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Private Health Insurance Bill 2007

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2004-2005-2006-2007

 

 

THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA

 

 

THE SENATE

 

 

Private Health Insurance Bill 2006

 

 

Schedule of the amendments made by the Senate

 

 

 

 

 

(1)     Govt (1) [Sheet PA372]

          Clause 23-10, page 10 (line 26), omit “policy to which subsection (1) applied”, substitute “ * complying health insurance policy”.

(2)     Govt (2) [Sheet PA372]

          Clause 23-10, page 10 (line 28), omit “amount payable”, substitute “reduction”.

(3)     Govt (3) [Sheet PA372]

          Clause 26-5, page 17 (line 6), omit “policy to which subsection (1) applied”, substitute “ * complying health insurance policy”.

(4)     Govt (4) [Sheet PA372]

          Heading to clause 50-5, page 31 (lines 18 to 20), omit the heading, substitute:

50-5   Private Health Insurance Rules relevant to this Chapter

(5)     Govt (5) [Sheet PA372]

          Clause 50-5, page 31 (line 23), after “Rules,”, insert “the Private Health Insurance (Benefit Requirements) Rules,”.

(6)     Govt (6) [Sheet PA372]

          Clause 55-5, page 32 (line 26), omit “paragraph 66-10(2)(a)”, substitute “subsection 66-10(2)”.



(7)     Govt (7) [Sheet PA372]

          Clause 63-1, page 35 (line 5), before “A private”, insert “(1)”.

(8)     Govt (8) [Sheet PA372]

          Clause 63-1, page 35 (after line 7), at the end of the clause, add:

             (2)  However, subsection (1) does not apply in relation to * health insurance business of a kind that the Private Health Insurance (Complying Product) Rules specify is excluded from subsection (1).

(9)     Govt (9) [Sheet PA372]

          Clause 63-5, page 35 (after line 16), after subclause (2), insert:

          (2A)  A product subgroup , of a * product, is all the insurance policies in the product:

                     (a)  under which the addresses of the people insured, as known to the private health insurer, are located in the same * risk equalisation jurisdiction; and

                     (b)  under which the same kind of insured group (within the meaning of the Private Health Insurance (Complying Product) Rules) is insured.

          (2B)  The Private Health Insurance (Complying Product) Rules may specify insured groups for the purposes of paragraph (2A)(b). An insured group may be specified by reference to any or all of the number of people in the group, the kind of people in the group, or any other matter. A group may consist of only one person.

(10)   Govt (10) [Sheet PA372]

          Clause 66-5, page 37 (lines 27 to 29), omit paragraph (1)(a), substitute:

                     (a)  is the amount specified for the * product subgroup to which the policy belongs in the most recent approval under section 66-10; or

(11)   Govt (11) [Sheet PA372]

          Clause 66-5, page 38 (line 3), omit subparagraph (1)(c)(ii), substitute:

                             (ii)  because of a discount or discounts allowed under subsection (2), if the total percentage discount (not counting discounts available for the reason in paragraph (3)(f)) does not exceed the percentage specified in the Private Health Insurance (Complying Product) Rules as the maximum percentage discount allowed; or

(12)   Govt (12) [Sheet PA372]

          Clause 66-5, page 38 (lines 5 to 19), omit subclause (2), substitute:

             (2)  A discount is allowed if:

                     (a)  it is for a reason in subsection (3); and

                     (b)  the discount is also available for that reason under every policy in the * product; and

                     (c)  if there are different percentage discounts available for that reason—the same percentage discount is available on the same basis under every policy in the product; and

                     (d)  any other conditions set out in the Private Health Insurance (Complying Product) Rules are met.

             (3)  A discount may be for any of these reasons:

                     (a)  because premiums are paid at least 3 months in advance;

                     (b)  because premiums are paid by payroll deduction;

                     (c)  because premiums are paid by pre-arranged automatic transfer from an account at a bank or other financial institution;

                     (d)  because the persons insured under the policy have agreed to communicate with the private health insurer, and make claims under the policy, by electronic means;

                     (e)  because a person insured under the policy is, under the * rules of the private health insurer, treated as belonging to a contribution group;

                      (f)  because the insurer is not required to pay a levy in relation to the policy under a law of a State or Territory;

                     (g)  for a reason set out in the Private Health Insurance (Complying Product) Rules.

(13)   Govt (13) [Sheet PA372]

          Clause 66-10, page 38 (line 27) to page 39 (line 9), omit subclause (2), substitute:

             (2)  The application may propose different changes for policies in the * product, but the proposed changed amount must be the same for each policy in the product that belongs to the same * product subgroup.

(14)   Govt (14) [Sheet PA372]

          Clause 66-10, page 39 (lines 20 to 22), omit subclause (5).

