Part 2Requirement for records to be kept

Part 1 – Preliminary

1. Name of Rules

These Rules are the Private Health Insurance (Risk Equalisation Administration) Rules 2025.

2. Commencement

These Rules commence on 30 September 2025.

3. Interpretation

Note: Terms used in these Rules have the same meaning as in the Act – see section 13 of the Legislation Act 2003. These terms include:

APRA

complying health insurance policy

cover

health benefits fund

officer

policy holder

private health insurer

risk equalisation jurisdiction

1. In these Rules:

Act means the Private Health Insurance Act 2007.

adult is as defined in the Act.

Business Rules means the Private Health Insurance (Health Insurance Business) Rules 2018 made under the Act.

chronic disease management program or CDMP:

1. has the same meaning as in the Business Rules; and
2. for hospital treatment, includes a program similar to a chronic disease management program as referred to in the definition of ‘eligible benefit’ in the Risk Equalisation Policy Rules.

fund means a health benefits fund.

general treatment is as defined in the Act.

hospital cover is as defined in the Act.

hospital substitute treatment is as defined in the Act.

hospital treatment is as defined in the Act.

medicare benefit is as defined in the Act.

insured person, in relation to a policy, means a person covered by the policy.

insurer means a private health insurer.

policy means a complying health insurance policy.

quarter means a period of 3 months ending on 31 March, 30 June, 30 September or 31 December in a year.

quarterly return means a return required under the Financial Sector (Collection of Data) Act 2001 relating to risk equalisation information.

Risk Equalisation Policy Rules means the Private Health Insurance (Risk Equalisation Policy) Rules 2025 made under the Act.

1. In these Rules, a category of policy is to be identified as follows:
   1. for a policy under which only one person is insured – as ‘single’;
   2. for a policy under which 2 adults are insured (and no‑one else) – as ‘couple’;
   3. for a policy under which 2 or more people are insured, none of whom is an adult – as ‘2 + persons, no adults’;
   4. a policy under which 2 or more people are insured, only one of whom is an adult – as ‘single parent’;