Private Health Insurance (Risk Equalisation Administration) Amendment Rules 2011 (No. )

Schedule 1 Amendments

(rule 3)

[1] Subrule 3 (3)

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[2] Paragraph 4 (b)

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(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)

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(iii) whether the benefit was paid for:

(A) hospital treatment; or

(B) hospital-substitute treatment; or

(D) ambulance services; or

(E) other general treatment; and

[4] Rule 5

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(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)

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Council for each fund that it conducts

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Council, for each fund that it conducts,

[6] After subrule 6 (4)

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(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)

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(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)

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electronic form of the quarterly return

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data mentioned in paragraph 1 (a)

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

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(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)

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(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

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[12] Schedule — Quarterly return

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