Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4)

Administered by Department of Health, Disability and Ageing

Legislation au F2012L01050 Rules Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance Act 2007

 

Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4)

 

Authority

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Complying Product) Rules providing for matters required or permitted by Chapter 3 of the Act, or necessary or convenient in order to carry out or give effect to the Act.

 

The Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4) (the Amendment Rules) amend the Private Health Insurance (Complying Product) Rules 2010 (No. 2) (the Rules) which commenced on 14 January 2011.

 

Purpose

The purpose of the Amendment Rules is to update the information required to be contained in Standard Information Statements (SISs) in line with the introduction of means testing for the private health insurance rebate.

 

Background

Under Division 93 of the Act, health insurers are required to make standard product information, known as a SIS, for all of their active complying health insurance products available to consumers.  This requirement was included to ensure that consumers can easily compare health insurance policies and understand their entitlements under health insurance policies.

 

Details

The Amendment Rules delete and insert new Schedules 1-3 and Part 1 of Schedule 4 of the Rules.

 

Further details about the amendments to the SISs are provided in the Attachment of this explanatory statement.

 

Consultation

Consultation was not necessary with respect to these amendments as the amendments are of a minor nature and do not substantially alter existing arrangements.

 

The Office of Best Practice Regulation has advised that a Regulatory Impact Statement was not required as the amendments do not substantially increase business compliance costs for private health insurers.

 

The Amendment Rules commence on 1 July 2012.

 

The Amendment Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

Authority: Section 333-20 of the Private Health Insurance Act 2007

 

 

 

ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLYING PRODUCT) AMENDMENT RULES 2012 (No. 4)

 

Part 1  Preliminary

 

Section 1   Name of Rules

 

Section 1 provides that the title of the Rules is the Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4) (the Amendment Rules).

 

Section 2   Commencement

 

Section 2 provides the Rules commence on 1 July 2012.

 

Section 3   Amendment of Private Health Insurance (Complying Product) Rules 2010  (No. 2)

 

Section 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which commenced on 14 January 2011.

 

Schedule – Amendments

 

Item 1 – Schedule 1- Standard information statements: hospital treatment

 

Schedule 1 of the Rules is replaced with new Schedule 1- Standard information statements: hospital treatment.

 

The differences between the old Schedule 1 and the new Schedule 1 are as follows:

 

  • Under the heading ‘Monthly Premium’ two premium prices must be displayed. The SIS will continue to show the 30% rebated price, and more prominently, the full premium price; and
  • An additional explanation is to be included regarding the tiered rebates.  The SISs must now include the text: Your actual premium may include a Lifetime Health Cover loading or insurer discounts. Australian Government Rebates also range from 0% to 40% and depend on age and income levels. The most common rebate of 30% is shown above. Check with your insurer for more details.

 

Item 2 – Schedule 2- Standard information statements: general treatment

 

Schedule 2 of the Rules is replaced with new Schedule 2- Standard information statements: general treatment.

 

The differences between the old Schedule 2 and the new Schedule 2 are as follows:

 

  • Under the heading ‘Monthly Premium’ two premium prices must be displayed. The SIS will continue to show the 30% rebated price, and more prominently, the full premium price; and

 

  • An additional explanation is to be included regarding the tiered rebates.  The SISs must now include the text: Australian Government Rebates range from 0% to 40% and depend on age and income levels. The most common rebate of 30% is shown above. It does not include any discounts that may be available. Check with your insurer for more details.

 

Item 3 – Schedule 3- Standard information statements: combined products

 

Schedule 3 of the Rules is replaced with new Schedule 3 – Standard information statements: combined products.

 

The differences between the old Schedule 3 and the new Schedule 3 are as follows:

 

  • Under the heading ‘Monthly Premium’ two premium prices must be displayed. The SIS will continue to show the 30% rebated price, and more prominently, the full premium price; and
  • An additional explanation is to be included regarding the tiered rebates.  The SISs must now include the text: Your actual premium may include a Lifetime Health Cover loading or insurer discounts. Australian Government Rebates also range from 0% to 40% and depend on age and income levels. The most common rebate of 30% is shown above. Check with your insurer for more details.

