Private Health Insurance Act 2007No. 31, 2007

In force

Administered by

Department of Health, Disability and Ageing

Superseded version

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View as made version

C2010C00437 C13

01 July 2010 - 31 December 2010

Table of contents

Chapter 1—Introduction
Part 1-1—Introduction
- Division 1—Preliminary
- Division 3—Overview of this Act
- Division 5—Constitutional matters
Chapter 2—Incentives
Part 2-1—Introduction
- Division 15—Introduction
  - 15-1 What this Chapter is about
Part 2-2—Premiums reduction and incentive payments schemes
- Division 20—Introduction
  - 20-1 What this Part is about
  - 20-5 Private Health Insurance (Incentives) Rules
- Division 23—Premiums reduction scheme
  - Subdivision 23-A—Amount of reduction
  - Subdivision 23-B—Participation in the premiums reduction scheme
- Division 26—The incentive payments scheme
  - Subdivision 26-A—Amount of incentive payment
    - 26-1 Payment in relation to premiums
    - 26-5 Payment after a person 65 years or over ceases to be covered by policy
  - Subdivision 26-B—Claiming payments under the incentive payments scheme
Part 2-3—Lifetime health cover
- Division 31—Introduction
  - 31-1 What this Part is about
  - 31-5 Private Health Insurance (Lifetime Health Cover) Rules
- Division 34—General rules about lifetime health cover
- Division 37—Exceptions to the general rules about lifetime health cover
- 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
Chapter 3—Complying health insurance products
Part 3-1—Introduction
- Division 50—Introduction
  - 50-1 What this Chapter is about
  - 50-5 Private Health Insurance Rules relevant to this Chapter
Part 3-2—Community rating
- Division 55—Principle of community rating
Part 3-3—Requirements for complying health insurance products
- Division 60—Introduction
  - 60-1 What this Part is about
- Division 63—Basic rules about complying health insurance products
- Division 66—Community rating requirements
- Division 69—Coverage requirements
- Division 72—Benefit requirements for policies that cover hospital treatment
- Division 75—Waiting period requirements
- Division 78—Portability requirements
  - 78-1 Portability requirements
- Division 81—Quality assurance requirements
  - 81-1 Quality assurance requirements
- Division 84—Enforcement of this Part
Part 3-4—Obligations relating to complying health insurance products
- Division 90—Introduction
  - 90-1 What this Part is about
- Division 93—Giving information to consumers
- Division 96—Giving information to the Department, the Council and the Private Health Insurance Ombudsman
- Division 99—Transfer certificates
  - 99-1 Transfer certificates
- Division 102—Private health insurers to offer cover for hospital treatment
  - 102-1 Private health insurers to offer cover for hospital treatment
Chapter 4—Private health insurers
Part 4-1—Introduction
- Division 110—Introduction
  - 110-1 What this Chapter is about
Part 4-2—Carrying on health insurance business
- Division 115—Introduction
- Division 118—Prohibition of carrying on health insurance business without registration
  - 118-1 Carrying on health insurance business without registration
  - 118-5 Injunctions
- Division 121—What is health insurance business?
Part 4-3—Registration
- Division 126—Registration
Part 4-4—Health benefits funds
- Division 131—Introduction
- Division 134—The requirement to have health benefits funds
- Division 137—The operation of health benefits funds
- Division 140—The solvency standard for health benefits funds
- Division 143—The capital adequacy standard for health benefits funds
- Division 146—Restructure, merger and acquisition of health benefits funds
- Division 149—Termination of health benefits funds
- Division 152—Duties and liabilities of directors etc.
Part 4-5—Other obligations of private health insurers
- Division 157—Introduction
  - 157-1 What this Part is about
  - 157-5 The Private Health Insurance (Insurer Obligations) Rules
- Division 160—Appointed actuaries
- Division 163—Prudential standards
- Division 166—Disqualified persons
- Division 169—Reporting and notification requirements
- Division 172—Miscellaneous
Chapter 5—Enforcement
Part 5-1—Introduction
- Division 180—Introduction
  - 180-1 What this Chapter is about
Part 5-2—General enforcement methods
