Commonwealth Consolidated Acts Commonwealth Consolidated ActsAct No. 31 of 2007 as amended
This compilation was prepared on 24 May 2012
taking into account amendments up to Act No. 26 of 2012
The text of any of those amendments not in force
on that date is appended in the Notes section
The operation of amendments that have been incorporated may
be
affected by application provisions that are set out in the Notes section
Prepared by the Office of Legislative Drafting and
Publishing,
Attorney-General's Department, Canberra
Contents
Chapter 1--Introduction 1
Part 1-1--Introduction 1
Division 1--Preliminary 1
1-1......... Short title [see Note 1] ........................................................................ 1
1-5......... Commencement ................................................................................... 1
1-10....... Identifying defined terms .................................................................... 1
Division 3--Overview of this Act 3
3-1......... What this Act is about ......................................................................... 3
3-5......... Incentives (Chapter 2) ......................................................................... 3
3-10....... Complying health insurance products (Chapter 3) .............................. 3
3-15....... Private health insurers (Chapter 4) ...................................................... 3
3-20....... Enforcement (Chapter 5) ..................................................................... 4
3-25....... Administration (Chapter 6) ................................................................. 4
3-30....... Dictionary (Schedule 1) ...................................................................... 4
Division 5--Constitutional matters 5
5-1......... Meaning of insurance ......................................................................... 5
5-5......... Act not to apply to State insurance within that State ............................ 5
5-10....... Compensation for acquisition of property ........................................... 5
Chapter 2--Incentives 6
Part 2-1--Introduction 6
Division 15--Introduction 6
15-1....... What this Chapter is about .................................................................. 6
Part 2-2--Premiums reduction and incentive payments schemes 7
Division 20--Introduction 7
20-1....... What this Part is about ........................................................................ 7
20-5....... Private Health Insurance (Incentives) Rules ........................................ 7
Division 23--Premiums reduction scheme 8
Subdivision 23-A--Amount of reduction 8
23-1....... Reduction in premiums ....................................................................... 8
23-5....... Meaning of incentive amount .............................................................. 9
23-10..... Reduction after a person 65 years or over ceases to be covered by policy 10
Subdivision 23-B--Participation in the premiums reduction scheme 11
23-15..... Registration as a participant in the premiums reduction scheme ........ 11
23-20..... Refusal to register ............................................................................. 11
23-25..... Pre-1999 participants must keep information up to date .................... 12
23-30..... Participants who want to withdraw from scheme .............................. 13
23-35..... Revocation of registration ................................................................. 13
23-40..... Variation of registration .................................................................... 13
23-45..... Retention of applications by private health insurers .......................... 14
Division 26--The incentive payments scheme 15
Subdivision 26-A--Amount of incentive payment 15
26-1....... Payment in relation to premiums ....................................................... 15
26-5....... Payment after a person 65 years or over ceases to be covered by policy 16
Subdivision 26-B--Claiming payments under the incentive payments scheme 17
26-10..... Claim for payment under incentive payments scheme ....................... 17
26-15..... Withdrawal of claim .......................................................................... 17
26-20..... Determination of claim and payment of amount ................................ 18
26-25..... Reconsideration of decision refusing a claim .................................... 18
26-30..... Claimants to keep information up to date .......................................... 19
Part 2-3--Lifetime health cover 20
Division 31--Introduction 20
31-1....... What this Part is about ...................................................................... 20
31-5....... Private Health Insurance (Lifetime Health Cover) Rules ................... 20
Division 34--General rules about lifetime health cover 21
34-1....... Increased premiums for person who is late in taking out hospital cover .. 21
34-5....... Increased premiums for person who ceases to have hospital cover after his or her lifetime health cover base day 21
34-10..... Increased premiums stop after 10 years' continuous cover ............... 22
34-15..... Meaning of hospital cover ................................................................ 23
34-20..... Meaning of permitted days without hospital cover ........................... 23
34-25..... Meaning of lifetime health cover base day ........................................ 24
34-30..... When a person is overseas or enters Australia .................................. 25
Division 37--Exceptions to the general rules about lifetime health cover 26
37-1....... People born on or before 1 July 1934 ............................................... 26
37-5....... People over 31 and overseas on 1 July 2000 .................................... 26
37-7....... Person yet to turn 31 ......................................................................... 26
37-10..... Hardship cases .................................................................................. 26
37-15..... Increases cannot exceed 70% of base rates ....................................... 27
37-20..... Joint hospital cover ........................................................................... 27
Division 40--Administrative matters relating to lifetime health cover 28
40-1....... Notification to insured people etc. ..................................................... 28
40-5....... Evidence of having had hospital cover, or of a person's age ............. 29
Chapter 3--Complying health insurance products 30
Part 3-1--Introduction 30
Division 50--Introduction 30
50-1....... What this Chapter is about ................................................................ 30
50-5....... Private Health Insurance Rules relevant to this Chapter .................... 30
Part 3-2--Community rating 31
Division 55--Principle of community rating 31
55-1....... What this Part is about ...................................................................... 31
55-5....... Principle of community rating ........................................................... 31
55-10..... Closed products ................................................................................ 33
55-15..... Pilot projects ..................................................................................... 33
Part 3-3--Requirements for complying health insurance products 34
Division 60--Introduction 34
60-1....... What this Part is about ...................................................................... 34
Division 63--Basic rules about complying health insurance products 35
63-1....... Obligation to ensure products are complying products ..................... 35
63-5....... Meaning of complying health insurance product .............................. 35
63-10..... Meaning of complying health insurance policy ................................. 36
Division 66--Community rating requirements 37
66-1....... Community rating requirements ........................................................ 37
66-5....... Premium requirement ........................................................................ 37
66-10..... Minister's approval of premiums ...................................................... 39
66-15..... Entitlement to benefits for general treatment ...................................... 39
66-20..... Different amount of benefits depending on where people live .......... 40
Division 69--Coverage requirements 41
69-1....... Coverage requirements ...................................................................... 41
69-5....... Meaning of cover .............................................................................. 41
69-10..... Meaning of hospital-substitute treatment .......................................... 42
Division 72--Benefit requirements for policies that cover hospital treatment 43
72-1....... Benefit requirements ......................................................................... 43
72-5....... Rules requirement in relation to provision of benefits ....................... 46
72-10..... Minimum benefits for prostheses ...................................................... 46
72-15..... Ongoing listing fee for prostheses .................................................... 48
72-20..... Other matters ..................................................................................... 48
Division 75--Waiting period requirements 49
75-1....... Waiting period requirements ............................................................. 49
75-5....... Meaning of waiting period ................................................................ 49
75-10..... Meaning of transfers ........................................................................ 50
75-15..... Meaning of pre-existing condition .................................................... 50
Division 78--Portability requirements 52
78-1....... Portability requirements .................................................................... 52
Division 81--Quality assurance requirements 54
81-1....... Quality assurance requirements ......................................................... 54
Division 84--Enforcement of this Part 55
84-1....... Offence: advertising, offering or insuring under non-complying policies 55
84-5....... Offence: directors and chief executive officers liable if systems not in place to prevent breaches 55
84-10..... Injunction in relation to non-complying policies ............................... 56
84-15..... Remedies for people affected by non-complying policies ................. 57
Part 3-4--Obligations relating to complying health insurance products 58
Division 90--Introduction 58
90-1....... What this Part is about ...................................................................... 58
Division 93--Giving information to consumers 59
93-1....... Maintaining up to date standard information statements .................... 59
93-5....... Meaning of standard information statement ..................................... 60
93-10..... Making standard information statements available ............................ 60
93-15..... Giving information to newly insured people ..................................... 60
93-20..... Keeping insured people up to date ..................................................... 61
93-25..... Giving advance notice of detrimental changes to rules ...................... 62
93-30..... Failure to give information to consumers .......................................... 62
Division 96--Giving information to the Department, the Council and the Private Health Insurance Ombudsman 63
96-1....... Giving standard information statements on request ........................... 63
96-5....... Giving standard information statements for new products ................ 63
96-10..... Giving updated standard information statements ............................... 63
96-15..... Giving additional information on request .......................................... 64
96-20..... Failure to give information to Department, Council or Private Health Insurance Ombudsman 64
96-25..... Giving information required by the Private Health Insurance (Complying Product) Rules 65
Division 99--Transfer certificates 66
99-1....... Transfer certificates ........................................................................... 66
Division 102--Private health insurers to offer cover for hospital treatment 68
102-1..... Private health insurers to offer cover for hospital treatment .............. 68
Chapter 4--Private health insurers 69
Part 4-1--Introduction 69
Division 110--Introduction 69
110-1..... What this Chapter is about ................................................................ 69
Part 4-2--Carrying on health insurance business 70
Division 115--Introduction 70
115-1..... What this Part is about ...................................................................... 70
115-5..... The Private Health Insurance (Health Insurance Business) Rules ..... 70
115-10... Whether a business etc. is health insurance business ........................ 70
Division 118--Prohibition of carrying on health insurance business without registration 72
118-1..... Carrying on health insurance business without registration .............. 72
