Private Health Insurance (Complaints Levy) Rules 2017

Administered by Department of Health, Disability and Ageing

Legislation au F2017L01220 Rules Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance (Complaints Levy) Act 1995

 

Private Health Insurance (Complaints Levy) Rules 2017

 

Section 8 of the Private Health Insurance (Complaints Levy) Act 1995 (the Act) provides that the Minister may make Private Health Insurance (Complaints Levy) Rules providing for matters required or permitted by the Act to be provided, or necessary or convenient to be provided, in order to carry out or give effect to the Act.

 

The Private Health Insurance (Complaints Levy) Rules 2017 (the Rules) repeal and replace the Private Health Insurance (Complaints Levy) Rules 2016 (the Previous Rules) to alter the rate of Complaints Levy payable.

 

The purpose of the Complaints Levy is to finance the administrative costs of the Private Health Insurance Ombudsman (PHIO). The functions of PHIO are set out at section 20D of the Ombudsman Act 1976. Functions of PHIO include: dealing with complaints, conducting investigations, publishing and reporting information, and making recommendations.  The levy is imposed on private health insurers conducting health insurance business.

 

The Complaints Levy is collected in accordance with the Private Health Insurance Act 2007 and the Private Health Insurance (Levy Administration) Rules 2015.  The Private Health Insurance (Levy Administration) Rules 2015 specify that the levy is payable on 31st day of December each year.

 

The Act provides for the Rules to specify the rate of Complaints Levy, the complaints levy days and the census day. 

 

The Act provides that the rate of Complaints Levy must be based on the number of complying health insurance policies on issue on the census day and may be different for policies under which different numbers of people are insured. The Act also provides that the rate of Complaints Levy must not exceed $0.50 a quarter in respect of complying health insurance policies under which only one person is insured and, otherwise, $1.00 a quarter.

 

The rate of Complaints Levy is also based on the expected administrative costs of the PHIO for the financial year. 

 

The amount of Complaints Levy payable by a particular insurer will be based on the rate of levy and the number and type of policies on issue by that insurer on the census day.

 

A new rate of levy has been incorporated into the Rules. 

 

Details of the Rules are set out in the Attachment.

 

The Rules commence on the day following their registration on the Federal Register of Legislation.

 

 

Consultation

 

Private health insurers are aware that the Complaints Levy amount they are required to pay changes from year to year, according to changes in the number of policies that private health insurers hold and increases/decreases in the expected administrative costs of the PHIO.  Consequently, no consultation occurred in relation to these changes.

 

This Instrument is a legislative instrument for the purposes of the Legislation Act 2003.

 

ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLAINTS LEVY) RULES 2017

 

  1. Name of Rules

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Complaints Levy) Rules 2017 (the Rules).

 

2.             Commencement

 

The Rules commence on the day after they are registered on the Federal Register of Legislation.

 

3.             Repeal

 

Rule 3 repeals the Private Health Insurance (Complaints Levy) Rules 2016.

 

4.             Authority

 

Rule 4 provides that the Rules are made under section 8 of the Private Health Insurance (Complaints Levy) Act 1995. 

 

5.             Definitions

 

Rule 5 provides definitions for the Rules.

  • A single policy is defined as a policy under which only one person is insured.
  • A joint policy is defined as a policy under which two or more persons are insured.
  • The total number of single policies is defined as the number of single policies on issue from all private health insurers on the census day. 
  • The total number of joint policies is defined as the number of all joint policies on issue from all private health insurers on the census day. 

 

6.             Census day

 

Rule 6 provides that the census day is the 30 June last occurring before the day on which the levy is payable.  This is unchanged from the day specified in Rule 6 of the Previous Rules.

 

7.             Complaints levy day

 

Rule 7 specifies that the complaints levy day is 1 October each financial year. This is unchanged from the day specified in Rule 7 of the Previous Rules.

 

8.             Rate of levy for a single policy

 

Rule 8 provides that the rate of complaints levy for a single policy on issue from an insurer on the census day is calculated using the formula:

 

$1,858,000.00

total number of single policies + (2 × total number of joint policies)

 

 

Subrule (2) provides that if the rate of levy calculated for a single policy on issue from an insurer is more than $0.50, the rate for the policy is $0.50.

 

9.             Rate of levy for a joint policy

 

Rule 9 provides that the rate of complaints levy for a joint policy on issue from an insurer on the census day is calculated using the formula:

 

2 x

$1,858,000.00

total number of single policies + (2 × total number of joint policies)

 

 

Subrule (2) provides that if the rate of levy calculated for a joint policy on issue from an insurer is more than $1.00, the rate for the policy is $1.00.

 

 

 

 

 

 

 

 

GREG HUNT

MINISTER FOR HEALTH

2017


Statement of Compatibility with Human Rights

Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

Private Health Insurance (Complaints Levy) Rules 2017

This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.

