EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Private Health Insurance Act 2007
Private Health Insurance (Registration) Rules 2009
Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Registration) Rules providing for matters required or permitted by Part 4-3 of the Act, or necessary or convenient in order to carry out or give effect to Part 4-3 of the Act.
Part 4-3 of the Act contains provisions relating to the power of the Private Health Insurance Administration Council (the Council) to register private health insurers.
The Private Health Insurance (Registration) Rules 2009 (the Rules) commence on the day following their registration on the Federal Register of Legislative Instruments. The Rules revoke and replace the Private Health Insurance (Registration) Rules 2007 (No. 2) (the previous Rules) which commenced on 12 October 2007.
The Rules remain the same as the previous Rules except for the changes outlined below.
The previous Rules described 13 *restricted access groups (the Groups) for the purposes of paragraph 126-20(7)(e) of the Act. The Groups commenced on the commencement date of the previous Rules, 12 October 2007. The new Rules differ from the previous Rules in that the composition of two of these described groups have changed.
Specifically, subrule 6(b) of the Rules and Item 11.7 (Column 2) of the schedule of the Rules has been changed to the effect that, in the case of Teachers Federation Health Fund Ltd (TFHF), a person who is or becomes, an officer or employee (including a contractor) of TFHF must be a financial member of a union (if applicable) at the time that he or she seeks to become insured by TFHF in order to belong to the Group. For the avoidance of doubt, this requirement is from the commencement date of the Rules onwards and does not apply to those persons who already belonged to the Group immediately prior to the commencement of these Rules.
The composition of the South Australian Police Employees Health Fund Inc Group (SAPEH) in the Rules is changed by Items 10.2 and 10.3 (Column 2) of the schedule of the Rules. This Group has been broadened to include those people who were employed on or after 1 January 2001 but are no longer so employed by a State (other than South Australia), Territory or Federal police department or service, or a police association. For the avoidance of doubt, this requirement does not affect a person who is, or was, an employee of South Australia Police.
Details of the Rules are set out in the Attachment. The Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Office of Best Practice Regulation has advised that a Regulation Impact Statement is not required.
Consultation
The Department of Health and Ageing consulted with both private health insurers affected by these changes.
MINISTER FOR HEALTH AND AGEING
FEBRUARY 2009
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (REGISTRATION) RULES 2009
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Registration) Rules 2009 (the Rules).
2. Commencement
Rule 2 provides that the Rules commences on the day after they are registered on the Federal Register of Legislative Instruments.
3. Effect of Rules
Rule 3 provides for the Private Health Insurance (Registration) Rules 2007 (No. 2) to be revoked and to be replaced by these Rules.
4. Definitions
Rule 4 provides that terms used in the Rules have the same meaning as in the Private Health Insurance Act 2007 (the Act). It also defines the terms ‘Principal Insureds’ and ‘Act’ which is used in the Rules.
5. Deciding the application
Rule 5 provides that the Council is required to consider certain matters when deciding an application for registration as a private health insurer.
Subrule 5(1) provides that these matters are the likely ratio of management and administration expenses in respect of the funds to the likely amount of premiums of each fund; the likely number of persons who will contribute to the fund and the proposed premiums; and information on the application provided in writing by, or on behalf of, the Secretary of the Department. This may include information as to whether the body is likely to be able to comply with the obligations imposed by or under the Act on private health insurers.
6. Description of groups for existing restricted access insurers
Rule 6 contains, for the purpose of paragraph 126-20(7)(e) of the Act, the description of a group for restricted access insurers.
Subsection 126-20(7) of the Act provides that a restricted access group is a group of people who all belong to a particular group, based on whether they belong to one of the groups described in paragraphs 126-20(7)(a) to (e).
Rule 6(a) provides that persons who were already insured with a *restricted access insurer immediately before 12 October 2007 belong to a *restricted access group (‘a Group’) to whom that insurer’s *complying health insurance products are, or will be, made available.
As indicated in note (i) to Rule 6, the purpose of Rule 6(a) is to ensure that *restricted access insurers are able to continue to provide cover to all existing insured persons.