118-5..... Injunctions ........................................................................................ 72
Division 121--What is health insurance business? 74
121-1..... Meaning of health insurance business .............................................. 74
121-5..... Meaning of hospital treatment .......................................................... 75
121-7..... Conditions on declarations of hospitals ............................................. 76
121-10... Meaning of general treatment ........................................................... 77
121-15... Extension to employee health benefits schemes ................................. 78
121-20... Exception: accident and sickness insurance business ........................ 79
121-25... Exception: liability insurance business .............................................. 79
121-30... Exception: insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules 80
Part 4-3--Registration 81
Division 126--Registration 81
126-1..... What this Part is about ...................................................................... 81
126-5..... The Private Health Insurance (Registration) Rules ............................ 81
126-10... Applying for registration ................................................................... 81
126-15... Requesting further information ......................................................... 82
126-20... Deciding the application .................................................................... 82
126-25... Notifying the decision ....................................................................... 84
126-30... Council can be taken to refuse application ......................................... 84
126-35... Council to maintain record of registrations etc. ................................. 85
126-40... Changing registration status .............................................................. 85
126-42... Conversion to for profit status .......................................................... 86
126-45... Cancellation of registration ................................................................ 88
Part 4-4--Health benefits funds 89
Division 131--Introduction 89
131-1..... What this Part is about ...................................................................... 89
131-5..... The Private Health Insurance (Health Benefits Fund) Rules ............. 89
131-10... Meaning of health benefits fund ........................................................ 89
131-15... Meaning of health-related business .................................................. 90
Division 134--The requirement to have health benefits funds 91
134-1..... Private health insurers must have health benefits funds .................... 91
134-5..... Notifying the Council when health benefits funds are established .... 91
134-10... Inclusion of health-related businesses in health benefits funds ......... 92
Division 137--The operation of health benefits funds 93
137-1..... Assets of health benefits funds ......................................................... 93
137-5..... Payments to health benefits funds ..................................................... 94
137-10... Expenditure and application of health benefits funds ........................ 95
137-15... Effect of non-compliance with section 137-10 .................................. 96
137-20... Investment of health benefits funds ................................................... 97
137-25... Restriction on restructure, merger, acquisition or termination of health benefits funds 98
137-30... Operation of health-related businesses through health benefits funds 98
Division 140--The solvency standard for health benefits funds 99
140-1..... Purpose of Division .......................................................................... 99
140-5..... Council to establish solvency standard .............................................. 99
140-10... Purpose of solvency standard ........................................................... 99
140-15... Compliance with solvency standard .................................................. 99
140-20... Solvency directions ......................................................................... 101
Division 143--The capital adequacy standard for health benefits funds 104
143-1..... Purpose of Division ........................................................................ 104
143-5..... Council to establish capital adequacy standard ................................ 104
143-10... Purpose of capital adequacy standard .............................................. 104
143-15... Compliance with capital adequacy standard .................................... 105
143-20... Capital adequacy directions ............................................................. 106
Division 146--Restructure, merger and acquisition of health benefits funds 109
146-1..... Restructure of health benefits funds ................................................ 109
146-5..... Merger and acquisition of health benefits funds .............................. 111
146-10... Consent of policy holders not required ........................................... 113
146-15... Other laws not overridden ............................................................... 114
Division 149--Termination of health benefits funds 115
Subdivision 149-A--Approving the termination of health benefits funds 115
149-1..... Applying for termination ................................................................. 115
149-5..... Requesting further information ....................................................... 115
149-10... Deciding the application .................................................................. 115
149-15... Council can be taken to refuse application ....................................... 116
Subdivision 149-B--Conducting the termination of health benefits funds 116
149-20... Conduct of funds during termination process ................................. 116
149-25... Insurers etc. to give reports to Council ............................................ 117
149-30... Terminating managers displace management of funds .................... 117
Subdivision 149-C--Ending the termination of health benefits funds 118
149-35... Power to end termination ................................................................ 118
Subdivision 149-D--Completing the termination of health benefits funds 118
149-40... Completion of the termination process ............................................ 118
149-45... Distribution of remaining assets after completion of the termination process 119
149-50... Liability of officers of insurers for loss to terminated funds ........... 119
149-55... Report of terminating manager ........................................................ 120
149-60... Applying for winding up ................................................................ 120
Division 152--Duties and liabilities of directors etc. 121
152-5..... Notices to remedy contraventions ................................................... 121
152-10... Liability of directors in relation to non-compliance with notices ..... 121
152-15... Council may sue in the name of private health insurers ................... 122
Part 4-5--Other obligations of private health insurers 123
Division 157--Introduction 123
157-1..... What this Part is about .................................................................... 123
157-5..... The Private Health Insurance (Insurer Obligations) Rules .............. 123
Division 160--Appointed actuaries 124
160-1..... Appointment ................................................................................... 124
160-5..... Eligibility for appointment ............................................................... 124
160-10... Notification of appointment etc. ...................................................... 125
160-15... Cessation of appointment ................................................................ 125
160-20... Compliance with the Private Health Insurance (Insurer Obligations) Rules 125
160-25... Powers of appointed actuary ........................................................... 125
160-30... Actuary's obligations to report ........................................................ 126
160-35... Qualified privilege of appointed actuary .......................................... 127
Division 163--Prudential standards 129
163-1..... Private Health Insurance (Insurer Obligations) Rules to establish prudential standards 129
163-5..... Compliance with prudential standards ............................................. 130
163-10... Notice of breaches of prudential standards etc. ............................... 130
163-15... Directions to comply with standards ............................................... 130
163-20... Failure to comply with directions .................................................... 131
Division 166--Disqualified persons 132
166-1..... Private health insurers not to allow disqualified persons to act as directors 132
166-5..... Disqualified persons must not act for private health insurers .......... 132
166-10... Effect of non-compliance ................................................................ 132
166-15... Who is a disqualified person? ......................................................... 132
166-20... Council may disqualify persons ...................................................... 133
166-25... Council may determine that persons are not disqualified ................. 134
Division 169--Reporting and notification requirements 136
169-1..... Copies of reports to policy holders ................................................. 136
169-5..... Information to be given to the Council annually .............................. 136
169-10... Private health insurers to notify any changes to rules ...................... 136
169-15... Private health insurers to notify Department and Council about current chief executive officer 137
Division 172--Miscellaneous 138
172-1..... Private health insurers to comply with Council's requirements ....... 138
172-5..... Agreements with medical practitioners ............................................ 138
172-10... Private health insurers to give information to Secretary .................. 138
172-15... Restrictions on payment of pecuniary penalties etc. ........................ 139
Chapter 5--Enforcement 140
Part 5-1--Introduction 140
Division 180--Introduction 140
180-1..... What this Chapter is about .............................................................. 140
Part 5-2--General enforcement methods 141
Division 185--What this Part is about 141
185-1..... Introduction ..................................................................................... 141
185-5..... Meaning of enforceable obligation ................................................. 141
185-10... Meaning of Council-supervised obligation ..................................... 142
Division 188--Performance indicators 143
188-1..... Performance indicators .................................................................... 143
Division 191--Explanation of private health insurer's operations 144
191-1..... Minister or Council may seek an explanation from a private health insurer 144
191-5..... Writer must respond to insurer's explanation .................................. 144
Division 194--Investigation of private health insurer's operations 146
194-1..... Minister or Council may investigate a private health insurer ........... 146
194-5..... Notice to give information ............................................................... 146
194-10... Notice to produce documents .......................................................... 147
194-15... Notice to give evidence ................................................................... 147
194-20... Offences in relation to investigation notices .................................... 148
194-25... Authorisation to examine books and records etc. ............................ 149
194-30... Minister may consult Council ......................................................... 149
194-35... Minister or Council must notify outcome of investigation .............. 149
Division 197--Enforceable undertakings 150
197-1..... Minister or Council may accept written undertakings given by a private health insurer 150
197-5..... Enforcement of undertakings .......................................................... 150
Division 200--Ministerial and Council directions 151
200-1..... Minister or Council may give directions ......................................... 151
200-5..... Direction requirements .................................................................... 152
Division 203--Remedies in the Federal Court 153
203-1..... Minister or Council may apply to the Federal Court ....................... 153
203-5..... Declarations of contravention .......................................................... 153
203-10... Pecuniary penalty order ................................................................... 154
203-15... Compensation order ........................................................................ 154