Overview of the Legislative Instrument

The Private Health Insurance (Complaints Levy) Rules 2017 (the Rules) specify the days on which the Complaints Levy is imposed, and the rate at which it is imposed, for the purposes of the Private Health Insurance (Complaints Levy) Act 1995 (the Act).  The purpose of the complaints levy is to finance the administrative costs of the Private Health Insurance Ombudsman (PHIO). 

A new rate of levy has been incorporated into the Rules.

No change has been made to current caps on the maximum Complaints Levy that may be imposed quarterly.

Human rights implications

The Complaints Levy is imposed on private health insurers who conduct health insurance business, not on individuals.  To that extent, the Rules do not engage any of the individual human rights covered by the Human Rights (Parliamentary Scrutiny) Act 2011. 

 

However, the Complaints Levy funds the operations of the PHIO, which protects the interests of private health insurance consumers.  The PHIO’s work particularly supports consumers in dealing with complaints they have about access to, or administration of, private health insurance policies.  The continued collection of the Complaints Levy at an appropriate level to fund the PHIO is critical to ensure that consumers and health care providers have confidence in the administration of the private health insurance system, particularly through effective complaints management and consumer information services. 

 

Conclusion

This Legislative Instrument supports the right to health by ensuring the continued funding of the PHIO at appropriate levels.

 

Greg Hunt

Minister for Health

 

Overview

The Private Health Insurance (Complaints Levy) Rules 2017, enacted by the Minister for Health under the authority of the Private Health Insurance (Complaints Levy) Act 1995, aim to address the need for a sustainable funding mechanism to support the administrative costs of the Private Health Insurance Ombudsman (PHIO). The levy, which is imposed on private health insurers, is designed to finance the essential functions of the PHIO, including handling complaints, conducting investigations, and providing consumer information. This legislative instrument was necessary to ensure that the PHIO could continue to effectively protect the interests of private health insurance consumers. The Rules specify the rate of the Complaints Levy, which must be based on the number of health insurance policies in force and the expected administrative costs of the PHIO, while ensuring that the levy does not exceed specified caps. The Rules came into effect following their registration on the Federal Register of Legislation and replace the previous set of rules from 2016. The introduction of these rules maintains the integrity and efficiency of the private health insurance system by supporting the crucial role of the PHIO.

Scope and Application

The Private Health Insurance (Complaints Levy) Rules 2017, made under section 8 of the Private Health Insurance (Complaints Levy) Act 1995, provide detailed specifications regarding the rate, timing, and calculation of the Complaints Levy, which is designed to finance the administrative costs of the Private Health Insurance Ombudsman (PHIO). This levy applies to private health insurers conducting health insurance business in Australia. The levy is calculated based on the number and type of health insurance policies held by insurers on the census day, which is the last 30 June before the levy is payable. The levy is subject to maximum caps, with a quarterly limit of $0.50 per single policy and $1.00 per joint policy. The levy rate is determined by a formula that factors in the total number of single and joint policies and the expected administrative costs of PHIO for the financial year. The Rules do not engage individual human rights as they apply to insurers, not individuals, but they are crucial for ensuring the PHIO can effectively protect the interests of consumers in the private health insurance sector.

Key Provisions

The Private Health Insurance (Complaints Levy) Rules 2017 (the Rules) provide the specifics for the rate and timing of the Complaints Levy, as authorised under section 8 of the Private Health Insurance (Complaints Levy) Act 1995 (the Act). Rule 8 outlines that the rate of complaints levy for a single policy on issue from an insurer on the census day is calculated using a specified formula, with a cap of $0.50 per quarter. Rule 9 specifies that the rate of complaints levy for a joint policy on issue from an insurer on the census day is calculated similarly, with a cap of $1.00 per quarter. The levy is payable on the 31st day of December each year, as stated in the Private Health Insurance (Levy Administration) Rules 2015. Private health insurers are obligated to calculate and pay the Complaints Levy based on the number and type of policies they hold on the census day, which is the 30 June preceding the payment date. The levy is intended to fund the administrative costs of the Private Health Insurance Ombudsman (PHIO), ensuring that the PHIO can effectively handle complaints, conduct investigations, and provide consumer information and recommendations. There are no explicit offences or penalties mentioned in the Rules for non-compliance with the levy requirements. However, failure to pay the Complaints Levy could potentially lead to enforcement actions under the broader Private Health Insurance Act 2007 and related regulations. The levy is imposed on private health insurers, not on individuals, so any consequences of non-compliance would be directed at the insurers. The Rules ensure that the Complaints Levy is collected at a rate sufficient to support the PHIO's functions, which are crucial for maintaining consumer confidence in the private health insurance system. By setting specific rates and caps for the levy, the Rules provide clarity and predictability for insurers, helping them to budget and plan for their financial obligations under the Act.

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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.