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Health Benefits Reinsurance (Records of Organisations) Amendment Determination 1999 (No. 1)

Health Benefits Reinsurance (Records of Organisations) Amendment Determination 1999 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2005B01366 Not in force Legislative Instrument

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I, GAYLE GINNANE, Chief Executive Officer, Private Health Insurance Administration Council, make this Determination under subsection 73BB (1) of the National Health Act 1953.

Dated 21 September 1999.

G. GINNANE

Chief Executive Officer

Health Benefits Reinsurance (Records of Organisations) Amendment Determination 1999 (No. 1)

made under the

National Health Act 1953

Contents

Page

1 Name of Determination

2 Commencement

3 Amendment of Health Benefits Reinsurance (Records of Organisations) Determination 1998

Schedule 1 Amendment

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Do not delete : Division placeholder

1 Name of Determination

This Determination is the Health Benefits Reinsurance (Records of Organisations) Amendment Determination 1999 (No. 1).

2 Commencement

This Determination commences on gazettal.

3 Amendment of Health Benefits Reinsurance (Records of Organisations) Determination 1998

Schedule 1 amends the Health Benefits Reinsurance (Records of Organisations) Determination 1998.

Schedule 1 Amendment

Do not delete : Schedule Part placeholder

(section 3)

[1] Schedule, Part 2

substitute

Part 2 Form PHIAC 1

PHIAC 1 Template						Page 1
			Quarter
			Fund ID		DE
		(For Council use only)		Err.	Exp.

Name of Your Organisation
State				Phone
Contact Name				Fax

	Part 1 Membership and Coverage
Total Hospital Membership
			Front-end	Non Front-end
			deductible	deductibles	Total
Exclusionary Tables			0	0	0
Non–Exclusionary			0	0	0
Total Contributors			0	0	0
Total persons covered			0	0	0
			Age 64 & <	Age 65+	Total
Total persons covered			0	0	0
Single Membership
			Front-end	Non Front-end	Total
			deductible	deductibles
Exclusionary Tables			0	0	0
Non–Exclusionary			0	0	0
Total Contributors			0	0	0
Total persons covered			0	0	0
			Age 64 & <	Age 65+	Total
Single members			0	0	0
Family Membership
			Front-end	Non Front-end	Total
			deductible	deductibles
Exclusionary Tables			0	0	0
Non–Exclusionary			0	0	0
Total Contributors			0	0	0
Total persons covered			0	0	0
			Age 64 & <	Age 65+	Total
Total persons covered			0	0	0

The following Check Total must be Printed ––––>				0.00

	Part 1 (Cont.) Membership and Coverage
										Page 2
Single Parent Membership
							Front-end	Non Front-end
							deductible	deductibles	Total
		Exclusionary Tables					0	0	0
						Non–Exclusionary	0	0	0
						Total Contributors	0	0	0
		Total persons covered					0	0	0

							Age 64 & <	Age 65+	Total
			Total persons covered				0	0	0

Couples Membership							Front-end	Non Front-end	Total
							deductible	deductibles
					Exclusionary Tables		0	0	0
						Non–Exclusionary	0	0	0
						Total Contributors	0	0	0
				Total persons covered			0	0	0

							Age 64 & <	Age 65+	Total
				Total persons covered			0	0	0

Hospital Membership Changes During the Quarter
						Single Members	Family Members	Single Parents	Couples
Members Joining						0	0	0	0
Members Leaving						0	0	0	0

Medical Only Membership
						Single Members	Family Members	Single Parents	Couples
Medical Only Contributors						0	0	0	0
Total persons covered						0	0	0	0

	Part 1 (Cont.) Membership and Coverage
					Page 3
Ancillary Insurance Tables

(a) Ancillary Only Tables
Ambulance Only		Single Members	Family Members	Single Parents	Couples
Ambulance Only		0	0	0	0
Total persons covered		0	0	0	0

Other Ancillary Only		Single Members	Family Members	Single Parents	Couples
Other Ancillary Only Tables		0	0	0	0
Total persons covered		0	0	0	0

Total Ancillary Only Tables		Single Members	Family Members	Single Parents	Couples
Ancillary Only Tables		0	0	0	0
Total persons covered		0	0	0	0

(b) All Ancillary Tables (includes hospital and ancillary, and total ancillary only)
		Single Members	Family Members	Single Parents	Couples
Ancillary total		0	0	0	0
Total persons covered		0	0	0	0


The following Check Total must be Printed ––––>				0.00

	Part 2 Hospital Benefits Paid
										Page 4
All Tables – Reinsurance Account Transactions For Persons Aged 65 and Over

Acute Patients					Episodes			Days	Benefits Paid
Day Hospital Facilities					0			0	0
Recognised (Public) Hospitals Day Only					0			0	0
Overnight					0			0	0
Private Hospitals Day Only					0			0	0
Overnight					0			0	0
Total Acute Patients –
Reinsurance Aged 65 and Over					0			0	0
Nursing Home Type Patients					Episodes			Days	Benefits Paid
Recognised (Public) Hospitals					0			0	0
Private Hospitals					0			0	0
Total Nursing Home Type Patients					0			0	0
Medical Benefits – Reinsurance Account (65+)								Number	Benefits Paid
					Up to Schedule Fee			0	0
			Up to 16% Above Schedule Fee					0	0
			Above 16% Above Schedule Fee					0	0
								Number	Benefits Paid
					Prostheses Benefits			0	0