203-20... Adverse publicity order ................................................................... 155
203-25... Other order ...................................................................................... 155
203-30... Time limit for declarations and orders ............................................. 155
203-35... Civil evidence and procedure rules for declarations and orders ....... 155
203-40... Civil proceedings after criminal proceedings ................................... 155
203-45... Criminal proceedings during civil proceedings ............................... 156
203-50... Criminal proceedings after civil proceedings ................................... 156
203-55... Evidence given in proceedings for penalty not admissible in criminal proceedings 156
203-60... Minister or Council may require person to assist ............................ 157
203-65... Relief from liability for contravening an
enforceable
obligation
........................................................................................ 159
203-70... Powers of Federal Court ................................................................. 159
Division 206--Revoking entitlement to offer rebate as a premium reduction 160
206-1..... Revocation of status of participating insurer ................................... 160
Part 5-3--Enforcement of health benefits fund requirements 161
Division 211--Introduction 161
211-1..... What this Part is about .................................................................... 161
211-5..... Purpose of this Part ......................................................................... 161
211-10... The Private Health Insurance (Health Benefits Fund Enforcement) Rules 162
211-15... Limitation on external management and termination of health benefits funds 162
Division 214--Investigations into affairs of private health insurers 163
214-1..... Investigation of private health insurers by inspectors ...................... 163
214-5..... Powers of inspectors ....................................................................... 163
214-10... Person may be represented by lawyer ............................................. 164
214-15... Compliance with requirements of inspectors ................................... 164
214-20... Access to premises .......................................................................... 165
214-25... Reports of inspectors ...................................................................... 166
214-30... Dissemination of reports ................................................................. 167
214-35... Liability for publishing reports etc. ................................................. 168
214-40... Delegation by inspectors ................................................................. 168
214-45... Records not to be concealed etc. ...................................................... 169
Division 217--External management of health benefits funds 170
Subdivision 217-A--Preliminary 170
217-1..... Purpose of Division ........................................................................ 170
217-5..... The basis of the law relating to external management ...................... 170
Subdivision 217-B--Appointment of external managers 171
217-10... Council may appoint external managers .......................................... 171
217-15... Grounds of appointment of external managers ................................ 171
217-20... External managers to displace management of funds ...................... 172
Subdivision 217-C--Duties and powers of external managers 173
217-25... Duties of external managers ............................................................ 173
217-30... Additional powers of external managers ......................................... 173
217-35... Protection of property during external management ........................ 174
217-40... Rights of chargee, owner or lessor of property of fund under external management 174
Subdivision 217-D--Procedure relating to voluntary deeds of arrangement 175
217-45... Matters that may be included in the Private Health Insurance (Health Benefits Fund Enforcement) Rules 175
Subdivision 217-E--External managers' reports to Council 176
217-50... External managers to give reports to Council .................................. 176
217-55... Dealing with reports given to the Council ....................................... 177
217-60... Court orders in respect of schemes of arrangement ......................... 178
Subdivision 217-F--Miscellaneous 179
217-65... When an external management begins and ends .............................. 179
217-70... Effect of things done during external management of health benefits funds 179
217-75... Disclaimer of onerous property ....................................................... 180
217-80... Application of provisions of Corporations Act ............................... 180
Division 220--Ordering the termination of health benefits funds 183
220-1..... Applications by external managers to the Federal Court ................. 183
220-5..... Orders made on applications for appointments of terminating managers 183
220-10... Binding nature of Court orders ....................................................... 183
220-15... Notice of appointments ................................................................... 183
Chapter 6--Administration 184
Part 6-1--Introduction 184
Division 230--Introduction 184
230-1..... What this Chapter is about .............................................................. 184
Part 6-2--Private Health Insurance Ombudsman 186
Division 235--Introduction 186
235-1..... Principal object of this Part ............................................................. 186
235-5..... Private Health Insurance (Ombudsman) Rules ............................... 186
Division 238--Establishment and functions 187
238-1..... Establishment of office of Private Health Insurance Ombudsman .. 187
238-5..... Functions of Private Health Insurance Ombudsman ....................... 187
Division 241--Complaints 189
Subdivision 241-A--Relevant complaints 189
241-1..... Who may make a complaint ............................................................ 189
241-5..... Persons against whom complaints may be made ............................. 189
241-10... Grounds for complaint .................................................................... 189
Subdivision 241-B--Dealing with complaints 190
241-15... Initial receipt of complaint ............................................................... 190
241-20... Ways of dealing with complaints .................................................... 190
241-25... Referral to the Australian Competition and Consumer Commission 191
241-30... Referral to other bodies ................................................................... 192
241-35... Deciding not to deal with a complaint ............................................. 192
Subdivision 241-C--Referral to subjects of complaints 194
241-40... Referral to the subject of the complaint ........................................... 194
Subdivision 241-D--Investigation of complaints 195
241-45... Investigation of complaint ............................................................... 195
241-50... Minister may direct Private Health Insurance Ombudsman to investigate, or to continue to investigate, a complaint ........................................................................................................ 195
Subdivision 241-E--Recommendations and reports 195
241-55... Recommendations as a result of referral or investigation ................ 195
241-60... Report to Minister on outcome of investigation under Subdivision 241-D 196
Subdivision 241-F--Miscellaneous 197
241-65... Complainant to be kept informed .................................................... 197
Division 244--Investigations 199
Subdivision 244-A--Investigations 199
244-1..... Initiating investigations ................................................................... 199
244-5..... Investigations at Minister's request ................................................. 199
Subdivision 244-B--Recommendations and reports 200
244-10... Recommendations as a result of investigation ................................. 200
244-15... Report to Minister on outcome of investigations under this Division 201
244-20... Consultation with Australian Competition and Consumer Commission .. 202
Division 247--Mediation 203
247-1..... Conducting mediation ..................................................................... 203
247-5..... Participation in mediation may be compulsory ................................ 203
247-10... Medical practitioners may appoint representatives .......................... 204
247-15... Conduct of compulsory mediation .................................................. 205
247-20... Admissibility of things said in mediation ........................................ 205
247-25... Appointment of mediators ............................................................... 206
Division 250--Information-gathering 207
250-1..... Information-gathering ..................................................................... 207
250-5..... Limits on information-gathering ...................................................... 209
250-10... Disclosure of personal information ................................................. 209
Division 253--Provisions relating to the Private Health Insurance Ombudsman 211
253-1..... Appointment of the Private Health Insurance Ombudsman ............ 211
253-5..... Validity of appointments ................................................................. 211
253-10... Acting appointments ....................................................................... 211
253-15... Remuneration and allowances ......................................................... 212
253-20... Outside employment ....................................................................... 212
253-25... Leave of absence ............................................................................. 212
253-30... Resignation ..................................................................................... 213
253-35... Termination of appointment ............................................................ 213
253-40... Disclosure of interest by Private Health Insurance Ombudsman .... 213
253-45... Statutory agency etc. for purposes of Public Service Act ................ 214
253-50... Annual report .................................................................................. 214
253-55... Delegation ....................................................................................... 215
253-60... Private Health Insurance Ombudsman and staff not personally liable 215
Division 256--Miscellaneous 216
256-1..... Protection from civil actions ............................................................ 216
256-5..... Victimisation ................................................................................... 216
256-10... Giving information about the Private Health Insurance Ombudsman 216
Part 6-3--Private Health Insurance Administration Council 218
Division 261--Introduction 218
261-1..... What this Part is about .................................................................... 218
261-5..... The Private Health Insurance (Council) Rules ................................ 218
Division 264--Continuation, purposes, functions and powers 219
264-1..... Continuation of the Council ............................................................ 219
264-5..... Objectives of the Council ................................................................ 219
264-10... Functions of the Council ................................................................. 220
264-15... Report on private health insurers ..................................................... 222
264-20... Powers ............................................................................................ 223
264-25... Directions by Minister .................................................................... 223
Division 267--Constitution and administration 224
267-1..... Constitution of the Council ............................................................. 224
267-5..... Appointment of members ................................................................ 224
267-10... Meetings of the Council .................................................................. 224
267-15... Delegation by the Council ............................................................... 225
267-20... Modification of the Commonwealth Authorities and Companies Act 1997 225
Division 270--Members 226
270-1..... Terms and conditions etc. ................................................................ 226
270-5..... Validity of appointments ................................................................. 226
270-10... Acting Commissioner ..................................................................... 226
270-15... Deputy Commissioner to act as Commissioner in certain circumstances 226
270-20... Powers and duties of persons acting as Commissioner ................... 227
270-25... Remuneration and allowances of members ..................................... 228