(15)   Govt (15) [Sheet PA372]

          Clause 69-1, page 41 (lines 4 to 10), omit subclause (1), substitute:

             (1)  An insurance policy meets the coverage requirements in this Division if:

                     (a)  the only treatments the policy * covers are:

                              (i)  specified treatments that are * hospital treatment; or

                             (ii)  specified treatments that are hospital treatment and specified treatments that are * general treatment; or

                            (iii)  specified treatments that are general treatment but none that are hospital-substitute treatment; and

                     (b)  if the policy provides a benefit for anything else—the provision of the benefit is authorised by the Private Health Insurance (Complying Product) Rules.

(16)   Govt (16) [Sheet PA372]

          Clause 69-1, page 41 (line 11), omit “subsection (1)”, substitute “paragraph (1)(a)”.

(17)   Govt (17) [Sheet PA372]

          Clause 69-1, page 41 (line 14), omit “subsection (1)”, substitute “paragraph (1)(a)”.

(18)   Govt (18) [Sheet PA372]

          Page 41 (after line 27), at the end of Division 69, add:

69-10   Meaning of hospital-substitute treatment

                   Hospital-substitute treatment means * general treatment that:

                     (a)  substitutes for an episode of * hospital treatment; and

                     (b)  is any of, or any combination of, nursing, medical, surgical, podiatric surgical, diagnostic, therapeutic, prosthetic, pharmacological, pathology or other services or goods intended to manage a disease, injury or condition; and

                     (c)  is not specified in the Private Health Insurance (Complying Product) Rules as a treatment that is excluded from this definition.

(19)   Govt (19) [Sheet PA372]

          Clause 72-1, page 43 (cell at table item 1, 3rd column), omit the cell, substitute:

at least the amount set out, or worked out using the method set out, in the Private Health Insurance (Benefit Requirements) Rules as the minimum benefit, or method for working out the minimum benefit, for that treatment.

(20)   Govt (20) [Sheet PA372]

          Clause 72-1, page 44 (cell at table item 4, 3rd column), omit the cell, substitute:

(a) at least the amount set out, or worked out using the method set out, in the Private Health Insurance (Prostheses) Rules as the minimum benefit, or method for working out the minimum benefit, for the prosthesis; and

(b) if the Private Health Insurance (Prostheses) Rules set out an amount, or a method for working out an amount, as the maximum benefit, or method for working out the maximum benefit, for the prosthesis—no more than that amount or the amount worked out using that method.

 



(21)   Govt (21) [Sheet PA372]

          Clause 72-1, page 44 (table item 5), omit the table item, substitute:

5

any treatment for which the Private Health Insurance (Benefit Requirements) Rules specify there must be a benefit.

at least the amount set out, or worked out using the method set out, in the Private Health Insurance (Benefit Requirements) Rules as the minimum benefit, or method for working out the minimum benefit, for that treatment.

(22)   Govt (22) [Sheet PA372]

          Clause 72-1, page 44 (lines 1 and 2), omit “a policy holder with, or arranges for a policy holder”, substitute “an insured person with, or arranges for an insured person”.

(23)   Govt (23) [Sheet PA372]

          Clause 72-15, page 46 (line 25), omit “14 days”, substitute “28 days”.

(24)   Govt (24) [Sheet PA372]

          Page 46 (after line 30), at the end of Division 72, add:

72-20   Other matters

                   The Private Health Insurance (Prostheses) Rules may, in relation to application fees, initial listing fees or ongoing listing fees imposed under the Private Health Insurance (Prostheses Application and Listing Fees) Act 2007 , provide for, or for matters relating to, any or all of the following:

                     (a)  methods for payment;

                     (b)  extending the time for payment;

                     (c)  refunding or otherwise applying overpayments.

(25)   Govt (25) [Sheet PA372]

          Clause 75-1, page 47 (lines 23 and 24), omit “a policy holder with, or arranges for a policy holder”, substitute “an insured person with, or arranges for an insured person”.

(26)   Govt (26) [Sheet PA372]

          Clause 78-1, page 51 (lines 18 and 19), omit “a policy holder with, or arranges for a policy holder”, substitute “an insured person with, or arranges for an insured person”.



(27)   Govt (27) [Sheet PA372]

          Clause 84-1, page 53 (line 14), after “treatment”, insert “or provides a benefit for anything else”.

(28)   Govt (28) [Sheet PA372]

          Clause 93-1, page 58 (line 6), after “each”, insert “ * product subgroup of each”.

(29)   Govt (29) [Sheet PA372]

          Clause 93-1, page 58 (line 8), after “each”, insert “product subgroup of each”.

