THE FACTS
3 The applicant's evidentiary case commences on 4 November 1954, when, at a meeting of the Navy Central Canteen Fund Committee, it was resolved to recommend that a Naval Health Benefits Society be formed and that the Central Canteen Fund make a grant of Ł15,000 to that Society. On 4 January 1955 a memorandum over the hand of T J Hawkins, "Secretary" (possibly of the Department of the Navy) to the Assistant Secretary, Department of the Treasury, referred to the proposal for the formation of a Naval Health Benefits Society. Paragraphs 2 and 3 of that memorandum were as follows:
Serving personnel are entitled to receive medical, dental and hospital treatment at Departmental expense and are therefore under a disadvantage when joining an outside Health Benefits Society which requires them to pay a contribution which covers themselves as well as their families. They are also subject to frequent transfers from state to state, shore to sea, and to overseas locations and because of this factor, many are deprived from obtaining the benefits receivable by other members of the community, brought about by their difficulty in maintaining continuity of membership of local societies and also the lack of facilities for becoming a member of such a society when serving in certain posts.
It is therefore thought most desirable that an organisation be provided which will ensure that Naval personnel receive in respect of their dependants the benefits applicable to other members of the community, and at the same time allow him a concession in respect of his own non-insurable status. The lower deck committee of the R.A.N. Central Canteen Fund has also considered this matter and has recommended that a substantial grant be made from Canteen Funds to establish the society.
By 15 April 1955, Treasury approval had been received for the formation of a Naval Health Benefits Society. Implementation of the proposal was approved by the Naval Board on 6 May 1955.
4 The Society was duly formed. The objects of the Society were -
(a) to assist members in meeting the cost of
(i) medical, surgical and therapeutic treatment of and attendance on members and their dependants by legally qualified medical practitioners, and the provision of comforts, appliances and requisites arising out of any such treatment; and
(ii) accommodation, maintenance and treatment of members and their dependants as hospital patients; and
(b) to do all such other things as may be considered by the Committee to be necessary or desirable in connexion with all or any of the objects referred to in the last preceding paragraph.
The Society consisted of members, in accordance with the following eligibility provision:
Any person employed in continuous full-time duty -
(a) in the Naval Forces, other than a person without dependants, or
(b) as a civilian in the Department
shall be eligible to become a member.
When a member died, his widow during her widowhood, his children under the age of 16 or any other person approved by the committee as being wholly dependent upon him at the date of his death, were permitted to continue membership. The constitution provided for the establishment of a medical benefits fund and a hospital benefits fund. It provided for the circumstances in which benefits would be paid to members or their dependants. It set out the contributions which members were required to pay. It provided for general meetings of members, and for other matters commonly found in the rules of voluntary associations. If the Society were dissolved, its funds, property and assets remaining after the payment of outstanding claims, debts and liabilities were to be applied "as the Naval Board shall direct". At its formation and, it appears, throughout its life, the Society was a true association of members. Its particular feature, of course, was that the contributions which members made as such went into the fund from which benefits were paid in the case of illness or injury.
5 As appears from the provision defining eligibility for membership, a particular feature of the Society was that a member of the naval forces without dependants was not eligible. This was consistent with one of the originating purposes which led to the foundation of the Society, and to which I have referred above, namely, to provide a scheme which would, for an attractive family contribution rate, provide cover only for dependants. As I have said, serving members of the Navy did not (and still do not) require health insurance for themselves. Another feature of the Society which should be noted is that civilians employed in the Department of the Navy were also eligible for membership. Such persons were not provided with medical and hospital benefits as part of their employment, and were, in that respect, in the same position as members of the community having no connection with the Navy. However, apparently it was thought appropriate to include within the range of persons who would be eligible for membership of the Society the civilian employees of the department. Accordingly, there was a contribution rate for civilian members without dependants (whereas there was, for the reasons I have explained, no such rate for naval members without dependants). The family contribution rate for civilian members was higher than the corresponding rate for naval members.
6 The Society apparently operated as intended for many years. However, in 1972 the Society found itself in circumstances which, according to the evidence, made it "technically insolvent". As a result, it sought a loan of $30,000 from the RAN Central Canteens Board, and that loan was approved on 27 September 1972. On 14 June 1973 the loan was renewed, at which time the board also agreed to guarantee the operation of the Society "until it is overtaken by the National Health Scheme in July, 1974." It seems that the loan was never repaid, and was effectively forgiven, and treated as a donation.
7 In 2000, substantial changes were effected to the National Health Act 1953 (Cth) ("the NH Act"), under which the applicant was registered. These changes were introduced by the Health Legislation Amendment Act (No 3) 1999 (Cth) ("the 1999 Act"). A new s 68 was introduced, which provided that an organisation was not entitled to apply for registration unless -
· it was a company limited by shares, by guarantee or by both shares and guarantee,
· its constitution and rules provided that it was established for the purpose of conducting a health benefits fund and for no other purpose, unless that purpose was incidental to the conduct of that fund; and
· there was to be credited to that fund the whole of the income of the organisation arising out of the carrying on by the organisation of business as a registered health benefits organisation (including any income arising from the investment of money not immediately required for the payment of benefits).