270-30... Leave of absence ............................................................................. 228
270-35... Resignation ..................................................................................... 228
270-40... Termination of appointment ............................................................ 229
270-45... Disclosure of interests ..................................................................... 229
Division 273--Chief Executive Officer and staff 231
273-1..... Chief Executive Officer ................................................................... 231
273-5..... Duties of Chief Executive Officer ................................................... 231
273-10... Conflict of interests ......................................................................... 231
273-15... Staff and consultants ....................................................................... 232
273-20... Remuneration and allowances of Chief Executive Officer .............. 232
273-25... Leave of absence of Chief Executive Officer .................................. 232
Part 6-4--Administration of premiums reduction and incentive payments schemes 234
Division 276--Introduction 234
276-1..... What this Part is about .................................................................... 234
Division 279--Provisions applying only to premiums reduction scheme 235
Subdivision 279-A--Reimbursement of private health insurers for premiums reduced under scheme 235
279-1..... Participating insurers may claim reimbursement ............................. 235
279-5..... Participating insurers ....................................................................... 235
279-10... Requirements for claims .................................................................. 236
279-15... Amounts payable to the private health insurer ................................. 236
279-20... Notifying private health insurers if amount is not payable .............. 236
279-25... Additional payment if insurer claims less than entitlement .............. 237
279-30... Additional payment if insurer makes a late claim ............................ 237
279-35... Content and timing of application .................................................... 238
279-40... Decision on application ................................................................... 238
279-45... Reconsideration of decisions ........................................................... 239
Subdivision 279-B--Powers of Chief Executive Medicare in relation to participating insurers 240
279-50... Audits by Chief Executive Medicare ............................................... 240
279-55... Chief Executive Medicare may require production of applications .. 241
Division 282--Provisions applying to premiums reduction scheme and incentive payments scheme 242
Subdivision 282-A--When and how payments can be recovered 242
282-1..... Recovery of payments ..................................................................... 242
282-5..... Interest on amounts recoverable ...................................................... 243
282-10... Chief Executive Medicare may set off debts against amounts payable 244
282-15... Reconsideration of certain decisions under this Division ................ 245
Subdivision 282-B--Miscellaneous 246
282-20... Notification requirements--private health insurers ......................... 246
282-25... Use etc. of information relating to another person ........................... 247
282-30... Information to be provided to the Commissioner of Taxation ......... 247
282-35... Delegation ....................................................................................... 248
282-40... Appropriation .................................................................................. 248
Part 6-5--External managers and terminating managers 249
Division 287--Introduction 249
287-1..... What this Part is about .................................................................... 249
287-5..... The Private Health Insurance (Management) Rules ........................ 249
Division 290--Powers of managers 250
290-1..... Powers of managers ........................................................................ 250
290-5..... Officers etc. not to perform functions etc. while fund is under management 250
290-10... Managers act as agents of private health insurers ............................ 251
Division 293--Information concerning, and records and property of, health benefits funds 252
293-1..... Directors etc. to help managers ....................................................... 252
293-5..... Managers' rights to certain records ................................................. 253
293-10... Only manager can deal with property of fund under management .. 254
293-15... Order for compensation where officer involved in void transaction 255
Division 296--Provisions incidental to appointment of managers 257
296-1..... Remuneration of managers .............................................................. 257
296-5..... Council may give directions to managers ........................................ 257
296-10... Termination of appointments of managers ...................................... 257
296-15... Acts of managers valid etc. ............................................................. 258
296-20... Indemnity ........................................................................................ 259
296-25... Qualified privilege ........................................................................... 259
Division 299--Miscellaneous 260
299-1..... Time for doing act does not run while act prevented by this Division 260
299-5..... Continued application of other provisions of Act ............................ 260
299-10... Modifications of this Act in relation to health benefits funds under management 260
299-15... Order of Court to be binding on all persons .................................... 261
299-20... Jurisdiction of Federal Court ........................................................... 261
299-25... Private Health Insurance (Management) Rules dealing with various matters 261
Part 6-6--Private health insurance levies 263
Division 304--Introduction 263
304-1..... What this Part is about .................................................................... 263
304-5..... Private Health Insurance (Levy Administration) Rules ................... 263
304-10... Meaning of private health insurance levy ....................................... 263
Division 307--Collection and recovery of private health insurance levies 264
307-1..... When private health insurance levy must be paid ............................ 264
307-5..... Late payment penalty ....................................................................... 265
307-10... Payment of levy and late payment penalty ....................................... 265
307-15... Recovery of levy and late payment penalty ..................................... 266
307-20... Waiver of late payment penalty for levies other than collapsed insurer levy 267
307-25... Waiver of collapsed insurer levy and late payment penalty for that levy .. 267
307-30... Other matters ................................................................................... 268
Division 310--Returns, requesting information and keeping records: private health insurers 269
310-1..... Returns must be lodged with Council and Department ................... 269
310-5..... Insurer must keep records ............................................................... 269
310-10... Council may request information from insurer ................................ 270
Division 313--Power to enter premises and search for documents: private health insurers 272
313-1..... Authorised officer may enter premises with consent ....................... 272
313-5..... Authorised officer may enter premises under warrant ..................... 272
313-10... Announcement before entry ............................................................ 273
313-15... Executing a warrant to enter premises ............................................. 273
313-20... Identity cards ................................................................................... 274
Part 6-7--Private Health Insurance Risk Equalisation Trust Fund 276
Division 318--Private Health Insurance Risk Equalisation Trust Fund 276
318-1..... Private Health Insurance Risk Equalisation Trust Fund .................. 276
318-5..... Amounts to be paid into the Risk Equalisation Trust Fund ............. 276
318-10... Operation of the Risk Equalisation Trust Fund ............................... 277
318-15... Administration of the Risk Equalisation Trust Fund ....................... 277
Part 6-8--Disclosure of information 278
Division 323--Disclosure of information 278
323-1..... Prohibition on disclosure of information ......................................... 278
323-5..... Authorised disclosure: official duties .............................................. 278
323-10... Authorised disclosure: sharing information about insurers among agencies 279
323-15... Authorised disclosure: sharing information about insurers other than among agencies 280
323-20... Authorised disclosure: public interest ............................................. 280
323-25... Authorised disclosure: by the Secretary or Council if authorised by affected person 281
323-30... Authorised disclosure: court proceedings ....................................... 281
323-35... Authorised disclosure: Council's public information and agency cooperation functions 281
323-40... Offence: disclosure of information obtained by certain authorised disclosures 282
323-45... Offence: soliciting disclosure of information .................................. 282
323-50... Offence: use etc. of unauthorised information ................................. 282
323-55... Offence: offering to supply protected information .......................... 283
Part 6-9--Review of decisions 284
Division 328--Review of decisions 284
328-1..... What this Part is about .................................................................... 284
328-5..... AAT review of decisions ................................................................ 284
Part 6-10--Miscellaneous 289
Division 333--Miscellaneous 289
333-1..... Delegation by Minister .................................................................... 289
333-5..... Delegation by Secretary .................................................................. 289
333-10... Approved forms .............................................................................. 289
333-15... Signing approved forms .................................................................. 291
333-20... Private Health Insurance Rules made by the Minister ..................... 291
333-25... Private Health Insurance Rules made by the Council ...................... 292
333-30... Regulations ..................................................................................... 293
Schedule 1--Dictionary 294
1............ Dictionary ....................................................................................... 294
Notes 305
Notes to
the
Private Health Insurance Act 2007 Note 1 The Private Health Insurance Act 2007 as shown in this
compilation comprises Act No. 31, 2007 amended as indicated in the Tables
below. For application, saving or transitional provisions made by the
Private Health Insurance (Transitional Provisions and Consequential Amendments)
Act 2007, see Act No. 32, 2007. For all other relevant information pertaining to application,
saving or transitional provisions see Table A. Table of Acts
|
Act |
Number |
Date |
Date of commencement |
Application, saving or transitional provisions |
|
31, 2007 |
30 Mar 2007 |
1 Apr 2007 |
|
|
|
Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 |
32, 2007 |
30 Mar 2007 |
Schedule 3 (items 9D, 9E): 1 July 2007 |
[see Note 1] |
|
180, 2007 |
28 Sept 2007 |
Schedule 1 (items 1-3, 5): 1 Apr 2007 |
Sch. 1 (items 5, 6) |
|
|
54, 2008 |
25 June 2008 |
25 June 2008 |
Sch. 3 (items 3, 4) |
|
|
66, 2009 |
1 July 2009 |
Schedule 1 (items 2-14): 1 July 2009 (see s. 2(1)) |
-- |
|
|
8, 2010 |
1 Mar 2010 |
Schedule 5 (item 137(a)): (a) |
-- |
|
|
Private Health Insurance Legislation Amendment Act (No. 1) 2010 |
40, 2010 |
13 Apr 2010 |
13 Apr 2010 |
-- |
|
63, 2010 |
28 June 2010 |
Schedule 2: 1 July 2010 |
-- |
|
|
Trade Practices Amendment (Australian Consumer Law) Act (No. 2) 2010 |
103, 2010 |
13 July 2010 |
Schedule 6 (items 1, 84, 85): 1 Jan 2011 |
-- |
|
Human Services Legislation Amendment Act 2011 |
32, 2011 |
25 May 2011 |
Schedule 4 (items 506-545): 1 July 2011 |
-- |
|
Acts Interpretation Amendment Act 2011 |
46, 2011 |
27 June 2011 |
Schedule 2 (items 923-933) and Schedule 3 (items 10, 11): 27 Dec 2011 |
Sch. 3 (items 10, 11) |
|
Fairer Private Health Insurance Incentives Act 2012 |
26, 2012 |
4 Apr 2012 |
Schedule 1 (items 10-40, 48(1)): [see Note 2 and Table A] |
Sch. 1 (items 15, 48(1)) |
(a) Subsection 2(1) (items 31 and 38) of the Statute Law Revision Act 2010 provides as follows:
(1) Each provision of this Act specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.
