15Information provided to insured persons

15 Information provided to insured persons

(1) This rule is made for the purposes of section 96‑25 of the Act. (2) When giving an insured person a copy of a private health information statement in accordance with section 93‑15 or subsection 93‑20 (1) of the Act, the private health insurer must inform the person of the following: (a) the name of each person who is covered by the policy; (b) if the product subgroup to which the policy belongs covers hospital treatment—the following statements for each adult who is covered by the policy and to whom a lifetime health cover loading applies, with the bracketed text replaced with the appropriate amounts: (i) “Your Lifetime Health Cover Loading is [Number]%.”; (ii) “You have [the period of time expressed in years, months, days as appropriate] remaining until you have reached 10 continuous years of cover and your loading is removed.”. (3) However, the insurer does not need to inform the person of the information referred to in subrule (2) more than once in any 12 month period. (4) The information referred to in subrule (2) may be accompanied by either or both of the following: (a) information additional to the information and form of words that are required by subrule 12 (1); (b) other information about the policy and how it pertains to the person.

Note: Example for paragraph (4) (b): An insurer may also inform an insured person of:

Note:  the premium for hospital treatment and for general treatment that applies in relation to each adult insured under the policy, taking account of matters such as loadings, rebates and discounts; and

Note:  the remaining portion (if any) of the waiting period for any or each treatment covered by the policy.

(5) If the private health information statement and the additional information referred to in subrule (2) and paragraphs (4)(a) and (b) are set out in the same document, the additional information must not obscure or contradict the information and form of words that that are required by subrule 12 (1).

Note: Example: The document on which a private health information statement is provided might include information about the monthly premium that is payable by the insured person under the policy that is additional to the information required by item 6 of the table to clause 2 of Schedule 1. That additional information could be included adjacent to the required information, so long as the additional information did not obscure or contradict the required information.