At the same time, s 73AA was introduced into the NH Act, by which an existing unincorporated registered organisation (such as the Society) was required to "arrange for the health insurance business of the organization to be transferred to a company of a kind that would be eligible under section 68 to apply for registration as a health benefits organization".
8 As a result, the applicant was incorporated on 2 May 2000. There is no evidence of the mechanism by which the assets and liabilities of the Society were taken over by the applicant, but, in practical terms, it appears that the applicant thereafter operated in the same way as the Society had done previously.
9 In the years to which the proceeding relates, the applicant was a registered organisation within the meaning of the NH Act. The NH Act prohibited the carrying on of health insurance business save by a registered organisation. An "organisation" was "a society, body or group of persons, whether corporate or unincorporate, which conducts a health benefits fund".
10 The applicant was a "restricted membership organisation" within the meaning of the NH Act, that is -
… an organisation the rules of which restrict eligibility for membership by reference to:
(a) employment or former employment in a profession, trade, industry or calling;
(b) employment or former employment by a particular employer or by an employer included in a particular class of employers;
(c) membership or former membership of a particular profession, professional association or union;
(d) membership or former membership of the Defence Force or of a part of the Defence Force; or
(e) any other prescribed matter;
not being an organisation that has notified the Secretary in writing that it does not wish to be subject to the provisions of this Act relating to restricted membership organisations.
Save in the context of restricted membership organisations, the NH Act did not refer to "membership" of, or to "members" of, an organisation as such. Rather, it referred to membership of, or to membership as a contributor of, a fund. It seems that the concept of "membership" which the definition of "restricted membership organisation" contemplated was not that of membership of the organisation, but rather that of membership of the health benefits fund conducted by such an organisation. As a company limited by guarantee, the applicant did not itself have any such restriction on eligibility for membership as the definition contemplated. As it happened, the applicant had one member only (a matter to which I shall return). What the applicant (in common it seems with other registered organisations) referred to as its "members" were in fact its contributors, ie persons who, by their contributions, paid premiums for health insurance at various levels, or, in other words, the applicant's customers. Save where the context requires otherwise, in these reasons where I refer to "members", I mean members in this sense.
11 Many of the provisions of the NH Act contemplated that a registered organisation would have a "constitution". Many such provisions contemplated also that a registered organisation would have "rules", defined as:
… the body of principles devised by the management of the organisation that relate to the day‑to‑day operation of the health benefits fund conducted by the organization and include principles for determining the rates of contribution for contributors and the benefit entitlements, and the conditions relating to benefit entitlements, for contributors and for their dependants.
The applicant had a constitution, which provided that it was established "for the purpose of conducting a health benefits fund … and for no other purpose". The constitution also provided for the making of rules, in the following terms:
The Directors may from time to time by resolution of the Board make rules and regulations in relation to the Company and its business and to the funds conducted by it not inconsistent with this Constitution and may in like manner annul or vary any rule or regulation and all rules and regulations made for the time being in force will be binding on members and upon members of any of the funds and will have full force and effect accordingly. Without restricting the meaning of the above it is expressly declared that rights and privileges which may be accorded to contributors to the funds conducted by the Company may be dealt with by rule or regulation.
12 Under its constitution, the income and property of the applicant had to be applied solely towards the promotion of its single object, ie conducting a health benefits fund. If the applicant were dissolved, all its funds, property and assets that remained after payment of outstanding claims, debts and liabilities, were to be applied to another organisation or institution with objects similar to that of the applicant, which prohibited the distribution of income and assets to its members, and which was exempt from the payment of income tax. A person might have become a member of the applicant (ie as distinct from a member of the fund) by agreeing to be bound by its constitution, by the Chief of Naval Staff agreeing that he or she may be a member and by the directors admitting the person to membership. (The applicant had one member only: NHBS Company Ltd, which in turn had seven members, namely, the delegate of the Chief of Navy, three approved serving Navy personnel, two non-executive members and a Managing Director (who was also the Managing Director of the applicant)).
13 The management of the applicant was under the control of a board of directors, in the membership of which there were four serving Navy personnel. The Chief of Naval Staff might remove any director. The applicant had a general manager, who was appointed by the board with the approval of the Chief of Naval Staff. There was a Health Benefits Fund, to which had to be credited the whole of the income arising out of the carrying on by the applicant of the business of a registered health benefits organisation. No amount could be debited to that fund other than payments of benefits to contributors or their dependants, costs incurred in the carrying on of a business of a registered health benefits organisation, and other related activities.