(30)   Govt (30) [Sheet PA372]

          Clause 93-1, page 58 (after line 9), after subclause (1), insert:

          (1A)  A single * standard information statement may be the standard information statement for more than one * product subgroup of a * complying health insurance product if the premiums payable under policies in the subgroups the statement covers are the same.

(31)   Govt (1) [Sheet PA372]

          Clause 93-1, page 58 (line 10), after “for a”, insert “ * product subgroup of a”.

(32)   Govt (32) [Sheet PA372]

          Clause 93-1, page 58 (line 14), after “for a”, insert “ * product subgroup of a”.

(33)   Govt (33) [Sheet PA372]

          Clause 93-1, page 58 (line 18), after “for a”, insert “ * product subgroup of a”.

(34)   Govt (34) [Sheet PA372]

          Clause 93-5, page 58 (line 25), after “for a”, insert “ * product subgroup of a”.

(35)   Govt (35) [Sheet PA372]

          Clause 93-5, page 58 (line 26), after “the product”, insert “subgroup”.

(36)   Govt (36) [Sheet PA372]

          Clause 93-10, page 59 (line 10), omit “product”, substitute “ * product subgroup that is likely to apply to the person”.

(37)   Govt (37) [Sheet PA372]

          Clause 93-10, page 59 (line 13), after “statement”, insert “for that subgroup”.

(38)   Govt (38) [Sheet PA372]

          Clause 93-15, page 59 (line 19), omit “that the policy is in”, substitute “subgroup that the policy belongs to”.

(39)   Govt (39) [Sheet PA372]

          Clause 93-20, page 60 (lines 4 and 5), omit “that the policy is in”, substitute “subgroup that the policy belongs to”.

(40)   Govt (40) [Sheet PA372]

          Clause 93-20, page 60 (line 10), omit “statement”, substitute “statements”.

(41)   Govt (41) [Sheet PA372]

          Clause 93-20, page 60 (line 16), after “statement”, insert “for the * product subgroup that the policy belongs to”.

(42)   Govt (42) [Sheet PA372]

          Clause 93-20, page 60 (lines 23 to 30), omit subclause (4) (including the note), substitute:

             (4)  If a private health insurer changes the * health benefits fund to which a * complying health insurance policy of the insurer is * referable, the insurer must ensure that:

                     (a)  before the change takes effect, an * adult insured under the policy is given a statement identifying the health benefits fund to which the policy will be referable as a result of the change; or

                     (b)  within 2 weeks after the change takes effect, an adult insured under the policy is given a statement identifying the health benefits fund to which the policy is 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.

(43)   Govt (43) [Sheet PA372]

          Clause 96-1, page 62 (line 11), omit “statement”, substitute “statements”.

(44)   Govt (44) [Sheet PA372]

          Clause 96-1, page 62 (lines 12 and 13), omit “an * up to date copy of the statement”, substitute “ * up to date copies of the statements”.



(45)   Govt (45) [Sheet PA372]

          Clause 96-5, page 62 (lines 16 to 18), omit “a copy of the * standard information statement for a * complying health insurance product of the insurer is”, substitute “copies of the * standard information statements for a * complying health insurance product of the insurer are”.

(46)   Govt (46) [Sheet PA372]

          Clause 96-10, page 62 (lines 26 and 27), omit “statement for a * complying health insurance product of the insurer is updated, a copy of the updated statement is”, substitute “statements for a * complying health insurance product of the insurer are updated, copies of the updated statements are”.

(47)   Govt (47) [Sheet PA372]

          Clause 99-1, page 65 (after line 24), after subclause (2), insert:

          (2A)  A private health insurer must not request a certificate except in the circumstances set out in subsection (2).

(48)   Govt (48) [Sheet PA372]

          Clause 121-5, page 75 (line 16), omit “ * policy holders of”, substitute “persons insured under * complying health insurance products that are * referable to”.

(49)   Govt (49) [Sheet PA372]

          Clause 121-5, page 75 (after line 16), after paragraph (7)(e), insert:

                    (ea)  if the Minister is deciding whether to revoke such a declaration—any contravention of conditions to which the declaration is subject; and

(50)   Govt (50) [Sheet PA372]

          Page 75 (after line 21), after clause 121-5, insert:

121-7   Conditions on declarations of hospitals

             (1)  A declaration under paragraph 121-5(6)(a) that a facility is a hospital is subject to:

                     (a)  any conditions specified under subsection (2); and

                     (b)  any conditions that the Minister specifies under subsection (3) in relation to the facility.

Note:          Decisions by the Minister to specify conditions in relation to particular facilities are reviewable under Part 6-9.

             (2)  The Private Health Insurance (Health Insurance Business) Rules may specify conditions to which declarations under paragraph 121-5(6)(a) are subject. Any conditions so specified apply to all such declarations, whether or not the declarations were made before the conditions were so specified.

