Private Health Insurance (Lifetime Health Cover) Amendment Rules 2010

Administered by Department of Health, Disability and Ageing

Legislation au F2010L02896 Rules Not in force Legislative Instrument

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EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Private Health Insurance Act 2007

Private Health Insurance (Lifetime Health Cover) Amendment Rules 2010

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Lifetime Health Cover) Rules providing for matters required or permitted by Part 2-3 of the Act, or necessary or convenient to be provided in order to carry out or give effect to Part 2-3 of the Act.

Part 2-3 of the Act relates to Lifetime Health Cover. Under Lifetime Health Cover, private

health insurers are able to set different premiums depending on the age when an insured

person first takes out hospital cover with a private health insurer. People are encouraged to

take out hospital cover by the 1 July following their Lifetime Health Cover Base Day, which for most people is the 1 July following their 31st birthday. The Act sets out the rate

for increases in premiums for people who do not take out private health cover before that

time.

The Private Health Insurance (Lifetime Health Cover) Rules 2007 (the Principal Rules) commenced on 31 March 2007. The Rules set out administrative matters relating to Lifetime Health Cover, such as the categories of people who are taken to have hospital cover and the provision for suspension of hospital cover. Among other provisions, the Principal Rules also provide for categories of persons taken to have hospital cover for the purposes of Lifetime Health Cover provided by or through:

the Australian Antarctic Division of the Department of the Environment and

Heritage; or

the Australian Defence Force (for members on continuous full-time service or

their adult dependants).

The Private Health Insurance (Lifetime Health Cover) Amendment Rules 2010 (the Amendment Rules) amend Part 2, clause 4(a) and Part 3, subclause 9(1)(c) of the Principal Rules.

The purpose of these amendments is to update the references in the Principal Rules to the Department of the Environment and Heritage to reflect the current name of the Department, the Department of Sustainability, Environment, Water, Population and Communities.

Details of the Amendment Rules are set out in the Attachment.

The Act does not specify any condition that needs to be satisfied before the power to make Amendment Rules may be exercised.

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

Consultation

Consultation was not undertaken in relation to the amendments with registered private health insurers or the Australian Private Hospitals Association. These amendments are of a minor and mechanical nature only and do not alter existing arrangements.

Authority: Section 333-20 of the

Private Health Insurance Act 2007

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

OCTOBER 2010

ATTACHMENT

DETAILS OF THE PRIVATE HEALTH INSURANCE (LIFETIME HEALTH COVER) AMENDMENT RULES 2010.

1 Name of Rules

Rule 1 provides that the title of the Rules is the Private Health Insurance (Lifetime Health Cover) Amendment Rules 2010 (the Amendment Rules).

2. Commencement

Rule 2 provides that the Amendment Rules are to commence on the day after registration.

3. Amendment of the Private Health Insurance (Lifetime Health Cover) Rules 2007

Rule 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Lifetime Health Cover) Rules 2007 which commenced on 31 March 2007.

Schedule ― Amendments

Item 1 - Part 2, clause 4(a):

Clause 4(a) of Part 2 of the Principal Rules provides that adults whose health services are provided by or through the Australian Antarctic Division of the Department of the Environment and Heritage are taken to have hospital cover for the purpose of lifetime cover. Item 1 of the Schedule to the Amendment Rules amends Part 2, clause 4(a) by updating the reference to the Department of the Environment and Heritage to reflect the current name of the Department, the Department of Sustainability, Environment, Water, Population and Communities.

Item 2- Part 3, subclause 9(1)(c):

Subclause 9(1)(c) of the Principal Rules provides that a private health insurer must accept a written statement issued by the Australian Antarctic Division of the Department of the Environment and Heritage, that the person and health services provided by or through the Australian Antarctic Division at the particular time or during the particular period as conclusive evidence of a person having had hospital cover at a particular time or during a particular period. Item 2 of the Schedule to the Amendment Rules amends Part 3, subclause 9(1)(c) by updating the reference to the Department of the Environment and Heritage to reflect the current name of the Department, the Department of Sustainability, Environment, Water, Population and Communities.

