Many of the terms in this Act are defined in the Dictionary in Schedule 1.

Most of the terms that are defined in the Dictionary are identified by an asterisk appearing at the start of the term: as in “*health benefits fund”. The footnote with the asterisk contains a signpost to the Dictionary.

An asterisk usually identifies the first occurrence of a term in a section (if not divided into subsections), subsection, definition, table item or diagram. Later occurrences of the term in the same provision are not usually asterisked.

Terms are not asterisked in headings, notes, examples or guides.

If a term is not identified by an asterisk, disregard that fact in deciding whether or not to apply to that term a definition or other interpretation provision.

The following basic terms used throughout the Act are not identified with an asterisk:

If the operation of this Act would result in an acquisition of property from a person otherwise than on just terms, the Commonwealth is liable to pay a reasonable amount of compensation to the person.

If the Commonwealth and the person do not agree on the amount of the compensation, the person may institute proceedings in the Federal Court for the recovery from the Commonwealth of such reasonable amount of compensation as the court determines.

In this section:

acquisition of property has the same meaning as in paragraph 51(xxxi) of the Constitution.

just terms has the same meaning as in paragraph 51(xxxi) of the Constitution.

A private health insurer must increase the amount of premiums payable for *hospital cover in respect of an *adult if the adult did not have hospital cover on his or her *lifetime health cover base day.

The amount of the increase is worked out as follows:

where:

base rate, for *hospital cover, is the amount of premiums that would be payable for the cover if:

A private health insurer must increase the amount of premiums payable for *hospital cover in respect of an *adult if, after the adult’s *lifetime health cover base day, the adult ceases to have hospital cover.

The amount of the increase is worked out as follows:

where:

base rate is the *base rate for the *hospital cover.

years without hospital cover is the number obtained by:

Any increase under this section in the amount of premiums payable for *hospital cover is in addition to any increase under section 34-1 in the amount of premiums payable for that hospital cover.

A private health insurer must stop increasing the amount of premiums payable for *hospital cover in respect of an *adult under this Part if the adult has had hospital cover (including under an *applicable benefits arrangement), the premiums for which have been increased under this Part or *old Schedule 2:

The amount must stop being increased on the day after the last day of the 10 year period.

The amount of premiums payable for *hospital cover in respect of the *adult must start to be increased under this Part again if:

Subsection (3) does not prevent this section applying again in respect of any later 10 year period.

In subsection (1):

old Schedule 2 means Schedule 2 to the National Health Act 1953 as in force before 1 April 2007.

(1) Hospital cover is so much of a *complying health insurance policy as *covers *hospital treatment. An *adult has hospital cover if he or she is insured under a complying health insurance policy that covers hospital treatment.

An *adult is taken to have *hospital cover:

In this section:

gold card means a card that evidences a person’s entitlement to be provided with treatment: (a) in accordance with the Treatment Principles prepared under Veterans’ Entitlements Act 1986; orsection 90 of the (b) in accordance with a determination made under Military Rehabilitation and Compensation Act 2004 in respect of the provision of treatment.section 286 of the

(1) Any of the following days that occur after an *adult ceases, for the first time after his or her *lifetime health cover base day, to have *hospital cover are permitted days without hospital cover in respect of that adult:

The Private Health Insurance (Lifetime Health Cover) Rules may specify days that, despite subsection (1), are taken not to be *permitted days without hospital cover.

(1) Subject to subsections (2), (3), (4) and (4A), a person’s lifetime health cover base day is the 1 July after the person turns 31.

Person who had lifetime health cover base day on or before 30 June 2010

(2) If a person had a lifetime health cover base day on or before 30 June 2010, that lifetime health cover base day remains the person’s lifetime health cover base day.

Person who is not an Australian citizen and is not covered by subsection (2)

(3) Subject to subsection (4), the lifetime health cover base day of a person who is not an Australian citizen on the person’s *medicare eligibility day and is not covered by subsection (2) is the later of:

(4) However, if the person is *overseas on the day worked out under subsection (1) or (3), the person’s lifetime health cover base day is the first anniversary of:

If:

If:

(5) A person’s medicare eligibility day is the day on which the person is registered by the Chief Executive Medicare as an eligible person within the meaning of section 3 of the Health Insurance Act 1973.

