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Private Health Insurance Bill 2007

Part  6 -9 Review of decisions

Division 328 Review of decisions

328-1   What this Part is about

Several kinds of decisions made under this Act by the Medicare CEO, the Council, the Minister and the Private Health Insurance Ombudsman are reviewable by the Administrative Appeals Tribunal.

328-5   AAT review of decisions

                   An application may be made to the Administrative Appeals Tribunal for the review of any of the following decisions:

 

Reviewable decisions



Item

Decision

Provision under which decision is made

1

To reject an application for registration of a person in respect of a health insurance policy

section 23-20

2

To revoke a person’s registration in respect of a health insurance policy

section 23-35

3

To affirm an original decision of the Medicare Australia CEO rejecting a claim to be paid an amount under Division 26

section 26-25

4

To refuse to make a declaration, or to revoke a declaration, that a facility is a * hospital

subsection 121-5(6)

5

To refuse an application for registration as a private health insurer

subsection 126-20(1)

6

To grant an application, subject to terms and conditions, for registration as a private health insurer

subsection 126-20(1)

7

To refuse to make a declaration that the * solvency standard does not apply to a particular private health insurer

subsection 140-15(2)

8

To impose conditions on a declaration that the * solvency standard does not apply to a particular private health insurer

subsection 140-15(3)

9

To refuse to revoke or vary a declaration that the * solvency standard does not apply to a particular private health insurer

subsection 140-15(6) or (7)

10

To refuse to revoke or vary conditions imposed on a declaration that the * solvency standard does not apply to a particular private health insurer

subsection 140-15(6) or (7)

11

To refuse to revoke or vary a * solvency direction

subsection 140-20(8) or (9)

12

To refuse to make a declaration that the * capital adequacy standard does not apply to a particular private health insurer

subsection 143-15(2)

13

To impose conditions on a declaration that the * capital adequacy standard does not apply to a particular private health insurer

subsection 143-15(3)

14

To refuse to revoke or vary a declaration that the * capital adequacy standard does not apply to a particular private health insurer

subsection 143-15(6) or (7)

15

To refuse to revoke or vary conditions imposed on a declaration that the * capital adequacy standard does not apply to a particular private health insurer

subsection 143-15(6) or (7)

16

To refuse to revoke or vary a * capital adequacy direction

subsection 143-20(8) or (9)

17

To refuse to approve a restructure of the * health benefits funds of a private health insurer

subsection 146-1(3)

18

To refuse to approve a transfer of the * health benefits funds of one or more private health insurers

subsection 146-5(3)

19

To refuse to approve a restructure of the * health benefits funds of a private health insurer

section 149-10

20

To refuse to approve the appointment of a person as a private health insurer’s actuary

subsection 160-1(5)

21

To declare under the Private Health Insurance (Insurer Obligations) Rules that a person is not eligible for appointment as a private health insurer’s actuary

subsection 160-5(2)

22

To give a * prudential direction to a private health insurer

subsection 163-15(1)

23

To refuse to revoke a * prudential direction

subsection 163-15(3)

24

To disqualify a person from being or acting as a * director or * senior manager of a private health insurer

subsection 166-20(1)

25

To refuse to revoke a disqualification of a * disqualified person

subsection 166-20(3)

26

To refuse to determine that a person is not a * disqualified person

subsection 166-25(3)

27

To specify conditions in a determination that a person is not a * disqualified person

subsection 166-25(4)

28

To specify additional conditions to which determination that a person is not a * disqualified person is to be subject

subsection 166-25(4)

29

To vary conditions to which determination that a person is not a * disqualified person is to be subject

subsection 166-25(4)

30

To revoke a determination that a person is not a * disqualified person

subsection 166-25(8)

31

To direct a private health insurer not to make a change that it proposes to make to its * rules

subsection 169-10(2)

32

To refuse a request for a longer period for a private health insurer to respond to a request for an explanation

subsection 191-1(3)

33

To refuse to consent to a private health insurer withdrawing or varying an undertaking

subsection 197-1(3)

34

To give a direction to a private health insurer

section 200-1

35

To revoke a private health insurer’s status as a * participating insurer

section 206-1

36

To refuse to extend a period to report to the Private Health Insurance Ombudsman

subsection 241-40(3)

37

To refuse to extend a period to give a record or information to the Private Health Insurance Ombudsman

subsection 250-1(5)

38

To reject an application to become a * participating insurer

section 279-5

39

On reconsideration of a decision notifying a private health insurer in relation to a claim for payment under Division 279

section 279-45

40

To affirm an original decision by the Medicare Australia CEO that an amount is recoverable as a debt under paragraph 282-1(1)(a) or (b)

section 282-15

41

To affirm an original decision by the Medicare Australia CEO that an amount is recoverable as a debt under paragraph 282-1(1)(h) in respect of a payment made to an individual

section 282-15

42

To affirm an original decision by the Medicare Australia CEO to set off a debt against an amount otherwise payable to a person or his or her estate

section 282-15

43

Not to waive, or to waive only a part of, an amount of * late payment penalty (other than late payment penalty in respect of an amount of * collapsed insurer levy)

section 307-20

44

Not to waive, or to waive only a part of, an amount of * collapsed insurer levy or * late payment penalty in respect of an amount of collapsed insurer levy

section 307-25