Federal Register of Legislation - Australian Government

Primary content

Rules/Other as made
These Rules amend the Private Health Insurance (Risk Equalisation Administration) Rules 2007 by removing the Schedule - Quarterly Return. The removal of the Quarterly Return provides for PHIAC and the industry to be more responsive and adaptable to government and industry data requirements. The requirement to lodge a paper copy is also removed, taking a burden off private health insurers.
Administered by: Health
Registered 29 Mar 2011
Tabling HistoryDate
Tabled HR10-May-2011
Tabled Senate10-May-2011
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014

The Private Health Insurance Administration Council makes these Rules under subsection 333-25 (1) of the Private Health Insurance Act 2007.

Dated 18 March 2011

Lynn Ralph


1              Name of Rules

                These Rules are the Private Health Insurance (Risk Equalisation Administration) Amendment Rules 2011 (No. 1).

2              Commencement

                These Rules commence on the day after they are registered.

3              Amendment of Private Health Insurance (Risk Equalisation Administration) Rules 2007

                Schedule 1 amends the Private Health Insurance (Risk Equalisation Administration) Rules 2007.

Schedule 1        Amendments

(rule 3)


[1]           Subrule 3 (3)


[2]           Paragraph 4 (b)


               (b)    which of the following the policy covers:

                          (i)    hospital treatment;

                         (ii)    hospital-substitute treatment;

                        (iii)    chronic disease management programs;

                        (iv)    ambulance service;

                         (v)    other general treatment; and

[3]           Subparagraph 4 (e) (iii)


                        (iii)    whether the benefit was paid for:

                                   (A)     hospital treatment; or

                                   (B)     hospital-substitute treatment; or

                                   (C)     chronic disease management program treatment; or

                                   (D)     ambulance services; or

                                   (E)     other general treatment; and

[4]           Rule 5

omit everything before paragraph (a), insert

         (1)   This rule applies if the insurer includes in a quarterly return a gross benefit for the high cost claimants pool.

Note   Part 3 sets out the requirements for providing quarterly returns.

         (2)   In addition to the information to be kept in accordance with rule 4, the insurer must keep a record that contains the following information in respect of the insured person to whom the gross benefit relates:

[5]           Subrule 6 (1)


Council for each fund that it conducts


Council, for each fund that it conducts,

[6]           After subrule 6 (4)


      (4A)   For the purpose of quarterly returns, a benefit is regarded as being paid during the quarter in which the benefit is recorded and liability for it is accepted.

[7]           Subrule 7 (1)


         (1)   Quarterly returns must be:

                (a)    given to the Council as electronic data in the form approved by the Council; and

               (b)    accompanied by a signed copy of the certification mentioned in subrule (3) as a PDF file.

Note for paragraph (a)   The approved form for paragraph (a) is available at http://www.phiac.gov.au.

[8]           Subrule 7 (2)


electronic form of the quarterly return


data mentioned in paragraph 1 (a)

[9]           Subrule 7 (3), except the note


         (3)   For paragraph 7 (1) (b), an officer of the insurer must certify that the information in the quarterly return is true and correct.

[10]         Subrule 7 (4)


         (4)   If an officer is unable to give the certification mentioned in subrule (3), the quarterly return must be accompanied by a statement by an officer of the insurer stating why the certification cannot be provided.

[11]         Rule 9


[12]         Schedule — Quarterly return



1.       All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See http://www.frli.gov.au.