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Health Legislation Amendment Bill (No. 2) 2001
Schedule 3 Amendment of the Private Health Insurance Incentives Act 1998

Part 1 Low claims and late claims

1  After section 15-20

Insert:

15-21   Additional payment if fund claims less than entitlement

             (1)  This section applies to a * health fund in respect of a month if:

                     (a)  the health fund is a * participating fund in respect of the month; and

                     (b)  the health fund made a claim in respect of the month under section 15-5; and

                     (c)  the amount claimed by the health fund was less than the sum of the amounts by which premiums in respect of the month under the appropriate health insurance policies issued by the health fund were reduced because of the operation of this Chapter.

             (2)  The * health fund may apply to the * Managing Director for payment of an amount (the additional amount ) not exceeding the difference between:

                     (a)  the sum of the amounts by which premiums in respect of the month under the * appropriate health insurance policies issued by the health fund were reduced because of the operation of this Chapter; and

                     (b)  the amount already paid to the health fund under section 15-5 in respect of the month.

             (3)  An application under subsection (2) may relate to more than one month.

15-22   Additional payment if fund makes a late claim

             (1)  This section applies to a * health fund in respect of a month if:

                     (a)  the health fund did not make a claim in respect of the month on or before the last day of the * notification period for the month; and

                     (b)  premiums in respect of the month under the * appropriate health insurance policies issued by the health fund were reduced because of the operation of this Chapter.

             (2)  The * health fund may apply to the * Managing Director for payment of an amount (the additional amount ) not exceeding the sum of the amounts by which premiums in respect of the month under the * appropriate health insurance policies issued by the health fund were reduced because of the operation of this Chapter.

             (3)  An application under subsection (2) may relate to more than one month.

15-23   Contents and timing of application

             (1)  An application by a * health fund under section 15-21 or 15-22 for payment of an additional amount must contain the following:

                     (a)  the name of the health fund;

                     (b)  the additional amount sought;

                     (c)  the month, or months, in respect of which the additional amount is sought;

                     (d)  a certificate in writing signed by a registered company auditor that the additional amount sought is correct;

                     (e)  such other details as the * Managing Director determines in writing.

             (2)  The application must be made:

                     (a)  if the application relates to only one month—within 3 years of the last day of the * notification period for that month; or

                     (b)  if the application relates to more than one month—within 3 years of the last day of the notification period for the first of those months.

             (3)  An application under section 15-21 must also contain, in respect of each month to which the application relates, an explanation of why the amount claimed under section 15-5 was less than the sum of the amounts by which premiums in respect of the month under the * appropriate health insurance policies issued by the * health fund were reduced because of the operation of this Chapter.

             (4)  An application under section 15-22 must also contain, in respect of each month to which the application relates, an explanation of why the * health fund did not make a claim on or before the last day of the * notification period for the month.

15-24   Decision on application

             (1)  If a * health fund makes an application under section 15-21 or 15-22 for payment of an additional amount, the * Managing Director must pay the additional amount sought if the Managing Director is satisfied:

                     (a)  that the additional amount sought is correct; and

                     (b)  that it would be reasonable to grant the application, having regard to the explanation mentioned in subsection 15-23(3) or (4).

             (2)  The * Managing Director may refuse the application, or decide to pay only part of the additional amount sought, if the Managing Director is satisfied:

                     (a)  that the additional amount sought is incorrect; or

                     (b)  that it would not be reasonable to grant the application, having regard to the explanation mentioned in subsection 15-23(3) or (4).

             (3)  The * Managing Director must notify the * health fund of the Managing Director’s decision on the application.

             (4)  A notice under subsection (3) must include reasons for the decision.

             (5)  The * Managing Director is taken, for the purposes of this Act, to have decided that:

                     (a)  the additional amount sought is correct; and

                     (b)  that it would be reasonable to grant the application;

if the Managing Director does not give notice of his or her decision that the additional amount sought is incorrect, or that it would not be reasonable to grant the application, within the period of 3 months after the application was received by the Managing Director.

             (6)  If the * Managing Director is taken to have made a decision under subsection (5) in respect of a * health fund, the Managing Director is taken to have given notice of that decision to the health fund.

2  Subsection 15-25(1)

After “15-20(1A)”, insert “or 15-24(3)”.

3  Paragraphs 18-5(1)(c), (ca), (d) and (e)

After “15-5”, insert “or 15-24”.

4  Paragraph 19-10(e)

After “15-10”, insert “, or an additional amount sought under section 15-21 or 15-22,”.

5  Application

A * health fund may make an application under section 15-21 or 15-22 of the Private Health Insurance Incentives Act 1998 , as amended by this Part, in respect of a month occurring before or after the commencement of this item.



 

Part 2 Premium reductions

6  Subsection 11-25(1)

Omit “it must, within 28 days after the day on which the refusal occurs,”, substitute “it must”.

7  After subsection 12-5(1)

Insert:

          (1A)  The amount by which the premium is to be reduced depends on whether or not a person was registered, or eligible to apply for registration, before 1 January 1999 under the Private Health Insurance Incentives Act 1997 in respect of the policy for the financial year.

          (1B)  If the financial year is the financial year that began on 1 July 1998, and no person was so registered or eligible to apply for registration, the amount of the reduction is 30% of the amount of the premium payable under the policy for the financial year.

8  Subsection 12-5(2)

After “1998,”, insert “and a person was so registered or eligible to apply for registration,”.

9  After subsection 12-5(2)

Insert:

          (2A)  If the financial year is a later financial year, and no person was so registered or eligible to apply for registration, the amount of the reduction is 30% of the amount of the premium payable under the policy for the financial year.

10  Subsection 12-5(3)

After “financial year,” (second occurring), insert “and a person was so registered or eligible to apply for registration,”.

11  Transitional provision

If:

                     (a)  before the commencement day, a * health fund reduced premiums in respect of a month in accordance with section 12-5 of the Private Health Insurance Incentives Act 1998 ; and

                     (b)  the fund made a claim under section 15-10 in relation to the month within the period specified in that section;

the amendments made by this Schedule are taken not to affect the amount paid, or payable, to the fund in respect of the month.



 

Part 3 Technical amendment

12  Subsection 15-5(2)

Omit “The HIC must pay to the * health fund”, substitute “If a * health fund makes a claim that the HIC decides is correct, the HIC must pay to the fund”.