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Schedule 3—Private Health Insurance Ombudsman’s powers

Schedule 3 Private Health Insurance Ombudsman’s powers

   

Ombudsman Act 1976

1  After Division 3 of Part IID

Insert:

Division 3A Inspection and audit

Subdivision A Inspection and audit

20SA   Powers to conduct inspections and audits

                   The Private Health Insurance Ombudsman may:

                     (a)  at any reasonable time of the day, enter:

                              (i)  a place occupied by a private health insurer or private health insurance broker; or

                             (ii)  a place occupied by a person predominantly for the purpose of performing services for, or on behalf of, a private health insurer or private health insurance broker; or

                            (iii)  a place where documents or other records relating to a private health insurer, a private health insurance broker or the carrying on of health insurance business are kept; and

                     (b)  may exercise the following powers in relation to the place:

                              (i)  the power to inspect any documents or other records to verify evidence provided in relation to a complaint made under Division 3;

                             (ii)  the power to take extracts from, or make copies of, any such document or other record.

Note:          See also sections 20ZHA and 20ZHB.

Subdivision B Recommendations and reports

20SB   Recommendation and reporting powers as a result of inspection or audit

Recommendations to insurers or brokers

             (1)  After exercising powers under section 20SA, the Private Health Insurance Ombudsman may make recommendations under this section.

             (2)  The Private Health Insurance Ombudsman may recommend either or both of the following:

                     (a)  to a private health insurer, that the insurer take a specific course of action or make changes to its rules, or both;

                     (b)  to a health care provider or private health insurance broker, that the provider or broker take a specific course of action.

             (3)  The Private Health Insurance Ombudsman may, by written notice given to the person to whom the recommendation was made, or an officer of that person, require the person to report to the Private Health Insurance Ombudsman, before action is taken to give effect to the recommendation, on the action proposed to be taken. The notice must specify the period within which the report is to be given.

Reports to the Health Minister

             (4)  After exercising powers under section 20SA, the Private Health Insurance Ombudsman may:

                     (a)  report to the Health Minister on any recommendations made to a private health insurer or private health insurance broker and any responses to those recommendations; or

                     (b)  report to the Health Minister on any recommendations to general changes in regulatory practice or industry practices relating to the kind of issues raised as a result of the exercise of those powers.

             (5)  If the Private Health Insurance Ombudsman provides a report to the Health Minister, as mentioned in subsection (4):

                     (a)  the report must refer to the Private Health Insurance Ombudsman’s exercise of powers under section 20SA; and

                     (b)  the Private Health Insurance Ombudsman must notify any private health insurer or private health insurance broker named in a report provided to the Health Minister of that fact, unless doing so would, or could be reasonably expected to, prejudice the conduct of a current or pending investigation.

2  After section 20T

Insert:

20TA   Powers to inspect documents etc.

                   For the purposes of conducting an investigation under this Division, the Private Health Insurance Ombudsman may:

                     (a)  at any reasonable time of the day, enter:

                              (i)  a place occupied by a private health insurer or private health insurance broker; or

                             (ii)  a place occupied by a person predominantly for the purpose of performing services for, or on behalf of, a private health insurer or private health insurance broker; or

                            (iii)  a place where documents or other records relating to a private health insurer, a private health insurance broker or the carrying on of health insurance business are kept; and

                     (b)  exercise the following powers:

                              (i)  the power to inspect any documents or other records;

                             (ii)  the power to take extracts from, or make copies of, any such document or other record.

Note:          See also sections 20ZHA and 20ZHB.

3  After paragraph 20ZG(6)(c)

Insert:

                    (ca)  a summary of the exercise of powers during the period by the Private Health Insurance Ombudsman under section 20SA;

4  After section 20ZH

Insert:

20ZHA   Announcement before entry

             (1)  This section applies if the Private Health Insurance Ombudsman:

                     (a)  enters a place mentioned in paragraph 20SA(a) for the purposes of conducting an inspection and audit; or

                     (b)  enters a place mentioned in paragraph 20TA(a) for the purposes of conducting an investigation under section 20T.

             (2)  Before entering the place, the Private Health Insurance Ombudsman must show the Private Health Insurance Ombudsman’s identity card to the occupier of the place, or to another person who apparently represents the occupier, if the occupier or other person is present at the place.

Note:          See also section 20ZIA.

20ZHB   Responsibility to provide facilities and assistance

             (1)  A person commits an offence if:

                     (a)  the person is the occupier of, or is in charge of, a place mentioned in paragraph 20SA(a); and

                     (b)  the Private Health Insurance Ombudsman exercises, or purports to exercise, the powers mentioned in paragraph 20SA(b) in relation to the place; and

                     (c)  the person does not provide the Private Health Insurance Ombudsman with reasonable facilities and assistance for the effective exercise of those powers.

Penalty:  30 penalty units.

             (2)  A person commits an offence if:

                     (a)  the person is the occupier of, or is in charge of, a place entered mentioned in paragraph 20TA(a); and

                     (b)  the Private Health Insurance Ombudsman exercises, or purports to exercise, the powers mentioned in paragraph 20TA(b) in relation to the place; and

                     (c)  the person does not provide the Private Health Insurance Ombudsman with reasonable facilities and assistance for the effective exercise of those powers.

Penalty:  30 penalty units.

5  After section 20ZI

Insert:

20ZIA   Identity cards

             (1)  The Private Health Insurance Ombudsman must issue an identity card to a person who exercises the powers mentioned in paragraph 20SA(b) or 20TA(b).

             (2)  The identity card must:

                     (a)  be in the form approved by the Private Health Insurance Ombudsman; and

                     (b)  contain a photograph that is no more than 5 years old of the person to whom it is issued.

             (3)  A person must carry an identity card at all times when exercising powers under section 20SA or 20TA.

             (4)  A person commits an offence of strict liability if:

                     (a)  the person ceases to be:

                              (i)  a member of staff mentioned in section 31; or

                             (ii)  a person to whom the Private Health Insurance Ombudsman has delegated powers under section 34 in relation to section 20SA or 20TA; and

                     (b)  the person does not, within 14 days of so ceasing, return the person’s identity card to the Private Health Insurance Ombudsman.

Penalty:  1 penalty unit.

             (5)  Subsection (4) does not apply if the identity card was lost or destroyed.

Note:          A defendant bears an evidential burden in relation to the matter in subsection (5) (see subsection 13.3(3) of the Criminal Code ).

6  Subsection 34(2C)

Omit “a member of staff mentioned in section 31”, substitute “a person”.

7  Subsection 34(2C)

Omit “and 20V”, substitute “, paragraph 20SB(4)(b) and section 20V”.

8  Application

The amendments made by this Schedule apply in relation to a complaint made under Division 3 of Part IID of the Ombudsman Act 1976 on or after 1 July 2018.

9  Delegation

A delegation in force under subsection 34(2C) of the Ombudsman Act 1976 immediately before 1 July 2018 has effect on and after that day as if it were a delegation made under subsection 34(2C) of that Act as amended by this Schedule.