             (3)  The Minister may specify:

                     (a)  in a declaration under paragraph 121-5(6)(a) relating to a facility; or

                     (b)  in a written notice given to a facility for which such a declaration is already in force;

conditions, or additional conditions, to which the declaration is subject.

             (4)  A contravention of a condition to which a declaration under paragraph 121-5(6)(a) is subject does not cause the declaration to cease to have effect.

Note:          Contraventions are taken into consideration in deciding whether to revoke a declaration.

(51)   Govt (51) [Sheet PA372]

          Clause 126-40, page 83 (line 30) to page 84 (line 7), omit subclause (2), substitute:

             (2)  If:

                     (a)  because of subsection (1) or otherwise, a private health insurer is not * registered as a for profit insurer; and

                     (b)  the Council approves under section 126-42 an application by the insurer for the insurer to convert to being registered as a for profit insurer;

the insurer is taken, from the day specified in the Council’s approval, to be registered as a for profit insurer for the purposes of this Act.

(52)   Govt (52) [Sheet PA372]

          Page 84 (after line 34), after clause 126-40, insert:

126-42   Conversion to for profit stat us

             (1)  A private health insurer may apply to the Council for approval to convert to being * registered as a for profit insurer.

             (2)  The application:

                     (a)  must be in the * approved form; and

                     (b)  must include a conversion scheme that is:

                              (i)  in the approved form; and

                             (ii)  accompanied by such further information as is specified in the Private Health Insurance (Registration) Rules; and

                     (c)  must be given to the Council at least 90 days before the day specified in the application as the day on which the insurer proposes that it become * registered as a for profit insurer.

             (3)  The Council must approve the application if the Council is satisfied, within 30 days after the application was made, that the conversion scheme would not in substance involve the demutualisation of the insurer.

             (4)  If subsection (3) does not apply:

                     (a)  the Council must, at least 45 days before the day specified in the application, cause a notice of the application to be published in a national newspaper, or in a newspaper circulating in each jurisdiction where the insurer has its registered office or carries on business; and

                     (b)  the Council may, within 90 days after the application is made, give the insurer written notice requiring the insurer to give the Council such further information relating to the application as is specified in the notice.

             (5)  If subsection (3) does not apply, the Council must approve the application if:

                     (a)  the insurer has complied with subsection (2) in relation to the application, and given to the Council such further information as the Council has required under paragraph (4)(b); and

                     (b)  the Council is satisfied that the conversion scheme would not result in a financial benefit to any person who is not a * policy holder of, or another person insured through, a * health benefits fund conducted by the insurer; and

                     (c)  the Council is satisfied that the conversion scheme would not result in financial benefits from the scheme being distributed inequitably between such policy holders and insured persons.

             (6)  The Private Health Insurance (Registration) Rules may provide for criteria for deciding, for the purposes of subsection (3), whether a conversion scheme would not in substance involve the demutualisation of the insurer.

             (7)  The Council must cause the insurer to be notified in writing of the Council’s decision on the application.

Note:          Refusals of applications are reviewable under Part 6-9.

(53)   Govt (53) [Sheet PA372]

          Clause 137-1, page 90 (after line 21), after subclause (4), insert:

          (4A)  The assets of a * health benefits fund:

                     (a)  include assets that, in accordance with a restructure or arrangement approved under Division 146, are to be assets of the fund; but

                     (b)  do not include assets that, in accordance with such a restructure or arrangement, are no longer to be assets of the fund.

(54)   Govt (54) [Sheet PA372]

          Clause 137-10, page 92 (lines 7 to 9), omit subparagraph (2)(a)(i), substitute:

                              (i)  meeting * policy liabilities and other liabilities, or expenses, incurred for the purposes of the business of the fund (including policy liabilities and other liabilities that are treated, in accordance with a restructure or arrangement approved under Division 146, as policy liabilities and other liabilities incurred for the purposes of the fund); or

(55)   Govt (55) [Sheet PA372]

          Clause 137-10, page 92 (after line 12), at the end of paragraph (2)(a), add:

                            (iv)  a purpose specified in the Private Health Insurance (Health Benefits Fund Policy) Rules for the purposes of this subparagraph; or

(56)   Govt (56) [Sheet PA372]

          Clause 137-10, page 92 (line 19), omit “other” (second occurring).

(57)   Govt (57) [Sheet PA372]

          Clause 140-20, page 99 (line 16), omit “organisation”, substitute “insurer”.

(58)   Govt (58) [Sheet PA372]

          Clause 140-20, page 99 (line 26), omit “issuing”, substitute “giving”.

(59)   Govt (59) [Sheet PA372]

          Clause 143-20, page 104 (line 18), omit “organisation”, substitute “insurer”.

