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Schedule 5—Miscellaneous

Schedule 5 Miscellaneous

Part 1 Benefits for travel and accommodation

Private Health Insurance Act 2007

1  Paragraph 55-5(2)(d)

Repeal the paragraph, substitute:

                     (d)  where a person lives, except to the extent allowed under subsection 66-10(2) or section 66-20 or 66-25; or

2  At the end of Division 66

Add:

66-25   Different amounts of benefits for travel or accommodation

                   Neither:

                     (a)  the community rating principle in section 55-5; nor

                     (b)  the community rating requirements in section 66-1;

prevents a private health insurer from determining a person’s entitlement under a * complying health insurance policy to a benefit for travel or accommodation in respect of * hospital treatment or * general treatment based on the distance between the person’s principal place of residence and the facility where treatment is provided.

3  After subsection 121-5(2)

Insert:

          (2A)  Without limiting subsection (1) or (2), hospital treatment also includes benefits for travel or accommodation relating to treatment covered by subsection (1) or (2).

4  Subsection 121-5(4)

Omit “and (2)”, substitute “, (2) and (2A)”.

5  After subsection 121-10(2)

Insert:

          (2A)  Despite paragraph (1)(b), general treatment also includes benefits for travel or accommodation relating to hospital treatment.

6  Subsection 121-10(3)

Omit “and (2)”, substitute “, (2) and (2A)”.

Part 2 Information requirements

Private Health Insurance Act 2007

7  Section 93-1 (heading)

Omit “ standard information statements ”, substitute “ private health information statements ”.

8  Subsection 93-1(1)

Omit “ * standard information statement”, substitute “ * private health information statement”.

9  Subsection 93-1(1A)

Omit “ * standard information statement may be the standard information statement”, substitute “ * private health information statement may be the private health information statement”.

10  Subsections 93-1(2) and (3)

Omit “ * standard information statement”, substitute “ * private health information statement”.

11  Paragraph 93-1(4)(a)

Omit “ * standard information statement”, substitute “ * private health information statement”.

12  Paragraph 93-1(4)(b)

Omit “standard information statement”, substitute “private health information statement”.

13  Section 93-5 (heading)

Omit “ standard information statement ”, substitute “ private health information statement ”.

14  Subsection 93-5(1)

Omit “ standard information statement ”, substitute “ private health information statement ”.

15  Subsection 93-5(2)

Omit “ * standard information statements”, substitute “ * private health information statements”.

16  Section 93-10 (heading)

Omit “ standard information statements ”, substitute “ private health information statements ”.

17  Paragraph 93-10(a)

Omit “ * standard information statement”, substitute “ * private health information statement”.

18  Paragraph 93-15(1)(a)

Omit “ * standard information statement”, substitute “ * private health information statement”.

19  Subsection 93-20(1)

Omit “ * standard information statement”, substitute “ * private health information statement”.

20  Paragraph 93-20(2)(b)

Omit “ * standard information statements”, substitute “ * private health information statements”.

21  Paragraph 93-20(2)(d)

Omit “standard information statement”, substitute “private health information statement”.

22  Section 96-1 (heading)

Omit “ standard information statements ”, substitute “ private health information statements ”.

23  Section 96-1

Omit “ * standard information statements”, substitute “ * private health information statements”.

24  Section 96-5 (heading)

Omit “ standard information statements ”, substitute “ private health information statements ”.

25  Section 96-5

Omit “ * standard information statements”, substitute “ * private health information statements”.

26  Section 96-10 (heading)

Omit “ standard information statements ”, substitute “ private health information statements ”.

27  Section 96-10

Omit “ * standard information statements”, substitute “ * private health information statements”.

28  Clause 1 of Schedule 1

Insert:

private health information statement is defined in section 93-5.

29  Clause 1 of Schedule 1 (definition of standard information statement )

Repeal the definition.

30  Clause 1 of Schedule 1 (definition of up to date )

Repeal the definition, substitute:

up to date , in relation to a * private health information statement, is defined in subsection 93-1(2).

Part 3 Benefit requirements according to class of hospital

Private Health Insurance Act 2007

31  After section 121-7

Insert:

121-8   Application for inclusion of hospital in a class

             (1)  A person may apply to the Minister for a * hospital to be included in a class set out in the Private Health Insurance (Health Insurance Business) Rules.