Without limiting when a person is taken to be *overseas for the purposes of this Part:

For the purposes of this Part, a person is taken not to have returned to Australia from *overseas, or entered Australia, if the person returns to Australia, or enters Australia, but remains in Australia for a period of less than 90 days.

The amount of premiums payable for *hospital cover in respect of an *adult does not increase under this Part if the adult was born on or before 1 July 1934.

However, this section does not prevent 1 July 1934.section 37-20 applying to the *hospital cover in respect of any *adults who were born after

If:

The amount of the increase in the premiums payable for the cover is worked out by:

A private health insurer must comply with any requirements specified in the Private Health Insurance (Lifetime Health Cover) Rules relating to providing information to:

A private health insurer must comply with any requirements specified in the Private Health Insurance (Lifetime Health Cover) Rules relating to providing information to other private health insurers about increases under this Part in the amounts of premiums payable for *hospital cover with the private health insurer.

The Private Health Insurance (Lifetime Health Cover) Rules may require or permit a private health insurer to provide information of a kind referred to in this section in the form of an age notionally attributed, to an *adult or other person, as the age from which the adult or other person will be treated as having had continuous *hospital cover.

A private health insurer must keep separate records in relation to each *adult who has *hospital cover.

When an *adult ceases to be *covered by *hospital cover under which more than one adult was covered, the private health insurer must notify each other adult that the adult has ceased to be covered by the cover.

A private health insurer must not:

(2) Improper discrimination is discrimination that relates to:

Despite subsection (2), discrimination by a *restricted access insurer is not improper discrimination to the extent to which the insurer:

Despite subsection (2), discrimination by a private health insurer is not improper discrimination to the extent to which:

To avoid doubt, subsection (4) does not apply if taking or failing to take the action, or having regard or failing to have regard to that matter, has the effect of an insurance policy being cancelled because a person ceases to be an employee of, or ceases to be under contract to provide services to, a particular employer.

The principle of community rating in section 55-5 does not prevent a private health insurer from:

The Private Health Insurance (Complying Product) Rules may permit pilot projects of a kind specified in the Rules to be conducted by private health insurers in accordance with requirements specified in the Rules.

A private health insurer must ensure that the only kind of insurance that it makes available as part of its *health insurance business is insurance in the form of *complying health insurance products.

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).

(1) A complying health insurance product is a *product made up of *complying health insurance policies.

(2) A product is all the insurance policies issued by a private health insurer:

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

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.

Different premiums may be payable under policies in the same *product.

A premium payable for a policy that covers an insured group of 2 or more people that includes a *dependent non-student or *dependent person with a disability may be higher than a premium payable for a policy in the same *product that covers an insured group of 2 or more people that includes one or more *dependent children or *dependent students but no dependent non-student or dependent person with a disability.

An insurance policy meets the community rating requirements in this Division if:

For the purposes of paragraph (1)(d), an insurance policy is issued under a new *product if the amount of premiums charged under policies in the product has not changed since the first policy in the product was issued.

For the purposes of paragraph 66-1(1)(d), the premiums payable under an insurance policy for a period meet the premium requirement in this section if the amount of premiums payable under the policy for the period:

A discount is allowed if:

A discount may be for any of these reasons:

A private health insurer that proposes to change the premiums charged under a *complying health insurance product must apply to the Minister for approval of the change:

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.

The Minister must, by written instrument, approve the proposed changed amount or amounts, unless the Minister is satisfied that a change that would increase the amount or amounts would be contrary to the public interest.

If the Minister approves the proposed changed amount or amounts, the approval has effect:

If the Minister refuses to approve the proposed changed amount or amounts, the Minister must table the Minister’s reasons for refusal in each House of the Parliament no later than 15 sitting days of that House after the refusal.

An instrument made under subsection (3) is not a legislative instrument.