|
Commencement information |
||
|
Column 1 |
Column 2 |
Column 3 |
|
Provision(s) |
Commencement |
Date/Details |
|
31. Schedule 5, items 1 to 51 |
The day this Act receives the Royal Assent. |
1 March 2010 |
|
38. Schedule 5, Parts 2 and 3 |
Immediately after the provision(s) covered by table item 31. |
1 March 2010 |
Table of Amendments
|
ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted |
|
|
Provision affected |
How affected |
|
Chapter 1 |
|
|
Part 1-1 |
|
|
Division 1 |
|
|
S. 1-10................................ |
am. No. 32, 2011 |
|
Chapter 2 |
|
|
Part 2-2 |
|
|
Division 20 |
|
|
Note to s. 20-1................... |
am. No. 32, 2007 |
|
Division 23 |
|
|
Subdivision 23-B |
|
|
S. 23-15.............................. |
am. No. 32, 2011 |
|
S. 23-20.............................. |
am. No. 32, 2011 |
|
S. 23-25.............................. |
am. No. 32, 2011 |
|
S. 23-30.............................. |
am. No. 32, 2011 |
|
S. 23-35.............................. |
am. No. 32, 2011 |
|
S. 23-40.............................. |
am. No. 32, 2011 |
|
S. 23-45.............................. |
am. No. 32, 2011 |
|
Division 26 |
|
|
Subdivision 26-A |
|
|
S. 26-1................................ |
am. No. 32, 2007 |
|
Subdivision 26-B |
|
|
S. 26-10.............................. |
am. No. 32, 2011 |
|
S. 26-15.............................. |
rs. No. 32, 2011 |
|
S. 26-20.............................. |
am. No. 32, 2011 |
|
S. 26-25.............................. |
am. No. 32, 2011 |
|
S. 26-30.............................. |
am. No. 32, 2011 |
|
Part 2-3 |
|
|
Division 34 |
|
|
S. 34-25.............................. |
rs. No. 63, 2010 |
|
|
am. Nos. 32 and 46, 2011 |
|
Heading to s. 34-30........... |
am. No. 63, 2010 |
|
S. 34-30.............................. |
am. No. 63, 2010 |
|
Division 37 |
|
|
S. 37-5................................ |
am. No. 63, 2010; No. 46, 2011 |
|
S. 37-7................................ |
ad. No. 63, 2010 |
|
Chapter 3 |
|
|
Part 3-2 |
|
|
Division 55 |
|
|
S. 55-5................................ |
am. No. 54, 2008; No. 66, 2009 |
|
S. 55-15.............................. |
ad. No. 54, 2008 |
|
Part 3-3 |
|
|
Division 63 |
|
|
S. 63-5................................ |
am. No. 66, 2009 |
|
Division 72 |
|
|
S. 72-1................................ |
am. No. 40, 2010 |
|
S. 72-10.............................. |
am. No. 40, 2010 |
|
Division 84 |
|
|
S. 84-1................................ |
am. No. 180, 2007 |
|
Chapter 4 |
|
|
Part 4-3 |
|
|
Division 126 |
|
|
S. 126-10............................ |
am. No. 54, 2008 |
|
S. 126-20............................ |
am. No. 180, 2007; No. 54, 2008 |
|
S. 126-45............................ |
am. No. 54, 2008 |
|
Part 4-5 |
|
|
Division 172 |
|
|
Note to s. 172-5................. |
am. No. 103, 2010 |
|
Chapter 5 |
|
|
Part 5-2 |
|
|
Division 185 |
|
|
S. 185-5.............................. |
am. No. 54, 2008 |
|
Division 200 |
|
|
S. 200-1.............................. |
am. No. 54, 2008 |
|
Chapter 6 |
|
|
Part 6-2 |
|
|
Division 238 |
|
|
S. 238-5 ............................. |
am. No. 8, 2010 |
|
Division 244 |
|
|
Subdivision 244-B |
|
|
S. 244-20............................ |
am. No. 103, 2010 |
|
Division 253 |
|
|
S. 253-10............................ |
am. No. 46, 2011 |
|
Note to s. 253-10............... |
ad. No. 46, 2011 |
|
Part 6-3 |
|
|
Division 270 |
|
|
S. 270-10............................ |
am. No. 46, 2011 |
|
Note to s. 270-10............... |
ad. No. 46, 2011 |
|
S. 270-45............................ |
am. No. 180, 2007 |
|
Part 6-4 |
|
|
Division 276 |
|
|
S. 276-1.............................. |
am. No. 32, 2011 |
|
Division 279 |
|
|
Subdivision 279-A |
|
|
S. 279-1.............................. |
am. No. 32, 2011 |
|
S. 279-10............................ |
am. No. 32, 2011 |
|
S. 279-15............................ |
am. No. 32, 2011 |
|
S. 279-20............................ |
am. No. 32, 2011 |
|
S. 279-25............................ |
am. No. 32, 2011 |
|
S. 279-30............................ |
am. No. 32, 2011 |
|
S. 279-40............................ |
am. No. 32, 2011 |
|
S. 279-45............................ |
am. No. 32, 2011 |
|
Subdivision 279-B |
|
|
Heading to Subdiv. 279-B. |
rs. No. 32, 2011 |
|
Heading to s. 279-50......... |
am. No. 32, 2011 |
|
S. 279-50............................ |
am. No. 32, 2011 |
|
Heading to s. 279-55......... |
am. No. 32, 2011 |
|
S. 279-55............................ |
am. No. 32, 2011 |
|
Division 282 |
|
|
Subdivision 282-A |
|
|
S. 282-1.............................. |
am. No. 32, 2011 |
|
S. 282-5.............................. |
am. No. 32, 2011 |
|
Heading to s. 282-10......... |
am. No. 32, 2011 |
|
S. 282-10............................ |
am. No. 32, 2011 |
|
S. 282-15............................ |
am. No. 32, 2011 |
|
Note to s. 282-15(4)........... |
am. No. 32, 2011 |
|
Subdivision 282-B |
|
|
S. 282-20............................ |
am. No. 32, 2011 |
|
S. 282-30............................ |
am. No. 32, 2011 |
|
S. 282-35............................ |
am. No. 32, 2011 |
|
Part 6-6 |
|
|
Division 304 |
|
|
S. 304-10............................ |
am. No. 66, 2009 |
|
Division 307 |
|
|
S. 307-1.............................. |
am. No. 66, 2009 |
|
S. 307-5.............................. |
am. No. 66, 2009 |
|
S. 307-10............................ |
am. No. 66, 2009 |
|
S. 307-20............................ |
am. No. 66, 2009 |
|
Division 310 |
|
|
Heading to Div. 310.......... |
rs. No. 66, 2009 |
|
Division 313 |
|
|
Heading to Div. 313.......... |
rs. No. 66, 2009 |
|
Part 6-8 |
|
|
Division 323 |
|
|
S. 323-5.............................. |
am. No. 32, 2011 |
|
S. 323-10............................ |
am. No. 32, 2011 |
|
Part 6-9 |
|
|
Division 328 |
|
|
S. 328-1.............................. |
am. No. 32, 2011 |
|
S. 328-5.............................. |
am. No. 32, 2011 |
|
Part 6-10 |
|
|
Division 333 |
|
|
S. 333-1.............................. |
am. No. 32, 2011 |
|
S. 333-10............................ |
am. No. 32, 2011 |
|
Schedule 1 |
|
|
Schedule 1......................... |
am. No. 66, 2009; No. 63, 2010; Nos. 32 and 46, 2011 |
Note 2
Fairer Private Health Insurance Incentives Act 2012 (No. 26, 2012)
The following amendments commence on 1 July 2012:
Schedule 1
10 After Division 20
Insert:
Division 22--PHIIB, PHII benefit and related concepts
Subdivision 22-A--PHIIB, PHII benefit and related concepts
22-1 Application of Subdivision
This Subdivision applies if a premium, or an amount in respect of a premium, was paid, or is payable, during a financial year under a *complying health insurance policy in respect of a period (the premium period).