(60)   Govt (60) [Sheet PA372]

          Clause 143-20, page 104 (line 30), omit “issuing”, substitute “giving”.

(61)   Govt (61) [Sheet PA372]

          Clause 146-1, page 106 (lines 5 to 15), omit subclause (1), substitute:

             (1)  A private health insurer may restructure its * health benefits funds so that insurance policies that are * referable to a health benefits fund (a transferring fund ) of the insurer become referable to one or more other health benefits funds ( receiving funds ) of the insurer (whether existing or proposed) if:

                     (a)  the insurance policies concerned are all of the policies that, immediately before the restructure, were referable to the transferring fund and belonged to one or more * policy groups of that fund; and

                     (b)  the insurer applies to the Council, in the * approved form, for approval of the restructure; and

                     (c)  the Council approves the restructure in writing; and

                     (d)  the insurer complies with any requirements that the Private Health Insurance (Health Benefits Fund Administration) Rules impose on the insurer in relation to the restructure.

(62)   Govt (62) [Sheet PA372]

          Clause 146-1, page 106 (line 17), after “if”, insert “, and only if,”.

(63)   Govt (63) [Sheet PA372]

          Clause 146-1, page 106 (lines 18 and 19), omit paragraph (2)(a), substitute:

                     (a)  the * assets and liabilities that would be transferred to the receiving fund or funds represent a reasonable estimate of what would, immediately before the restructure, be the * net asset position of the transferring fund; and

                    (aa)  if there is more than one receiving fund—those assets and liabilities would be fairly distributed between the receiving funds; and



(64)   Govt (64) [Sheet PA372]

          Clause 146-1, page 106 (after line 21), after subclause (2), insert:

          (2A)  For the purposes of paragraph (2)(a), in working out the * net asset position of the transferring fund, disregard the net asset position of the fund to the extent that it relates to insurance policies that do not belong to a * policy group referred to in paragraph (1)(a).

(65)   Govt (65) [Sheet PA372]

          Clause 146-1, page 106 (lines 25 and 26), omit “(a transferring fund )”.

(66)   Govt (66) [Sheet PA372]

          Clause 146-1, page 106 (line 31), omit “(a receiving fund )”.

(67)   Govt (67) [Sheet PA372]

          Clause 146-1, page 107 (after line 5), after paragraph (4)(a), insert:

                    (aa)  how to work out reasonable estimates of the kind referred to in paragraph (2)(a);

                   (ab)  criteria for deciding, for the purposes of paragraph (2)(aa), whether assets and liabilities would be fairly distributed;

(68)   Govt (68) [Sheet PA372]

          Clause 146-1, page 107 (lines 12 and 13), omit subparagraph (4)(c)(ii), substitute:

                             (ii)  * policy liabilities and other liabilities incurred for the purposes of a transferring fund becoming treated as policy liabilities and other liabilities incurred for the purposes of a receiving fund or funds;

(69)   Govt (69) [Sheet PA372]

          Clause 146-5, page 108 (line 1) to page 109 (line 21), omit the clause, substitute:

146-5   Merger and acquisition of health benefits funds

             (1)  A private health insurer (the transferee insurer ) may enter into an arrangement with one or more other private health insurers ( transferor insurers ) under which:

                     (a)  insurance policies that are * referable to a * health benefits fund or funds ( transferring funds ) of the transferor insurer or transferor insurers become referable to a health benefits fund or funds ( receiving funds ) of the transferee insurer; and

                     (b)  in relation to each of the transferring funds, the insurance policies concerned are:

                              (i)  all of the insurance policies that are referable to the transferring fund; or

                             (ii)  all of the insurance policies that are referable to the transferring fund and that belong to one or more * policy groups of the fund.

             (2)  However, the arrangement must not take effect unless:

                     (a)  the insurers referred to in subsection (1) apply jointly to the Council, in the * approved form, for approval of the arrangement; and

                     (b)  the Council approves the arrangement in writing; and

                     (c)  the insurers comply with any requirements that the Private Health Insurance (Health Benefits Fund Administration) Rules impose on the insurers in relation to the arrangement.

             (3)  The Council must approve the arrangement if, and only if, it is satisfied that:

                     (a)  the * assets and liabilities that would be transferred, under the arrangement, to the receiving fund or funds represent a reasonable estimate of what would, immediately before the restructure, be:

                              (i)  if there is only one transferring fund—the * net asset position of the fund; or

                             (ii)  if there is more than one transferring fund—the sum of the net asset positions of each of the funds; and

                     (b)  if, under the arrangement, there would be more than one receiving fund—those assets and liabilities would be fairly distributed between the receiving funds; and

                     (c)  if subparagraph (1)(b)(i) applies to any transferring fund—the net asset position of the fund immediately after the arrangement takes effect will not be greater than zero; and

                     (d)  the arrangement will not result in any breach of the * solvency standard or the * capital adequacy standard if it takes effect.

