Private Health Insurance (Risk Equalisation Administration) Amendment Rules 2011 (No. 1) (Cth)

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

Private Health Insurance Act 2007

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

Commissioner

Private Health Insurance Administration Council

1Name of Rules

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

2Commencement

These Rules commence on the day after they are registered.

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

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

Schedule 1Amendments

(rule 3)

[1]Subrule 3 (3)

omit

[2]Paragraph 4 (b)

substitute

  1. (b)

    which of the following the policy covers:

    1. (i)

      hospital treatment;

    2. (ii)

      hospital-substitute treatment;

    3. (iii)

      chronic disease management programs;

    4. (iv)

      ambulance service;

    5. (v)

      other general treatment; and

[3]Subparagraph 4 (e) (iii)

substitute

  1. (iii)

    whether the benefit was paid for:

    1. (A)

      hospital treatment; or

    2. (B)

      hospital-substitute treatment; or

    3. (C)

      chronic disease management program treatment; or

    4. (D)

      ambulance services; or

    5. (E)

      other general treatment; and

[4]Rule 5

omit everything before paragraph (a), insert

  1. (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.

  1. (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)

omit

Council for each fund that it conducts

insert

Council, for each fund that it conducts,

[6]After subrule 6 (4)

insert

  1. (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)

substitute

  1. (1)

    Quarterly returns must be:

    1. (a)

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

    2. (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 7 (2)

omit

electronic form of the quarterly return

insert

data mentioned in paragraph 1 (a)

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

substitute

  1. (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)

substitute

  1. (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

omit

[12]Schedule — Quarterly return

omit

Note

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003.See

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