Note: Where available, the PDF/Word icon below is provided to view the complete and fully formatted document

 Download WordDownload Word  Download PDFDownload PDF 


Bill home page
Table Of Contents
Previous Fragment    Next Fragment
Private Health Insurance Bill 2007

Part 3-4 Obligations relating to complying health insurance products

Division 90 Introduction

90-1   What this Part is about

Private health insurers have obligations to people insured under their complying health insurance products and people seeking to become insured under those products. Private health insurers also have to keep the Department, the Council and the Private Health Insurance Ombudsman informed about their health insurance business.



 

Division 93 Giving information to consumers

93-1   Maintaining up to date standard information statements

             (1)  A private health insurer must ensure that it maintains at all times an * up to date * standard information statement:

                     (a)  for each * complying health insurance product that it makes available; and

                     (b)  for each complying health insurance product under which it insures people.

             (2)  The * standard information statement for a * complying health insurance product is up to date at a particular time, if, at that time, the information in the statement is accurate.

             (3)  A private health insurer commits an offence if there is no * standard information statement for a * complying health insurance product of the insurer.

Penalty:  60 penalty units.

             (4)  A private health insurer commits an offence if:

                     (a)  there is a * standard information statement for a * complying health insurance product of the insurer; and

                     (b)  the standard information statement is not * up to date.

Penalty:  60 penalty units.

             (5)  Strict liability applies to subsections (3) and (4).

Note:          For strict liability , see section 6.1 of the Criminal Code .

93-5   Meaning of standard information statement

             (1)  A standard information statement for a * complying health insurance product is a statement about the product that contains the information, and is in the form, set out in the Private Health Insurance (Complying Product) Rules.

             (2)  The Private Health Insurance (Complying Product) Rules may set out methods by which * standard information statements are to be made available to people who ask for information about * complying health insurance products.

93-10   Making standard information statements available

                   A private health insurer must ensure that, if a person asks an * officer, employee or agent of the insurer for information about a * complying health insurance product of the insurer:

                     (a)  the person is told about the * standard information statement for the product and how to obtain a copy of the statement; and

                     (b)  if the person asks for a copy—the person is given an * up to date copy of the statement.

93-15   Giving information to newly insured people

             (1)  A private health insurer must ensure that, when an * adult first becomes insured under a * complying health insurance policy of the insurer, the adult is given:

                     (a)  an * up to date copy of the * standard information statement for the * product that the policy is in, by a method (if any) set out in the Private Health Insurance (Complying Product) Rules; and

                     (b)  details about what the policy * covers and how benefits provided under it are worked out; and

                     (c)  a statement identifying the * health benefits fund to which the policy is referable.

             (2)  If more than one * adult becomes insured under a single * complying health insurance policy of a private health insurer, the insurer is taken to comply with subsection (1) if the insurer complies with that subsection in relation to only one of those adults.

93-20   Keeping insured people up to date

             (1)  A private health insurer must ensure that an * adult insured under a * complying health insurance policy issued by the insurer is given the * standard information statement for the * product that the policy is in, at least once every 12 months.

             (2)  A private health insurer must ensure that, if a proposed change to the insurer’s * rules:

                     (a)  is or might be detrimental to the interests of an insured person; and

                     (b)  will require an update to the * standard information statement for a * complying health insurance product of the insurer;

an * adult insured under each * complying health insurance policy in the product:

                     (c)  is informed about the proposed change a reasonable time before the change takes effect; and

                     (d)  is given the updated standard information statement as soon as practicable after the statement is updated.

             (3)  A private health insurer must ensure that, if an * adult who is insured under a * complying health insurance policy of the insurer asks an * officer, employee or agent of the insurer for information about what the policy covers or the benefits the policy provides, the adult is given the information as soon as practicable.

             (4)  A private health insurer must ensure that, if the insurer proposes to change the * health benefits fund to which a * complying health insurance policy of the insurer is * referable, an * adult insured under the policy is, before the change takes effect, given a statement identifying the health benefits fund to which the policy will be referable as a result of the change.

Note:          The health benefits fund to which a policy is referable may change in accordance with Division 146.

             (5)  If more than one * adult is insured under a single * complying health insurance policy of a private health insurer, the insurer is taken to comply with subsection (1), (2) or (4) if the insurer complies with the subsection in relation to only one of those adults.

93-25   Giving advance notice of detrimental changes to rules

             (1)  A private health insurer must ensure an * adult insured under a * complying health insurance policy issued by the insurer is informed about any proposed change to the insurer’s * rules (other than a change to which subsection 93-20(2) applies), a reasonable time before the change takes effect, if the proposed change is or might be detrimental to the interests of an insured person.

             (2)  If more than one * adult is insured under a single * complying health insurance policy of a private health insurer, the insurer is taken to comply with subsection (1) if the insurer complies with that subsection in relation to only one of those adults.

