Private Health Insurance (Complaints Levy) Rules 2020

Administered by Department of Health, Disability and Ageing

Legislation au F2020L01195 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

 

Issued by the Authority of the Minister for Health and Aged Care

 

Private Health Insurance (Complaints Levy) Act 1995

 

Private Health Insurance (Complaints Levy) Rules 2020

 

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 Act imposes levies on private health insurers conducting health insurance business. 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 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 complaints levy is payable on 31 December each year.

 

Purpose of the Rules

 

The Private Health Insurance (Complaints Levy) Rules 2020 (the Rules) repeal and replace the Private Health Insurance (Complaints Levy) Rules 2019 (the Previous Rules) to alter the rate of complaints levy payable. The Rules also specify the complaints levy days and the census day for the purposes of the Act.

 

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 rate of complaints levy is based on the expected administrative costs of the PHIO for the financial year. A new numerator, equal to the PHIO budget for the current financial year, is inputted into the formulas for calculating the complaints levy rates in the Rules each year unless the PHIO budget is the same as the previous financial year.

 

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 2020

 

  1. Name

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Complaints Levy) Rules 2020 (the Rules).

 

2.             Commencement

 

Rule 2 provides that the Rules commence on the day after they are registered on the Federal Register of Legislation.

 

3.             Authority

 

Rule 3 provides that the Rules are made under section 8 of the Private Health Insurance (Complaints Levy) Act 1995.

 

4.             Definitions

 

Rule 4 provides definitions for the Rules.

 

5.             Schedules

 

Rule 5 provides that each instrument that is specified in a Schedule to the Rules is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to the Rules has effect according to its terms. Schedule 1 specifies and repeals the Previous Rules.

 

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 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:

 

$ 2,871,000.00

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

 

 

Subrule 8(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

$ 2,871,000.00

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

 

 

Subrule 9(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.

 

Schedule 1—Repeals

 

Schedule 1 specifies and repeals the Previous Rules.

 

 

 

 


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 2020

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 2020 (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.

 

Human rights implications

The Rules do not directly engage any of the individual human rights covered by the Human Rights (Parliamentary Scrutiny) Act 2011 because the complaints levy is imposed on private health insurers who conduct health insurance business, not on individuals.

 

However, the Rules indirectly engage article 12(1) of the International Covenant on Economic Social and Cultural Rights by assisting with the progressive realisation of the right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

 

The complaints levy funds the operations of the PHIO, which protects the interests of private health insurance consumers. The PHIO 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

The Rules are compatible with human rights because it supports the right to health by ensuring the continued funding of the PHIO at appropriate levels.

 

Greg Hunt
Minister for Health and Aged Care

 

 

Overview

The Private Health Insurance (Complaints Levy) Rules 2020, enacted under section 8 of the Private Health Insurance (Complaints Levy) Act 1995, address the need to regulate the complaints levy imposed on private health insurers to fund the administrative costs of the Private Health Insurance Ombudsman (PHIO). The purpose of the complaints levy is to support the PHIO's functions, which include dealing with complaints, conducting investigations, and making recommendations to improve the private health insurance system. These rules were introduced to ensure that the rate of complaints levy aligns with the PHIO's expected administrative costs for the financial year, thereby supporting the PHIO's role in protecting consumers' interests and maintaining confidence in the private health insurance system. The rules specify the rate of the levy for single and joint policies, ensuring that it is based on the number of policies held by insurers and does not exceed set limits. The rules were made by the Minister for Health and Aged Care and are compatible with human rights, as they indirectly support the right to health by enabling the PHIO to effectively manage complaints and provide consumer information services. This ensures that consumers and healthcare providers have confidence in the administration of the private health insurance system. The rules were registered on the Federal Register of Legislation and commenced on the day following their registration.

Scope and Application

The Private Health Insurance (Complaints Levy) Act 1995 applies to private health insurers conducting health insurance business within Australia. The Act imposes a complaints levy on these insurers, with the rate varying based on the number of complying health insurance policies held on census day and the number of people insured under these policies. The levy is capped at $0.50 per quarter for single policies and $1.00 per quarter for joint policies. The levy is collected in accordance with the Private Health Insurance Act 2007 and the Private Health Insurance (Levy Administration) Rules 2015, with the levy due on 31 December each year. The Private Health Insurance (Complaints Levy) Rules 2020 were made under section 8 of the Private Health Insurance (Complaints Levy) Act 1995 and serve to detail the rate of complaints levy payable, the complaints levy days, and the census day for the purposes of the Act. The purpose of the complaints levy is to fund the administrative costs of the Private Health Insurance Ombudsman (PHIO), which handles complaints, conducts investigations, and provides consumer information services. The levy rate is based on the PHIO's expected administrative costs for the financial year, with adjustments made annually unless the PHIO budget remains unchanged. The Rules are compatible with human rights as they support the right to health by ensuring the continued funding of the PHIO at appropriate levels.

Key Provisions

The Private Health Insurance (Complaints Levy) Rules 2020 set out the specific details of the complaints levy imposed on private health insurers, as required under the Private Health Insurance (Complaints Levy) Act 1995. The Rules specify the rate of the complaints levy, the days on which it is imposed, and the method of calculating the levy based on the number of policies held by insurers on the census day. For instance, Rule 8 establishes that the rate for a single policy is calculated using the formula of $2,871,000 divided by the total number of single policies plus twice the total number of joint policies, with a cap of $0.50 per quarter. Similarly, Rule 9 outlines that the rate for a joint policy is calculated using a similar formula but with a cap of $1.00 per quarter. These calculations ensure that the levy rates are set to cover the expected administrative costs of the Private Health Insurance Ombudsman (PHIO). The obligations imposed by these Rules on private health insurers primarily involve calculating and paying the appropriate complaints levy based on the specified formulas and timelines. Rule 6 sets the census day as the last 30 June before the levy is due, while Rule 7 sets the complaints levy day as 1 October each year. Insurers must determine the number of single and joint policies they hold on the census day and use these numbers to calculate the levy due for the financial year. They must then remit the levy by the specified date to comply with the Act and the Rules. Breach of the obligations set out in these Rules can result in financial penalties. Although the specific penalties are not detailed in the explanatory statement, under the Private Health Insurance Act 2007, failure to comply with the levy requirements can result in civil penalties. These penalties serve to ensure that private health insurers adhere to the levy requirements, thereby maintaining the funding necessary for the PHIO to operate effectively. The continued and accurate collection of the complaints levy is critical to support the PHIO’s role in protecting consumer interests and ensuring the efficient administration of private health insurance in Australia.

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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.