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Private Health Insurance Act 2007
In force
Administered by
Department of Health, Disability and Ageing
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C2025C00686 C40
05 December 2025
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Table of contents
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Chapter 1—Introduction
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Part 1-1—Introduction
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Division 1—Preliminary
1-1 Short title
1-5 Commencement
1-10 Identifying defined terms
1-15 Extension to Norfolk Island
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Division 3—Overview of this Act
3-1 What this Act is about
3-5 Incentives (Chapter 2)
3-10 Complying health insurance products (Chapter 3)
3-15 Health insurance business, health benefits funds and miscellaneous obligations of private health insurers (Chapter 4)
3-20 Enforcement (Chapter 5)
3-25 Administration (Chapter 6)
3-30 Dictionary (Schedule 1)
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Division 5—Constitutional matters
5-1 Meaning of insurance
5-5 Act not to apply to State insurance within that State
5-10 Compensation for acquisition of property
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Chapter 2—Incentives
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Part 2-1—Introduction
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Division 15—Introduction
15-1 What this Chapter is about
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Part 2-2—Premiums reduction scheme
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Division 20—Introduction
20-1 What this Part is about
20-5 Private Health Insurance (Incentives) Rules
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Division 22—PHIIB, PHII benefit and related concepts
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Subdivision 22-A—PHIIB, PHII benefit and related concepts
22-1 Application of Subdivision
22-5 Meaning of PHIIB
22-10 Meaning of PHII benefit
22-15 Meaning of share of the PHII benefit—single PHIIB
22-20 Meaning of share of the PHII benefit—multiple PHIIBs
22-25 Application of subsection 22-15(1) after a person 65 years or over ceases to be covered by policy
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Subdivision 22-B—Private health insurance tiers
22-30 Private health insurance tiers
22-35 Private health insurance singles thresholds
22-40 Private health insurance family thresholds
22-45 Indexation
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Division 23—Premiums reduction scheme
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Subdivision 23-A—Amount of reduction
23-1 Reduction in premiums
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Subdivision 23-B—Participation in the premiums reduction scheme
23-15 Registration as a participant in the premiums reduction scheme
23-20 Refusal to register
23-30 Participants who want to withdraw from scheme
23-35 Revocation of registration
23-40 Variation of registration
23-45 Retention of applications by private health insurers
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Part 2-3—Lifetime health cover
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Division 31—Introduction
31-1 What this Part is about
31-5 Private Health Insurance (Lifetime Health Cover) Rules
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Division 34—General rules about lifetime health cover
34-1 Increased premiums for person who is late in taking out hospital cover
34-5 Increased premiums for person who ceases to have hospital cover after his or her lifetime health cover base day
34-10 Increased premiums stop after 10 years’ continuous cover
34-15 Meaning of hospital cover
34-20 Meaning of permitted days without hospital cover
34-25 Meaning of lifetime health cover base day
34-30 When a person is overseas or enters Australia
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Division 37—Exceptions to the general rules about lifetime health cover
37-1 People born on or before 1 July 1934
37-5 People over 31 and overseas on 1 July 2000
37-7 Person yet to turn 31
37-10 Hardship cases
37-15 Increases cannot exceed 70% of base rates
37-20 Joint hospital cover
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Division 40—Administrative matters relating to lifetime health cover
40-1 Notification to insured people etc.
40-5 Evidence of having had hospital cover, or of a person’s age
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Part 2-4—Excess levels for medicare levy and medicare levy surcharge purposes
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Division 42—Introduction
42-1 What this Part is about
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Division 45—Excess levels for medicare levy and medicare levy surcharge purposes
45-1 Excess level amounts
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Chapter 3—Complying health insurance products
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Part 3-1—Introduction
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Division 50—Introduction
50-1 What this Chapter is about
50-5 Private Health Insurance Rules relevant to this Chapter
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Part 3-2—Community rating
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Division 55—Principle of community rating
55-1 What this Part is about
55-5 Principle of community rating
55-10 Closed products, and terminated products and product subgroups
55-15 Pilot projects
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Part 3-3—Requirements for complying health insurance products
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Division 60—Introduction
60-1 What this Part is about
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Division 63—Basic rules about complying health insurance products
63-1 Obligation to ensure products are complying products
63-5 Meaning of complying health insurance product
63-10 Meaning of complying health insurance policy
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Division 66—Community rating requirements
66-1 Community rating requirements
66-5 Premium requirement
66-10 Minister’s approval of premiums
66-15 Entitlement to benefits for general treatment
66-20 Different amount of benefits depending on where people live
66-25 Different amounts of benefits for travel or accommodation
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Division 69—Coverage requirements
69-1 Coverage requirements
69-5 Meaning of cover
69-10 Meaning of hospital-substitute treatment
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Division 72—Benefit requirements for policies that cover hospital treatment
72-1 Benefit requirements
