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Private Health Insurance Act 2007 | Zoe

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Home/Legislation/Private Health Insurance Act 2007

Commonwealth act

Private Health Insurance Act 2007

In ForceCTH

Jurisdiction

Commonwealth

Act Number

31 of 2007

Collection

act

JSON API Health / NDIS / medicines

Plain English

No plain-English breakdown of this one yet.

Zoe can read the full text and write a clear summary plus a deeper analysis of what it does, who it affects and how it works.

Current sections

Direct links to the current provisions in Private Health Insurance Act 2007.

310

Part 1‑1—Introduction Division 1Preliminary Section 1‑1 Short title1‑1 Short title Section 1‑5 Commencement1‑5 Commencement Section 1‑10 Identifying defined terms1‑10 Identifying defined terms

Section 1‑15 Extension to Norfolk Island1‑15 Extension to Norfolk Island

Division 3Overview of this Act

Section 3‑1 What this Act is about3‑1 What this Act is about

Section 3‑5 Incentives (Chapter 2)3‑5 Incentives (Chapter 2)

Section 3‑10 Complying health insurance products3‑10 Complying health insurance products (Chapter 3)

Section 3‑15 Health insurance business, health b3‑15 Health insurance business, health benefits funds and miscellaneous obligations of private health insurers (Chapter 4)

Section 3‑20 Enforcement (Chapter 5)3‑20 Enforcement (Chapter 5)

Section 3‑25 Administration (Chapter 6)3‑25 Administration (Chapter 6)

Section 3‑30 Dictionary (Schedule 1)3‑30 Dictionary (Schedule 1)

Division 5Constitutional matters

Section 5‑1 Meaning of insurance5‑1 Meaning of insurance

Section 5‑5 Act not to apply to State insurance 5‑5 Act not to apply to State insurance within that State

Section 5‑10 Compensation for acquisition of pro5‑10 Compensation for acquisition of property

Part 2‑1—Introduction

Division 15Introduction

Section 15‑1 What this Chapter is about15‑1 What this Chapter is about

Division 20Introduction

Section 20‑1 What this Part is about20‑1 What this Part is about

Section 20‑5 Private Health Insurance (Incentive20‑5 Private Health Insurance (Incentives) Rules

Division 22PHIIB, PHII benefit and related concepts

Subdivision 22‑A—PHIIB, PHII benefit and related concepts

Section 22‑1 Application of Subdivision22‑1 Application of Subdivision

Section 22‑5 Meaning of PHIIB22‑5 Meaning of PHIIB

Section 22‑10 Meaning of PHII benefit22‑10 Meaning of PHII benefit

Section 22‑15 Meaning of share of the PHII benef22‑15 Meaning of share of the PHII benefit—single PHIIB

Section 22‑20 Meaning of share of the PHII benef22‑20 Meaning of share of the PHII benefit—multiple PHIIBs

Section 22‑25 Application of subsection 22‑15(1)22‑25 Application of subsection 22‑15(1) after a person 65 years or over ceases to be covered by policy

Section 22‑30 Private health insurance tiers22‑30 Private health insurance tiers

Section 22‑35 Private health insurance singles t22‑35 Private health insurance singles thresholds

Section 22‑40 Private health insurance family th22‑40 Private health insurance family thresholds

Section 22‑45 Indexation22‑45 Indexation

Division 23Premiums reduction scheme

Subdivision 23‑A—Amount of reduction

Section 23‑1 Reduction in premiums23‑1 Reduction in premiums

Section 23‑15 Application to register as a parti23‑15 Application to register as a participant in the premiums reduction scheme

Section 23‑16 Registration of participants23‑16 Registration of participants

Section 23‑20 Refusal to register23‑20 Refusal to register

Section 23‑30 Participants who want to withdraw 23‑30 Participants who want to withdraw from scheme

Section 23‑35 Revocation of registration23‑35 Revocation of registration

Section 23‑40 Variation of registration23‑40 Variation of registration

Section 23‑45 Retention of applications by priva23‑45 Retention of applications by private health insurers

Division 31Introduction

Section 31‑1 What this Part is about31‑1 What this Part is about

Section 31‑5 Private Health Insurance (Lifetime 31‑5 Private Health Insurance (Lifetime Health Cover) Rules