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

Despite paragraph (1)(a), the policy must also *cover any treatment that a policy of its kind is required by the Private Health Insurance (Complying Product) Rules to cover.

Despite paragraph (1)(a), the policy must not *cover any treatment that a policy of its kind is not allowed under the Private Health Insurance (Complying Product) Rules to cover.

(1) An insurance policy covers a treatment if, under the policy, the insurer undertakes liability in respect of some or all loss arising out of a liability to pay fees or charges relating to the provision of goods or a service that is or includes that treatment.

(2) An insurance policy also covers a treatment if the insurer provides an insured person, or arranges for an insured person to be provided with, goods or a service that is or includes that treatment.

If an insurance policy *covers a treatment in the way described in subsection (2), this Part applies as if the provision of the goods or service were a benefit provided under the policy.

An insurance policy that *covers *hospital treatment meets the benefit requirements in this Division if:

These are the requirements that a policy must meet for the purposes of paragraph (1)(a):

(3) For the purposes of this section, disregard Health Insurance Act 1973 when determining whether medicare benefit is payable.section 19AD of the

(4) If an amount of a benefit payable under an insurance policy does not meet the requirements in the table in subsection (2) merely because of the operation of subsection 10(4) of the Health Insurance Act 1973 (which rounds the calculation of a *medicare benefit), the amount of the benefit payable is taken to meet the requirements in the table in subsection (2).

For the purposes of paragraph 72-1(1)(d), the *rules of the private health insurer that issues the policy meet the rules requirement in this section if the rules have the effect required by subsection (2).

The effect required is that if, under an agreement or arrangement with a private health insurer, a particular *health care provider (other than a *medical practitioner) provides particular *hospital treatment or *hospital-substitute treatment to people insured under the same *complying health insurance product of the insurer, any charge for the treatment:

The Private Health Insurance (Complying Product) Rules may modify the effect required by subsection (2) in relation to all or particular kinds of *complying health insurance products, benefits, treatments or *health care providers. To the extent the Rules do so, the rules requirement is taken to be met if the conditions in the Rules are met.

Private Health Insurance (Medical Devices and Human Tissue Products) Rules made for the purposes of item 4 of the table in subsection 72-1(2) must only list a kind of *medical device or *human tissue product if:

A person may apply to the Minister to have the Private Health Insurance (Medical Devices and Human Tissue Products) Rules list a *medical device or *human tissue product of the kind to which the application relates.

The application must be:

The Minister must inform the applicant in writing of the Minister’s decision whether or not to grant the application. If the Minister decides not to grant the application, the Minister must also inform the applicant of the reason for that decision.

If:

(6) The Private Health Insurance (Medical Devices and Human Tissue Products) Rules may set out criteria (listing criteria) to be satisfied in order for an application (a listing application) made under subsection (2) to be granted. The Rules may provide for different listing criteria to apply in different circumstances.

The Minister must not grant a listing application if any applicable listing criteria are not satisfied in relation to the application.

(1) A medical device is:

(2) For the purposes of paragraph (1)(a), the purpose for which an instrument, apparatus, appliance, software, implant, reagent, material or other article (the main equipment) is to be used is to be ascertained from the information supplied, by the person under whose name the main equipment is or is to be supplied, on or in any one or more of the following:

(3) In relation to a *medical device covered by paragraph (1)(a) or (b), an accessory is a thing that the manufacturer of the thing specifically intended to be used together with the device to enable or assist the device to be used as the manufacturer of the device intended.

(1) The Private Health Insurance (Medical Devices and Human Tissue Products) Rules may specify fees (cost-recovery fees) that may be charged in relation to activities carried out by, or on behalf of, the Commonwealth in connection with the performance of functions, or the exercise of powers, conferred by or under this Act in relation to the list of kinds of *medical devices and *human tissue products in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules.

Without limiting subsection (1), the Private Health Insurance (Medical Devices and Human Tissue Products) Rules may do any of the following:

A *cost-recovery fee specified under this section must not be such as to amount to taxation.