14 The applicant's rules confined the classes of persons who could become members to the following:
a. Any person employed on full time duty:
i. in the Navy, Army or Air Force other than a person without dependants, or
Note: A serving Navy, Army or Air Force member is ineligible for benefits whilst a member of the RAN, ARA or RAAF if paying Defence family premiums. They can opt to be a Navy Health member by choosing to pay the Civilian Contribution rates.
Any member transferring from a Defence membership to a Civilian membership, but has not left the Defence forces, will not be able to return to a Defence membership.
A member paying the Defence contribution rates can leave the Defence forces and become a Civilian member. If they rejoin the Defence forced they are eligible to return to a Defence membership which offers a discounted rate to the Civilian membership.
as a civilian/civilian contractor with the Department of Defence, Naval Shore Establishment, Dockyards, other Defence Establishment, employee of the Australian Public Service, or an employee or member of an organisation contracted to supply Navy Health Limited.
shall be eligible to become a Member
b. as a civilian/civilian contractor with the Department of Defence, Naval Shore Establishment, Dockyards, other Defence Establishment, employee of the Australian Public Service, or an employee or member of an organisation contracted to supply Navy Health Limited.
c. A person on full time duty in the Navy, Army or Air Force who is without dependants shall be eligible to become a member from the day after discharge from the RAN, ARA or RAAF
d. An active member of the RANR, ARAR or RAAFR is eligible to become a member.
e. A dependant, shall upon ceasing to be a dependant, be eligible to become a civilian member by paying a contribution specified in the rules.
f. An ex member of the RAN, ARA, RAAF or RANR, ARAR or RAAFR, the Department of Defence or Defence Civilian workforce are eligible to become civilian members by paying the civilian rate of contributions as specified in the Schedule of contributions.
e. Dependants and ex-dependants or serving and ex-serving members are eligible to join.
f. Cadets (RAN, ARA & RAFF), and their immediate family are eligible to join.
g. Any person, who at some stage is eligible to join Navy Health, is able to join at any stage, regardless of wether their eligibility status at the particular time of joining has changed.
h. Other such persons approved by the Board.
There was a certain clumsiness about the drafting of par a. and b. of the provision set out above. It was common ground that par a. made eligible for membership any person employed full-time in the Navy, Army or Air Force, other than a person without dependants. It may seem curious that a person employed directly by the Navy, Army or Air Force who had no dependants was not eligible for membership. This arose from the fact that a serving member of the armed forces was comprehensively covered as part of the conditions of his or her service for medical and hospital treatment in the event of illness or injury and would, therefore, have had no need for privately arranged health insurance. That cover, however, would not have been available in the event of an illness or injury befalling one of the serving member's dependants, such as a member of his or her immediate family. By offering family cover only in such circumstances, the applicant effectively provided cover for the dependants, but not for the serving member. Thus the serving member without dependants was not within the applicant's cohort of potential customers.
15 The rules of the applicant also covered such matters as membership (ie of the fund), contributions, benefits and claims, and contained detailed tables of benefits applicable in particular circumstances. Save in the case of a member whose services had been terminated for misconduct, discreditable service or inefficiency, a member who ceased to be employed on full-time duty in the Navy, Army or Air Force, or in the department, was eligible to continue membership of the fund. Where a member died, his or her dependants might have continued unbroken membership of the fund, and were deemed to be civilian members, but might have, for a period of 12 months after the death of the original member, continued making contributions at the defence rate. Where a dependant of a member had attained the age of 22 years and was no longer dependant, he or she might have continued membership in his or her own right in accordance with the rules. Likewise, where a spouse was no longer a dependant, he or she might have continued membership in his or her own right in accordance with the rules.
16 The applicant's rules permitted the temporary suspension of membership, according to the following provision:
Navy Health at its absolute direction may allow, within a clearly defined limited set of circumstances, for a member to suspend their membership for an agreed period. Where the suspension has been approved in writing by the fund, members will be advised of the conditions relating to waiting periods and pre-existing condition rules which may be applied upon reinstatement of membership. The agreed suspension period is not subject to change without written notification to and written confirmation from Navy Health.
17 The tables of benefits for which the rules provided would not be unfamiliar to any person who has considered the matter of private health insurance. There were many variations of "Top Hospital" cover, some of which were called, for example, "Top Hospital Saver 1 with Top Extras", "Top Hospital Saver 1 with Premium Extras" and "Top Hospital Saver 1 with Single Selection". There was a "Basic Hospital" table, together with other tables involving basic hospital cover, including, for example, "Basic Hospital with Top Extras" and "Basic Hospital with Budget Extras". There was a "Pay & Save" table, a "Couples Choice" table, a "Lifestyle" and a "Couples Econo Cover" table. Those to which I have referred were some only of the more than 30 tables for which the rules provided.
18 The applicant placed in evidence before me a copy of its health cover guide and application forms dated 1 April 2005. Although that publication is subsequent to the years to which the proceeding relates, both parties agreed that I might take it as indicative of the kind of guide which the applicant published in the years in question.