Division 34General rules about lifetime health cover

Section 34‑1 Increased premiums for person who i34‑1 Increased premiums for person who is late in taking out hospital cover

Section 34‑5 Increased premiums for person who c34‑5 Increased premiums for person who ceases to have hospital cover after his or her lifetime health cover base day

Section 34‑10 Increased premiums stop after 10 y34‑10 Increased premiums stop after 10 years’ continuous cover

Section 34‑15 Meaning of hospital cover34‑15 Meaning of hospital cover

Section 34‑20 Meaning of permitted days without 34‑20 Meaning of permitted days without hospital cover

Section 34‑25 Meaning of lifetime health cover b34‑25 Meaning of lifetime health cover base day

Section 34‑30 When a person is overseas or enter34‑30 When a person is overseas or enters Australia

Division 37Exceptions to the general rules about lifetime health cover

Section 37‑1 People born on or before 1 July 19337‑1 People born on or before 1 July 1934

Section 37‑5 People over 31 and overseas on 1 Ju37‑5 People over 31 and overseas on 1 July 2000

Section 37‑7 Person yet to turn 3137‑7 Person yet to turn 31

Section 37‑10 Hardship cases37‑10 Hardship cases

Section 37‑15 Increases cannot exceed 70% of bas37‑15 Increases cannot exceed 70% of base rates

Section 37‑20 Joint hospital cover37‑20 Joint hospital cover

Division 40Administrative matters relating to lifetime health cover

Section 40‑1 Notification to insured people etc.40‑1 Notification to insured people etc.

Section 40‑5 Evidence of having had hospital cov40‑5 Evidence of having had hospital cover, or of a person’s age

Division 42Introduction

Section 42‑1 What this Part is about42‑1 What this Part is about

Division 45Excess levels for medicare levy and medicare levy surcharge purposes

Section 45‑1 Excess level amounts45‑1 Excess level amounts

Part 3‑1—Introduction

Division 50Introduction

Section 50‑1 What this Chapter is about50‑1 What this Chapter is about

Section 50‑5 Private Health Insurance Rules rele50‑5 Private Health Insurance Rules relevant to this Chapter

Division 55Principle of community rating

Section 55‑1 What this Part is about55‑1 What this Part is about

Section 55‑5 Principle of community rating55‑5 Principle of community rating

Section 55‑10 Closed products, and terminated pr55‑10 Closed products, and terminated products and product subgroups

Section 55‑15 Pilot projects55‑15 Pilot projects

Division 60Introduction

Section 60‑1 What this Part is about60‑1 What this Part is about

Division 63Basic rules about complying health insurance products

Section 63‑1 Obligation to ensure products are c63‑1 Obligation to ensure products are complying products

Section 63‑5 Meaning of complying health insuran63‑5 Meaning of complying health insurance product

Section 63‑10 Meaning of complying health insura63‑10 Meaning of complying health insurance policy

Division 66Community rating requirements

Section 66‑1 Community rating requirements66‑1 Community rating requirements

Section 66‑5 Premium requirement66‑5 Premium requirement

Section 66‑10 Minister’s approval of premiums66‑10 Minister’s approval of premiums

Section 66‑15 Entitlement to benefits for genera66‑15 Entitlement to benefits for general treatment

Section 66‑20 Different amount of benefits depen66‑20 Different amount of benefits depending on where people live

Section 66‑25 Different amounts of benefits for 66‑25 Different amounts of benefits for travel or accommodation

Division 69Coverage requirements

Section 69‑1 Coverage requirements69‑1 Coverage requirements

Section 69‑5 Meaning of cover69‑5 Meaning of cover

Section 69‑10 Meaning of hospital‑substitute tre69‑10 Meaning of hospital‑substitute treatment

Division 72Benefit requirements for policies that cover hospital treatment

Section 72‑1 Benefit requirements72‑1 Benefit requirements

Section 72‑5 Rules requirement in relation to pr72‑5 Rules requirement in relation to provision of benefits

Section 72‑10 Minimum benefits for medical devic72‑10 Minimum benefits for medical devices and human tissue products

