers. The expansion of family member eligibility in Rule 7 is a modest evolution within the existing framework rather than a significant scope creep. The Rules do not extend into unrelated policy areas."},"complexity_factors":["Multiple layers of cross-referencing: Rules modify subsection 15(4) of the Private Health Insurance (Prudential Supervision) Act 2015, which itself references other groups in paragraphs (a)-(d)","Complex family relationship definitions spanning paragraphs 7(f)-(i): includes 'former partners', 'adult children', 'siblings', 'grandchildren', 'dependent children', and partners of those categories, creating nested eligibility criteria","Interaction between three separate Acts: the 2015 Prudential Supervision Act, the 2007 Private Health Insurance Act, and the Financial Sector (Collection of Data) Act 2001","Defined terms rely on external legislation (section 13 of the Legislative Instruments Act 2003 for statutory interpretation)","Transition arrangements reference three previous versions of the Rules (2017, 2015, and 2009 No. 2), requiring historical knowledge to interpret current permissions","Conditional logic in Rule 8 creates prohibitions on top of the permissive framework in Rule 7 — insurers 'may' do certain things but 'may not' do others"],"plain_english_summary":"These Rules set APRA’s criteria for registering private health insurers, with special rules for “restricted access insurers” — niche funds limited to a single closed membership group. They modestly expand who such insurers may cover (existing customers, insurer staff/contractors, extended family of principal insureds, and employees of linked contractors/franchisees), preserve the one-group limit, and validate prior approvals.\n\nIt affects applicants, existing restricted insurers, and prospective members by clarifying approval standards and giving limited flexibility so specialised funds remain viable."}},"importantCases":[],"_links":{"self":"/api/acts/private-health-insurance-registration-rules-2017-no-2","history":"/api/acts/private-health-insurance-registration-rules-2017-no-2/history","analysis":"/api/acts/private-health-insurance-registration-rules-2017-no-2/analysis","conflicts":"/api/acts/private-health-insurance-registration-rules-2017-no-2/conflicts","importantCases":"/api/acts/private-health-insurance-registration-rules-2017-no-2/important-cases","documents":"/api/acts/private-health-insurance-registration-rules-2017-no-2/documents"}}