Adults insured under policy
(1) Each *adult insured under the *complying health insurance policy throughout the premium period is a PHIIB, in respect of the premium or amount.
Note: PHIIB is short for private health insurance incentive beneficiary.
Dependent child-only policies
(2) Subsections (3) and (4) apply if the only persons insured under the *complying health insurance policy throughout the premium period are one or more *dependent children.
(3) Each person who is a parent (within the meaning of Part 2.11 of the Social Security Act 1991) in relation to one or more of those *dependent children on the last day of the financial year mentioned in section 22-1 is a PHIIB, in respect of the premium or amount.
(4) However, the person who pays the premium or amount is the only PHIIB, in respect of the premium or amount, if:
(a) disregarding this subsection, more than one person would be a *PHIIB in respect of the premium or amount because of subsection (3); and
(b) those persons are not married to each other (within the meaning of the A New Tax System (Medicare Levy Surcharge--Fringe Benefits) Act 1999) at the end of the financial year; and
(c) the person who pays the premium or amount is not a *dependent child.
The amount of the PHII benefit, in respect of the premium or amount, is:
(a) if there is only one *PHIIB in respect of the premium or amount--the PHIIB's *share of the PHII benefit in respect of the premium or amount; or
(b) if there is more than one PHIIB in respect of the premium or amount--the sum of each of those PHIIB's share of the PHII benefit in respect of the premium or amount.
Note: PHII benefit is short for private health insurance incentive benefit.
22-15 Meaning of share of the PHII benefit--single PHIIB
(1) If there is only one *PHIIB in respect of the premium or amount, the amount of the *PHIIB's share of the PHII benefit, in respect of the premium or amount, is the sum of:
(a) 30% of the amount of the premium, or of the amount in respect of a premium, paid or payable in respect of days in the premium period on which no person insured under the policy was aged 65 years or over; and
(b) 35% of the amount of the premium, or of the amount in respect of a premium, paid or payable in respect of days in the premium period on which:
(i) at least one person insured under the policy was aged 65 years or over; and
(ii) no person insured under the policy was aged 70 years or over; and
(c) 40% of the amount of the premium, or of the amount in respect of a premium, paid or payable in respect of days in the premium period on which at least one person insured under the policy was aged 70 years or over.
(2) Reduce the amount of each percentage mentioned in subsection (1) by 10 percentage points if the *PHIIB is a *tier 1 earner for the financial year mentioned in section 22-1.
(3) Reduce the amount of each percentage mentioned in subsection (1) by 20 percentage points if the *PHIIB is a *tier 2 earner for the financial year mentioned in section 22-1.
(4) Reduce the amount of each percentage mentioned in subsection (1) to nil if the *PHIIB is a *tier 3 earner for the financial year mentioned in section 22-1.
(5) For the purposes of applying subsections (2), (3) and (4) in relation to the premium or amount, treat the table in subsection 22-30(1) as applying to the *PHIIB for the financial year if he or she is a PHIIB in respect of the premium or amount because of subsection 22-5(3) or (4).
Note 1: The table in subsection 22-30(1) sets out the private health insurance tiers for families.
Note 2: Subsections 22-5(3) and (4) apply if the only persons insured under the policy are dependent children.
22-20 Meaning of share of the PHII benefit--multiple PHIIBs
If there is more than one *PHIIB in respect of the premium or amount, work out in accordance with section 22-15 the amount of each of those PHIIB's share of the PHII benefit, in respect of the premium or amount, on the following assumptions:
(a) assume that the PHIIB is the only person who is a PHIIB in respect of the premium or amount;
(b) assume that the premium or amount is the amount of the premium (or the amount in respect of the premium) divided by the number of persons who are PHIIBs in respect of the premium or amount.
(1) If:
(a) the *PHIIB mentioned in subsection 22-15(1) was insured under a *complying health insurance policy (the original policy) (whether or not the policy mentioned in section 22-1) at a time before the start of the premium period mentioned in that section; and
(b) the PHIIB was not a *dependent child at that time; and
(c) at that time, another person (the entitling person) was:
(i) insured under the original policy; and
(ii) aged 65 years or over; and
(d) the entitling person subsequently ceased to be insured under the original policy;
subsection 22-15(1) applies in relation to the complying health insurance policy mentioned in section 22-1 as if:
(e) the entitling person were also insured under that policy; and
(f) the entitling person were the same age as the age at which he or she ceased to be insured under the original policy.
(2) Subsection (1) ceases to apply if a person (other than a *dependent child) who was not insured under the original policy at the time the entitling person ceased to be insured under it becomes insured under the *complying health insurance policy mentioned in section 22-1.
(3) Subsection (1) does not apply if its application would result in the *PHIIB's *share of the PHII benefit being less than it would otherwise have been.
Subdivision 22-B--Private health insurance tiers
22-30 Private health insurance tiers
Families
(1) The following table applies to a person (the first person) for a financial year if:
(a) on the last day of the financial year, the person is married (within the meaning of the A New Tax System (Medicare Levy Surcharge--Fringe Benefits) Act 1999); or
(b) on any day in the financial year, the person contributes in a substantial way to the maintenance of a *dependent child who is:
(i) the person's child (within the meaning of the Income Tax Assessment Act 1997); or
(ii) the person's sibling (including the person's half-brother, half-sister, adoptive brother, adoptive sister, step-brother, step-sister, foster-brother or foster-sister) who is dependent on the person for economic support:
|
Private health insurance tiers--families |
|||
|
Item |
Column 1 For the financial year, the person is a ... |
Column 2 if his or her income for surcharge purposes for the financial year exceeds the following for the financial year ... |
Column 3 but does not exceed the following (if applicable) for the financial year ... |
|
1 |
tier 1 earner |
his or her *family tier 1 threshold |
his or her *family tier 2 threshold. |
|
2 |
tier 2 earner |
his or her *family tier 2 threshold |
his or her *family tier 3 threshold. |
|
3 |
tier 3 earner |
his or her *family tier 3 threshold |
not applicable. |
(2) For the purposes of subsection (1), if paragraph (1)(a) applies, treat the *income for surcharge purposes for the financial year of the person to whom the first person is married (as mentioned in that paragraph) as included in the first person's income for surcharge purposes for the financial year.
(3) Subdivision 960-J of the Income Tax Assessment Act 1997 (Family relationships) applies to subparagraphs (1)(b)(i) and (ii) of this section in the same way as it applies to that Act.
