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Rules/Other as amended, taking into account amendments up to Private Health Insurance Legislation Amendment (Risk Equalisation Jurisdiction) Rules 2016
Administered by: Health
Registered 29 Aug 2016
Start Date 01 Jul 2016
Table of contents.

Commonwealth Coat of Arms

Private Health Insurance (Health Benefits Fund Policy) Rules 2015

made under item 8 of the table in section 333-20 of the

Private Health Insurance Act 2007

Compilation No. 1               

Compilation date:                              1 July 2016

Includes amendments up to:            Private Health Insurance Legislation Amendment (Risk Equalisation Jurisdiction) Rules 2016

 

 

About this compilation

 

This compilation

This is a compilation of the Private Health Insurance (Health Benefits Fund Policy) Rules 2015 that shows the text of the law as amended and in force on 1 July 2016 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

 

 

  

  

  


Contents

 

Part 1       Preliminary. 2

1.      Name of Rules. 2

4.      Authority. 2

5.      Definitions. 2

Part 2       Meaning of health-related business. 3

6.      Overseas treatment. 3

7.      Agency business. 3

Part 3       Risk equalisation jurisdictions. 5

8.      Areas that are risk equalisation jurisdictions. 5

Part 4       Operation of health-related businesses through health benefits funds. 6

9.      Insurance for overseas students or specified temporary visa holders. 6

Endnotes. 8

Endnote 1—About the endnotes. 8

Endnote 2—Abbreviation key. 9

Endnote 3—Legislation history. 10

Endnote 4—Amendment history. 11

 


 

Part 1        Preliminary

1.               Name of Rules

These Rules are the Private Health Insurance (Health Benefits Fund Policy) Rules 2015.

4.               Authority

These Rules are made under the Private Health Insurance Act 2007.

5.               Definitions

In these rules:

Act means the Private Health Insurance Act 2007.

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

                   assets
general treatment
health benefits fund
hospital treatment
medicare benefit
policy holder
private health insurer

 

Part 2       Meaning of health-related business

6.               Overseas treatment

(1)        For the purposes of paragraph 131-15 (1) (d) of the Act, the business described in subrule (2) is specified.

(2)        The business is the undertaking of liability by way of insurance for the provision outside Australia of treatment that is intended to manage a disease, injury or condition, but only when:

(a)                    the disease, injury or condition is chronic and permanent; and

(b)                   the liability is confined to treatment that would be required routinely, whether or not the person had remained in Australia; and

(c)                    the amount of the liability incurred by the insurer for any particular treatment does not exceed the amount of the liability that would be incurred by the insurer for that treatment if it were provided in Australia; and

(d)                   the liability does not extend to any treatment administered to a person more than 60 days after the person last departed from Australia.

7.               Agency business

(1)        For the purposes of paragraph 131-15 (1) (d) of the Act, the business described in subrule (2) is specified.

(2)        The business is the offering of goods, services or benefits by a private health insurer under an agency arrangement.

(3)        In this rule agency arrangement means a written arrangement between a person (the agent) and another person (the principal) under which:

(a)                    the agent is permitted to act on behalf of the principal to create legal relations between the principal and a third person in transactions to provide goods, services or benefits; and

(b)                   the principal assumes liability for the transaction to the third person, including for the provision of the goods, services or benefits; and

(c)                    the agent assumes no liability in respect of the transaction, other than to perform its obligations under the arrangement for and on behalf of the principal.

Note:         an example of the specified business is a private health insurer offering travel insurance policies under an arrangement with an overseas travel insurance company where the principal assumes the insurable risks under the policy and responsibility for the provision of benefits under the policy, and the private health insurer takes on no such liability, except to duly perform its obligations under the contract or agreement between it and the overseas travel insurance company which establishes the agency arrangement.

Part 3        Risk equalisation jurisdictions

8.               Areas that are risk equalisation jurisdictions

For subsection 131-20(1) of the Act, the areas specified in the following paragraphs are each a risk equalisation jurisdiction:

(a) Australian Capital Territory, Norfolk Island and New South Wales;

(b) Northern Territory;

(c) Queensland;

(d) South Australia;

(e) Tasmania;

(f) Victoria;

(g) Western Australia and the Territory of Christmas Island and the Territory of Cocos (Keeling) Islands.

 

Part 4       Operation of health-related businesses through health benefits funds

9.               Insurance for overseas students or specified temporary visa holders

(1)        This section applies if a private health insurer has a health benefits fund in respect of its health insurance business and some or all of its health-related businesses.

(2)        For section 131-25 of the Act, requirements are specified in subrule (3) relating to how the insurer must conduct that health-related business.

(3)        The private health insurer must not:

(a)                    take or fail to take any action; or

(b)                   in making a decision, have regard to or fail to have regard to any matter;

that would result in the insurer discriminating between people who are, or wish to be, insured under an overseas student health insurance contract or specified temporary visa holder health insurance contract of the insurer.

(4)        In this rule, discriminating relates to:

(a)                    the suffering by a person from a chronic disease, illness or other medical condition or from a disease, illness or medical condition of a particular kind; or

(b)                   the gender, race, sexual orientation or religious belief of a person; or

(c)                    the age of a person; or

(d)                   where a person lives; or

(e)                    any other characteristic of a person (including but not just matters such as occupation or leisure pursuits) that is likely to result in an increased need for hospital treatment or general treatment; or

(f)                    the frequency with which a person needs hospital treatment or general treatment; or

(g)                   the amount or extent of the benefits to which a person becomes entitled during a period under an overseas student health insurance contract or a specified temporary visa holder health insurance contract, as the case may be, except to the extent allowed by the written agreement, between the private health insurer and the Commonwealth, referred to in the definition of overseas student health insurance contract and specified temporary visa holder health insurance contract in the Private Health Insurance (Health Insurance Business) Rules 2007.

In this rule, overseas student, overseas student health insurance contract, specified temporary visa holder and specified temporary visa holder health insurance contract have the same meaning as in Private Health Insurance (Health Insurance Business) Rules made under the Act, as in force from time to time.

 

 


Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history. 

Endnote 2—Abbreviation key

 

o = order(s)

ad = added or inserted

Ord = Ordinance

am = amended

orig = original

amdt = amendment

par = paragraph(s)/subparagraph(s)

c = clause(s)

    /sub‑subparagraph(s)

C[x] = Compilation No. x

pres = present

Ch = Chapter(s)

prev = previous

def = definition(s)

(prev…) = previously

Dict = Dictionary

Pt = Part(s)

disallowed = disallowed by Parliament

r = regulation(s)/rule(s)

Div = Division(s)

 

exp = expires/expired or ceases/ceased to have

reloc = relocated

    effect

renum = renumbered

F = Federal Register of Legislation

rep = repealed

gaz = gazette

rs = repealed and substituted

LA = Legislation Act 2003

s = section(s)/subsection(s)

LIA = Legislative Instruments Act 2003

Sch = Schedule(s)

(md) = misdescribed amendment can be given

Sdiv = Subdivision(s)

    effect

SLI = Select Legislative Instrument

(md not incorp) = misdescribed amendment

SR = Statutory Rules

    cannot be given effect

Sub‑Ch = Sub‑Chapter(s)

mod = modified/modification

SubPt = Subpart(s)

No. = Number(s)

underlining = whole or part not

 

    commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Private Health Insurance Legislation Amendment (Risk Equalisation Jurisdiction) Rules 2016

F2016L00492

1 July 2016

 

 

 

 

 

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2

s 3

Part 3, Paragraph 8(a)

rep LA s 48D

rep LA s 48C

ad F2016L00492