19 In the section of the guide headed "Introduction", the following appears:
For the past 50 years Navy Health has continued to support the wider defence family.
Navy Health began its life in 1955 to provide for the unique needs of defence personnel.
The membership eligibility criteria has since extended to include others who have provided support to the defence community.
Navy Health is a fund belonging to the members. It is not for profit and is registered as a Restricted Membership Organisation under the National Health Act.
Approximately 30,000 people have chosen Navy Health as the fund of their choice.
The categories of membership eligibility are then set out. Under the headings "Advantages of Private Health Insurance", "Rebated Premiums", "Lower Premiums - For Life" and "Save on your Tax" the guide makes broad promotional and informational statements about private health insurance as such, without any particular focus upon circumstances which set the applicant apart from other private health insurance providers. However, the guide continues as follows:
Advantages for Serving ADF Members
As a serving member of the ADF, you are entitled to receive discounted military family premiums.
On discharge you will receive immediate benefits and will be entitled to the discounted family premiums for a further 12 months.…
In the event that you are posted overseas, Navy Health will allow you to suspend your membership….
For ADF Reservists
As a full time reservist (or if you have 28 days or more of continuous service) you may be entitled to suspend your membership or take advantage of the discounted military family premiums….
For Young Adult Dependants
Young adult dependants can remain on their family cover until they turn 22 or 25 if they are a full time student….
20 Under the heading "Product Options", the guide then sets out a checklist of benefit categories available in private and public hospitals respectively, and gives some simple guidance on the subjects of "Choosing Your Extras Cover" and "Choosing Your Packaged Options". The guide then refers to "Other Services" provided by the applicant, being travel insurance and total and permanent disability insurance (each provided through the agency of a separate insurance company) and home loans, available through the mortgage broking arm of the applicant.
21 The guide next turns to a detailed explanation of the medical and hospital benefits provided by the applicant, under the various tables. Details of premiums are set out. A feature of these is that there are separate tables covering "Military Family Premiums" and "Civilian Family Premiums". The consequence of the fact that a member who is enlisted in the armed services will not, himself or herself, be covered is to be seen in a comparison between the military family premiums and the civilian family premiums. Taking the example of top hospital cover, the non-rebated fortnightly contribution for military family premiums is $86.05, whereas the corresponding contribution for civilian family premiums is $101.30.
22 Under the heading "Health Care Costs of Serving Members" the guide states as follows:
Health care costs of serving members are met by the Commonwealth until the date of discharge. This is regarded as the equivalent of private health insurance and as such no Lifetime Health Care penalty applies to members of the ADF when they separate, providing they take out private health insurance within 90 days.
For the serving member waiting periods and pre-existing ailment restrictions can be avoided if you join within 90 days of discharge and the membership application takes effect from the day following the discharge.
Families with one serving member can opt to pay the Military family premium. This premium excludes the cost of one adult and this adult can NOT make any claims on the fund. Refer to the Military family premium table on page 24.
Families with two serving members can also opt to pay the Military family premium. This premium excludes the cost of two adults and these two adults can NOT make any claims on the fund. Refer to the Military family premium table on page 25.
23 Under the heading "Overseas Benefits" the guide states as follows:
When a member incurs a health care expense whilst overseas, health fund benefits are payable according to the level of cover (providing the membership is current). Benefits are based on the Australian Exchange rate as at date of service.
Any claims for services rendered overseas must be fully paid and receipted prior to claiming.
We caution members, that these benefits may not be sufficient to give reasonable cover for hospitalisation in many countries. Medicare and Gap Medical Benefits are not payable and as a result the patient is solely responsible for the cost of all associated medical services. As a consequence we strongly advise all members to link their normal health insurance with Navy Health Travel Insurance when travelling overseas. (Refer to page 4 for further details.)
Advice regarding countries holding reciprocal Medicare agreements with Australia can be obtained from your local Medicare office.
24 The applicant's summary annual report for 2004 is in evidence. In it, the applicant's Managing Director provided his "Review of Operations". He referred to matters of financial and economic efficiency, both in the trading result of the applicant itself and in relation to the private health insurance sector as a whole. He referred in particular to the need for the continuation of Federal government support by way of the 30% rebate on private health insurance contributions. He continued:
Despite the call of a number of the major open funds for industry rationalisation as a driver of increased efficiencies there is an absence of any tangible facts to support this claim.
There is a considerable difficulty in making direct comparison between the various insurance products offered by the open funds compared to the restricted funds. However, there is sufficient evidence to demonstrate that the latter offers significantly more attractive benefits than the open funds at highly competitive contribution rates.
There has been a level of market driven rationalisation over the past 12 months with Goldfields and IOR being acquired after suffering financial difficulties and NRMA (SGIC) and IOOF being taken-over in an open commercial environment.
In this context, it was very pleasing to note that Navy Health was rated in the August/September edition of the Choice magazine in the top four in each of the hospital tables assessed by the Australian Consumers Association.
