Private Health Insurance Incentives Amendment Act 2005

Administered by Department of Health, Disability and Ageing

Legislation au C2005A00009 In force Act

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Private Health Insurance Incentives Amendment Act 2005

 

No. 9, 2005

 

 

 

 

 

An Act to amend the law relating to private health insurance incentives, and for other purposes

 

 

Contents

1 Short title

2 Commencement

3 Schedule(s)

Schedule 1—Changes to the private health insurance rebate for people aged 65 and over

Part 1—Amendment of the Private Health Insurance Incentives Act 1998

Part 2—Amendment of the Income Tax Assessment Act 1997

Part 3—Application

Schedule 2—Gold cards

National Health Act 1953

 

 

 

Private Health Insurance Incentives Amendment Act 2005

No. 9, 2005

 

 

 

An Act to amend the law relating to private health insurance incentives, and for other purposes

[Assented to 22 February 2005]

The Parliament of Australia enacts:

1  Short title

  This Act may be cited as the Private Health Insurance Incentives Amendment Act 2005.

2  Commencement

  This Act commences on the day on which it receives the Royal Assent.

3  Schedule(s)

  Each Act that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.


Schedule 1—Changes to the private health insurance rebate for people aged 65 and over

Part 1—Amendment of the Private Health Insurance Incentives Act 1998

1  Subsections 410(5) and (6)

Repeal the subsections, substitute:

If noone registered or eligible to apply for registration

 (5) If no person was so registered or eligible to apply for registration, the amount payable is the sum of the following amounts:

 (a) 30% of the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later financial year on which no person covered by the policy was aged 65 years or over;

 (b) 35% of the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later financial year on which:

 (i) at least one person covered by the policy was aged 65 years or over; and

 (ii) no person covered by the policy was aged 70 years or over;

 (c) 40% of the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later financial year on which at least one person covered by the policy was aged 70 years or over.

If someone registered or eligible to apply for registration

 (6) If a person was so registered or eligible to apply for registration, the amount payable is the greater of:

 (a) the sum of the amounts referred to in paragraphs (5)(a), (b) and (c); and

 (b) the *incentive amount for the policy for the later financial year.

2  After section 410

Insert:

4‑12  Saving provision where a person 65 years or over ceases to be covered by policy

 (1) This section applies to a person (the first person) at a particular time (the relevant time) if:

 (a) at any time before the relevant time, the first person was covered by an *appropriate private health insurance policy (the original policy), other than as a *dependent child; and

 (b) at any time when the person was so covered, the amount payable under this Chapter was 35% or 40% of the amount of premium payable under the original policy because of the age of another person (the entitling person) covered by the policy; and

 (c) before the relevant time, the entitling person ceased to be covered by the original policy.

 (2) If, at the relevant time:

 (a) the first person is covered by an *appropriate private health insurance policy (which may be either the original policy or another policy); and

 (b) each other person (if any) covered, since the entitling person ceased to be covered by the original policy, by an *appropriate private health insurance policy that also covered the first person:

 (i) is or was covered as a *dependent child; or

 (ii) is a person who was covered by the original policy immediately before that cessation;

subsections 410(5) and (6) are taken to apply (other than for the purposes of working out the *incentive amount) as if the entitling person:

 (c) were covered by the policy mentioned in paragraph (a); and

 (d) were the same age as at that cessation.

 (3) Subsection (2) does not apply if its application would result in the amount payable under subsection 410(5) or (6) being less than it would otherwise have been.

3  Subsections 125(2A) and (3)

Repeal the subsections, substitute:

 (2A) If the financial year is a later financial year, and no person was so registered or eligible to apply for registration, the amount of the reduction is the sum of the following amounts:

 (a) 30% of the amount of the premium payable under the policy in respect of days in the later financial year on which no person covered by the policy was aged 65 years or over;

 (b) 35% of the amount of the premium payable under the policy in respect of days in the later financial year on which:

 (i) at least one person covered by the policy was aged 65 years or over; and

 (ii) no person covered by the policy was aged 70 years or over;

 (c) 40% of the amount of the premium payable under the policy in respect of days in the later financial year on which at least one person covered by the policy was aged 70 years or over.

 (3) If the financial year is a later financial year and a person was so registered or eligible to apply for registration, the amount of the reduction is the greater of:

 (a) the sum of the amounts referred to in paragraphs (2A)(a), (b) and (c); and

 (b) the *incentive amount for the policy for the later financial year.