Singles
(4) The following table applies to a person for a financial year if the table in subsection (1) does not apply to the person for the financial year:
|
Private health insurance tiers--singles |
|||
|
Item |
Column 1 For the financial year, the person is a ... |
Column 2 if his or her income for surcharge purposes for the financial year exceeds the following for the financial year ... |
Column 3 but does not exceed the following (if applicable) for the financial year ... |
|
1 |
tier 1 earner |
his or her *singles tier 1 threshold |
his or her *singles tier 2 threshold. |
|
2 |
tier 2 earner |
his or her *singles tier 2 threshold |
his or her *singles tier 3 threshold. |
|
3 |
tier 3 earner |
his or her *singles tier 3 threshold |
not applicable. |
22-35 Private health insurance singles thresholds
(1) A person's singles tier 1 threshold for the 2008-09 financial year is $70,000. This amount is indexed annually.
(2) A person's singles tier 2 threshold for the 2010-11 financial year is $90,000. This amount is indexed annually.
(3) A person's singles tier 3 threshold for the 2010-11 financial year is $120,000. This amount is indexed annually.
Note 1: A person may be a tier 1 earner, tier 2 earner or tier 3 earner if his or her income for surcharge purposes exceeds the applicable threshold for that tier: see section 22-30.
Note 2: Section 22-45 shows how to index amounts.
22-40 Private health insurance family thresholds
(1) A person's family tier 1 threshold for a financial year is an amount equal to double his or her *singles tier 1 threshold for the financial year.
(2) A person's family tier 2 threshold for a financial year is an amount equal to double his or her *singles tier 2 threshold for the financial year.
(3) A person's family tier 3 threshold for a financial year is an amount equal to double his or her *singles tier 3 threshold for the financial year.
(4) However, if the person has 2 or more dependants (within the meaning of the A New Tax System (Medicare Levy Surcharge--Fringe Benefits) Act 1999) who are children, increase his or her family tier 1 threshold, family tier 2 threshold and family tier 3 threshold for the financial year by the result of the following formula:
Example: If the person has 3 such dependants who are children, his or her family tier 2 threshold for the 2010-11 financial year is:
Note: A person may be a tier 1 earner, tier 2 earner or tier 3 earner if his or her income for surcharge purposes exceeds the applicable threshold for that tier: see section 22-30.
(1) This section applies in relation to an amount mentioned in section 22-35 (Private health insurance singles thresholds).
Indexing amounts
(2) Index the amount by:
(a) firstly:
(i) if the amount is mentioned in subsection 22-35(1) (singles tier 1 threshold)--multiplying the amount for the 2008-2009 financial year by its *indexation factor mentioned in subsection (4); or
(ii) if the amount is mentioned in subsection 22-35(2) or (3) (singles tier 2 threshold or singles tier 3 threshold)--multiplying the amount for the 2010-2011 financial year by its indexation factor mentioned in subsection (5); and
(b) next, rounding the result in paragraph (a) down to the nearest multiple of $1,000.
Example 1: If the amount to be indexed is $90,000 and the indexation factor increases this to an indexed amount of $90,500, the indexed amount is rounded back down to $90,000.
Example 2: If the amount to be indexed is $120,000 and the indexation factor increases this to an indexed amount of $121,500, the indexed amount is rounded down to $121,000.
(3) Do not index the amount if its indexation factor mentioned in subsection (4) or (5) is 1 or less.
Indexation factor
(4) For indexation of the amount on an annual basis in accordance with subparagraph (2)(a)(i), the indexation factor is:
(5) For indexation of the amount on an annual basis in accordance with subparagraph (2)(a)(ii), the indexation factor is:
(6) Work out the *indexation factor mentioned in subsection (4) or (5) to 3 decimal places (rounding up if the fourth decimal place is 5 or more).
Index number
(7) For calculating the amounts, the index number for a *quarter is the estimate of full-time adult average weekly ordinary time earnings for the middle month of the quarter first published by the Australian Statistician in respect of that month.
11 Subdivision 23-A
Repeal the Subdivision, substitute:
Subdivision 23-A--Amount of reduction
(1) The amount of premiums payable under a *complying health insurance policy in respect of a period is reduced in accordance with this section if a person is a *participant in the *premiums reduction scheme in respect of the policy.
(2) The amount of the reduction for each premium is the *PHII benefit in respect of the premium.
12 Paragraph 23-15(1)(b)
Repeal the paragraph, substitute:
(b) the person is a *PHIIB in respect of a premium paid or payable under the policy; and
13 Section 23-25
Repeal the section.
14 Subsections 26-1(1), (2), (3) and (4)
Repeal the subsections, substitute:
Entitlement to payment
(1) A person is entitled to a payment under this subsection if:
(a) a premium was paid (whether or not by the person) under a *complying health insurance policy in respect of a period; and
(b) the person is a *PHIIB in respect of the premium; and
(c) the amount of the premium was not reduced under Division 23; and
(d) the person meets any requirements specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph.
Amount of payment
(2) The amount of the payment is the *PHII benefit in respect of the premium.
(2A) However, if there is more than one *PHIIB in respect of the premium, the amount of the payment is the *PHII benefit in respect of the premium divided by the number of those PHIIBs.
Payment if there is more than one PHIIB
(3) If subsection (2A) applies and the person is paid the amount to which he or she is entitled under subsection (1) in respect of the premium:
(a) the person is also to be paid each amount to which another person is entitled under subsection (1) in respect of the premium because the other person is one of those *PHIIBs; and
(b) if the person is paid an amount in accordance with paragraph (a)--he or she is liable to account for that amount to the other person mentioned in that paragraph.
Reduction in amount payable
(4) A person's entitlement under subsection (1) in respect of the premium is reduced to the extent that:
(a) a previous payment was made under this section in relation to that entitlement; or
(b) the person has received a tax offset under Subdivision 61-G of the Income Tax Assessment Act 1997 in respect of the premium.
16 Section 26-5
Repeal the section.
17 Section 26-30
Repeal the section.
18 After subsection 282-1(1)
Insert:
(1A) However, an amount is not recoverable under paragraph (1)(d), (e), (f) or (g) if the situation giving rise to the amount did not occur due to the fault of the private health insurer.
19 After Subdivision 282-A
Insert:
Subdivision 282-AA--Recovery of certain amounts by Commissioner of Taxation
282-16 Administration of this Subdivision by Commissioner of Taxation
The Commissioner of Taxation has the general administration of:
(a) this Subdivision; and
(b) any other provision of this Act to the extent that it relates to this Subdivision.
282-17 Subdivision operates in addition to Subdivision 282-A
(1) This Subdivision:
(a) operates in addition to Subdivision 282-A; and
(b) does not limit the operation of that Subdivision.
(2) Subdivision 282-A does not limit the operation of this Subdivision.
No double recovery
(3) Despite subsections (1) and (2):
(a) an amount is not recoverable under section 282-1 to the extent that it has already been recovered in accordance with section 282-18; and
(b) an amount is not recoverable under section 282-18 to the extent that it has already been recovered in accordance with section 282-1.
Note: This section means that an amount that is recoverable under both paragraph 282-1(1)(e) and section 282-18 is recoverable from the private health insurer in accordance with section 282-1 or from the participant in accordance with section 282-18.
282-18 Liability for excess private health insurance premium reduction or refund
(1) This section applies if any of the following requirements are satisfied:
(a) the amount of a premium payable during a financial year under a *complying health insurance policy is reduced because of the operation or purported operation of Division 23;
(b) a payment is made to a person because of the operation or purported operation of Division 26 in relation to a premium paid during a financial year (whether or not by the person) under a complying health insurance policy.
(2) Divide the total of the reduction (if any) and payment (if any) by the number of persons who are *PHIIBs in respect of the premium.
(3) If the amount worked out under subsection (2) exceeds the *share of the PHII benefit of a person who is a *PHIIB in respect of the premium, that person is liable to pay the amount of that excess to the Commonwealth.
(4) If subsection (3) applies, the Commissioner of Taxation must give the person a notice stating that the person is liable to pay the amount of that excess to the Commonwealth.
(5) A notice given to a person under subsection (4) may be contained in a notice of assessment under the Income Tax Assessment Act 1936.
(6) An amount that a person is liable to pay under subsection (3) is due and payable at the same time as the income tax the person must pay for the financial year is due and payable under section 5-5 of the Income Tax Assessment Act 1997. For the purposes of determining that time, assume that the person must pay income tax for the financial year and that the Commissioner of Taxation makes an assessment of the income tax.
Note: The liability is a tax-related liability: see Part 4-15 in Schedule 1 to the Taxation Administration Act 1953 for collection and recovery provisions.
(7) If the person is dissatisfied with the notice under subsection (4), he or she may object against it in the manner set out in Part IVC of the Taxation Administration Act 1953.