Rule 6(b) provides that persons who are, or become, officers or employees (including contractors) of a *restricted access insurer that makes available its *complying health insurance products to a Group are also taken to belong to that Group, except where the person is or becomes an employee (including a contractor) of Reserve Bank Health Society Limited or where the person becomes an officer or employee (including a contractor) of Teachers Federation Health Fund Ltd (TFHF).
Rule 6(c) provides that the partners and *dependent children of Principal Insureds are also taken to belong to the same Group as those Principal Insureds.
Rule 6(d) provides that the former partners and adult children of Principal Insureds are also taken to belong to the same Group as those Principal Insureds, except where the Principal Insured is insured by Reserve Bank Health Society Limited.
Rule 6(e) provides that the siblings, grandchildren and parents of Principal Insureds are also taken to belong the same Group as those Principal Insureds, except where the Principal Insured is insured by the following *restricted access insurers: ACA Health Benefits Fund, South Australian Police Employees Health Fund Inc, or Reserve Bank Health Society Limited.
Rule 6(f) provides that the partners and *dependent children of persons who are the adult children of Principal Insureds are also taken to belong to the same Group as those Principal Insureds, except where the Principal Insured is insured by Reserve Bank Health Society Limited.
Rule 6(g) provides that the partners and *dependent children of persons who are the siblings of Principal Insureds are also taken to belong to the same Group as those Principal Insureds, except where the Principal Insured is insured by the following *restricted access insurers: ACA health Benefits Fund, or South Australian Police Employees Health Fund Inc, or Reserve Bank Health Society Limited.
Rule 6(h) provides that on and from commencement of the Rules, the Group to whom a *restricted access insurer specified in Column 1 of the Schedule does or will make its *complying health insurance products available comprises:
- the persons described in paragraphs 6(a), (b), (c), (d), (e), (f) and (g); and
- the classes of people specified in Column 2 of the Schedule for that insurer.
As indicated in note (ii) to Rule 6 the purpose of paragraph (h) is to ensure that, on and from the commencement of these Rules, *restricted access insurers are able to continue to make *complying health insurance products available to limited classes of people who might not otherwise form part of a *restricted access group for the purposes of subsection 126-20(7) of the Act.
7. Limits on insurance provided by restricted access insurers
For the avoidance of doubt, Rule 7(a) confirms that a *restricted access insurer’s constitution may only specify one *restricted access group to whom the insurer’s complying health insurance products are, or will be, available.
For the avoidance of doubt, Rule 7(b) confirms that a *restricted access insurer may not add new persons to this *restricted access group in addition to the persons included in that group by the operation of the Act and these Rules.
For the avoidance of doubt, Rule 7(c) confirms that paragraphs 6(c), 6(f) and 6(g) of these Rules modify the operation of subsection 126-20 (7) of the Act in relation to the partners and dependent children of people who belong to a *restricted access group.
Schedule – restricted access groups for certain insurers
This is the Schedule referred to in Rule 6(h) of the Rules.
Item 10.2 (Column 2) – Persons deemed to be included in the insurer’s restricted access group for the South Australian Policy Employees Health Fund Inc
Item 10.1 remains unchanged.
Item 10.2 is changed so that a person who is employed, or was employed on or after 1 January 2001 but is no longer so employed, by a State, Territory or Federal police department or service other than SAPOL forms part of the Group.
Item 10.3 is changed so that a person who is employed, or was employed on or after 1 January 2001 but is no longer so employed, by a State, Territory or Federal police association forms part of the Group.
Item 11.7 (Column 2) – Persons deemed to be included in the insurer’s restricted access group for Teachers Federation Health Fund Ltd
Items 11.1 to 11.6 remain unchanged.
Item 11.7 is inserted and provides that a person who is, or becomes, an officer or employee of, or a contractor to, TFHF and who is, at the time at which they seek to become insured by TFHF, a financial member of a union (if any) of which they are eligible to be a member, forms part of the Group.
MINISTER FOR HEALTH AND AGEING
FEBRUARY 2009