• Lawyers in Sydney
• Lawyers in Melbourne
• Lawyers in Brisbane
• Lawyers in Perth
• Family lawyers
• Employment lawyers
• Criminal lawyers
• Wills and estates lawyers
• Find a lawyer

Note: This table relates only to the provisions of this Act as originally enacted. It will not be amended to deal with any later amendments of this Act.

(2) Any information in column 3 of the table is not part of this Act. Information may be inserted in this column, or information in it may be edited, in any published version of this Act.

3 Simplified outline of this Act

Only a private health insurer may carry on health insurance business. A private health insurer is a company that is registered under Division 3 of Part 2.

A private health insurer must have at least one health benefits fund. There are regimes governing:

(a) how health benefits funds are operated; and

(b) changing the health benefits fund to which a policy of insurance is referable; and

(c) terminating health benefits funds; and

(d) external management of health benefits funds.

Private health insurers must comply with prudential standards made by APRA, and with directions given by APRA.

Private health insurers and their appointed actuaries also have various other obligations.

APRA has monitoring and investigative powers in relation to private health insurers.

APRA may accept enforceable undertakings, and may seek remedies in the Federal Court in relation to contraventions of enforceable obligations.

Note: The Private Health Insurance Act 2007 defines the key concepts of health insurance business and health benefits funds as well as other concepts that relate to health benefits funds. That Act also sets out rules governing private health insurance products and provides incentives to encourage people to have private health insurance.

4 Interpretation

(1) In this Act:

ADI means an authorised deposit‑taking institution within the meaning of the Banking Act 1959.

application provision: see subsection 65(2).

applied Corporations Act provision: see subsection 65(3).

appointed actuary of a private health insurer means the person appointed as the actuary of the insurer in accordance with Division 2 of Part 5.

approved form: see section 172.

APRA means the Australian Prudential Regulation Authority.

APRA rules: see subsection 174(1).

APRA staff member has the same meaning as in the Australian Prudential Regulation Authority Act 1998.

assets of a health benefits fund: see section 26.

chief executive officer of a private health insurer means the person who is primarily and directly responsible to the directors of the insurer for the general and overall management of the insurer.

civil penalty order: see subsection 156(2).

complying health insurance policy has the same meaning as in the Private Health Insurance Act 2007.

complying health insurance product has the same meaning as in the Private Health Insurance Act 2007.

constitutional corporation means a corporation to which paragraph 51(xx) of the Constitution applies.

cover, in relation to an insurance policy, has the same meaning as in the Private Health Insurance Act 2007.

declaration of contravention means a declaration under subsection 155(1).

dependent person has the same meaning as in the Private Health Insurance Act 2007.

director has the same meaning as in the Corporations Act 2001.

disqualified person: see sections 119 and 121.

enforceable obligation means any of the following:

(a) a provision of this Act;
(b) a direction given under this Act;
(c) a provision of the risk equalisation levy legislation;
(d) if the registration of a private health insurer is subject to terms and conditions (see subsection 15(1))—those terms and conditions;
(e) in the case of a restricted access insurer—a provision included in the insurer’s constitution or rules in order to comply with subsection 15(3).

Note: References to this Act include prudential standards and APRA rules (see the definition of this Act in this subsection).

external administration means administration or control (however described) by an external administrator.

external administrator means:

(a) any of the following, within the meaning of the Corporations Act 2001:
(i) a liquidator or provisional liquidator;
(ii) a receiver, manager, managing controller, receiver and manager or other controller;
(iii) an administrator or a scheme manager; or
(b) a person who performs a similar role to a person referred to in subparagraph (a)(i), (ii) or (iii), whether under a law of the Commonwealth, or of a State or Territory, or otherwise;

but does not include an external manager or terminating manager.

external management means management, by an external manager, under Divisions 6 and 8 of Part 3.

external manager, in relation to a health benefits fund, means a person appointed under section 51 as the external manager of the fund.

Federal Court means the Federal Court of Australia.

for profit insurer means a private health insurer that is registered under Division 3 of Part 2 as a for profit insurer.

health benefits fund has the same meaning as in the Private Health Insurance Act 2007.

Health Department means the Department administered by the Health Minister.

health insurance business has the same meaning as in the Private Health Insurance Act 2007.

Health Minister means the Minister administering the Private Health Insurance Act 2007.

health‑related business has the same meaning as in the Private Health Insurance Act 2007.