4  After section 125

Insert:

12‑7  Saving provision where a person 65 years or over ceases to be covered by policy

 (1) This section applies to a person (the first person) at a particular time (the relevant time) if:

 (a) at any time before the relevant time, the first person was covered by an *appropriate private health insurance policy (the original policy), other than as a *dependent child; and

 (b) at any time when the person was so covered, the amount of the premium reduction under this Chapter was 35% or 40% of the amount of premium payable under the original policy because of the age of another person (the entitling person) covered by the policy; and

 (c) before the relevant time, the entitling person ceased to be covered by the original policy.

 (2) If, at the relevant time:

 (a) the first person is covered by an *appropriate private health insurance policy (which may be either the original policy or another policy); and

 (b) each other person (if any) covered, since the entitling person ceased to be covered by the original policy, by an *appropriate private health insurance policy that also covered the first person:

 (i) is or was covered as a *dependent child; or

 (ii) is a person who was covered by the original policy immediately before that cessation;

subsections 125(2A) and (3) are taken to apply (other than for the purposes of working out the *incentive amount) as if the entitling person:

 (c) were covered by the policy mentioned in paragraph (a); and

 (d) were the same age as at that cessation.

 (3) Subsection (2) does not apply if its application would result in the amount of the premium reduction under subsection 125(2A) or (3) being less than it would otherwise have been.


Part 2—Amendment of the Income Tax Assessment Act 1997

5  Subsections 61340(5) and (6)

Repeal the subsections, substitute:

 (5) If no person was so registered or eligible to apply for registration, the amount of the *tax offset is the sum of the following amounts:

 (a) 30% of the amount of the premium, or of the amount in respect of a premium, paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later income year on which no person covered by the policy was aged 65 years or over;

 (b) 35% of the amount of the premium, or of the amount in respect of a premium, paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later income year on which:

 (i) at least one person covered by the policy was aged 65 years or over; and

 (ii) no person covered by the policy was aged 70 years or over;

 (c) 40% of the amount of the premium, or of the amount in respect of a premium, paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later income year on which at least one person covered by the policy was aged 70 years or over.

 (6) If a person was so registered or eligible to apply for registration, the amount of the *tax offset is the greater of:

 (a) the sum of the amounts referred to in paragraphs (5)(a), (b) and (c); and

 (b) the incentive amount for the policy for the later income year.

6  After section 61340

Insert:

61‑342  Saving provision where a person 65 years or over ceases to be covered by policy

 (1) This section applies to a person (the first person) at a particular time (the relevant time) if:

 (a) at any time before the relevant time, the first person was covered by an appropriate private health insurance policy (the original policy), other than as a dependent child; and

 (b) at any time when the person was so covered, the amount of the *tax offset under section 61340 was 35% or 40% of the amount of premium payable under the original policy because of the age of another person (the entitling person) covered by the policy; and

 (c) before the relevant time, the entitling person ceased to be covered by the original policy.

 (2) If, at the relevant time:

 (a) the first person is covered by an appropriate private health insurance policy (which may be either the original policy or another policy); and

 (b) each other person (if any) covered, since the entitling person ceased to be covered by the original policy, by an appropriate private health insurance policy that also covered the first person:

 (i) is or was covered as a dependent child; or

 (ii) is a person who was covered by the original policy immediately before that cessation;

subsections 61340(5) and (6) are taken to apply (other than for the purposes of working out the incentive amount) as if the entitling person:

 (c) were covered by the policy mentioned in paragraph (a); and

 (d) were the same age as at that cessation.

 (3) Subsection (2) does not apply if its application would result in the amount of the *tax offset under subsection 61340(5) or (6) being less than it would otherwise have been.

 (4) In this section:

dependent child has the same meaning as in the Private Health Insurance Incentives Act 1998.


Part 3—Application

7  Application of amendments

The amendments made by this Schedule apply to amounts of premium, and amounts in respect of premium, paid or payable in respect of a period beginning on or after 1 April 2005.


Schedule 2—Gold cards

 

National Health Act 1953

1  Paragraph 4(2)(a) of Schedule 2

Omit “under the Veterans’ Entitlements Act 1986”.