The competitiveness of the restricted funds can be attributed in a large part to two major initiatives.
In 1994 when the then Labor Health Minister, Graeme Richardson, threatened to reduce the number of registered funds to "no more than twelve" the restricted funds were instrumental in founding the Australian Health Service Alliance (AHSA), which after controlled expansion, now counts 27 funds in its membership.
AHSA as an umbrella buying group and data manager is the second largest purchaser of health services in Australia. This ensures that AHSA on behalf of its membership is able to negotiate very competitive hospital and medical contracts. A capacity that none of the member funds would be able to address individually.
AHSA, by pooling the utilisation data of all its member funds has an enviable performance and cost history on providers and is regarded by the Commonwealth as the source of the most reliable and best quality, utilisation, cost indices and trend analysis data.
Within the same approximate time-from the restricted funds acquired a specialist software house, Hamb Systems Limited, from National Mutual. Today there are 23 funds utilising the second version of the Hamb's Software and this has enabled containment of what would otherwise be an extremely volatile cost centre.
The restricted funds have appreciably improved their representation politically and to Government bureaucracy by strengthening the resources of their dedicated industry body, the Health Insurance Restricted Membership Association of Australia (HIRMAA).
The financial difficulties encountered by a number of funds have resulted in the Government regulator, Private Health Insurance Administrative Council (PHIAC), institute a more formal and regulated review process of each individual fund. Navy Health had a three day review conducted in December 2003. The Company was pleased with the process and the outcome and the various recommendations emanating from the review will provide the foundation for another level of improvement in our governance and compliance practices.
Overall, the company has invested significant resources into ensuring that our corporate governance meets the highest standards and there are many examples where the company has shown considerable innovation in embracing advanced techniques to underpin our objective of "being second to none" in this area.
I have set out this rather lengthy passage from the Managing Director's report as it provides some insight into the operations and concerns of the applicant in the years in question, and into the kind of business imperatives to which it was subject. Manifestly, the applicant recognised the reality that it was a commercial enterprise operating in a competitive market, notwithstanding that it was a fund of restricted membership eligibility, and that it was a "not- for-profit" organisation. Indeed, the operating surplus for the applicant's fund for the 12 months to 30 June 2004 was $2,261,000 on contribution income of $26,977,000.
25 It is common ground that, in legislation of the kind presently before the court, a "charitable" institution is an institution which is charitable by reference to the preamble to the Statute of Elizabeth, and the four classifications propounded by Lord Macnaghten in Pemsel. The contentious question is whether the applicant was such an institution. It was not suggested by the respondent that the applicant was not an institution. To determine whether it was "charitable" requires a consideration of its objects, to be discerned from its constitution, its rules and its activities. As stated in its constitution, the single purpose of the applicant was to conduct a health benefits fund. To secure a finding that its objects were charitable, therefore, the applicant needs to go beyond the constitution to its rules and activities.
26 In contending that it was, in the years in question, a charitable institution, the applicant relied upon the following facts and circumstances:
· The provision of a special premium for family cover where the member was a serving member of the armed forces;
· The continuation of cover where members and their families travelled interstate or overseas;
· The facility for unlimited suspension of membership;
· The special treatment accorded to personnel discharging from the armed forces;
· The composition of its board, and the role of the Chief of Navy in relation to the applicant; and
· Its practical focus, in its marketing and other activities, upon Navy personnel and the advantages to them of contributing to the applicant's fund.
I shall consider each of these in turn, and certain other circumstances upon which the applicant relied in support of its proposition that it was a charitable institution.
27 Unlike the other health insurance funds referred to in the evidence, the applicant offered premiums for "military families" which were, in the examples before the court, some 15% less than the corresponding premiums which it charged for civilian families (or 30% less where the military family had two serving members). This distinction was a reflection of the circumstance that, in the case of a military family, the member himself or herself was not covered. To take the example of a family of four, whereas the civilian family would have all four members covered by benefits under the fund, the military family would have three members only so covered (or two members only if two members of the family were serving members of the forces). This reduced level of coverage was reflected in a comparison between military family premiums charged by the applicant and corresponding premiums for family cover charged by other general health benefit organisations: the former were cheaper, by about 18% on average in the case of the top product tables and by about 12% on average in the case of the basic product tables. The point which the applicant made was that its premiums were specifically designed to meet the needs of families, at least one of whose members was a serving member of the forces. It was submitted that, in the case of other health benefits organisations, the option of securing, for a competitive premium, family cover which excluded one or more members of the family because their hospital and medical needs were provided by the Commonwealth, would not be available. In this sense, it was said, the applicant's products were specifically tailored to the needs of Defence Force (particularly Navy) families.
28 The applicant next relied upon the second of the two main reasons for the formation of the Society, namely, that it provided uninterrupted coverage for the families of its members when they travelled interstate and overseas. This was said to be a feature of the applicant's offerings which placed it apart from the generality of private health insurance funds.