Note:          Refusals to approve transfers are reviewable under Part 6-9.

             (4)  For the purposes of paragraph (3)(a), in working out the * net asset position of a transferring fund to which subparagraph (1)(b)(ii) applies, disregard the net asset position of the fund to the extent that it relates to insurance policies that do not belong to a * policy group referred to in that subparagraph.

             (5)  The Private Health Insurance (Health Benefits Fund Administration) Rules may provide for the following:

                     (a)  criteria for approving or refusing to approve applications under this section;

                     (b)  how to work out reasonable estimates of the kind referred to in paragraph (3)(a);

                     (c)  criteria for deciding, for the purposes of paragraph (3)(b), whether assets and liabilities would be fairly distributed;

                     (d)  requirements to notify interested persons of the outcomes of such applications;

                     (e)  matters connected with how arrangements take effect, including the following:

                              (i)  insurance policies becoming * referable to a * health benefits fund or funds of the transferee insurer;

                             (ii)  * policy liabilities and other liabilities incurred for the purposes of a health benefits fund or funds of a transferor insurer becoming treated as policy liabilities and other liabilities incurred for the purposes of a health benefits fund or funds of the transferee insurer;

                            (iii)  * assets of a health benefits fund or funds of a transferor insurer becoming assets of a health benefits fund or funds of the transferee insurer;

                            (iv)  the timing of arrangements;

                      (f)  requirements for private health insurers to give the Council information following arrangements taking effect.

             (6)  The transferee insurer must, within 28 days after the arrangement takes effect, notify the Council of the arrangement. The notice must comply with any requirements specified in the Private Health Insurance (Health Benefits Fund Administration) Rules.

             (7)  For the purposes of this Act, an insurance policy that becomes * referable to a * health benefits fund of the transferee insurer as a result of the arrangement is treated, after the arrangement takes effect, as if it were an insurance policy issued by the transferee insurer.

(70)   Govt (70) [Sheet PA372]

          Page 109 (after line 21), at the end of Division 146, add:

146-10   Consent of policy holders not required

                   The consent of the * policy holders of a * health benefits fund is not required for any:

                     (a)  restructuring health benefits funds as provided for in section 146-1; or

                     (b)  entering into arrangements of a kind referred to in section 146-5, or implementing such arrangements;

unless the constitution of the private health insurer conducting the fund provides otherwise.

(71)   Govt (71) [Sheet PA372]

          Page 109 (after line 21), at the end of Division 146, add:

146-15   Other laws not overridden

                   This Division does not affect the operation of any other law of the Commonwealth, a State or a Territory in relation to:

                     (a)  restructuring * health benefits funds as provided for in section 146-1; or

                     (b)  entering into arrangements of a kind referred to in section 146-5, or implementing such arrangements.

(72)   Govt (72) [Sheet PA372]

          Clause 149-45, page 114 (line 26), omit “amount”, substitute “value”.

(73)   Govt (73) [Sheet PA372]

          Clause 149-55, page 115 (lines 13 to 21), omit the clause, substitute:

149-55   Report of terminating manager

             (1)  The * terminating manager may, at any time, make a written report to the Council on the termination of the * health benefits funds of a private health insurer, and must make such a report as soon as practicable after the termination of the funds.

             (2)  The report may include a recommendation that an application be made under section 149-60 for the winding up of the insurer.



(74)   Govt (74) [Sheet PA372]

          Clause 149-60, page 115 (lines 23 to 32), omit subclause (1), substitute:

             (1)  If the * terminating manager’s report under section 149-55 includes a recommendation that an application be made under this section for the winding up of a private health insurer, the Council, or the terminating manager, may apply to the Federal Court for an order that the insurer be wound up.

(75)   Govt (75) [Sheet PA372]

          Clause 149-60, page 116 (after line 2), after subclause (2), insert:

          (2A)  On an application under subsection (1), the Federal Court may make an order that the insurer be wound up if the Court is satisfied that it is in the financial interests of the * policy holders of the * health benefits funds conducted by the insurer that such an order be made.

(76)   Humphries (1) [Sheet 5230]

          Clause 152-1, page 117 (line 3) to page 118 (line 5), omit the clause.

(77)   Humphries (2) [Sheet 5230]

          Clause 152-20, page 119 (lines 21 to 24), omit the clause.

(78)   Govt (76) [Sheet PA372]

          Clause 163-10, page 127 (line 23), omit “ * policy holder of”, substitute “person insured under a * complying health insurance product that is * referable to”.