		Total Reinsurance Benefits For Persons Aged 65 and Over							0
All Tables – All Reinsurance Account Transactions
					Episodes			Days	Benefits Paid
Day Hospital Facilities					0			0	0
Recognised (Public) Hospitals Day Only					0			0	0
Overnight					0			0	0
Private Hospitals Day Only					0			0	0
Overnight					0			0	0
Total Acute Patients –
All Reinsurance					0			0	0

Nursing Home Type Patients					Episodes			Days	Benefits Paid
Recognised (Public) Hospitals					0			0	0
Private Hospitals					0			0	0
Total Nursing Home Type Patients					0			0	0

Medical Benefits – All Reinsurance								Number	Benefits Paid
					Up to Schedule Fee			0	0
				Up to 16% Above Schedule Fee				0	0
				Above 16% Above Schedule Fee				0	0
								Number	Benefits Paid
					Prostheses Benefits			0	0

							All Tables Total Reinsurance		0
The following Check Total must be Printed––>						0.00

	Part 2 (Cont.) Hospital Benefits Paid
											Page 5


All Tables – Total Benefits
		All Claims (Ordinary and Reinsurance)
Acute Patients						Episodes			Days	Benefits Paid
Day Hospital Facilities						0			0	0
Recognised (Public) Hospitals Day Only						0			0	0
Overnight						0			0	0
Private Hospitals Day Only						0			0	0
Overnight						0			0	0

						Episodes			Days	Benefits Paid
Total Acute Patients – All Claims						0			0	0


Nursing Home Type Patients						Episodes			Days	Benefits Paid
Recognised (Public) Hospitals						0			0	0
Private Hospitals						0			0	0
Total Nursing Home Type Patients						0			0	0


Medical Benefits									Number	Benefits Paid
				Up to Schedule Fee					0	0
				Up to 16% Above Schedule Fee					0	0
				Above 16% Above Schedule Fee					0	0

									Number	Benefits Paid
					Prostheses Benefits				0	0



							Ineligible Benefits			0


								Total Benefits
			Ordinary and Reinsurance Accounts Combined							0




The following Check Total must be Printed ––––>									0.00



The following Check Total must be Printed ––––>									0.00

	Part 3 Hospital Benefits by Age Category
All Tables – Benefits Paid by Age Category						Page 6




Males
Age Group		Persons Covered	Episodes	Days	Benefits
0–4		0	0	0	0
5–9		0	0	0	0
10–14		0	0	0	0
15–19		0	0	0	0
20–24		0	0	0	0
25–29		0	0	0	0
30–34		0	0	0	0
35–39		0	0	0	0
40–44		0	0	0	0
45–49		0	0	0	0
50–54		0	0	0	0
55–59		0	0	0	0
60–64		0	0	0	0
65–69		0	0	0	0
70–74		0	0	0	0
75–79		0	0	0	0
80–84		0	0	0	0
85–89		0	0	0	0
90–94		0	0	0	0
95+		0	0	0	0


Total		0	0	0	0
















		The following Check Total must be Printed ––––>			0.00

	Part 3 (Cont.) Hospital Benefits by Age Category
All Tables – Benefits Paid by Age Category						Page 7




Females
Age Group		Persons Covered	Episodes	Days	Benefits
0–4		0	0	0	0
5–9		0	0	0	0
10–14		0	0	0	0
15–19		0	0	0	0
20–24		0	0	0	0
25–29		0	0	0	0
30–34		0	0	0	0
35–39		0	0	0	0
40–44		0	0	0	0
45–49		0	0	0	0
50–54		0	0	0	0
55–59		0	0	0	0
60–64		0	0	0	0
65–69		0	0	0	0
70–74		0	0	0	0
75–79		0	0	0	0
80–84		0	0	0	0
85–89		0	0	0	0
90–94		0	0	0	0
95+		0	0	0	0


Total		0	0	0	0
















		The following Check Total must be Printed ––––>			0.00

	Part 4 Benefits Paid From All Tables
BENEFITS PAID FROM INDIVIDUAL HOSPITAL TABLES						Page 8
(ORDINARY AND REINSURANCE COMBINED)
Table identification				Total
(please specify)				Contributors	Benefits Paid
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0

Total				0	0

		Part 5 Benefits Paid From Ancillary Tables
BENEFITS PAID FROM INDIVIDUAL ANCILLARY TABLES
Table identification				Total
(please specify)				Contributors	Benefits Paid
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0
				0	0

Total				0	0
CONTRACTUAL ARRANGEMENTS PAID OUT OF ANCILLARY TABLES
Type of Ancillary					Benefits Paid
					0
					0
					0
			Total Contractual Arrangements		0