Section 72‑11 Meaning of medical device72‑11 Meaning of medical device

Section 72‑12 Meaning of human tissue product72‑12 Meaning of human tissue product

Section 72‑15 Fees for certain activities72‑15 Fees for certain activities

Section 72‑20 Delisting because of unpaid fees o72‑20 Delisting because of unpaid fees or levy

Section 72‑25 Minister may direct that activitie72‑25 Minister may direct that activities not be carried out

Section 72‑27 Matters to have regard to before e72‑27 Matters to have regard to before exercising certain powers

Section 72‑30 When cost‑recovery fee must be pai72‑30 When cost‑recovery fee must be paid

Section 72‑35 Payment of cost‑recovery fee72‑35 Payment of cost‑recovery fee

Section 72‑40 Recovery of fee72‑40 Recovery of fee

Section 72‑45 Other matters72‑45 Other matters

Division 75Waiting period requirements

Section 75‑1 Waiting period requirements75‑1 Waiting period requirements

Section 75‑5 Meaning of waiting period75‑5 Meaning of waiting period

Section 75‑10 Meaning of transfers75‑10 Meaning of transfers

Section 75‑15 Meaning of pre‑existing condition75‑15 Meaning of pre‑existing condition

Division 78Portability requirements

Section 78‑1 Portability requirements78‑1 Portability requirements

Division 81Quality assurance requirements

Section 81‑1 Quality assurance requirements81‑1 Quality assurance requirements

Division 84Enforcement of this Part

Section 84‑1 Offence: advertising, offering or i84‑1 Offence: advertising, offering or insuring under non‑complying policies

Section 84‑5 Offence: directors and chief execut84‑5 Offence: directors and chief executive officers liable if systems not in place to prevent breaches

Section 84‑10 Injunction in relation to non‑comp84‑10 Injunction in relation to non‑complying policies

Section 84‑15 Remedies for people affected by no84‑15 Remedies for people affected by non‑complying policies

Division 90Introduction

Section 90‑1 What this Part is about90‑1 What this Part is about

Division 93Giving information to consumers

Section 93‑1 Maintaining up to date private heal93‑1 Maintaining up to date private health information statements

Section 93‑5 Meaning of private health informati93‑5 Meaning of private health information statement

Section 93‑10 Making private health information 93‑10 Making private health information statements available

Section 93‑15 Giving information to newly insure93‑15 Giving information to newly insured people

Section 93‑20 Keeping insured people up to date93‑20 Keeping insured people up to date

Section 93‑25 Giving advance notice of detriment93‑25 Giving advance notice of detrimental changes to rules

Section 93‑30 Failure to give information to con93‑30 Failure to give information to consumers

Division 96Giving information to the Department and the Private Health Insurance Ombudsman

Section 96‑1 Giving private health information s96‑1 Giving private health information statements on request

Section 96‑5 Giving private health information s96‑5 Giving private health information statements for new products

Section 96‑10 Giving updated private health info96‑10 Giving updated private health information statements

Section 96‑15 Giving additional information on r96‑15 Giving additional information on request

Section 96‑20 Failure to give information to Dep96‑20 Failure to give information to Department or Private Health Insurance Ombudsman

Section 96‑25 Giving information required by the96‑25 Giving information required by the Private Health Insurance (Complying Product) Rules

Division 99Transfer certificates

Section 99‑1 Transfer certificates99‑1 Transfer certificates

Division 102Private health insurers to offer cover for hospital treatment

Section 102‑1 Private health insurers to offer c102‑1 Private health insurers to offer cover for hospital treatment

Part 4‑1—Introduction

Division 110Introduction

Section 110‑1 What this Chapter is about110‑1 What this Chapter is about

Division 115Introduction

Section 115‑1 What this Part is about115‑1 What this Part is about

Section 115‑5 Private Health Insurance (Health I115‑5 Private Health Insurance (Health Insurance Business) Rules

Section 115‑10 Whether a business etc. is health115‑10 Whether a business etc. is health insurance business

Division 121What is health insurance business?

