National Health Amendment Regulations 1999 (No. 3) 1999 No. 162
EXPLANATORY STATEMENT
STATUTORY RULES 1999 No. 162
Issued by Authority of the Minister for Health and Aged Care
National Health Act 1953
National Health Amendment Regulations 1999 (No. 3)
Section 140 of the National Health Act 1953 (the Act) provides that the Governor-General may make Regulations prescribing matters that are required or permitted by the Act to be prescribed, or that are necessary and convenient to be prescribed for carrying out or giving effect to the Act.
Section 67 of the Act prohibits a person (other than a registered organisation) from carrying on health insurance business. The term "health insurance business" is defined in subsection 67(4) of the Act. In so far as is relevant, paragraph 67(4)(e) of the Act provides that health insurance business does not include business of a kind prescribed.
Regulation 48 of the National Health Regulations (the Principal Regulations) prescribes various types of business for the purposes of paragraph (c) of the definition of "health insurance business". To date, regulation 48 has been used to allow insurers that are not registered organisations under the Act to provide health insurance for certain situations/events that would otherwise fall within the standard definition of "health insurance business".
The amending regulations will prescribe Overseas Student Health Cover (OSHC) policies offered by a registered health benefits organisation under an agreement with the Commonwealth.
OSHC policies provide medical and hospital insurance for full fee paying overseas students and any accompanying or joining dependents. To the extent that they insure against fees for hospital treatment or ancillary health benefits OSHC policies would, but for the amending regulations, fall within the definition of "health insurance business" and would therefore be subject to the regulatory provisions contained in the Act. Some of these provisions, for example those giving effect to the community rating principle, are not appropriate for OSHC policies. The amending regulations therefore exclude from the definition of "health insurance business" OSHC policies offered by a registered health benefits organisation under an agreement with the Commonwealth. The agreement will set out the requirements pertaining to OSHC policies.
In addition to insuring against fees for hospital treatment and ancillary health benefits, OSHC policies will also be able to cover fees for professional services for which medicare benefits would otherwise be payable under the Health Insurance Act 1973.
The purpose of the regulations is to enable registered organisations (but not other insurers) to offer OSHC policies that are not subject to the provisions of the Act but which are subject to certain requirements set out in a contract with the Commonwealth.
Details of the regulations are set out in the Attachment.
The regulations commenced on Gazettal.
ATTACHMENT
Regulation 1 provides that the Regulations may be cited as the National Health Amendment Regulations 1999 (No. 3 ).
Regulation 2 provides that the Regulations commence on gazettal.
Regulation 3 provides that the National Health Regulations 1954 are amended by Schedule 1.
item 1 of Schedule 1 inserts a new subregulation 48 (2A). The new subregulation excludes, from the definition of "health insurance business" in subsection 67 (4) of the Act, insurance undertaken by a registered organisation under an overseas student health insurance contract.
Item 2 of Schedule 1 inserts a new subregulation 48(5) which defines the terms "overseas student" and "overseas student health insurance contract".
Overview
The National Health Amendment Regulations 1999 (No. 3) were enacted under the National Health Act 1953 to address the issue of defining the scope of health insurance business, particularly in relation to Overseas Student Health Cover (OSHC) policies. The regulations were introduced by the Minister for Health and Aged Care and aim to exclude OSHC policies from the definition of "health insurance business" when offered by registered health benefits organisations under an agreement with the Commonwealth. This exclusion allows these specific policies to operate outside the regulatory provisions of the Act, while still being subject to certain requirements set out in the Commonwealth agreement.
These regulations were necessary to ensure that OSHC policies, which provide medical and hospital insurance for overseas students and their dependents, are not subject to inappropriate regulatory provisions such as those enforcing the community rating principle. By amending the National Health Regulations 1954, the new subregulations specifically define and exclude OSHC policies from the broader definition of "health insurance business", thereby allowing registered organisations to provide these policies under specified conditions.
Scope and Application
The National Health Amendment Regulations 1999 (No. 3) pertain to the amendment of the National Health Act 1953, specifically addressing the scope of health insurance business as defined in the Act. These regulations apply to registered health benefits organisations that offer Overseas Student Health Cover (OSHC) policies in accordance with an agreement with the Commonwealth. The aim is to exclude certain OSHC policies from the definition of "health insurance business" under the Act, thereby exempting them from certain regulatory provisions applicable to standard health insurance business. These provisions, such as community rating principles, are deemed inappropriate for OSHC policies. The exclusion is contingent upon the OSHC policies being offered by registered organisations under a Commonwealth agreement that outlines specific requirements. The regulations came into effect upon gazettal and are part of the broader framework established by the Principal Regulations, which are further supplemented by subordinate instruments as necessary.
The jurisdictional reach of these regulations is within the Commonwealth of Australia, affecting entities and persons involved in providing health insurance, particularly those offering OSHC policies. The exclusions and exemptions specified in the amending regulations ensure that while OSHC policies are not subject to the full regulatory framework of the National Health Act, they are nonetheless subject to the terms and conditions stipulated in the Commonwealth agreement. This nuanced approach aims to provide adequate coverage for overseas students without imposing inappropriate regulatory burdens. The regulations thus provide a clear delineation of the types of health insurance business that are exempt from the National Health Act's provisions, ensuring that the regulatory framework remains both relevant and effective for its intended scope.
Key Provisions
The National Health Amendment Regulations 1999 (No. 3) provide specific amendments to the National Health Regulations 1954, primarily focusing on the definition of "health insurance business" (subsection 67(4) of the Act) and the types of business activities that are prescribed under Regulation 48. The key operative section of these regulations is Regulation 3, which amends the existing regulations to exclude Overseas Student Health Cover (OSHC) policies from the definition of "health insurance business" when these policies are offered by a registered health benefits organisation under an agreement with the Commonwealth (item 1 of Schedule 1). Additionally, Regulation 3 defines "overseas student" and "overseas student health insurance contract" (item 2 of Schedule 1), providing clarity on the terms and conditions under which these policies can be offered.
The regulations impose specific obligations on registered health benefits organisations that offer OSHC policies. These organisations must comply with the terms of an agreement with the Commonwealth, which sets out the requirements for OSHC policies. This includes ensuring that the policies provide coverage for medical and hospital insurance for full fee-paying overseas students and their dependents, as well as fees for professional services for which Medicare benefits would otherwise be payable. The regulations also mandate that these organisations adhere to any additional terms and conditions specified in the agreement.
Breach of the regulations or failure to comply with the terms of the agreement can result in legal consequences. While the specific penalties are not detailed in the provided text, it is understood that breaches of health insurance regulations under the National Health Act 1953 can lead to civil or criminal penalties. For example, individuals or entities found to be carrying on health insurance business without the required registration may face fines and other legal actions. The penalties can vary depending on the severity and nature of the breach, and can include both monetary fines and potential criminal charges for serious or repeated violations. The exact penalties are typically outlined in the National Health Act 1953 or related legislation.