29 It appears that there was no uniform practice amongst health insurance funds on the matter of the continuation of coverage where a member travelled interstate. The practices of four of the major general funds were the subject of evidence. One of them - MBF - was in the same situation as the applicant in that it provided uninterrupted coverage, at a single premium, wherever in Australia the member and his or her family happened to be. So was HBF, but, being a WA-based fund, local arrangements in that State did not apply to members in other States. The other two - Medibank and BUPA - had what were described as "state specific" premiums, which meant, I presume, that a member moving interstate was required to pay the premium which related to the State where he or she was at the time when each premium fell due. The coverage itself was uninterrupted. Clearly, depending upon the State from which, and the State to which, the member travelled, the move might involve a higher, a lower, or the same, premium. On this evidence, I could not conclude that a member of the applicant, of MBF or of HBF, would necessarily be better-off, in relation to interstate travel, than a member of one of the latter two funds.
30 Turning to the situation where a member and his or her family travelled overseas - such as, for example, in the case of a serving member of the Navy who was posted to another country - the starting point is to note that Australia has signed reciprocal health care agreements with New Zealand, the United Kingdom, Ireland, Sweden, the Netherlands, Finland, Italy, Malta and Norway. This meant that Australian residents were entitled to assistance with the cost of medical treatment required when in those countries, but the nature and extent of the entitlement varied from place to place. It appears that, in most if not all cases, some further coverage was required if the traveller desired to be covered to the same extent as would have been the case under existing private health insurance arrangements in Australia.
31 The applicant provided health benefits to members and their families who incurred health care expenses overseas. Benefits were those to which a corresponding entitlement arose under the particular level of cover to which the member in question had contributed, and were based on the exchange rate at the date of service. The applicant cautioned its members that the benefits so provided may not be sufficient to cover the expenses in fact incurred, and encouraged them to take out travel insurance. If such insurance were taken out, the applicant required the member to claim on that insurance first, and limited its liability for the payment of benefits to the sum necessary to bridge the difference between the amount paid by the insurer and the amount to which the member was entitled under the rules of the applicant.
32 With very limited exceptions, the four general funds mentioned in the evidence did not provide coverage for medical or hospital expenses incurred overseas. The respondent did not contend that the more favourable coverage provided by the applicant in this respect was in effect counterbalanced by less attractive service definitions or more costly premiums. I think the appropriate conclusion in the circumstances is that the applicant provided some assistance to its members in relation to overseas travel that was not generally available to contributors to other health funds.
33 Associated with the matter of overseas travel is the next point which the applicant emphasised: the conditions under which membership of a health fund may be suspended. I have set out the applicant's relevant rule in this regard at par 16 above. It will be seen that the fact of suspension, and the conditions attaching to suspension in particular cases, were wholly within the discretion of the applicant. The evidence of its practice in this regard is a statement in the affidavit of its Managing Director that the applicant permits suspension "while the serving member and their family are overseas and lifts that suspension on their return without potential hardship or inconvenience as to waiting periods or ineligibility due to pre-existing conditions". The four general funds referred to in the evidence provided for suspension of membership in circumstances more clearly defined. HBF permitted suspension for overseas travel of more than 8 weeks, with no upper limit. Members were required to re-activate their membership within 30 months of their return to Australia. Medibank permitted suspension for overseas travel of between 2 months and 4 years. A longer period of suspension was available on application, but only after the member had completed a 6-month intervening period of re-activated membership. The other two funds permitted suspension for overseas travel of between 2 and 24 months, after which, at MBF, members could apply for an extension of the suspension or, at BUPA, they could suspend for a further 24 months, but only after completing a 2-month intervening period of re-activated membership. In the case of both of these funds, members must have been in the fund for certain periods before qualifying for suspension.
34 If one looked only at the applicant's rules, one could not conclude that the applicant provided a more beneficial product than the other funds on the matter of suspension. Under those rules, a member's entitlement to suspend lay wholly in the discretion of the applicant. In the case of the other funds, there were more clearly defined rights, notwithstanding that they are subject to various conditions. However, looking also at what the Managing Director said was the applicant's practice, it seems that the discretion was generally exercised in favour of permitting serving members and their families to suspend, without further conditions, in the event of overseas travel. I think the appropriate conclusion is that this aspect should be added to the one previously dealt with in support of a general conclusion that the applicant's benefits were provided in a way that was, in practice, generally of greater utility to serving members of the forces than were the benefits of other funds.