 

Item 4 – Schedule 4, Part 1- Standard information statements: permitted content

 

Part 1, Schedule 4 of the Rules is replaced with new Part 1 – all statements.

 

The differences between the old Part 1 and new Part 1 are as follows:

 

  • Under the heading ‘Monthly Premium’ two premium prices must be displayed. The SIS will continue to show the 30% rebated price, and now more prominently, the full premium price.

 

 

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

MAY 2012

 


Overview

The Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4) were enacted to amend the Private Health Insurance (Complying Product) Rules 2010 (No. 2) which commenced on 14 January 2011. These amendments were introduced to update the information required to be contained in Standard Information Statements (SISs) in response to the introduction of means testing for the private health insurance rebate. The Private Health Insurance Act 2007 mandates that health insurers provide standard product information known as SISs for all active complying health insurance products, aiming to ensure that consumers can easily compare health insurance policies and understand their entitlements. The purpose of these rules is to reflect the new means testing framework in the SISs to aid consumers in making informed decisions about their health insurance policies. The rules were developed under the authority of Section 333-20 of the Private Health Insurance Act 2007, which allows the Minister to make rules necessary to carry out or give effect to the Act. The Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4) update the SISs by deleting and inserting new Schedules 1-3 and Part 1 of Schedule 4 of the Rules, ensuring that they now include detailed explanations about the tiered rebates and display both the 30% rebated price and the full premium price more prominently. These changes were implemented to align with the new policy objective of reflecting the means-tested nature of the Australian Government Rebates in the SISs. The amendment rules came into effect on 1 July 2012.

Scope and Application

The Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4) apply to private health insurers operating in Australia, who must comply with the Private Health Insurance Act 2007. These Amendment Rules specifically pertain to the Standard Information Statements (SISs) that insurers are required to provide for their active complying health insurance products. The purpose of these amendments is to update the information in the SISs to align with the introduction of means testing for the private health insurance rebate, ensuring that consumers can effectively compare health insurance policies and understand their entitlements. These Rules commenced on 1 July 2012 and amend the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which began on 14 January 2011. The changes include modifications to Schedules 1-3 and Part 1 of Schedule 4 of the original Rules, primarily focusing on updating the information regarding monthly premiums and Australian Government Rebates to reflect the new tiered rebate structure. No exclusions, exemptions, or thresholds are specified within these Amendment Rules, and they are considered minor amendments that do not substantially alter existing arrangements or increase compliance costs for insurers.

Key Provisions

The Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 4) (Amendment Rules) primarily focus on updating the Standard Information Statements (SISs) to align with the introduction of means testing for the private health insurance rebate. Section 3 of the Amendment Rules amends the Private Health Insurance (Complying Product) Rules 2010 (No. 2) (Rules), which had commenced on 14 January 2011. The changes involve replacing Schedules 1-3 and Part 1 of Schedule 4 of the Rules with new versions to reflect the updated requirements for the SISs. Under the amended Rules, health insurers are mandated to provide updated SISs for their active complying health insurance products. These SISs must prominently display two premium prices: the 30% rebated price and the full premium price. Additionally, SISs must include an explanation about the tiered rebates, which range from 0% to 40% based on the insured's age and income levels. This includes details such as Lifetime Health Cover loadings and any insurer discounts that may apply. The explanations must also direct consumers to check with their insurer for more detailed information. The obligations imposed by the Amendment Rules require health insurers to ensure that their SISs are updated and compliant with the new provisions. They must prominently display both the rebated and full premium prices and include the specified explanations about tiered rebates. Failure to comply with these requirements may result in non-compliance with the Private Health Insurance Act 2007, potentially leading to enforcement actions by regulatory authorities. There are no specific offences, penalties, or civil/criminal consequences outlined in the Amendment Rules themselves. However, non-compliance with the requirements of the Private Health Insurance Act 2007, including the obligation to provide accurate and complete SISs, could lead to regulatory actions, including fines and other enforcement measures as prescribed under the Act. The precise penalties would be determined under the relevant provisions of the Act rather than the Amendment Rules.

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