Health Secretary means the Secretary of the Health Department.

improper discrimination has the same meaning as in the Private Health Insurance Act 2007.

inspector means a person appointed under section 130 to be an inspector.

insurance has the same meaning as in paragraph 51(xiv) of the Constitution.

investigation warrant: see subsection 136(1).

lawyer means a duly qualified legal practitioner and, in relation to a person, means such a practitioner acting for the person.

makes a permitted capital payment: see subsection 27(3).

manager, in relation to a health benefits fund, means an external manager or terminating manager of the fund.

net asset position of a health benefits fund means the difference between:

(a) the assets of the fund; and
(b) the policy liabilities and other liabilities of the fund that the private health insurer conducting the fund has incurred for the purposes of the fund.

officer of a private health insurer means:

(a) a director of the insurer; or
(b) a chief executive officer of the insurer; or
(c) any other person who has or exercises senior management responsibilities (within the meaning of prudential standards) for the insurer.

penalty includes forfeiture or punishment.

personal information has the same meaning as in the Privacy Act 1988.

policy group of a health benefits fund: see subsection 32(7).

policy holder of a health benefits fund has the same meaning as in the Private Health Insurance Act 2007.

policy liability of a private health insurer means:

(a) a liability that has arisen under an insurance policy; or
(b) a liability that, subject to the terms and conditions of an insurance policy, will arise on the happening of an event, or at a time, specified in the policy.

premises includes the following:

(a) a structure, building, vehicle, vessel or aircraft;
(b) a place (whether or not enclosed or built on);
(c) a part of a thing referred to in paragraph (a) or (b).

Private Health Insurance Ombudsman has the same meaning as in the Private Health Insurance Act 2007.

private health insurer means a body that is registered under Division 3 of Part 2.

proceeding means:

(a) a proceeding in a court; or
(b) a proceeding or hearing before, or an examination by or before, a tribunal;

whether the proceeding, hearing or examination is of a civil, administrative, criminal, disciplinary or other nature.

prudential matters: see subsection 92(2).

prudential standards: see subsection 92(1).

referable has the same meaning as in the Private Health Insurance Act 2007.

responsible insurer means:

(a) for a health benefits fund that is under external management—the private health insurer that was conducting the fund prior to the appointment of the external manager of the fund; or
(b) for a health benefits fund that is under terminating management—the private health insurer that was conducting the fund prior to the appointment of the terminating manager of the fund.

restricted access group: see subsection 15(4).

restricted access insurer means a private health insurer that is registered under Division 3 of Part 2 as a restricted access insurer.

risk equalisation jurisdiction has the same meaning as in the Private Health Insurance Act 2007.

risk equalisation levy legislation means any of the following:

(a) the Private Health Insurance (Risk Equalisation Levy) Act 2003;
(b) the provisions of the Private Health Insurance Act 2007, as they apply in relation to:
(i) levy imposed under the Private Health Insurance (Risk Equalisation Levy) Act 2003; or
(ii) the Risk Equalisation Special Account.

Risk Equalisation Special Account has the same meaning as in the Private Health Insurance Act 2007.

rules of a private health insurer has the same meaning as in the Private Health Insurance Act 2007.

search powers means powers to search for, inspect, take extracts from, and make copies of, documents.

State insurance has the same meaning as in paragraph 51(xiv) of the Constitution.

statutory functions and duties of an actuary of a private health insurer: see subsection 107(2).

terminating management means management, by a terminating manager, under Divisions 5 and 8 of Part 3.

terminating manager, in relation to the health benefits funds of a private health insurer, means a person appointed under Division 5 or 7 of Part 3 as the terminating manager of the funds.

termination day, in relation to the health benefits funds of a private health insurer: see subsection 40(2).

this Act includes prudential standards and APRA rules.

voluntary deed of arrangement means:

(a) a deed of arrangement agreed on at a meeting of a kind referred to in section 58; or
(b) such a deed as varied in accordance with APRA rules made for the purpose of this paragraph.

(2) To avoid doubt, a reference in this Act to another Act includes a reference to any regulations, rules, standards or other instruments made, and to any conditions imposed, under that other Act.

Note: For example:

(a) a reference to the Private Health Insurance Act 2007 includes a reference to rules made under that Act; and
(b) a reference to the Financial Sector (Collection of Data) Act 2001 includes a reference to reporting standards made under that Act.

5 General administration of Act

APRA has the general administration of this Act.

5A Norfolk Island

This Act extends to Norfolk Island.

Division 2—Constitutional matters

6 Act binds the Crown

Subject to section 7, this Act binds the Crown in each of its capacities.

7 Act not to apply to State insurance within that State

This Act does not apply with respect to State insurance that does not extend beyond the limits of the State concerned.

8 Compensation for acquisition of property

(1) If the operation of this Act would result in an acquisition of property (within the meaning of paragraph 51(xxxi) of the Constitution) from a person otherwise than on just terms (within the meaning of that paragraph), the Commonwealth is liable to pay a reasonable amount of compensation to the person. (2) If the Commonwealth and the person do not agree on the amount of the compensation, the person may institute proceedings in the Federal Court for the recovery from the Commonwealth of such reasonable amount of compensation as the Court determines.

Part 2—Registration of private health insurers

Division 1—Introduction

9 Simplified outline of this Part

Only a private health insurer may carry on health insurance business. A private health insurer is a company that is registered under Division 3 of this Part.

Note: Part 4‑2 of the Private Health Insurance Act 2007 defines the concept of health insurance business.

There are 2 kinds of special status that some private health insurers may have. T

This is an opening excerpt, not the complete document.