The Minister may remove a kind of *medical device or *human tissue product from the list in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules if:

The Minister may remove a kind of *medical device or *human tissue product from the list in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules if:

This section applies if:

(2) Despite any other provision of this Act, the Minister may refuse to carry out, or direct a person not to carry out, specified activities or kinds of activities in relation to the debtor under this Division until the fee or levy has been paid.

An insurance policy meets the waiting period requirements in this Division if the *waiting period that applies to a person who did not *transfer to the policy is no longer than:

The Private Health Insurance (Complying Product) Rules may modify the requirements in subsection (1) in relation to all or particular kinds of private health insurers, benefits or insured persons. To the extent the Rules do so, the waiting period requirements in this Division are taken to be met if the conditions in the Rules are met.

(1) A person insured under an insurance policy has a pre-existing condition if:

In forming an opinion for the purposes of paragraph (1)(b), the *medical practitioner must have regard to any information in relation to the ailment, illness or condition that the medical practitioner who treated the ailment, illness or condition gives him or her.

If:

An insurance policy meets the portability requirements in this Division if the policy meets the requirements in subsections (2), (3), (4) and (5A).

(2) An insurance policy meets the requirement in this subsection if the *waiting period that applies to a person who *transferred to the policy (the new policy) from another policy (the old policy) is no longer than:

An insurance policy meets the requirement in this subsection if the policy does not impose on a person who *transferred to the policy any period (other than a *waiting period allowed under subsection (2)) during which the amount of a benefit in relation to any particular *hospital treatment or *hospital-substitute treatment is less than the amount the person would be eligible for during any other period.

An insurance policy meets the requirement in this subsection if, in relation to a benefit for *hospital treatment or *hospital-substitute treatment:

In working out:

An insurance policy meets the requirement in this subsection if:

The Private Health Insurance (Complying Product) Rules may modify the requirements in this section in relation to all or particular kinds of private health insurers, benefits or insured persons. To the extent the Rules do so, the portability requirements in this Division are taken to be met if the conditions in the Rules are met.

A person commits an offence if:

In imposing a penalty on a private health insurer for an offence under subsection (1), the court:

If a private health insurer has engaged, is engaging, or is proposing to engage, in conduct:

If:

For the purposes of subsections (1) and (2), an application may be made by:

The court may grant an interim injunction pending the determination of an application under subsection (1) or (2).

The court must not require an applicant for an injunction to give an undertaking as to damages as a condition of granting an interim injunction.

The court may discharge or vary an injunction granted under this section.

The power of the court to grant an injunction restraining a private health insurer from engaging in conduct may be exercised:

The power of the court to grant an injunction requiring a private health insurer to do a thing may be exercised:

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

A single *private health information statement may be the private health 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.

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

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

A private health insurer commits an offence if:

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

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

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

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:

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.

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

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

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.

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:

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.

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.

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.

A private health insurer commits an offence if:

Strict liability applies to subsection (1).

Any of the following:

The request must:

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

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.

A private health insurer commits an offence if:

Strict liability applies to subsection (1).

(1) A private health insurer (the old insurer) must, if a person ceases to be insured under a *complying 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:

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

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

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 private health insurer commits an offence if:

Strict liability applies to subsection (4).

The Private Health Insurance (Health Insurance Business) Rules also deal with matters relating to *health insurance business. The provisions of this Part indicate when a particular matter is or may be dealt with in these Rules.

Before making Private Health Insurance (Health Insurance Business) Rules, the Minister must consult *APRA. However, a failure to consult APRA does not affect the validity of those Rules.

(1) Health insurance business is:

The liability by way of insurance, or the arrangement to make payments under the *employee health benefits scheme, must relate to:

It does not matter for the purposes of paragraph (2)(d) whether payment of benefits to the insured is dependent upon one or more of the following:

(1) Hospital treatment is treatment (including the provision of goods and services) that:

(2) Without limiting subsection (1), hospital treatment includes any other treatment, or treatment included in a class of treatments, specified in the Private Health Insurance (Health Insurance Business) Rules for the purposes of this subsection.