Section 121‑1 Meaning of health insurance busine121‑1 Meaning of health insurance business

Section 121‑5 Meaning of hospital treatment121‑5 Meaning of hospital treatment

Section 121‑7 Conditions on declarations of hosp121‑7 Conditions on declarations of hospitals

Section 121‑8 Application for inclusion of hospi121‑8 Application for inclusion of hospital in a class

Section 121‑8A Minister to decide application121‑8A Minister to decide application

Section 121‑8B Period of inclusion of hospital i121‑8B Period of inclusion of hospital in a class

Section 121‑8C Revocation of inclusion of hospit121‑8C Revocation of inclusion of hospital in a class

Section 121‑8D Private Health Insurance (Health 121‑8D Private Health Insurance (Health Insurance Business) Rules

Section 121‑10 Meaning of general treatment121‑10 Meaning of general treatment

Section 121‑15 Extension to employee health bene121‑15 Extension to employee health benefits schemes

Section 121‑20 Exception: accident and sickness 121‑20 Exception: accident and sickness insurance business

Section 121‑25 Exception: liability insurance bu121‑25 Exception: liability insurance business

Section 121‑30 Exception: insurance business exc121‑30 Exception: insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules

Division 131Health benefits funds

Section 131‑1 What this Part is about131‑1 What this Part is about

Section 131‑5 Private Health Insurance (Health B131‑5 Private Health Insurance (Health Benefits Fund Policy) Rules

Section 131‑10 Meaning of health benefits fund131‑10 Meaning of health benefits fund

Section 131‑15 Meaning of health‑related busines131‑15 Meaning of health‑related business

Section 131‑20 Risk equalisation jurisdictions131‑20 Risk equalisation jurisdictions

Section 131‑25 Operation of health‑related busin131‑25 Operation of health‑related businesses through health benefits funds

Division 157Introduction

Section 157‑1 What this Part is about157‑1 What this Part is about

Section 157‑5 Private Health Insurance (Data Pro157‑5 Private Health Insurance (Data Provision) Rules

Division 169Notification obligations

Section 169‑10 Private health insurers to notify169‑10 Private health insurers to notify any changes to rules

Division 172Other obligations

Section 172‑5 Agreements with medical practition172‑5 Agreements with medical practitioners

Section 172‑10 Private health insurers to give i172‑10 Private health insurers to give information to Secretary

Section 172‑15 Restrictions on payment of pecuni172‑15 Restrictions on payment of pecuniary penalties etc.

Part 5‑1—Introduction

Division 180Introduction

Section 180‑1 What this Chapter is about180‑1 What this Chapter is about

Division 185What this Part is about

Section 185‑1 Introduction185‑1 Introduction

Section 185‑5 Meaning of enforceable obligation185‑5 Meaning of enforceable obligation

Division 188Performance indicators

Section 188‑1 Performance indicators188‑1 Performance indicators

Division 191Explanation of private health insurer’s operations

Section 191‑1 Minister may seek an explanation f191‑1 Minister may seek an explanation from a private health insurer

Section 191‑5 Minister must respond to insurer’s191‑5 Minister must respond to insurer’s explanation

Division 194Investigation of private health insurer’s operations

Section 194‑1A Purposes for which powers may be 194‑1A Purposes for which powers may be exercised etc.

Section 194‑1 Minister may investigate a private194‑1 Minister may investigate a private health insurer

Section 194‑5 Notice to give information194‑5 Notice to give information

Section 194‑10 Notice to produce documents194‑10 Notice to produce documents

Section 194‑15 Notice to give evidence194‑15 Notice to give evidence

Section 194‑20 Offences in relation to investiga194‑20 Offences in relation to investigation notices

Section 194‑25 Authorisation to examine books an194‑25 Authorisation to examine books and records etc.