Reallocation of liability between spouses
(8) Subsection (10) applies if:
(a) a person (the first person) is a *PHIIB in respect of the premium; and
(b) the first person is, on the last day of the financial year, married (within the meaning of the A New Tax System (Medicare Levy Surcharge--Fringe Benefits) Act 1999; and
(c) the person to whom the first person is married is also a PHIIB in respect of the premium; and
(d) either:
(i) the first person has made a choice under section 61-215 of the Income Tax Assessment Act 1997 in relation to the *income year corresponding to the financial year mentioned in subsection (1); or
(ii) the requirement in subsection (9) is satisfied.
(9) The requirement in this subsection is satisfied if:
(a) during an *income year (the lodgement year), the first person lodges his or her income tax return for the income year (the return year) corresponding to the financial year mentioned in subsection (1); and
(b) the person to whom the first person is married does not lodge his or her income tax return for the return year before the end of the lodgement year (whether or not he or she is required to lodge such a return).
(10) If this subsection applies:
(a) the amount (if any) that the person to whom the first person is married is liable to pay under subsection (3) in respect of the premium is reduced to nil; and
(b) the first person's liability under subsection (3) is increased by that amount.
282-19 When general interest charge payable
(1) If:
(a) a person is liable under section 282-18 to pay an amount; and
(b) the whole or a part of the amount remains unpaid after the time by which the amount is due to be paid;
the person is liable to pay *general interest charge on the unpaid amount.
(2) A person who is liable under this section to pay *general interest charge on an unpaid amount is liable to pay the charge for each day in the period that:
(a) started at the beginning of the day by which the unpaid amount was due to be paid; and
(b) finishes at the end of the last day at the end of which any of the following remains unpaid:
(i) the unpaid amount;
(ii) general interest charge on any of the unpaid amount.
20 Section 282-25
Omit "or this Part" (wherever occurring), substitute ", this Part or paragraph 323-5(c)".
21 At the end of section 323-5
Add:
; or (c) for the purpose of enabling a person to perform functions under:
(i) a provision of the A New Tax System (Medicare Levy Surcharge--Fringe Benefits) Act 1999; or
(ii) a provision of the Medicare Levy Act 1986; or
(iii) a provision of Subdivision 61-G of the Income Tax Assessment Act 1997; or
(iv) any other provision of the Income Tax Assessment Act 1997, or of any other Act, to the extent that the provision relates to a provision mentioned in subparagraph (i), (ii) or (iii).
22 Clause 1 of Schedule 1
Insert:
family tier 1 threshold has the meaning given by section 22-40.
23 Clause 1 of Schedule 1
Insert:
family tier 2 threshold has the meaning given by section 22-40.
24 Clause 1 of Schedule 1
Insert:
family tier 3 threshold has the meaning given by section 22-40.
25 Clause 1 of Schedule 1
Insert:
general interest charge means the charge worked out under Part IIA of the Taxation Administration Act 1953.
26 Clause 1 of Schedule 1 (definition of incentive amount)
Repeal the definition.
27 Clause 1 of Schedule 1
Insert:
income for surcharge purposes, of a person for a financial year, means the income for surcharge purposes (within the meaning of the Income Tax Assessment Act 1997) for the person for the *income year corresponding to the financial year.
28 Clause 1 of Schedule 1
Insert:
income year has the meaning given by the Income Tax Assessment Act 1997.
29 Clause 1 of Schedule 1
Insert:
indexation factor has the meaning given by section 22-45.
30 Clause 1 of Schedule 1
Insert:
index number has the meaning given by section 22-45.
31 Clause 1 of Schedule 1
Insert:
PHIIB (short for Private Health Insurance Incentive Beneficiary) has the meaning given by section 22-5.
32 Clause 1 of Schedule 1
Insert:
PHII benefit (short for Private Health Insurance Incentive benefit) has the meaning given by section 22-10.
33 Clause 1 of Schedule 1
Insert:
quarter has the meaning given by the Income Tax Assessment Act 1997.
34 Clause 1 of Schedule 1
Insert:
share of the PHII benefit has the meaning given by sections 22-15, 22-20 and 22-25.
35 Clause 1 of Schedule 1
Insert:
singles tier 1 threshold has the meaning given by section 22-35.
36 Clause 1 of Schedule 1
Insert:
singles tier 2 threshold has the meaning given by section 22-35.
37 Clause 1 of Schedule 1
Insert:
singles tier 3 threshold has the meaning given by section 22-35.
38 Clause 1 of Schedule 1
Insert:
tier 1 earner has the meaning given by section 22-30.
39 Clause 1 of Schedule 1
Insert:
tier 2 earner has the meaning given by section 22-30.
40 Clause 1 of Schedule 1
Insert:
tier 3 earner has the meaning given by section 22-30.
As at 24 May 2012 the amendments are not incorporated in this compilation.
Table A
Application, saving or transitional provisions
Health Legislation Amendment Act 2007 (No. 180, 2007)
Schedule 1
5 Transitional provision in relation to health cover for overseas visitors
(1) This item applies in relation to business that, at any time in the period starting on 1 April 2007 and ending on 30 June 2008 (the transition period), is covered by subrule 17(2) of the Private Health Insurance (Health Insurance Business) Rules made under the Private Health Insurance Act 2007.
(2) During the transition period, sections 63-1 and 84-1 of the Private Health Insurance Act 2007 do not apply in relation to insurance that is that kind of business.
6 Certain business taken to be health insurance business for certain purposes during transition period
For the purposes of:
(a) paragraphs 12BAA(7)(d) and (8)(b) of the Australian Securities and Investments Commission Act 2001; and
(b) paragraph 765A(1)(c) of the Corporations Act 2001; and
(c) paragraph (k) of the definition of insurance business in subsection 3(1) of the Insurance Act 1973; and
(d) paragraph 9(1)(b) of the Insurance Contracts Act 1984;
business that, at any time during the period starting on the day this item commences and ending on 30 June 2008, is covered by rule 18 of the Private Health Insurance (Health Insurance Business) Rules made under the Private Health Insurance Act 2007 is, during that period, taken to be health insurance business.
Private Health Insurance Legislation Amendment Act 2008 (No. 54, 2008)
Schedule 3
3 Applications for registration for which decisions are pending
An application made before the commencement of this item for registration as a private health insurer is taken, on that commencement, not to be a valid application under section 126-10 of the Private Health Insurance Act 2007 if, as at that commencement:
(a) the applicant was not a company within the meaning of the Corporations Act 2001; and
(b) the Council had not decided the application under section 126-20 of the Private Health Insurance Act 2007.
4 Exemption from stamp duty etc. relating to certain private health insurers becoming companies
(1) Stamp duty, or any other tax, imposed under a law of a State or Territory is not payable in relation to a thing done (including, for example, a transaction entered into or an instrument or document made, executed, lodged or given) for the purpose of, because of or as a result of the registration of a body as a company if:
(a) the thing is done after the commencement of this item and before 1 January 2010; and
(b) at the time the thing is done, the body is a private health insurer; and
(c) the registration as a company is solely for the purpose of avoiding the body's registration as a private health insurer being cancelled under paragraph 126-45(1)(c) of the Private Health Insurance Act 2007.
(2) In this item:
company means a company within the meaning of the Corporations Act 2001.
private health insurer means a person registered under Part 4-3 of the Private Health Insurance Act 2007, and includes a body that is taken to be a private health insurer because of section 18 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007.
Acts Interpretation Amendment Act 2011 (No. 46, 2011)
Schedule 3
10 Saving--appointments
The amendments made by Schedule 2 do not affect the validity of an appointment that was made under an Act before the commencement of this item and that was in force immediately before that commencement.
11 Transitional regulations
The Governor-General may make regulations prescribing matters of a transitional nature (including prescribing any saving or application provisions) relating to the amendments and repeals made by Schedules 1 and 2.
Fairer Private Health Insurance Incentives Act 2012 (No. 26, 2012)
The following provisions commence on 1 July 2012:
Schedule 1
15 Saving provision--Private Health Insurance (Incentives) Rules
(1) This item applies to a requirement specified in the Private Health Insurance (Incentive) Rules if:
(a) the requirement was specified for the purposes of paragraph 26-1(1)(c) of the Private Health Insurance Act 2007; and
(b) the requirement was in force immediately before the commencement of this item.
(2) The requirement has effect, on and after the commencement of this item, as if it had been made for the purposes of paragraph 26-1(1)(d) of that Act as amended by this Schedule.
48 Application
(1) The amendments made by this Schedule apply in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.