Private Health Insurance (Transition) Rules 2007 (Cth)

Private Health Insurance (Transition) Rules 2007

as amended

made under section 55 of the

Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007

This compilation was prepared on 8 March 2008

taking into account amendments up to Private Health Insurance (Transition) Amendment Rules 2008

Prepared by the Office of Legislative Drafting and Publishing,

Attorney‑General’s Department, Canberra

Contents

1Name of Rules [see Note 1]

These Rules are the Private Health Insurance (Transition) Rules 2007.

2Commencement [see Note 1]

These Rules commence:

1. (a)

   if the Rules are registered before the Private Health Insurance Act 2007 commences ― at the same time as that Act commences; or

2. (b)

   if the Rules are registered on or after the day on which the Private Health Insurance Act 2007 commences ― on the date on which the Rules are registered,

whichever occurs first.

3Definitions

Note Terms used in these Rules have the same meaning as in section 4 of the Transitional Provisions Act ─ see section 13 of the Legislative Instruments Act 2003. These terms include:

commencement time

new Act

complying health insurance policy

In these Rules:

complaints levy has the same meaning as in the Private Health Insurance Act 2007.

health care provider has the same meaning as in the Private Health Insurance Act 2007.

Incentives Actmeans the Private Health Insurance Incentives Act 1998.

insured person has the same meaning as in the Private Health Insurance Act 2007.

National Health Act means the National Health Act 1953.

private health insurer has the same meaning as in the Private Health Insurance Act 2007.

Transitional Provisions Act means the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007.

4Continued application of section 82ZVC of the National Health Act

Despite the repeal of section 82ZVC of the National Health Act by the Transitional Provisions Act, the section continues to apply after the commencement time, to the exclusion of Part 6‑6 of the new Act, in relation to an amount of complaints levy to which section 82ZVC applied immediately before the commencement time.

5Interpretation of the Incentives Act from the commencement time to repeal

1. (1)

   Despite the operation of item 2 of the table in subsection 6 (1) of the Transitional Provisions Act, for the Incentives Act to apply after 1 April 2007 to an insurance policy, whether the policy is issued before, on or after that date, and whether the policy is designated an appropriate private health insurance policy or a complying health insurance policy, the policy must satisfy the condition set out in the definition of ‘appropriate private health insurance policy’ in section 20‑5 of the Incentives Act that the person, or each of the persons, covered by the policy is:

   1. (a)

      an eligible person within the meaning of subsection 3 (1) of the Health Insurance Act 1973; or

   2. (b)

      treated as an eligible person because of the operation of sections 6, 6A or 7 of that Act.

   This rule ceases to operate on the day on which the Incentives Act is repealed.

6Persons who are taken to be registered as participants under new Act

1. (1)

   A person who is a ‘participant in the premiums reduction scheme’, within the meaning of that term in the Incentives Act, immediately before 1 July 2007, is taken to be, on and after 1 July 2007, a person who is registered as a participant in the premium reductions scheme under subsection 23‑15 (3) of the new Act.

   (2) This rule ceases to apply to the person if the Medicare Australia CEO revokes the person’s registration under section 23‑35 of the new Act.

7Applications for a determination that a prosthesis is a gap prosthesis or a no gap prosthesis

If:

(1) before the commencement time, an application was made to the Minister for a determination under subsections 73AAG (6) or (7) of the National Health Act that a prosthesis is a gap prosthesis or no gap prosthesis for the purposes of that Act; and

(2) as at the commencement time, the Minister had not decided the application,

the application is taken to be an application to the Minister under subsection 72‑10 (2) of the new Act, but subsection 72‑10 (3) does not apply to the application.

Note Subsection 72‑10 (3) of the new Act requires applications to be in the approved form and to be accompanied by the application fee imposed under the Private Health Insurance (Prostheses Application and Listing Fees) Act 2007.

8Continuing agreements and quality standards

The repeal of provisions of the National Health Act that refer to hospital purchaser‑provider agreements or any other arrangements between private health insurers and health care providers does not affect the operation of any such arrangements to the extent that they are not inconsistent with the new Act, and in particular does not affect the operation of provisions in such arrangements that require the health care provider to meet particular quality assurance standards, accreditation standards or professional standards in respect of the provision of treatment to insured persons.

9Continuing operation of contracts resulting in discounts

If, immediately before the commencement of the new Act, a private health insurer is a party to a written contract, the effect of which results in a discount being available under an insurance policy of the insurer for a period, and the discount, or the total of that discount and any other discounts for the policy, would result in the policy not meeting the premium requirement specified in paragraph 66‑1 (1) (c) of the new Act, the discount may continue to be provided as long as:

1. (a)

   the contract remains in force; and

2. (b)

   the discount resulting from the contract continues to meet requirements in and under the National Health Act, including the determination under section 73AAG (4) of the National Health Act, as in force immediately before the commencement of the new Act.

10Transition for restricted access insurers

1. (1)

   This rule applies to an applicant for registration as a restricted access insurer under Part 4-3 of the new Act where the applicant at the time of the application:

   1. (a)

      is a private health insurer because of subsection 18 (1) of the Transitional Provisions Act; and

   2. (b)

      is a restricted access insurer because of subsection 20 (1) of the Transitional Provisions Act; and

   3. (c)

      has a constitution that does not comply with subsection 126-20 (6) of the new Act.

2. (2)

   If this rule applies to the applicant, subsection 126‑20 (6) of the new Act does not apply to the insurer until 31 December 2008.

Notes to the Private Health Insurance (Transition) Rules 2007

Note 1

The Private Health Insurance (Transition) Rules 2007 (in force under section 55 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 ) as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Title	Date of FRLI registration	Date of commencement	Application, saving or transitional provisions
Private Health Insurance (Transition) Rules 2007	31 Mar 2007 (see F2007L00913)	1 Apr 2007 (see r. 2 (a))	—
Private Health Insurance (Transition) Amendment Rules 2008	7 Mar 2008 (see F2008L00711)	8 Mar 2008	—

Table of Amendments

ad. = added or inserted am. = amended rep. = repealed rs. = repealed and substituted
Provision affected	How affected
R. 10.......................................	ad. F2008L00711