Section 194‑35 Minister must notify outcome of i194‑35 Minister must notify outcome of investigation

Division 197Enforceable undertakings

Section 197‑1 Minister may accept written undert197‑1 Minister may accept written undertakings given by a private health insurer

Section 197‑5 Enforcement of undertakings197‑5 Enforcement of undertakings

Division 200Ministerial directions

Section 200‑1 Minister may give directions200‑1 Minister may give directions

Section 200‑5 Direction requirements200‑5 Direction requirements

Division 203Remedies in the Federal Court

Section 203‑1 Minister may apply to the Federal 203‑1 Minister may apply to the Federal Court

Section 203‑5 Declarations of contravention203‑5 Declarations of contravention

Section 203‑10 Pecuniary penalty order203‑10 Pecuniary penalty order

Section 203‑15 Compensation order203‑15 Compensation order

Section 203‑20 Adverse publicity order203‑20 Adverse publicity order

Section 203‑25 Other order203‑25 Other order

Section 203‑30 Time limit for declarations and o203‑30 Time limit for declarations and orders

Section 203‑35 Civil evidence and procedure rule203‑35 Civil evidence and procedure rules for declarations and orders

Section 203‑40 Civil proceedings after criminal 203‑40 Civil proceedings after criminal proceedings

Section 203‑45 Criminal proceedings during civil203‑45 Criminal proceedings during civil proceedings

Section 203‑50 Criminal proceedings after civil 203‑50 Criminal proceedings after civil proceedings

Section 203‑55 Evidence given in proceedings for203‑55 Evidence given in proceedings for penalty not admissible in criminal proceedings

Section 203‑60 Minister may require person to as203‑60 Minister may require person to assist

Section 203‑65 Relief from liability for contrav203‑65 Relief from liability for contravening an enforceable obligation

Section 203‑70 Powers of Federal Court203‑70 Powers of Federal Court

Division 206Revoking entitlement to offer rebate as a premium reduction

Section 206‑1 Revocation of status of participat206‑1 Revocation of status of participating insurer

Part 6‑1—Introduction

Division 230Introduction

Section 230‑1 What this Chapter is about230‑1 What this Chapter is about

Division 276Introduction

Section 276‑1 What this Part is about276‑1 What this Part is about

Division 279Reimbursement of participating insurers and powers of Chief Executive Medicare

Subdivision 279‑A—Reimbursement of private health insurers for premiums reduced under scheme

Section 279‑1 Who can make reimbursement claims279‑1 Who can make reimbursement claims

Section 279‑5 Participating insurers279‑5 Participating insurers

Section 279‑10 Requirements relating to reimburs279‑10 Requirements relating to reimbursement claims

Section 279‑11 Determination of claim279‑11 Determination of claim

Section 279‑15 Amounts payable to the private he279‑15 Amounts payable to the private health insurer

Section 279‑45 Reconsideration of decisions279‑45 Reconsideration of decisions

Section 279‑50 Audits by Chief Executive Medicar279‑50 Audits by Chief Executive Medicare

Section 279‑55 Chief Executive Medicare may requ279‑55 Chief Executive Medicare may require production of applications

Division 282Recovery of amounts and other matters

Subdivision 282‑A—When and how payments can be recovered

Section 282‑1 Recovery of payments282‑1 Recovery of payments

Section 282‑5 Interest on amounts recoverable282‑5 Interest on amounts recoverable

Section 282‑10 Chief Executive Medicare may set 282‑10 Chief Executive Medicare may set off debts against amounts payable

Section 282‑15 Reconsideration of certain decisi282‑15 Reconsideration of certain decisions under this Division

Section 282‑16 Administration of this Subdivisio282‑16 Administration of this Subdivision by Commissioner of Taxation

Section 282‑17 Subdivision operates in addition 282‑17 Subdivision operates in addition to Subdivision 282‑A

Section 282‑18 Liability for excess private heal282‑18 Liability for excess private health insurance premium reduction or refund

Section 282‑19 When general interest charge paya282‑19 When general interest charge payable

Section 282‑20 Notification requirements—private282‑20 Notification requirements—private health insurers

Section 282‑25 Use etc. of information relating 282‑25 Use etc. of information relating to another person

Section 282‑30 Information to be provided to the282‑30 Information to be provided to the Commissioner of Taxation

Section 282‑35 Delegation282‑35 Delegation

Section 282‑40 Appropriation282‑40 Appropriation

Division 304Introduction

Section 304‑1 What this Part is about304‑1 What this Part is about

Section 304‑5 Private Health Insurance (Levy Adm304‑5 Private Health Insurance (Levy Administration) Rules