			Total Benefits Paid From Ancillary Tables		0
The following Check Total must be Printed ––––>				0.00

	Part 5 (Cont.) Benefits Paid From Ancillary Tables
						Page 9

Benefits paid from Ancillary Tables
TYPE OF ANCILLARY (NON CONTRACTUAL)		SERVICES		COST	BENEFITS
Accidental Death / Funeral Expenses		0		0	0
Acupuncture / Acupressure		0		0	0
Ambulance		0		0	0
Chiropractic		0		0	0
Community, Home, District Nursing		0		0	0
Dental		0		0	0
Dietetics		0		0	0
Domestic Assistance		0		0	0
Ex gratia Payments		0		0	0
Fitness and Lifestyle Courses / Equipment		0		0	0
Hearing Aids and Audiology		0		0	0
Hypnotherapy		0		0	0
Maternity Services		0		0	0
Natural Therapies		0		0	0
Occupational Therapy		0		0	0
Optical		0		0	0
Orthoptics (Eye Therapy)		0		0	0
Osteopathic Services		0		0	0
Overseas		0		0	0
Pharmacy		0		0	0
Physiotherapy		0		0	0
Podiatry (Chiropody)		0		0	0
Prostheses, Aids and Appliances		0		0	0
Psych / Group Therapy		0		0	0
School		0		0	0
Sickness and Accident		0		0	0
Speech Therapy		0		0	0
Theatre Fees		0		0	0
Travel and Accommodation		0		0	0
Other (please specify)
		0		0	0
		0		0	0
		0		0	0
		0		0	0
		0		0	0
		0		0	0
		0		0	0

Total Non-Contractual Ancillaries		0		0	0

The following Check Total must be Printed ––––>			0.00

Overview

The Health Benefits Reinsurance (Records of Organisations) Amendment Determination 1999 (No. 1) was made under subsection 73BB(1) of the National Health Act 1953 by Gayle Ginnane, the Chief Executive Officer of the Private Health Insurance Administration Council (PHIAC). This determination was introduced to address the need for amendments to the Health Benefits Reinsurance (Records of Organisations) Determination 1998, ensuring the accuracy and relevance of the records maintained by private health insurance organisations. The policy objective is to facilitate the proper administration of health benefits reinsurance by ensuring that the information provided by these organisations is up-to-date and accurate. This determination came into effect upon gazettal, ensuring prompt implementation of the necessary changes.

Scope and Application

The Health Benefits Reinsurance (Records of Organisations) Amendment Determination 1999 (No. 1) applies to private health insurance funds in Australia, specifically those that participate in the reinsurance arrangements established under the National Health Act 1953. This Determination amends the Health Benefits Reinsurance (Records of Organisations) Determination 1998 to update the records and data required to be submitted by the Private Health Insurance Administration Council (PHIAC) to accurately reflect the health benefits provided by these funds. The amendment ensures that the information collected is consistent and up-to-date, thereby facilitating effective administration and oversight of the reinsurance arrangements. The Determination is a Commonwealth instrument, applying nationally across Australia, and it comes into effect upon gazettal. There are no specific exclusions, exemptions, or thresholds mentioned in this Determination, which applies directly as set out in the Amendment. Subordinate instruments may further extend or detail the requirements of this Determination as necessary.

Key Provisions

The Health Benefits Reinsurance (Records of Organisations) Amendment Determination 1999 (No. 1) amends the Health Benefits Reinsurance (Records of Organisations) Determination 1998 under the National Health Act 1953. The primary change introduced by this amendment pertains to the form PHIAC 1, which must be completed and submitted by organisations. This form, detailed in Part 2 of the Schedule 1 amendment, outlines various membership categories and the corresponding details such as deductibles, contributors, and persons covered. The amendment requires organisations to provide detailed information on different types of memberships including hospital, single, family, single parent, and couples memberships, along with their respective front-end and non-front-end deductibles. It also mandates that organisations report on the total persons covered under each membership category, broken down by age groups, and the benefits paid for hospital and medical services, particularly focusing on reinsurance accounts for persons aged 65 and over. This Determination imposes obligations on the organisations to accurately record and report their membership data, including total persons covered, types of memberships, and the benefits paid. The organisations must provide detailed information on hospital benefits paid, broken down by the type of facility (public or private), duration of stay (day only or overnight), and the total benefits paid under various medical services. They are also required to report on the benefits paid for ancillary services such as ambulance, dental, physiotherapy, and others, and must ensure the totals match the check totals provided in the form. Breach of the obligations imposed by this Determination can lead to various civil and administrative consequences. Organisations failing to accurately report the required data or submitting incomplete or incorrect information may face penalties. Although the specific penalties are not detailed in the provided text, generally, such breaches could result in fines, corrective actions, or further investigation by the Private Health Insurance Administration Council. Non-compliance could also lead to reputational damage and potential loss of accreditation or eligibility to participate in the private health insurance system.

Area of Law: Health Law
Instrument: Legislative Instrument
Concepts: Definitions & Interpretation; Reporting & Disclosure Obligations; Compliance Obligations

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.

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