2  Subclause 4(3) of Schedule 2 (definition of gold card)

Repeal the definition, substitute:

gold card means a card that evidences a person’s entitlement to be provided with treatment:

 (a) in accordance with the Treatment Principles prepared under section 90 of the Veterans’ Entitlements Act 1986; or

 (b) in accordance with a determination made under section 286 of the Military Rehabilitation and Compensation Act 2004 in respect of the provision of treatment.

3  Application of amendment

The amendment made by item 2 of this Schedule applies to a card held in respect of a period beginning on or after 1 July 2004.

 

 

 

[Minister’s second reading speech made in—

House of Representatives on 18 November 2004

Senate on 9 February 2005]

(214/04)

 

Overview

The Private Health Insurance Incentives Amendment Act 2005 was enacted by the Parliament of Australia to amend the law relating to private health insurance incentives, particularly in relation to the rebates and tax offsets available for individuals aged 65 and over. The Act received Royal Assent on 22 February 2005 and commenced on the same day. It makes changes to the Private Health Insurance Incentives Act 1998, the Income Tax Assessment Act 1997, and the National Health Act 1953, primarily to adjust the rebate percentages based on the age of the insured individuals and to clarify the definition of gold cards under the National Health Act. The objective of the amendments is to ensure that the incentives provided under private health insurance align with the age-related risk profiles of policyholders, thereby potentially reducing the financial burden on the system.

Scope and Application

The Private Health Insurance Incentives Amendment Act 2005 applies to amendments concerning the rebates available for private health insurance policies, specifically modifying the rebates for individuals aged 65 and over. The Act amends the Private Health Insurance Incentives Act 1998 and the Income Tax Assessment Act 1997, impacting entities such as health insurers and individuals who are policyholders. It sets forth a tiered rebate structure based on the age of the insured persons, with different percentages applied depending on whether any insured person is aged 65 or over, 70 or over, or none of the insured persons reaches these age thresholds. The Act also includes provisions that ensure the rebate calculations remain consistent even if an insured person aged 65 or over ceases to be covered by a policy. Additionally, the Act amends the definition of 'gold card' under the National Health Act 1953, redefining it to include entitlements under the Veterans' Entitlements Act 1986 and the Military Rehabilitation and Compensation Act 2004. The amendments apply to premiums paid or payable on or after 1 April 2005, and the definition amendment applies to cards held for periods beginning on or after 1 July 2004. The Act does not specify exclusions or thresholds, and its application is not extended or restricted through subordinate instruments.

Key Provisions

The Private Health Insurance Incentives Amendment Act 2005 (C2005A00009) brings about significant changes to the law governing private health insurance incentives, particularly focusing on the rebate for individuals aged 65 and over. The Act amends the Private Health Insurance Incentives Act 1998 (section 1) and the Income Tax Assessment Act 1997 (section 5). These changes are effective for premiums paid or payable on or after 1 April 2005. The core of the Act involves modifying the rebate structure for private health insurance policies based on the age of the policyholders. Specifically, it introduces a tiered rebate system: 30% for premiums paid when no one on the policy is aged 65 or over, 35% when at least one person is aged 65 but no one is aged 70 or over, and 40% when at least one person is aged 70 or over (subsections 4-10(5) and (6), 12-5(2A) and (3), and 61-340(5) and (6)). Additionally, it includes provisions to maintain these benefits when a person aged 65 or over is no longer covered under the policy but was previously entitling the policy to a higher rebate (subsections 4-12, 12-7, and 61-342). These provisions ensure that the benefit structure remains intact under certain conditions even when the original qualifying condition is no longer met. The Act imposes specific obligations on insurers and policyholders to adhere to the new rebate structure. Insurers must calculate and apply the rebates according to the age demographics of the policyholders, while policyholders must ensure that their policy details accurately reflect the age of the covered individuals to claim the correct rebate. The Act also mandates that these changes apply retroactively to premiums paid from 1 April 2005, necessitating adjustments in accounting and record-keeping practices by both insurers and policyholders. Breach of the obligations set out in the Act could lead to financial penalties, as the Act does not explicitly state criminal or civil penalties for non-compliance, it is implied that failure to adhere to the rebate provisions could result in financial repercussion for both insurers and policyholders, potentially including audits and reassessments of tax returns or rebates claimed. The precise penalties, however, are not detailed within the Act itself but would be determined under the respective Acts it amends.

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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.