Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019

Administered by Department of Health, Disability and Ageing

Legislation au F2019L00327 Rules Not in force Legislative Instrument

Legislation content

Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019

made under item 3A of the table in section 33320 of the

Private Health Insurance Act 2007

Compilation No. 1

Compilation date:   30 April 2019

Includes amendments up to: F2019L00639

Registered:    23 May 2019

 

About this compilation

This compilation

This is a compilation of the Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019 that shows the text of the law as amended and in force on 30 April 2019 (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. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

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.

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. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Selfrepealing 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

1 Name

2 Commencement

3 Authority

4 Schedules

Schedule 1—Amendments commencing 20 March 2019

Private Health Insurance (Benefit Requirements) Rules 2011

Schedule 2—Amendments commencing 1 July 2019

Private Health Insurance (Benefit Requirements) Rules 2011

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Endnote 5—Editorial changes

 

1  Name

  This instrument is the Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019.

2  Commencement

 (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.  Sections 1 to 4 of this instrument

20 March 2019

20 March 2019

2.  Schedule 1 of this instrument

20 March 2019

20 March 2019

3.  Schedule 2 of this instrument

1 July 2019

1 July 2019

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

 (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

  This instrument is made under item 3A of the table in section 33320 of the Private Health Insurance Act 2007.

4  Schedules

  Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1—Amendments commencing 20 March 2019

Private Health Insurance (Benefit Requirements) Rules 2011

1  Schedule 4, clause 6 (Table 1, table item dealing with New South Wales)

Repeal the item, substitute:

New South Wales

$129.30

2  Schedule 4, clause 6 (Table 1, table item dealing with Tasmania)

Repeal the item, substitute:

Tasmania

$147.10

3  Schedule 4, clause 6 (Table 2)

Repeal the table, substitute:

Private hospitals

$49.80

 

Schedule 2—Amendments commencing 1 July 2019

Private Health Insurance (Benefit Requirements) Rules 2011

1  Schedule 4, clause 6 (Table 1, table item dealing with the Northern Territory)

Repeal the item, substitute:

Northern Territory

$125.00

 

Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

 

Endnote 2—Abbreviation key

 

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

    /subsubparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

    effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

    effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

SubCh = SubChapter(s)

    cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

    commenced or to be commenced

 

Endnote 3—Legislation history

 

Name

Registration

Commencement

Application, saving and transitional provisions

Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019

20 Mar 2019 (F2019L00327)

Sch 2: 1 July 2019 (s 2(1) item 3)
Remainder: 20 Mar 2019 (s 2(1) items 1, 2)

 

Private Health Insurance Legislation Amendment Rules (No. 1) 2019

29 Apr 2019 (F2019L00639)

Sch 2: 30 Apr 2019 (s 2(1) item 3)

 

Endnote 4—Amendment history

 

Provision affected

How affected

s 2.....................

am F2019L00639

Schedule 2

 

Schedule 2 heading..........

ed C1

 

Endnote 5—Editorial changes

In preparing this compilation for registration, the following kinds of editorial change(s) were made under the Legislation Act 2003.

 

Schedule 2 (heading)

 

Kind of editorial change

 

Show the effect of an amendment of the instrument

 

Details of editorial change

 

Schedule 2 item 1 of the Private Health Insurance Legislation Amendment Rules (No. 1) 2019 amends the commencement date of Schedule 2 in this instrument to 1 July 2019.

 

The heading to Schedule 2 refers to “Amendments commencing 1 May 2019”.

 

This compilation was editorially changed to show the effect of an amendment of the instrument by omitting the words “1 May 2019” and substituting the words “1 July 2019”.

 

Overview

The Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019, made under the authority of the Private Health Insurance Act 2007, amend the Private Health Insurance (Benefit Requirements) Rules 2011. These amendments adjust the benefit requirements for certain private health insurance policies to ensure they remain appropriate and reflective of current health care costs. The legislative instrument addresses gaps in the regulatory framework by updating the minimum benefit standards for various health services and treatments. The amendments are intended to ensure that private health insurance policies continue to provide adequate coverage for policyholders while promoting consistency across the industry. The rules were enacted by the Australian Parliament and aim to maintain the integrity of the private health insurance system by ensuring it meets the evolving needs of consumers and providers.

Scope and Application

The Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019 amends the Private Health Insurance (Benefit Requirements) Rules 2011, which are made under the Private Health Insurance Act 2007. The amendment rules apply to health insurers that are regulated under the Act, which includes all private health insurance providers operating in Australia. The primary focus of these rules is on the benefit requirements for certain hospital-related services. Specific amendments include changes to the benefit amounts for hospital services in New South Wales, Tasmania, and the Northern Territory, as well as adjustments to the benefit amount for private hospitals. These amendments are intended to reflect updated cost data and ensure that insurance policies meet the mandated benefit requirements. The amendments made by Schedule 1 of this instrument commenced on 20 March 2019, while the amendments in Schedule 2 commenced on 1 July 2019. This legislative instrument operates at the Commonwealth level and is applicable across Australia, as it amends rules made under a federal Act. The rules do not specify any exclusions or exemptions, but they do provide for the substitution of certain figures to reflect updated costs, thereby affecting the financial obligations of health insurers.

Key Provisions

The Private Health Insurance (Benefit Requirements) Amendment Rules (No. 2) 2019 primarily amends the Private Health Insurance (Benefit Requirements) Rules 2011 to update certain benefit amounts. Under Schedule 1, clause 6 of the amended rules, specific table items relating to New South Wales, Tasmania, and the classification of private hospitals are repealed and substituted with new values. For instance, the item concerning New South Wales is updated to $129.30 (section 1 of Schedule 1). Similarly, the item for Tasmania is updated to $147.10 (section 2 of Schedule 1), and the table item for private hospitals is updated to $49.80 (section 3 of Schedule 1). These changes came into effect on 20 March 2019. The rules impose specific obligations on private health insurers operating in Australia. Insurers must ensure that their benefit packages meet the updated requirements as stipulated in the amended rules. This includes revising their benefit tables to reflect the new amounts for specific services and treatments, ensuring compliance with the updated legislative requirements. Additionally, insurers must inform their policyholders about any changes in the benefit amounts that may affect their coverage and out-of-pocket expenses. For breaches of the amended rules, there are potential civil and administrative consequences. Although the rules themselves do not explicitly outline specific penalties, non-compliance with the Private Health Insurance Act 2007 or its associated rules could lead to enforcement actions by the Australian Prudential Regulation Authority (APRA). Such actions may include fines, corrective measures, or other administrative actions to ensure compliance. The penalties for non-compliance with the overarching Act can be significant, depending on the severity and impact of the breach. Therefore, it is imperative for insurers to adhere to the updated benefit requirements to avoid any regulatory repercussions.

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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.