93-30   Failure to give information to consumers

             (1)  A private health insurer commits an offence if:

                     (a)  the insurer is required under section 93-10, 93-15, 93-20 or 93-25 to ensure that a particular thing happens in relation to a particular person; and

                     (b)  the thing does not happen in relation to the person.

Penalty:  60 penalty units.

             (2)  Strict liability applies to subsection (1).

Note:          For strict liability , see section 6.1 of the Criminal Code .



 

Division 96 Giving information to the Department, the Council and the Private Health Insurance Ombudsman

96-1   Giving standard information statements on request

                   A private health insurer must ensure that, if:

                     (a)  the Secretary of the Department; or

                     (b)  the Council; or

                     (c)  the Private Health Insurance Ombudsman;

requests the private health insurer for the * standard information statement for a * complying health insurance product of the insurer, the insurer gives the person who made the request an * up to date copy of the statement, as soon as practicable after being asked and by the method (if any) specified by the person.

96-5   Giving standard information statements for new products

                   A private health insurer must ensure that a copy of the * standard information statement for a * complying health insurance product of the insurer is given to:

                     (a)  the Secretary of the Department; and

                     (b)  the Council; and

                     (c)  the Private Health Insurance Ombudsman;

no later than the first day on which the insurer first begins to make the * product available.

96-10   Giving updated standard information statements

                   A private health insurer must ensure that, if the * standard information statement for a * complying health insurance product of the insurer is updated, a copy of the updated statement is given to:

                     (a)  the Secretary of the Department; and

                     (b)  the Council; and

                     (c)  the Private Health Insurance Ombudsman;

as soon as practicable after the statement is updated.

96-15   Giving additional information on request

             (1)  Any of the following:

                     (a)  the Secretary of the Department;

                     (b)  the Council;

                     (c)  the Private Health Insurance Ombudsman;

may request a private health insurer for specified information about, or in relation to, a * complying health insurance product or products, or a * complying health insurance policy, of the insurer.

             (2)  The request must:

                     (a)  be in writing; and

                     (b)  specify the time by which the information requested is to be given.

             (3)  The request may specify the manner and form in which the information requested is to be given.

             (4)  A private health insurer must ensure that the request is complied with, by the time specified in the request or any longer time allowed by the person who made the request.

96-20   Failure to give information to Department, Council or Private Health Insurance Ombudsman

             (1)  A private health insurer commits an offence if:

                     (a)  the insurer is required under section 96-1, 96-5, 96-10 or 96-15 to ensure that a particular thing is given to a particular person; and

                     (b)  the thing is not given to the person.

Penalty:  60 penalty units.

             (2)  Strict liability applies to subsection (1).

Note:          For strict liability , see section 6.1 of the Criminal Code .

96-25   Giving information required by the Private Health Insurance (Complying Product) Rules

                   The Private Health Insurance (Complying Product) Rules may set out any or all of the following:

                     (a)  information in relation to * complying health insurance products;

                     (b)  persons to whom the information is to be given (who may include, but need not be limited to, the Secretary of the Department, the Council or the Private Health Insurance Ombudsman);

                     (c)  the time within which, or the intervals at which, the information is to be given to a person;

                     (d)  the manner and form in which the information is to be given to a person.



 

Division 99 Transfer certificates

99-1   Transfer certificates

Certificate for the insured person

             (1)  A private health insurer (the old insurer ) must, if a person ceases to be insured under a * complying private health insurance policy of the insurer and does not become insured under another policy of the insurer, give the person a certificate under this subsection:

                     (a)  in the * approved form; and

                     (b)  within the period set out in the Private Health Insurance (Complying Product) Rules.

Certificate for the new insurer

             (2)  A private health insurer (the new insurer ) must request a certificate from an old insurer if:

                     (a)  a person who is or has been insured under a * complying health insurance policy of the old insurer * transfers to a complying health insurance policy of the new insurer; and

                     (b)  the person does not give the new insurer the certificate the old insurer gave the person under subsection (1) within 7 days of becoming insured by the new insurer.

The request must be made:

                     (c)  in the * approved form; and

                     (d)  within the period set out in the Private Health Insurance (Complying Product) Rules.

             (3)  If a certificate is requested by the new insurer (whether or not the request is in the * approved form or made within the period mentioned in paragraph (2)(d)), the old insurer must give the new insurer a certificate:

                     (a)  in the approved form; and

                     (b)  within the period set out in the Private Health Insurance (Complying Product) Rules.

Offence

             (4)  A private health insurer commits an offence if:

                     (a)  the insurer is required to do a thing under subsection (1), (2) or (3); and

                     (b)  the insurer does not do the thing.

Penalty:  60 penalty units.

             (5)  Strict liability applies to subsection (4).

Note:          For strict liability , see section 6.1 of the Criminal Code .



 

Division 102 Private health insurers to offer cover for hospital treatment

102-1   Private health insurers to offer cover for hospital treatment

                   At any time when a private health insurer makes available a * complying health insurance product that * covers * general treatment, the insurer must also make available a complying health insurance product that covers * hospital treatment.