(79)   Govt (77) [Sheet PA372]

          Clause 169-5, page 133 (line 19), omit “The report”, substitute “Any such accounts or statements”.

(80)   Govt (78) [Sheet PA372]

          Clause 169-15, page 134 (line 24), omit “before”, substitute “not more than 28 days after”.



(81)   Opposition (1) [Sheet 5219]

          Clause 172-5, page 136 (lines 7 to 12), omit the clause, substitute:

172-5  Agreements with medical practitioners

Medical purchaser-provider agreements

             (1)  If a private health insurer enters into an agreement with a *medical practitioner for the provision of treatment to persons insured by the insurer, the agreement must not limit the medical practitioner’s professional freedom, within the scope of accepted clinical practice, to identify and provide appropriate treatments.

Practitioner agreements

             (2)  If a hospital or day hospital facility enters into an agreement with a *medical practitioner, under which treatment is provided to persons insured by the insurer, the agreement must not limit the medical practitioner’s professional freedom, within the scope of accepted clinical practice, to identify and provide appropriate treatments.

(82)   Govt (79) [Sheet PA372]

          Clause 172-5, page 136 (after line 12), at the end of the clause, add:

Note:          Medical practitioners may, in dealings with private health insurers, be able to take advantage of the collective bargaining provisions of Subdivision B of Division 2 of Part VII of the Trade Practices Act 1974 .

(83)   Govt (80) [Sheet PA372]

          Clause 172-10, page 136 (line 15), omit “ * policy holders of”, substitute “persons insured under * complying health insurance products that are * referable to”.

(84)   Govt (81) [Sheet PA372]

          Clause 200-1, page 151 (line 10), omit “the insurer”, substitute “a private health insurer”.

(85)   Govt (82) [Sheet PA372]

          Clause 217-10, page 172 (line 23), omit “the * policy holder”, substitute “a * policy holder”.

(86)   Govt (83) [Sheet PA372]

          Clause 217-35, page 175 (line 14), omit “administrator”, substitute “ * external manager”.

(87)   Govt (84) [Sheet PA372]

          Clause 217-35, page 175 (line 16), omit “administrator”, substitute “external manager”.



(88)   Govt (85) [Sheet PA372]

          Page 181 (after line 25), at the end of Division 217, add:

217-80   Application of provisions of Corporations Act

Regulations etc. under the Corporations Act

             (1)  A reference in an * application provision to an * applied Corporations Act provision includes (unless the contrary intention appears) a reference to any regulations or other instruments in force for the purposes of that provision, or any of those provisions, of the Corporations Act 2001 .

Note:          So, for example, a provision of this Act that applies a particular provision of the Corporations Act 2001 also applies any regulations that have effect for the purposes of that provision (unless a contrary intention appears).

             (2)  An application provision is a provision of this Division that:

                     (a)  provides for the application of a provision, or a group of provisions (including a Chapter, Part, Division or Subdivision), of the Corporations Act 2001 ; or

                     (b)  refers to a provision, or group of provisions, of the Corporations Act 2001 as so applied.

             (3)  An applied Corporations Act provision is a provision, or a provision in a group of provisions, of the Corporations Act 2001 that is applied as mentioned in paragraph (2)(a).

Modifications under the Private Health Insurance (Health Benefits Fund Enforcement) Rules

             (4)  If an * application provision contains a power for the Private Health Insurance (Health Benefits Fund Enforcement) Rules to modify an * applied Corporations Act provision:

                     (a)  the power extends to modifying any regulations or other instruments, in force for the purposes of that provision of the Corporations Act 2001 , that are applied as a result of subsection (1); and

                     (b)  the modifications (whether of the applied Corporations Act provision or of regulations or instruments referred to in paragraph (a)) that may be made include omissions, additions and substitutions.

             (5)  The fact that provision is made in this Act for a specific modification of one or more * applied Corporations Act provisions does not imply that further modifications of that provision, or any of those provisions, consistent with that specific modification, should not be made by the Private Health Insurance (Health Benefits Fund Enforcement) Rules.

Corporations Act definitions and interpretation principles

             (6)  The definitions and interpretation principles that have effect in or under the Corporations Act 2001 have the same effect in relation to:

                     (a)  an * applied Corporations Act provision; or

                     (b)  a provision of regulations or another instrument that is applied as a result of subsection (1);

as that provision applies for the purposes of a provision of this Division, unless a contrary intention appears in an * application provision or in a modification made by the Private Health Insurance (Health Benefits Fund Enforcement) Rules.