Overview

The Private Health Insurance (Lifetime Health Cover) Amendment Rules 2010 were introduced to amend the Private Health Insurance (Lifetime Health Cover) Rules 2007, as required by Section 333-20 of the Private Health Insurance Act 2007. The amendment was necessary to update references in the Principal Rules to the Department of the Environment and Heritage to the current name of the department, the Department of Sustainability, Environment, Water, Population and Communities. The Act itself does not specify any conditions that need to be satisfied before exercising the power to make these Amendment Rules. These amendments are of a minor and mechanical nature and do not alter existing arrangements. They were made under the authority of the Minister for Health and Ageing and were registered as a legislative instrument under the Legislative Instruments Act 2003. Notably, consultation with registered private health insurers or the Australian Private Hospitals Association was not undertaken due to the minor nature of the changes.

Scope and Application

The Private Health Insurance (Lifetime Health Cover) Amendment Rules 2010 are subordinate legislation that amends the Private Health Insurance (Lifetime Health Cover) Rules 2007. These amendments are designed to update references in the Principal Rules to the Department of the Environment and Heritage to reflect its current name, the Department of Sustainability, Environment, Water, Population and Communities. The rules apply to private health insurers and individuals who may have hospital cover through or by the Australian Antarctic Division of the Department of the Environment and Heritage. The changes are minor and mechanical, aiming to ensure that the administrative framework remains current with governmental restructuring, without altering the underlying provisions or obligations of the Act. These rules operate nationally, aligning with the scope of the Private Health Insurance Act 2007, which governs private health insurance practices across Australia. No specific exclusions or thresholds are outlined in the Amendment Rules, and the amendments do not introduce new substantive requirements beyond the name update of the Department.

Key Provisions

The Private Health Insurance (Lifetime Health Cover) Amendment Rules 2010 (the Amendment Rules) serve to update and clarify certain references within the Private Health Insurance (Lifetime Health Cover) Rules 2007 (the Principal Rules). Section 333-20 of the Private Health Insurance Act 2007 empowers the Minister to make these rules, which are necessary to ensure the Act is properly implemented. The Amendment Rules specifically address the references to the Department of the Environment and Heritage, updating them to reflect the current name, the Department of Sustainability, Environment, Water, Population and Communities. This change ensures that the administrative processes outlined in the Principal Rules continue to align with the current governmental structure. The Amendment Rules impose certain obligations on private health insurers. For instance, under the updated references, insurers must accept written statements from the Australian Antarctic Division of the Department of Sustainability, Environment, Water, Population and Communities as conclusive evidence of hospital cover. This requirement remains consistent with the original intent of the Principal Rules but ensures that the references are accurate and up-to-date. The obligation for insurers to accept such statements helps maintain the integrity of the Lifetime Health Cover system by ensuring that claims for cover are appropriately validated. Failure to comply with the requirements set out in the Amendment Rules may result in consequences under the Private Health Insurance Act 2007. While the specific penalties for non-compliance are not detailed within the Amendment Rules themselves, the overarching Act provides a framework within which penalties may be imposed. Breaches of the Act can result in both civil and criminal penalties, including fines and imprisonment, depending on the severity and intent of the breach. It is crucial for private health insurers to adhere to the rules to avoid any potential legal repercussions. The Amendment Rules do not explicitly detail the penalties for non-compliance but operate within the broader legal framework of the Private Health Insurance Act 2007. This means that any failure to comply with the rules could lead to enforcement actions under the Act, potentially including substantial fines or other penalties. The rules are designed to ensure that the Lifetime Health Cover provisions are administered correctly and fairly, maintaining the integrity of the private health insurance system in Australia.

Area of Law: Private Health Insurance Law
Instrument: Regulation
Concepts: Commencement Provisions; Reporting & Disclosure Obligations; Regulatory Standards

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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.

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