7Requirements in relation to a restructure

7 Requirements in relation to a restructure

(1) A private health insurer must submit to the Council with an application for approval of a restructure proposal: (a) a business plan (the Business Plan) for each receiving fund covering the period of the first 36 months of operation from the restructure date including the following: (i) a statement of the liabilities to become treated as incurred for the purposes of the fund and the assets of the fund at the restructure date; and (ii) a budget statement for the fund for each month of the period of the Business Plan, setting out in detail: (A) the projected income and expenditure for the fund; and; (B) the projected assets and liabilities at the end of each month; and (C) the projected solvency and capital adequacy position of the fund at the end of each month; and (iii) the ratio that the projected amount of the management and administrative expenses in respect of the conduct of the fund bears to the estimated amount of premiums paid to that fund; and (iv) a summary of proposed changes, if any, to the insurer’s marketing plan, including strategies and costs associated with the restructuring and promotion of the fund; and (v) the estimated number of policy holders of the fund at the end of each month; and (vi) a summary of any proposed changes to the insurer’s contractual procedures and arrangements with health service providers and other service providers; and (vii) a summary of any proposed changes to benefits or premiums; and (viii) particulars of any arrangements or processes necessary for the restructure to take place, including: (A) any proposed amendments to the insurer’s constitution or rules required for the restructure to take place; and (B) any steps required under any other law of the Commonwealth, or State or Territory required for the restructure to take place; and (b) a statement by an officer (the certification of compliance) confirming that: (i) the insurer is not being wound up; and (ii) the board, or other governing body, of the insurer has considered the restructure proposal and is of the view it meets, and the operation of the restructuring funds from the restructure date in accordance with the restructure will meet, the requirements of: (A) the Act; and (B) any Regulations; and (C) the Rules; and (c) a report from the insurer’s appointed actuary (the actuary’s report) which provides the opinion of the actuary: (i) that the aspects of the Business Plan which provide the information required in paragraph (1)(a) are well‑founded; and (ii) that the assets and liabilities that would be transferred to the receiving fund or funds represent a reasonable estimate of what would be, immediately before the restructure, the net asset position of the transferring funds; and (iii) about how the restructure will affect the ability of the insurer to comply with: (A) the solvency standard; and (B) any solvency direction to which the insurer is subject; and (C) the capital adequacy standard; and (D) any capital adequacy direction to which the insurer is subject, in relation to each of the restructuring funds of the insurer at each of the following times: (E) the restructure date; and (F) any time over the first 36 months after the restructure date; and (G) any time within the foreseeable future of operation of the funds beyond 36 months after the restructure date; and (iv) about what effects the restructure is likely to have on the premiums for and benefits under: (A) each policy group of policies which are referable to the transferring fund immediately before the restructure; and (B) each policy group of policies which are not referable to a receiving fund immediately before the restructure; and at each of the following times: (C) the restructure date; and (D) any time over the first 36 months after the restructure date; and (E) any time within the foreseeable future of operation of the funds beyond 36 months after the restructure date; and (d) a copy of the statement, if any, issued by the insurer in accordance with subsection 93‑20(2) of the Act about any proposed change of the rules of the insurer associated with the proposed restructure; and (e) a copy of any statement issued in accordance with subsection 93‑20(4) about the aspect of the proposed restructure which involves the proposed change in funds to which policies are referable; and (f) a summary of any submissions in writing (including email or other electronic form) to the insurer from a policy holder of a fund conducted by the insurer in relation to any aspect of the restructure proposal regardless of whether the submission was made in response to a statement issued under subsection 93‑20(2) or subsection 93‑20(4) of the Act or otherwise. (2) Prior to the restructure date, the insurer must, except to the extent provided for in the Act, procure any amendment of its constitution and any of its rules required for the restructure proposal to take place.