             (2)  The application must be:

                     (a)  in the * approved form; and

                     (b)  accompanied by any application fee imposed under the Private Health Insurance (Health Insurance Business) Rules.

121-8A   Minister to decide application

             (1)  The Minister must consider whether a * hospital to which an application relates satisfies the assessment criteria set out in the Private Health Insurance (Health Insurance Business) Rules.

             (2)  If the * hospital satisfies the assessment criteria, the Minister must, within 60 days after the day the application is made:

                     (a)  include the hospital in a class set out in the Private Health Insurance (Health Insurance Business) Rules; and

                     (b)  notify the person, in writing, of:

                              (i)  the hospital’s inclusion in a class set out in the Rules; and

                             (ii)  the day that the hospital is included in that class and the day that the hospital’s inclusion in that class ends.

             (3)  If the * hospital does not satisfy the assessment criteria, the Minister must, within 60 days after the day the application is made:

                     (a)  notify the person, in writing, of that fact; and

                     (b)  provide reasons for the decision.

Note:          A decision that a hospital does not satisfy the assessment criteria set out in the Private Health Insurance (Health Insurance Business) Rules is reviewable under Part 6-9.

121-8B   Period of inclusion of hospital in a class

                   The inclusion of a * hospital in a class set out in the Private Health Insurance (Health Insurance Business) Rules:

                     (a)  comes into force on the day specified in the notice referred to in subparagraph 121-8A(2)(b)(ii); and

                     (b)  expires on the day specified in that notice, unless it is revoked earlier.

121-8C   Revocation of inclusion of hospital in a class

                   The Minister may revoke the inclusion of a * hospital in a class set out in the Private Health Insurance (Health Insurance Business) Rules if the Minister considers that the hospital ceases to satisfy the assessment criteria set out in the Rules.

Note:          A decision to revoke the inclusion of a hospital in a class set out in the Private Health Insurance (Health Insurance Business) Rules is reviewable under Part 6-9.

121-8D   Private Health Insurance (Health Insurance Business) Rules

                   The Private Health Insurance (Health Insurance Business) Rules may provide for all or any of the following:

                     (a)  for the purposes of this Part and Division 72—set out one or more classes of * hospital;

                     (b)  impose an application fee for the purposes of section 121-8;

                     (c)  set out assessment criteria for including a hospital in a particular class;

                     (d)  set out matters of a transitional nature relating to the current arrangements for hospitals and the new application process provided for by section 121-8.

32  Section 328-5 (after table item 4A)

Insert:

 

5

To decide that a * hospital does not satisfy the assessment criteria set out in the Private Health Insurance (Health Insurance Business) Rules

section 121-8A

6

To decide to revoke a * hospital’s inclusion in a class set out in the Private Health Insurance (Health Insurance Business) Rules

section 121-8C

 

Part 4 Closed and terminated products

Private Health Insurance Act 2007

33  Section 55-10

Repeal the section, substitute:

55-10   Closed products, and terminated products and product subgroups

                   The principle of community rating in section 55-5 does not:

                     (a)  prevent a private health insurer from closing a * complying health insurance product, such that the * product will not be available to anyone except those persons, who at the time of closing, are insured under a policy forming part of the product; or

                     (b)  prevent a private health insurer from terminating a complying health insurance product or a * product subgroup of a complying health insurance product, such that:

                              (i)  in the case of a product—the product will not be available to any person insured under a policy forming part of the product; and

                             (ii)  in the case of a product subgroup—the product subgroup will not be available to any person insured under a policy that belongs to the product subgroup.

34  Subsection 78-1(1)

Omit “and (4)”, substitute “, (4) and (5A)”.

35  After subsection 78-1(5)

Insert:

          (5A)  An insurance policy meets the requirement in this subsection if:

                     (a)  the policy forms part of a * complying health insurance product or belongs to a * product subgroup of a complying health insurance product; and

                     (b)  the * product or product subgroup is being terminated by the private health insurer, and as a consequence, an * adult insured under the policy is to be transferred to a new policy; and

                     (c)  the insurer informs the adult insured under the policy, in writing, of the matters set out in the Private Health Insurance (Complying Product) Rules; and

                     (d)  the adult insured under the policy is informed of those matters a reasonable time before the transfer to the new policy is to take effect.

Note:          See also section 55-10.