Private Health Insurance (Complaints Levy) Rules 2021

Administered by Department of Health, Disability and Ageing

Legislation au F2021L01340 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

 

Issued by the Authority of the Minister for Health and Ageing

 

Private Health Insurance (Complaints Levy) Act 1995

 

Private Health Insurance (Complaints Levy) Rules 2021

 

 

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 the 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 the 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 2021 (the Rules) repeal and replace the Private Health Insurance (Complaints Levy) Rules 2020 (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 the 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 have been consulted, including to ensure they 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 2021

 

  1. Name

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Complaints Levy) Rules 2021 (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:

 

$ 2,876,000.00

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

$ 2,876,000.00

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 2021

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 2021 (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 Ageing

 

Overview

The Private Health Insurance (Complaints Levy) Rules 2021 were enacted to provide for the administration of the complaints levy under the Private Health Insurance (Complaints Levy) Act 1995. This Act was introduced to address the need for a sustainable funding mechanism to support the operations of the Private Health Insurance Ombudsman (PHIO), which handles complaints and other functions related to private health insurance. Enacted by the Minister for Health and Ageing under the authority granted by the Act, the policy objective of these rules is to ensure the PHIO can effectively manage and resolve complaints, thereby maintaining consumer confidence in the private health insurance system. The rules determine the rate of the complaints levy, which is based on the number of health insurance policies and the expected administrative costs of the PHIO for the financial year. The Private Health Insurance (Complaints Levy) Rules 2021 specify the days for imposing the levy and the rates applicable to single and joint policies, with a cap of $0.50 per quarter for single policies and $1.00 for joint policies. These rules were designed to replace the previous rules from 2020, ensuring that the levy amount adjusts annually based on the number of policies and changes in PHIO's expected costs. By funding the PHIO's operations through this levy, the rules support the right to health by ensuring that the ombudsman can continue to provide essential services to consumers and maintain the integrity of the private health insurance system.

Scope and Application

The Private Health Insurance (Complaints Levy) Act 1995 applies to private health insurers who conduct health insurance business within Australia, with the primary objective of imposing a levy to fund the administrative costs of the Private Health Insurance Ombudsman (PHIO). This levy is intended to support the PHIO’s functions, which include dealing with complaints, conducting investigations, and providing consumer information. The Act operates across the Commonwealth, thereby affecting all private health insurers operating in Australia. The rate of the complaints levy is determined based on the number of policies on issue and is subject to a maximum of $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, which specify the timing and method of payment. The Private Health Insurance (Complaints Levy) Rules 2021 provide detailed specifications on the rate of the levy and the days on which it is imposed, and these rules are made under the authority of section 8 of the Private Health Insurance (Complaints Levy) Act 1995. The Rules are designed to ensure that the PHIO’s functions are adequately funded to maintain consumer confidence in the administration of private health insurance.

Key Provisions

The Private Health Insurance (Complaints Levy) Rules 2021 (the Rules) establish the framework for imposing a complaints levy on private health insurers as per section 8 of the Private Health Insurance (Complaints Levy) Act 1995 (the Act). The levy is intended to fund the administrative costs of the Private Health Insurance Ombudsman (PHIO), which is responsible for handling complaints and conducting investigations related to private health insurance. The Rules specify the rate of the complaints levy, which varies depending on the type of policy (single or joint) and is calculated based on the expected administrative costs of the PHIO for the financial year. The levy rate is determined by the formula provided in Rule 8 for single policies and Rule 9 for joint policies, with caps of $0.50 and $1.00 per quarter, respectively. The Rules impose several obligations on private health insurers, including the requirement to calculate and pay the complaints levy based on the number of policies they hold on the specified census day (Rule 6). Insurers must ensure that the levy is paid by the complaints levy day, which is 1 October each year (Rule 7). Additionally, the Rules mandate that the complaints levy be calculated according to the formulas outlined in Rule 8 for single policies and Rule 9 for joint policies, with the specified caps (Subrule 8(2) and Subrule 9(2)). The Act and the Rules do not explicitly outline specific offences, penalties, or consequences for non-compliance with the complaints levy requirements. However, failure to comply with the levy obligations could potentially result in legal actions taken by the PHIO or other relevant authorities under the Private Health Insurance Act 2007 and the Private Health Insurance (Levy Administration) Rules 2015. Non-compliance may also lead to reputational damage and loss of consumer confidence, which could indirectly affect the insurer's business operations.

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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.