Private Health Insurance Act 2007
No. 31, 2007
Compilation No. 41
Compilation date: 1 April 2026
Includes amendments: Act No. 54, 2025
About this compilation
This compilation
This is a compilation of the Private Health Insurance Act 2007 that shows the text of the law as amended and in force on 1 April 2026 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au).
Application, saving and transitional provisions
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Presentational changes
The Legislation Act 2003 provides for First Parliamentary Counsel to make presentational changes to a compilation. Presentational changes are applied to give a more consistent look and feel to legislation published on the Register, and enable the user to more easily navigate those documents.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. Any modifications affecting the law are accessible on the Register.
Self‑repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
Chapter 1—Introduction
Part 1‑1—Introduction
Division 1—Preliminary
1‑1 Short title
1‑5 Commencement
1‑10 Identifying defined terms
1‑15 Extension to Norfolk Island
Division 3—Overview of this Act
3‑1 What this Act is about
3‑5 Incentives (Chapter 2)
3‑10 Complying health insurance products (Chapter 3)
3‑15 Health insurance business, health benefits funds and miscellaneous obligations of private health insurers (Chapter 4)
3‑20 Enforcement (Chapter 5)
3‑25 Administration (Chapter 6)
3‑30 Dictionary (Schedule 1)
Division 5—Constitutional matters
5‑1 Meaning of insurance
5‑5 Act not to apply to State insurance within that State
5‑10 Compensation for acquisition of property
Chapter 2—Incentives
Part 2‑1—Introduction
Division 15—Introduction
15‑1 What this Chapter is about
Part 2‑2—Premiums reduction scheme
Division 20—Introduction
20‑1 What this Part is about
20‑5 Private Health Insurance (Incentives) Rules
Division 22—PHIIB, PHII benefit and related concepts
Subdivision 22‑A—PHIIB, PHII benefit and related concepts
22‑1 Application of Subdivision
22
Overview
The Private Health Insurance Act 2007 was enacted by the Commonwealth Parliament to regulate the private health insurance industry in Australia, ensuring that private health insurance is accessible, efficient, and equitable. The Act addresses gaps in the market by providing incentives for individuals to take out private health insurance and establishing a framework for the operation of private health insurance products. The key objectives of the Act include promoting non-discriminatory access to private health insurance, enforcing compliance with standards for health insurance products, and implementing mechanisms to monitor and regulate the private health insurance market. Through the establishment of a premiums reduction scheme and a lifetime health cover scheme, the Act aims to encourage the uptake of private health insurance among the Australian population, ultimately enhancing the overall health care system by reducing the reliance on public health resources.
Scope and Application
The Private Health Insurance Act 2007 regulates the private health insurance industry in Australia, focusing on providing incentives for people to have private health insurance and ensuring that health insurance products are offered in a fair and non-discriminatory manner. This Act applies to private health insurers, entities carrying on health insurance business, health benefits funds, and the conduct and transactions associated with private health insurance. The Act has a Commonwealth reach, extending to Norfolk Island, and it does not apply to State insurance that does not extend beyond the limits of the State. The Act includes provisions for exemptions and thresholds, such as the exclusion of certain types of insurance business and the application of lifetime health cover loadings based on age and insurance history. Additionally, the Act’s application and enforcement are extended through various subordinate instruments, including rules made by the Minister and the Australian Prudential Regulation Authority (APRA), which provide further detail and modify certain provisions of the Act. These rules and regulations play a crucial role in operationalising the Act's provisions and ensuring compliance within the private health insurance sector.
Key Provisions
- The Private Health Insurance Act 2007 establishes a comprehensive framework for regulating private health insurance in Australia. Its primary focus is on providing incentives to encourage people to take out private health insurance and ensuring that the insurance products offered are fair and accessible. The Act includes specific provisions for premiums reduction, lifetime health cover, and various requirements for complying health insurance products. Insurers must ensure that their products are community-rated, meaning they cannot discriminate between people based on health status or other factors. They must also adhere to coverage, benefit, waiting period, and quality assurance requirements.
- Under the Act, private health insurers are required to offer a range of products, including hospital and general treatment policies. They must ensure that these products meet the criteria set out in the legislation, including providing appropriate benefits for certain treatments and adhering to prescribed waiting periods. Insurers are also obligated to maintain up-to-date private health information statements and provide these to consumers upon request. Furthermore, insurers must offer cover for hospital treatment when they offer cover for general treatment and ensure that newly insured individuals receive information about their policy and rights.
- The Act imposes several offences and penalties for breaches. Advertising, offering, or insuring under non-complying policies can result in an offence, with penalties of up to 1,000 penalty units or imprisonment for 5 years, or both. Directors and chief executive officers of insurers can be held liable if systems are not in place to prevent breaches. The Federal Court can impose various remedies, including pecuniary penalty orders, compensation orders, and adverse publicity orders. Failure to provide required information to consumers or regulatory bodies can result in fines of up to 60 penalty units. Additionally, there are specific penalties for late payment of levies, unauthorised use of protected information, and other breaches.
- The Act also includes administrative provisions to facilitate its enforcement. The Minister can set performance indicators, seek explanations from insurers, and investigate their operations. The Chief Executive Medicare has powers to accept enforceable undertakings from insurers and can revoke an insurer’s status as a participating insurer in certain circumstances. Decisions made by the Chief Executive Medicare, APRA, and the Minister under the Act are reviewable by the Administrative Review Tribunal. The Act further provides for the collection and administration of private health insurance levies, reimbursement of insurers for reduced premiums, and the establishment of a Risk Equalisation Special Account to manage risk equalisation payments.
- Area of Law
- Consumer Law
- Insurance Law
- Taxation Law
- Instrument
- Act
- Concepts
- Definitions & Interpretation
- Commencement Provisions
- Offence Provisions
- Licensing & Registration
- Enforcement Powers
- Compliance Obligations
- Reporting & Disclosure Obligations
- Review & Sunset Clauses