(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).

Without limiting subsection (1) or (2), the reference to treatment in those subsections includes a reference to any of, or any combination of, accommodation, nursing, medical, surgical, podiatric surgical, diagnostic, therapeutic, prosthetic, pharmacological, pathology or other services or goods intended to manage a disease, injury or condition.

Despite subsections (1), (2) and (2A), treatment is not *hospital treatment if it is specified in, or is included in a class of treatments specified in, the Private Health Insurance (Health Insurance Business) Rules for the purposes of this subsection.

(5) A hospital is a facility for which a declaration under subsection (6) is in force.

The Minister may, in writing:

In deciding whether to declare that a facility is a *hospital, or to revoke such a declaration, the Minister must have regard to:

A declaration under subsection (6) that a facility is a *hospital must include either a statement that the hospital is a public hospital or a statement that the hospital is a private hospital.

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

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.

The Minister may specify:

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.

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.

The application must be:

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.

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

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

(1) General treatment is treatment (including the provision of goods and services) that:

(2) Without limiting subsection (1), general treatment includes any other treatment, or treatment included in a class of treatments, specified in the Private Health Insurance (Health Insurance Business) Rules for the purposes of this subsection.

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

Despite subsections (1), (2) and (2A), neither of the following is *general treatment:

(1) An arrangement is an employee health benefits scheme if:

It does not matter for the purposes of this section whether the arrangement:

However, an arrangement:

Despite section 121-1, *health insurance business does not include the business of undertaking liability, by way of insurance, to pay a lump sum, or to make periodic payments, on the happening of a personal accident, disease or sickness.

However, this section does not apply to:

*Health benefits funds (and some related matters) are also dealt with in the Private Health Insurance (Health Benefits Fund Policy) Rules. The provisions of this Part indicate when a particular matter is or may be dealt with in these Rules.

Before making Private Health Insurance (Health Benefits Fund Policy) Rules for the purposes of the Minister must consult *APRA. However, a failure to consult APRA does not affect the validity of those Rules.section 131-15,

(1) Health-related business is business that is any one or more of the following:

(2) Despite subsection (1), neither of the following is health-related business:

(1) An area is a risk equalisation jurisdiction if the Private Health Insurance (Health Benefits Fund Policy) Rules so provide.

(2) The Private Health Insurance (Health Benefits Fund Policy) Rules may specify circumstances in which a private health insurer may (despite subsection 23(2) of the Private Health Insurance (Prudential Supervision) Act 2015) have more than one *health benefits fund in respect of a particular *risk equalisation jurisdiction.

A private health insurer that proposes to change its *rules (other than a change to which the Secretary of the Department of the proposed change:section 66-10 applies) must notify

The Minister may, in writing, direct the insurer not to make the change if the Minister is satisfied that the change might or would result in a breach of the Act.

The Minister must give the Secretary and *APRA a copy of a direction under subsection (2).

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

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.

The Private Health Insurance (Data Provision) Rules may specify kinds of information, relating to treatment of persons insured under *complying health insurance products that are *referable to *health benefits funds, that private health insurers are to give to the Secretary of the Department.

A private health insurer must, in accordance with the Private Health Insurance (Data Provision) Rules, give to the Secretary of the Department any information of that kind that the insurer receives from a *hospital.

The Private Health Insurance (Complying Product) Rules may set out performance indicators to be used by the Minister in monitoring private health insurers’ compliance with the principle of community rating in section 55-5 and the community rating requirements in Division 66.

The performance indicators are to be framed:

If, having regard to information available to the Minister or to any performance indicators under the Private Health Insurance (Complying Product) Rules, the Minister believes that a private health insurer may have contravened an *enforceable obligation, the Minister may write to the private health insurer:

The private health insurer must respond within the specified period, or any longer period that the Minister, in writing before the end of the specified period, allows.

If the Minister refuses a request by the private health insurer for a longer period to respond, the Minister must state the Minister’s reasons for refusing.

The powers in this Division may only be exercised for the purposes of this Act.