72-5 Rules requirement in relation to provision of benefits
72-10 Minimum benefits for medical devices and human tissue products
72-11 Meaning of medical device
72-12 Meaning of human tissue product
72-15 Fees for certain activities
72-20 Delisting because of unpaid fees or levy
72-25 Minister may direct that activities not be carried out
72-27 Matters to have regard to before exercising certain powers
72-30 When cost-recovery fee must be paid
72-35 Payment of cost-recovery fee
72-40 Recovery of fee
72-45 Other matters
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Division 75—Waiting period requirements
75-1 Waiting period requirements
75-5 Meaning of waiting period
75-10 Meaning of transfers
75-15 Meaning of pre-existing condition
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Division 78—Portability requirements
78-1 Portability requirements
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Division 81—Quality assurance requirements
81-1 Quality assurance requirements
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Division 84—Enforcement of this Part
84-1 Offence: advertising, offering or insuring under non-complying policies
84-5 Offence: directors and chief executive officers liable if systems not in place to prevent breaches
84-10 Injunction in relation to non-complying policies
84-15 Remedies for people affected by non-complying policies
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Part 3-4—Obligations relating to complying health insurance products
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Division 90—Introduction
90-1 What this Part is about
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Division 93—Giving information to consumers
93-1 Maintaining up to date private health information statements
93-5 Meaning of private health information statement
93-10 Making private health information statements available
93-15 Giving information to newly insured people
93-20 Keeping insured people up to date
93-25 Giving advance notice of detrimental changes to rules
93-30 Failure to give information to consumers
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Division 96—Giving information to the Department and the Private Health Insurance Ombudsman
96-1 Giving private health information statements on request
96-5 Giving private health information statements for new products
96-10 Giving updated private health information statements
96-15 Giving additional information on request
96-20 Failure to give information to Department or Private Health Insurance Ombudsman
96-25 Giving information required by the Private Health Insurance (Complying Product) Rules
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Division 99—Transfer certificates
99-1 Transfer certificates
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Division 102—Private health insurers to offer cover for hospital treatment
102-1 Private health insurers to offer cover for hospital treatment
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Chapter 4—Health insurance business, health benefits funds and miscellaneous obligations of private health insurers
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Part 4-1—Introduction
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Division 110—Introduction
110-1 What this Chapter is about
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Part 4-2—Health insurance business
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Division 115—Introduction
115-1 What this Part is about
115-5 Private Health Insurance (Health Insurance Business) Rules
115-10 Whether a business etc. is health insurance business
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Division 121—What is health insurance business?
121-1 Meaning of health insurance business
121-5 Meaning of hospital treatment
121-7 Conditions on declarations of hospitals
121-8 Application for inclusion of hospital in a class
121-8A Minister to decide application
121-8B Period of inclusion of hospital in a class
121-8C Revocation of inclusion of hospital in a class
121-8D Private Health Insurance (Health Insurance Business) Rules
121-10 Meaning of general treatment
121-15 Extension to employee health benefits schemes
121-20 Exception: accident and sickness insurance business
121-25 Exception: liability insurance business
121-30 Exception: insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules
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Part 4-4—Health benefits funds
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Division 131—Health benefits funds
131-1 What this Part is about
131-5 Private Health Insurance (Health Benefits Fund Policy) Rules
131-10 Meaning of health benefits fund
131-15 Meaning of health-related business
131-20 Risk equalisation jurisdictions
131-25 Operation of health-related businesses through health benefits funds
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Part 4-5—Miscellaneous obligations of private health insurers
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Division 157—Introduction
157-1 What this Part is about
157-5 Private Health Insurance (Data Provision) Rules
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Division 169—Notification obligations
169-10 Private health insurers to notify any changes to rules
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Division 172—Other obligations
172-5 Agreements with medical practitioners
172-10 Private health insurers to give information to Secretary
172-15 Restrictions on payment of pecuniary penalties etc.
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Chapter 5—Enforcement
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Part 5-1—Introduction
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Division 180—Introduction
180-1 What this Chapter is about
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Part 5-2—General enforcement methods
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Division 185—What this Part is about
185-1 Introduction
185-5 Meaning of enforceable obligation
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Division 188—Performance indicators
188-1 Performance indicators
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Division 191—Explanation of private health insurer’s operations
191-1 Minister may seek an explanation from a private health insurer
191-5 Minister must respond to insurer’s explanation
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Division 194—Investigation of private health insurer’s operations
194-1A Purposes for which powers may be exercised etc.
194-1 Minister may investigate a private health insurer
194-5 Notice to give information
194-10 Notice to produce documents
194-15 Notice to give evidence
194-20 Offences in relation to investigation notices
194-25 Authorisation to examine books and records etc.