- Division 185—What this Part is about
- Division 188—Performance indicators
  - 188-1 Performance indicators
- Division 191—Explanation of private health insurer’s operations
  - 191-1 Minister or Council may seek an explanation from a private health insurer
  - 191-5 Writer must respond to insurer’s explanation
- Division 194—Investigation of private health insurer’s operations
- Division 197—Enforceable undertakings
  - 197-1 Minister or Council may accept written undertakings given by a private health insurer
  - 197-5 Enforcement of undertakings
- Division 200—Ministerial and Council directions
  - 200-1 Minister or Council may give directions
  - 200-5 Direction requirements
- Division 203—Remedies in the Federal Court
- Division 206—Revoking entitlement to offer rebate as a premium reduction
  - 206-1 Revocation of status of participating insurer
Part 5-3—Enforcement of health benefits fund requirements
- Division 211—Introduction
- Division 214—Investigations into affairs of private health insurers
- Division 217—External management of health benefits funds
- Division 220—Ordering the termination of health benefits funds
Chapter 6—Administration
Part 6-1—Introduction
- Division 230—Introduction
  - 230-1 What this Chapter is about
Part 6-2—Private Health Insurance Ombudsman
- Division 235—Introduction
  - 235-1 Principal object of this Part
  - 235-5 Private Health Insurance (Ombudsman) Rules
- Division 238—Establishment and functions
  - 238-1 Establishment of office of Private Health Insurance Ombudsman
  - 238-5 Functions of Private Health Insurance Ombudsman
- Division 241—Complaints
- Division 244—Investigations
  - Subdivision 244-A—Investigations
    - 244-1 Initiating investigations
    - 244-5 Investigations at Minister’s request
  - Subdivision 244-B—Recommendations and reports
- Division 247—Mediation
- Division 250—Information-gathering
- Division 253—Provisions relating to the Private Health Insurance Ombudsman
- Division 256—Miscellaneous
Part 6-3—Private Health Insurance Administration Council
- Division 261—Introduction
  - 261-1 What this Part is about
  - 261-5 The Private Health Insurance (Council) Rules
- Division 264—Continuation, purposes, functions and powers
- Division 267—Constitution and administration
- Division 270—Members
- Division 273—Chief Executive Officer and staff
Part 6-4—Administration of premiums reduction and incentive payments schemes
- Division 276—Introduction
  - 276-1 What this Part is about
- Division 279—Provisions applying only to premiums reduction scheme
  - Subdivision 279-A—Reimbursement of private health insurers for premiums reduced under scheme
  - Subdivision 279-B—Powers of Medicare Australia CEO in relation to participating insurers
    - 279-50 Audits by Medicare Australia CEO
    - 279-55 Medicare Australia CEO may require production of applications
- Division 282—Provisions applying to premiums reduction scheme and incentive payments scheme
  - Subdivision 282-A—When and how payments can be recovered
  - Subdivision 282-B—Miscellaneous
Part 6-5—External managers and terminating managers
- Division 287—Introduction
  - 287-1 What this Part is about
  - 287-5 The Private Health Insurance (Management) Rules
- Division 290—Powers of managers
- Division 293—Information concerning, and records and property of, health benefits funds
- Division 296—Provisions incidental to appointment of managers
- Division 299—Miscellaneous
Part 6-6—Private health insurance levies
- Division 304—Introduction
- Division 307—Collection and recovery of private health insurance levies
- Division 310—Returns, requesting information and keeping records: private health insurers
- Division 313—Power to enter premises and search for documents: private health insurers
Part 6-7—Private Health Insurance Risk Equalisation Trust Fund
- Division 318—Private Health Insurance Risk Equalisation Trust Fund
Part 6-8—Disclosure of information
- Division 323—Disclosure of information
Part 6-9—Review of decisions
- Division 328—Review of decisions
  - 328-1 What this Part is about
  - 328-5 AAT review of decisions
Part 6-10—Miscellaneous
- Division 333—Miscellaneous
Schedule 1—Dictionary
- 1 Dictionary
  - Notes to the STYLEREF ShortT \* MERGEFORMAT Private Health Insurance Act 2007

Private Health Insurance Act 2007No. 31, 2007

Legislation text