Section 304‑10 Meaning of private health insuran304‑10 Meaning of private health insurance levy

Division 307Collection and recovery of private health insurance levies

Section 307‑1 When private health insurance levy307‑1 When private health insurance levy must be paid

Section 307‑5 Late payment penalty307‑5 Late payment penalty

Section 307‑10 Payment of levy and late payment 307‑10 Payment of levy and late payment penalty

Section 307‑15 Recovery of levy and late payment307‑15 Recovery of levy and late payment penalty

Section 307‑20 Waiver of late payment penalty307‑20 Waiver of late payment penalty

Section 307‑30 Other matters307‑30 Other matters

Division 310Returns, requesting information and keeping records: private health insurers

Section 310‑1 Returns relating to complaints lev310‑1 Returns relating to complaints levy

Section 310‑5 Insurer must keep records310‑5 Insurer must keep records

Section 310‑10 Power to request information from310‑10 Power to request information from insurer

Division 313Power to enter premises and search for documents related to complaints levy

Section 313‑1 Authorised officer may enter premi313‑1 Authorised officer may enter premises with consent

Section 313‑5 Authorised officer may enter premi313‑5 Authorised officer may enter premises under warrant

Section 313‑10 Announcement before entry313‑10 Announcement before entry

Section 313‑15 Executing a warrant to enter prem313‑15 Executing a warrant to enter premises

Section 313‑20 Identity cards313‑20 Identity cards

Division 318Private Health Insurance Risk Equalisation Special Account

Section 318‑1 Private Health Insurance Risk Equa318‑1 Private Health Insurance Risk Equalisation Special Account

Section 318‑5 Credits to the Risk Equalisation S318‑5 Credits to the Risk Equalisation Special Account

Section 318‑10 Purpose of the Risk Equalisation 318‑10 Purpose of the Risk Equalisation Special Account

Section 318‑15 Record keeping318‑15 Record keeping

Division 323Disclosure of information

Section 323‑1 Prohibition on disclosure of infor323‑1 Prohibition on disclosure of information

Section 323‑5 Authorised disclosure: official du323‑5 Authorised disclosure: official duties

Section 323‑10 Authorised disclosure: sharing in323‑10 Authorised disclosure: sharing information about insurers among agencies

Section 323‑15 Authorised disclosure: sharing in323‑15 Authorised disclosure: sharing information about insurers other than among agencies

Section 323‑20 Authorised disclosure: public int323‑20 Authorised disclosure: public interest

Section 323‑25 Authorised disclosure: by the Sec323‑25 Authorised disclosure: by the Secretary if authorised by affected person

Section 323‑30 Authorised disclosure: court proc323‑30 Authorised disclosure: court proceedings

Section 323‑40 Offence: disclosure of informatio323‑40 Offence: disclosure of information obtained by certain authorised disclosures

Section 323‑45 Offence: soliciting disclosure of323‑45 Offence: soliciting disclosure of information

Section 323‑50 Offence: use etc. of unauthorised323‑50 Offence: use etc. of unauthorised information

Section 323‑55 Offence: offering to supply prote323‑55 Offence: offering to supply protected information

Division 328Review of decisions

Section 328‑1 What this Part is about328‑1 What this Part is about

Section 328‑5 ART review of decisions328‑5 ART review of decisions

Division 333Miscellaneous

Section 333‑1 Delegation by Minister333‑1 Delegation by Minister

Section 333‑5 Delegation by Secretary333‑5 Delegation by Secretary

Section 333‑10 Approved forms333‑10 Approved forms

Section 333‑15 Signing approved forms333‑15 Signing approved forms

Section 333‑16 Approved electronic system333‑16 Approved electronic system

Section 333‑17 Automation of administrative acti333‑17 Automation of administrative action

Section 333‑18 Oversight and safeguards for auto333‑18 Oversight and safeguards for automation of administrative action

Section 333‑20 Private Health Insurance Rules ma333‑20 Private Health Insurance Rules made by the Minister

Section 333‑25 Private Health Insurance Rules ma333‑25 Private Health Insurance Rules made by APRA

Section 333‑30 Regulations333‑30 Regulations

Section 1Dictionary