The powers in this Division cannot be exercised for the purposes of this Act, as it applies in relation to:

The Minister may give a written notice to a person who is or who has been an *officer, employee or agent of:

The Minister may require the person to give the information orally or in writing.

The Minister may require the person to give the information on oath or affirmation. For that purpose, the Minister or the person specified in the notice may administer an oath or affirmation.

(4) The person is not excused from giving information on the ground that giving the information might tend to incriminate the person or make the person liable to a penalty. However, the information, or anything obtained as a direct or indirect consequence of the information, is not admissible in evidence against the person in any proceedings, other than proceedings for an offence against Criminal Code.section 137.1 or 137.2 of the

The Minister may give a written notice to a person who is or who has been an *officer, employee or agent of:

(2) The person is not excused from producing a document on the ground that the production of the document might tend to incriminate the person or make the person liable to a penalty. However, the production of the document, or anything obtained as a direct or indirect consequence of the production, is not admissible in evidence against the person in any proceedings, other than proceedings for an offence against Criminal Code.section 137.1 or 137.2 of the

The Minister may give a written notice to a person who is or who has been an *officer, employee or agent of:

The Minister may require the person to give the evidence orally or in writing.

The Minister may require the person to give the evidence on oath or affirmation. For that purpose, the Minister or the person specified in the notice may administer an oath or affirmation.

(4) The person is not excused from answering a question on the ground that the answer to the question might tend to incriminate the person or make the person liable to a penalty. However, the answer, or anything obtained as a direct or indirect consequence of the answer, is not admissible in evidence against the person in any proceedings, other than proceedings for an offence against Criminal Code.section 137.1 or 137.2 of the

A person must not fail to comply with a requirement contained in a notice given to the person:

A person must not fail to be sworn or to make an affirmation when required to do so:

An offence under subsection (1) or (2) is an offence of strict liability.

The Minister may, in writing, authorise a person to examine and report on the records, books, accounts and other documents of:

A person authorised under subsection (1) must, at all reasonable times, have full and free access to any *premises at which the records, books, accounts and other documents are kept and may take extracts from, or copies of, the records, books, accounts and other documents.

The Minister may accept a written undertaking, given by a private health insurer at the Minister’s request, if the Minister considers that compliance with the undertaking will:

The private health insurer may withdraw or vary the undertaking at any time with the consent of the acceptor of the undertaking.

If the Minister considers that a private health insurer that gave an undertaking under this Division has contravened any of its terms, the Minister may apply to the Federal Court for an order under subsection (2).

If the Federal Court is satisfied that the private health insurer has contravened a term of the undertaking, the court may make one or more of the following orders:

If, at any time and for any reason, the Minister considers that it will assist in the prevention of *improper discrimination to do so, the Minister may give a direction to a private health insurer requiring it:

If, at any time and for any reason, the Minister considers that there appears to be a contravention of an *enforceable obligation involving *improper discrimination by a private health insurer, the Minister may give a direction to the insurer requiring it to address the contravention by:

A direction mentioned in subsection (1) or (2) may, if the Minister considers it proper to do so, include requirements with respect to the reconsideration by the private health insurer of an application or claim made to the insurer and dealt with by it before the direction takes effect.

A private health insurer must, in reconsidering an application or claim in accordance with subsection (3), deal with the application or claim as if the direction had been in force at the time when the application or claim was first considered.

A direction given under this section must be published on the Department’s website not later than 5 working days after the direction is given.

If the Federal Court is satisfied that a private health insurer has contravened an *enforceable obligation, it must make a declaration of contravention.

The declaration must specify:

A *declaration of contravention is conclusive evidence of the matters mentioned in subsection (2).

If the Federal Court has made a *declaration of contravention that specifies an *officer of a private health insurer (see paragraph 203-5(2)(d)), the court may order the officer to pay the Commonwealth a pecuniary penalty of up to 1,000 penalty units.