Things that may be done under regulations under the Corporations Act

             (7)  If an * applied Corporations Act provision allows something to be done in or by regulations, then:

                     (a)  the Private Health Insurance (Health Benefits Fund Enforcement) Rules may do that thing for the purposes of the applied Corporations Act provision; and

                     (b)  if they do, any regulations or instruments that are applied as a result of subsection (1) are ineffective, for the purposes of this Division, to the extent that they are inconsistent with the provisions of the Private Health Insurance (Health Benefits Fund Enforcement) Rules that do that thing.

(89)   Govt (86) [Sheet PA372]

          Clause 250-1, page 208 (line 15), after “subsection (1)”, insert “or (2)”.

(90)   Govt (87) [Sheet PA372]

          Clause 261-5, page 218 (lines 11 and 12), omit “ * External management and * terminating management of * health benefits funds”, substitute “The Private Health Insurance Administration Council”.

(91)   Govt (88) [Sheet PA372]

          Clause 290-10, page 252 (line 22), after “fund”, insert “power”.

(92)   Govt (89) [Sheet PA372]

          Page 268 (after line 31), at the end of Division 307, add:

307-30   Other matters

                   The Private Health Insurance (Levy Administration) Rules may, in relation to * private health insurance levy or * late payment penalty, provide for, or for matters relating to, any or all of the following:

                     (a)  methods for payment;

                     (b)  extending the time for payment;

                     (c)  refunding or otherwise applying overpayments.

(93)   Govt (90) [Sheet PA372]

          Clause 328-5, page 284 (after table item 4), insert:

4A

To specify a condition, in relation to a particular facility, to which a declaration that a facility is a * hospital is subject

paragraph 121-7(1)(b)

 



(94)   Govt (91) [Sheet PA372]

          Clause 328-5, page 284 (after table item 6), insert:

6A

To refuse an application for approval for a private health insurer to convert to being * registered as a for profit insurer

subsection 126-42(5)

 

(95)   Govt (92) [Sheet PA372]

          Clause 333-20, page 291 (line 8), before “The”, insert “(1)”.

(96)   Govt (93) [Sheet PA372]

          Clause 333-20, page 291 (table item 3), omit “, section 188-1 and definition of hospital-substitute treatment in the Dictionary in Schedule 1”, substitute “and section 188-1”.

(97)   Govt (94) [Sheet PA372]

          Clause 333-20, page 291 (after table item 3), insert:

3A

Private Health Insurance (Benefit Requirements) Rules

Part 3-3

(98)   Govt (95) [Sheet PA372]

          Clause 333-20, page 292 (after line 1), at the end of the clause, add:

             (2)  If, under this Act, Private Health Insurance Rules made by the Minister may modify a provision of this Act or another Act (including by modifying the effect, or the requirements, of such a provision), the Rules may do so by adding, omitting or substituting provisions (including effects or requirements of provisions).

(99)   Govt (96) [Sheet PA372]

          Clause 333-25, page 293 (after line 6), at the end of the clause, add:

             (3)  If, under this Act, Private Health Insurance Rules made by the Council may modify a provision of this Act or another Act (including by modifying the effect, or the requirements, of such a provision), the Rules may do so by adding, omitting or substituting provisions (including effects or requirements of provisions).

(100) Govt (97) [Sheet PA372]

          Schedule 1, page 294 (after line 12), after the definition of applicable benefits arrangement , insert:

application provision is defined in subsection 217-80(2).

(101) Govt (98) [Sheet PA372]

          Schedule 1, page 294 (after line 12), after the definition of applicable benefits arrangement , insert:

applied Corporations Act provision is defined in subsection 217-80(3).

(102) Govt (99) [Sheet PA372]

          Schedule 1, page 294 (lines 17 and 18), omit “subsections 137-1(3) and (4)”, substitute “subsections 137-1(3) to (4A)”.

(103) Govt (100) [Sheet PA372]

          Schedule 1, page 297 (lines 6 to 14), omit the definition of hospital-substitute treatment , substitute:

hospital-substitute treatment is defined in section 69-10.

(104) Govt (101) [Sheet PA372]

          Schedule 1, page 298 (after line 17), after the definition of member , insert:

net asset position , of a * health benefits fund, means the difference between:

                     (a)  the * assets of the fund; and

                     (b)  the * policy liabilities and other liabilities of the fund that the private health insurer conducting the fund has incurred for the purposes of the fund.

(105) Govt (102) [Sheet PA372]

          Schedule 1, page 301 (line 22), after “treatment”, insert “or provides a benefit for anything else”.

(106) Govt (103) [Sheet PA372]

          Schedule 1, page 301 (after line 24), after the definition of product , insert:

product subgroup is defined in subsection 63-5(2A).

(107) Govt (104) [Sheet PA372]

          Schedule 1, page 302 (line 27), omit the definition of relevant amount .

 

 

 



HARRY EVANS

Clerk of the Senate

The Senate

23 March 2007