35 The applicant relied also upon what were said to be special benefits provided to, or arrangements made in the case of, persons taking their discharge from the armed forces. In this respect, I need to consider first one aspect of the statutory framework which bore upon the circumstances of such persons. Under s 73BAAA of the NH Act, it was a condition of registration that an organisation comply with Sched 2. That schedule set up a system by which, unless a person had "hospital cover" by his or her 31st birthday, the contributions which he or she was required to pay to a registered organisation for such cover had to be increased in accordance with a formula, such that, the longer the person was without hospital cover, the more expensive it would be for him or her to contribute for such cover if and when he or she chose to do so. Part of the formula provided that, if a person did have, but ceased to have, hospital cover, the contributions which he or she would be required to pay would increase by 2% for each year (calculated by reference to fractions of a year) that the absence of hospital cover continued. However, the first 730 days after a person ceasing to have hospital cover were not counted. The term "hospital cover" was so defined that a person would be taken to have such cover if he or she were included in a class of persons specified in the regulations. Regulation 6(1)(b) of the National Health (Lifetime Health Cover) Regulations 2000 prescribed, as a relevant class of reasons, members of the Australian Defence Force on continuous full time service whose health services were provided by the Force. The general effect of these provisions, relevantly to the present case, was that a serving member of the forces over the age of 31 was insulated from the risk that the contributions which he or she would eventually have to pay in the event of taking out private health insurance after discharge would increase each year in accordance with the legislative formula; and that he or she had a period of two years after discharge within which to take up private health insurance without being subject to the adverse impact of the formula.
36 In so far as the legislative and regulatory provisions to which I have just referred were concerned, the applicant was in no different a position from that of any other health fund. A discharging member of the forces could join any fund within two years and still be treated as having had lifetime health cover. However, there were several aspects of the products offered to such members by the applicant which, it submitted, set it apart from other funds.
37 For the single person, the policy of the applicant was not to enforce waiting periods and existing ailment restrictions, normally applicable in the case of a person newly joining the fund, so long as the person joined within 90 days after discharge from the armed forces. The same policy seems to have applied in the case of someone who wished to take up family coverage for the first time upon discharge. The period of grace allowed was shorter in the case of the other four general funds: 30 days for BUPA and two months for Medibank, MBF and HBF. Service in the armed forces was regarded by the applicant as equivalent to coverage at the highest level, such that the 90-day policy had the practical result that the discharging serviceman or woman could take up the highest level of coverage offered by the applicant within that period without waiting periods and existing ailment restrictions. It is said by the applicant that the other funds were less generous in this regard, but it is not clear to me from the evidence exactly what the position was there, and I do not make any finding about it.
38 As an incentive for discharging personnel to join the applicant's fund, the applicant offered coverage at the military family rate (where one family member was serving) for the first 12 months of civilian family coverage, so long as the full 12-month contribution was paid in advance. To reflect payment in advance, the applicant provided a further 4% discount on that first contribution. After the 12 months, contributions reverted to the normal civilian family rate. There appears to have been no corresponding provision made by the four general funds referred to in the evidence.
39 The next matter on which the applicant relied was the composition of its board, and the particular powers and functions which the Chief of Navy had in connection with the applicant. It is said that these indicated a continuing close relationship between the applicant and the Navy. It was pointed out that the Chief of Navy was not separately remunerated for his or her services in relation to the applicant, the implication being that the Navy itself was thereby assisting to keep the applicant's operating costs down, to the benefit of its members. The applicant also pointed out that although its potential membership was very wide, its practical focus was upon those directly or indirectly connected with the Navy itself. As is apparent from the passages to which I have referred above in the guide which it publishes, the applicant promoted itself as the most suitable fund for Navy personnel and Navy families. The evidence is that the applicant often had a promotional presence at Navy functions, and at places where Navy personnel, and their families, had cause to gather.
40 The applicant submitted that, quite apart from the matter of cheaper military family premiums, the benefits provided by the applicant at any given level of cover were more generous than those of the general funds under comparison. I have reviewed the material upon which the applicant relied in this regard, but ultimately I do not consider that I should make any such finding as a generalisation. The market for private health insurance was, it seems, quite competitive. The funds all had their own tables of benefits - hospital, medical and ancillary - and they all provided various conditions attaching to the receipt of those benefits. Whether one package would be more beneficial than another would, I consider, depend very substantially upon the circumstances of the contributor in question. For example, it was pointed out on behalf of the applicant that BUPA had longer waiting periods than the applicant for laser eye surgery, whereas HBF had longer waiting periods than the applicant for joint surgery. It would be quite unsafe for a court to conclude that one fund, overall, provided "better benefits" than another fund or all other funds.
41 The applicant also placed considerable reliance upon the history of its predecessor, the Society. The special circumstances which brought the Society into existence in the 1950s were said to bespeak a purpose of benefiting Navy families, particularly in so far as the Society was established by a grant from the Navy Central Canteen Fund.
