Private Health Insurance (Complaints Levy) Rules 2023

Administered by Department of Health, Disability and Ageing

Legislation au F2023L01272 Rules 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 2023

 

 

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 2023 (the Rules) repeal and replace the Private Health Insurance (Complaints Levy) Rules 2022 (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 are aware 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 2023

 

  1. Name

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Complaints Levy) Rules 2023 (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:

 

$ 2,964,000.00

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

$ 2,964,000.00

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 2023

 

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 2023 (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.

 

Mark Butler
Minister for Health and Aged Care

 

Overview

The Private Health Insurance (Complaints Levy) Rules 2023 were introduced to update the rate of the complaints levy payable under the Private Health Insurance (Complaints Levy) Act 1995. This Act was enacted to provide for a levy on private health insurers to fund the administrative costs of the Private Health Insurance Ombudsman (PHIO), which supports consumers in resolving complaints about private health insurance. The Rules were made under section 8 of the Act and specify the rate of the complaints levy, the days on which the levy is imposed, and the census day for calculating the number of policies. The levy rate is based on the expected administrative costs of the PHIO for the financial year and is intended to ensure that the PHIO can continue to operate effectively, thereby supporting the right to health by ensuring that consumers and health care providers have confidence in the administration of the private health insurance system. The Rules were developed with the purpose of maintaining the necessary funding for the PHIO, which indirectly engages with human rights by supporting the progressive realisation of the right to a system of health protection that provides equality of opportunity for people to enjoy the highest attainable level of health, as outlined in article 12(1) of the International Covenant on Economic, Social and Cultural Rights. This is achieved by ensuring that the PHIO can effectively manage complaints and provide consumer information services. The Rules are compatible with human rights as they facilitate the continued funding of the PHIO, thus supporting the right to health through effective complaints management and consumer information services.

Scope and Application

The Private Health Insurance (Complaints Levy) Rules 2023 apply to private health insurers who conduct health insurance business in Australia, providing the necessary framework for the imposition of complaints levies as stipulated in the Private Health Insurance (Complaints Levy) Act 1995. These rules, which replace the previous 2022 rules, determine the rate of the complaints levy, establish the levy days, and specify the census day. The complaints levy is essential for financing the administrative costs of the Private Health Insurance Ombudsman (PHIO), whose functions include handling complaints, conducting investigations, and making recommendations. The levy is calculated based on the number of single and joint health insurance policies on issue, with specific rates set for each policy type, not exceeding $0.50 per quarter for single policies and $1.00 per quarter for joint policies. The new rules incorporate updated formulas for calculating the levy rates, which are based on the PHIO budget for the financial year. These rules have a national reach, affecting all private health insurers operating in Australia, and are implemented in accordance with the Private Health Insurance Act 2007 and the Private Health Insurance (Levy Administration) Rules 2015.

Key Provisions

The Private Health Insurance (Complaints Levy) Rules 2023 (the Rules) are instrumental in setting the operational framework for the collection of the complaints levy, as per the Private Health Insurance (Complaints Levy) Act 1995 (the Act). Rule 1 establishes the title of the Rules, while Rule 2 stipulates their commencement date, which is the day following their registration on the Federal Register of Legislation (Rule 2). Rule 3 confirms the authority under which the Rules are made, which is section 8 of the Act. Rule 4 provides necessary definitions, and Rule 5 addresses the amendment or repeal of specified instruments as outlined in the Schedules. The Rules also maintain the census day, which is 30 June preceding the levy payment date (Rule 6), and specify the complaints levy day as 1 October each year (Rule 7). The calculation of the complaints levy rate for single and joint policies is detailed in Rules 8 and 9, respectively, ensuring that the rates do not exceed $0.50 per quarter for single policies and $1.00 per quarter for joint policies (Rules 8(2) and 9(2)). The Rules impose specific obligations on private health insurers, primarily concerning the calculation and payment of the complaints levy. Insurers must determine the rate of the complaints levy based on the formulas provided in Rules 8 and 9. They must ensure that the levy is calculated accurately and paid by the specified due date, which is 1 October each year. The levy must be based on the number of complying health insurance policies on issue on the census day. This calculation and payment are necessary to fund the administrative costs of the Private Health Insurance Ombudsman (PHIO), as stated in section 20D of the Ombudsman Act 1976. The PHIO's functions, including dealing with complaints, conducting investigations, and publishing information, are supported by these levy payments. There are no direct offences or penalties stipulated within the Rules themselves. However, failure to comply with the Act, including the timely and accurate payment of the complaints levy, may result in enforcement actions under the Private Health Insurance Act 2007 and related regulations. Penalties for non-compliance with the Private Health Insurance (Levy Administration) Rules 2015 could include financial penalties, which are not specified in the Rules but are outlined in the overarching legislation. The continued non-compliance could potentially undermine the PHIO's ability to effectively manage complaints and support consumers, thereby affecting the overall administration of the private health insurance system. The importance of adhering to these levy requirements is underscored by the critical role the PHIO plays in protecting consumer interests and ensuring confidence in the private health insurance system.

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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.