194-35 Minister must notify outcome of investigation
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Division 197—Enforceable undertakings
197-1 Minister may accept written undertakings given by a private health insurer
197-5 Enforcement of undertakings
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Division 200—Ministerial directions
200-1 Minister may give directions
200-5 Direction requirements
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Division 203—Remedies in the Federal Court
203-1 Minister may apply to the Federal Court
203-5 Declarations of contravention
203-10 Pecuniary penalty order
203-15 Compensation order
203-20 Adverse publicity order
203-25 Other order
203-30 Time limit for declarations and orders
203-35 Civil evidence and procedure rules for declarations and orders
203-40 Civil proceedings after criminal proceedings
203-45 Criminal proceedings during civil proceedings
203-50 Criminal proceedings after civil proceedings
203-55 Evidence given in proceedings for penalty not admissible in criminal proceedings
203-60 Minister may require person to assist
203-65 Relief from liability for contravening an enforceable obligation
203-70 Powers of Federal Court
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Division 206—Revoking entitlement to offer rebate as a premium reduction
206-1 Revocation of status of participating insurer
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Chapter 6—Administration
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Part 6-1—Introduction
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Division 230—Introduction
230-1 What this Chapter is about
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Part 6-4—Administration of premiums reduction scheme
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Division 276—Introduction
276-1 What this Part is about
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Division 279—Reimbursement of participating insurers and powers of Chief Executive Medicare
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Subdivision 279-A—Reimbursement of private health insurers for premiums reduced under scheme
279-1 Participating insurers may claim reimbursement
279-5 Participating insurers
279-10 Requirements for claims
279-15 Amounts payable to the private health insurer
279-20 Notifying private health insurers if amount is not payable
279-25 Additional payment if insurer claims less than entitlement
279-30 Additional payment if insurer makes a late claim
279-35 Content and timing of application
279-40 Decision on application
279-45 Reconsideration of decisions
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Subdivision 279-B—Powers of Chief Executive Medicare in relation to participating insurers
279-50 Audits by Chief Executive Medicare
279-55 Chief Executive Medicare may require production of applications
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Division 282—Recovery of amounts and other matters
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Subdivision 282-A—When and how payments can be recovered
282-1 Recovery of payments
282-5 Interest on amounts recoverable
282-10 Chief Executive Medicare may set off debts against amounts payable
282-15 Reconsideration of certain decisions under this Division
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Subdivision 282-AA—Recovery of certain amounts by Commissioner of Taxation
282-16 Administration of this Subdivision by Commissioner of Taxation
282-17 Subdivision operates in addition to Subdivision 282-A
282-18 Liability for excess private health insurance premium reduction or refund
282-19 When general interest charge payable
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Subdivision 282-B—Miscellaneous
282-20 Notification requirements—private health insurers
282-25 Use etc. of information relating to another person
282-30 Information to be provided to the Commissioner of Taxation
282-35 Delegation
282-40 Appropriation
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Part 6-6—Private health insurance levies
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Division 304—Introduction
304-1 What this Part is about
304-5 Private Health Insurance (Levy Administration) Rules
304-10 Meaning of private health insurance levy
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Division 307—Collection and recovery of private health insurance levies
307-1 When private health insurance levy must be paid
307-5 Late payment penalty
307-10 Payment of levy and late payment penalty
307-15 Recovery of levy and late payment penalty
307-20 Waiver of late payment penalty
307-30 Other matters
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Division 310—Returns, requesting information and keeping records: private health insurers
310-1 Returns relating to complaints levy
310-5 Insurer must keep records
310-10 Power to request information from insurer
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Division 313—Power to enter premises and search for documents related to complaints levy
313-1 Authorised officer may enter premises with consent
313-5 Authorised officer may enter premises under warrant
313-10 Announcement before entry
313-15 Executing a warrant to enter premises
313-20 Identity cards
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Part 6-7—Private Health Insurance Risk Equalisation Special Account
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Division 318—Private Health Insurance Risk Equalisation Special Account
318-1 Private Health Insurance Risk Equalisation Special Account
318-5 Credits to the Risk Equalisation Special Account
318-10 Purpose of the Risk Equalisation Special Account
318-15 Record keeping
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Part 6-8—Disclosure of information
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Division 323—Disclosure of information
323-1 Prohibition on disclosure of information
323-5 Authorised disclosure: official duties
323-10 Authorised disclosure: sharing information about insurers among agencies
323-15 Authorised disclosure: sharing information about insurers other than among agencies
323-20 Authorised disclosure: public interest
323-25 Authorised disclosure: by the Secretary if authorised by affected person
323-30 Authorised disclosure: court proceedings
323-40 Offence: disclosure of information obtained by certain authorised disclosures
323-45 Offence: soliciting disclosure of information
323-50 Offence: use etc. of unauthorised information
323-55 Offence: offering to supply protected information
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Part 6-9—Review of decisions
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Division 328—Review of decisions
328-1 What this Part is about
328-5 ART review of decisions
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Part 6-10—Miscellaneous
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Division 333—Miscellaneous
333-1 Delegation by Minister
333-5 Delegation by Secretary
333-10 Approved forms
333-15 Signing approved forms
333-20 Private Health Insurance Rules made by the Minister
333-25 Private Health Insurance Rules made by APRA
333-30 Regulations
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Schedule 1—Dictionary
1 Dictionary
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Endnotes
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