42 Summarising the matters to which I have referred and upon which the applicant placed particular reliance, I would find first, that the applicant provided a product that was especially beneficial to serving members of the forces with dependants, in the sense of offering them a limited form of cover not generally available; secondly, that coverage under the applicant's fund continued while a member (and/or his or her dependants) travelled overseas, in which respect the applicant's products were superior to those offered by the general funds; thirdly, that the applicant generally offered a facility of suspension in a way that was of greater utility to serving members, and their dependants, than any corresponding facility offered by the general funds; fourthly, that the applicant's arrangements for the transition between military and civilian membership (or between an absence of membership in the case of serving personnel without dependants and civilian membership for such personnel) were generally more favourable than like arrangements elsewhere; fifthly, that there was a close relationship between the applicant and the Navy at board level; sixthly, that the applicant concentrated its promotional efforts amongst Navy personnel and Navy families; and seventhly, that the applicant's origins, in the formation of the Society in the 1950s, involved a conscious endeavour to establish a system that would be of particular benefit to Navy personnel, as undoubtedly it proved to be thereafter. However, I also find that the applicant's fund was conducted under conventional commercial arrangements and that the members of the fund derived no greater benefits than were fairly reflected in the premiums which they paid, notwithstanding that it was no part of the applicant's purpose to earn a surplus or profit for the benefit of its shareholder.
43 The matters to which I have referred in the previous paragraph might be regarded as qualitative indicators of the applicant's activities, and therefore of its object. Quantitative indicators must also be considered.
44 The applicant was a restricted membership organisation. The nature of the restrictions on its membership gave definition to the kind of fund which it conducted, and thereby to its purposes. The applicant's eligibility rule (set out in par 14 above) provided for the following classes of members:
(a) Persons serving full-time in the Navy, Army or Air Force other than those without dependants (sub-cl a.);
(b) Active members of the Navy, Army or Air Force Reserve (sub-cl d.);
(c) Navy, Army or Air Force cadets and their immediate families (sub-cl f. 2)
(d) Persons employed by, or contracted to, the Department of Defence, the naval shore establishment, the dockyards or another defence establishment (sub-cl b.);
(e) Persons employed in the Australian Public Service (sub-cl b);
(f) Persons employed by, or who were members of, an organisation contracted to supply the applicant (sub-cl b.);
(g) Former full-time serving members of the Navy, Army or Air Force, with or without dependants (sub-cl c. & f.)
(h) Former members of the Navy, Army or Air Force Reserve (sub-cl f.)
(i) Former employees of the Department of Defence (sub-cl f.)
(j) Persons formerly employed in the "Defence Civilian workforce" (sub-cl f.);
(k) Persons who were, but ceased to be, dependants of members of the fund (sub-cl e.);
(l) Dependants, and persons who were dependants, of those referred to in (a) and (b) above (sub-cl e. 2);
(m) Persons who were, at any time in the past, eligible for membership (sub-cl g.);
(n) Other persons approved by the board (sub-cl h.)
(It will be noted that, in the eligibility rule itself, sub-cll e. and f. have been repeated. In the list above, I have identified the second appearance of each sub-clause with the subscript "2".)
45 In the previous paragraph, I have re-organised the classes of the applicant's membership somewhat for the purposes of clarification. One may now see that the applicant had what I shall call primary classes of membership, being those persons who, without reference to a relationship with another person or to any previous circumstance, were eligible. In those classes I would place the persons referred to in (a)-(f) above. Next, the applicant had classes of membership which were referable to the previous circumstances of the person concerned. In those classes I would place the persons referred to in (g)-(j) and (m) above. Next again, the applicant had classes of membership which were referrable to an existing or previous relationship of dependency apropos another person who was, or had been, eligible. In those classes I would place the persons referred to in (k), (l) and, to an extent, (m) above. Finally, the applicant had an open class of membership at the direction of the board ((n) above), but it was not suggested by the respondent that that class would, of itself, have affected the outcome of the matters which I have to decide.
46 There was no evidence as to the relative size, in the overall revenue of the applicant, of contributions received from the various categories of members; nor as to the relative size, in the overall outlays of the applicant, of benefits paid to those various categories. In financial terms, therefore, the court does not know whether the centre of gravity of the applicant's operations lay in that part of its membership in relation to which it claims to be different, especially Navy families. However, counsel for the applicant provided, without objection, certain information as to the composition of the applicant's membership in 2001 which was said to be typical. At that time, 21.5% of members were current serving military personnel and 37.2% of members had been serving military personnel and had carried over their memberships after discharge. Apparently a very small number of the latter had been in the Army or the Air Force. The remaining 41.3% of members were distributed among the other membership categories, but counsel for the applicant were able to go no further than to inform me that this group would have consisted of those who had been in the forces but who either had not had continuous unbroken membership or had joined for the first time only after discharge, and those who were "civilian members". Again without objection, counsel informed that his instructions were that less than 10% of the applicant's members were "civilian". Other than may be implicit by exclusion of the other classes, counsel did not specify what they meant by "civilian". Some classes of membership should obviously be so described - eg (d)-(f), (i) and (j). Others may be less clear - eg persons eligible under class (k), such as the adult (and no longer dependent) children of serving or former members of the forces.