EXPLANATORY STATEMENT
STATUTORY RULES 1985 NO. 50
ISSUED BY AUTHORITY OF THE MINISTER FOR HEALTH
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE REGULATIONS
Section 133 of the Health Insurance Act 1973 (‘the Act’) provides that the Governor-General may make regulations prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Sub-section 130(1) of the Act provides that a person shall not, directly or indirectly, except in the performance of his duties, or in the exercise of his powers or functions, under the Act, and while he is, or after he ceases to be, an officer, make a record of, divulge or communicate to any person, any information with respect to the affairs of another person acquired by him in the performance of his duties, or in the exercise of his powers or functions, under the Act. An “officer” is, by virtue of sub-section 130(14) of the Act, a person performing duties, or exercising
powers or functions, under, or in relation to, the Act.
By virtue of paragraph 130(3)(b) of the Act, the Secretary to the Department of Health or the General Manager of the Health Insurance Commission may divulge information to which sub-section 130(1) of the Act relates, notwithstanding the provisions of that sub-section, to any prescribed authority or person. Sub-section 130(4) of the Act, however, prohibits information so divulged from being further divulged by the recipient authority or person, and by any person or employee under the control of that person or authority.
Regulation 9B of the Health Insurance Regulations (‘the Regulations’) prescribes for the purposes of paragraph 130(3)(b) of the Act, authorities and persons to whom information, to which sub-section 130(1) of the Act relates, may be divulged.
Since the introduction of medicare in 1984, Deparment of Veterans’ Affairs beneficiaries may now have a dual entitlement to benefits under
the Repatriation legislation and medicare. Because of this the Department of Veterans’ Affairs requires limited access to claims data held by the Health Insurance Commission. Such an access not only streamlines claiming procedures but also minimises opportunities for lodging fraudulent claims on either organization.
New sub-regulation 9B(2A) prescribes the Secretary of the Department of Veterans’ Affairs to be a person to whom such information may be divulged.
The Statutory Rules came into operation on the date of their notification in the Commonwealth of Australia Gazette.
Overview
The Health Insurance Act 1973 was enacted to establish a universal health insurance scheme in Australia, known as Medicare. This legislation was introduced to address the gap in healthcare coverage and ensure that all Australians have access to affordable and quality healthcare services. The Act is administered by the Parliament of Australia and its primary policy objective is to provide a comprehensive health insurance system that guarantees essential medical services to all residents. The explanatory statement for Statutory Rules 1985 No. 50, issued under the authority of the Minister for Health, further clarifies provisions of the Act by allowing specific information to be disclosed to prescribed authorities and persons, such as the Secretary of the Department of Veterans' Affairs, to facilitate streamlined claims processes and reduce fraudulent activities. These regulations aim to ensure that the Act's objectives are effectively met while maintaining the confidentiality and security of personal health information.
Scope and Application
The Health Insurance Act 1973, as supplemented by Statutory Rules 1985 No. 50, governs the protection and handling of health insurance information within Australia. This legislation applies to any person designated as an "officer" under the Act, who includes those performing duties or exercising powers or functions under, or in relation to, the Act. The Act prohibits officers from divulging any information acquired in the course of their duties, unless explicitly permitted by the Act or as an exception under sub-section 130(1). However, sub-section 130(3)(b) allows the Secretary to the Department of Health or the General Manager of the Health Insurance Commission to divulge such information to prescribed authorities or persons, as outlined in Regulation 9B. Notably, any information divulged under this provision cannot be further communicated by the recipient, ensuring stringent control over sensitive data. The new sub-regulation 9B(2A) specifically includes the Secretary of the Department of Veterans’ Affairs as a recipient, facilitating streamlined and secure claims processes for beneficiaries eligible for both Repatriation and Medicare benefits. This legislative framework is designed to protect personal health information while enabling necessary information sharing to support efficient and honest service delivery across relevant authorities.
Key Provisions
The Health Insurance Regulations, under the Health Insurance Act 1973, are designed to govern the handling of sensitive information related to health insurance affairs. Section 133 of the Act empowers the Governor-General to issue regulations that are necessary for the operation of the Act. Specifically, Regulation 9B details the authorities and individuals who may receive specific information, despite the general prohibition on disclosing such information (subsection 130(1)). Regulation 9B(2A) specifically allows the Secretary of the Department of Veterans’ Affairs access to certain claims data held by the Health Insurance Commission, facilitating a more streamlined process for dual entitlement beneficiaries under both Repatriation legislation and Medicare. This regulation aims to reduce the potential for fraudulent claims by ensuring that the Department of Veterans’ Affairs can verify claims data more efficiently.
The obligations imposed by these regulations are stringent in protecting the confidentiality of health insurance information. Officers of the Health Insurance Commission and other relevant bodies are explicitly prohibited from disclosing any information acquired in the course of their duties to unauthorised persons (subsection 130(1)). This extends to any indirect communication of such information. The only exceptions to this rule are when the information is disclosed in the performance of official duties or when it is communicated to a prescribed authority or person as outlined in Regulation 9B (subsection 130(3)(b)). Furthermore, any recipient of such information is strictly forbidden from further divulging it, as stipulated in subsection 130(4).
Breaches of these provisions carry significant legal consequences. Any person found guilty of unauthorised disclosure of health insurance information may face substantial penalties. While the exact penalties are not specified within the explanatory statement, it is clear that any unauthorised divulgence of sensitive information is treated with serious legal repercussions. This includes both civil and potential criminal penalties, as the misuse of such confidential data is considered a grave offence under the Act. The stringent measures are in place to ensure the integrity and security of health insurance data, reflecting the high importance placed on privacy and confidentiality in the administration of health benefits.