The court must not make an order under subsection (1) if it is satisfied that a court has ordered the *officer to pay damages in the nature of punitive damages in respect of:

The penalty is a civil debt payable to the Commonwealth. The Commonwealth may enforce the order as if it were an order made in civil proceedings against the *officer to recover a debt due by the officer. The debt arising from the order is taken to be a judgment debt.

If the Federal Court has made a *declaration of contravention, the court may order the private health insurer specified in the declaration to compensate an individual for any injury or loss suffered by the individual as a result of the contravention.

The order must specify the amount of compensation.

The order may be enforced as if it were a judgment of the court.

If the Federal Court has made a *declaration of contravention, the court may make an order requiring the private health insurer specified in the declaration to do either or both of the following:

The order may be enforced as if it were a judgment of the court.

If the Federal Court has made a *declaration of contravention, the court may make any order that the applicant applies for.

The order may be enforced as if it were a judgment of the court.

Proceedings for a pecuniary penalty order against an *officer of a private health insurer are stayed if:

The proceedings for the order may be resumed if the *officer is not convicted of the offence. Otherwise, the proceedings for the order are dismissed.

The Minister may, in writing, require a person to give all reasonable assistance in connection with:

The Minister must not require the person to assist in connection with an application for a declaration or order unless:

The Minister must not require the person to assist in connection with criminal proceedings unless:

The Minister may require the person to assist regardless of whether:

The person cannot be required to assist if the person is or has been a lawyer for:

The Federal Court may order the person to comply with the requirement in a specified way. Only the Minister may apply to the court for an order under this subsection.

If, in proceedings brought against a person under this Division, it appears to the Federal Court that:

A person who thinks that proceedings will or may be begun against the person under this Division may apply to the Federal Court for relief.

On an application under subsection (2), the court may grant relief under subsection (1) as if the proceedings had been begun in the court.

For the purposes of subsection (1) as applying for the purposes of a case tried by a judge with a jury:

If a *participating insurer:

Upon the giving of the notice, the insurer ceases to be a *participating insurer.

(1) A *private health insurance levy that is imposed on a particular day (the imposition day) becomes due and payable on the day specified as the payment day for that imposition day in:

The Minister must obtain, and take into account, advice from *APRA in relation to the day that is to be specified as the payment day in a determination made under subparagraph (1)(a)(iv).

If a *private health insurance levy remains wholly or partly unpaid by a person after it becomes due and payable, the person is liable to pay a late payment penalty under this section.

The *late payment penalty is calculated:

The following must be paid to the Commonwealth:

The following must be paid to *APRA, on behalf of the Commonwealth:

A *private health insurance levy that is due and payable is a debt due to the Commonwealth.

A *late payment penalty is a debt due to the Commonwealth.

An amount referred to in subsection (1) or (2) may be recovered as a debt by action in a court of competent jurisdiction by:

The Minister may waive the whole or part of an amount of *late payment penalty in respect of an unpaid amount of:

*APRA may waive the whole or part of an amount of *late payment penalty in respect of an unpaid amount of *risk equalisation levy if APRA considers that there are good reasons for doing so.

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:

The Private Health Insurance (Levy Administration) Rules may specify persons who are liable to pay *medical devices and human tissue products levy.

(1) A private health insurer must lodge a return for each day that, under the Private Health Insurance (Complaints Levy) Act 1995, is a census day.

The return must:

A private health insurer commits an offence if the insurer fails to lodge the return.

Strict liability applies to subsection (4).

A private health insurer must keep all records that are relevant to either or both of following:

The records must be kept in:

The records must be retained for a period of 7 years (or a shorter period allowed by the Private Health Insurance (Levy Administration) Rules) starting on the later of:

A private health insurer commits an offence if the insurer fails to:

Strict liability applies to subsection (4).

Nothing in this section is to be taken to have required an insurer to do an act or thing before the day on which this Act commences.

*APRA may, if it believes on reasonable grounds that a private health insurer is capable of giving information that is relevant to:

The Secretary of the Department may, if he or she believes on reasonable grounds that a private health insurer is capable of giving information that is relevant to:

A request under subsection (1) or (2):

A private health insurer commits an offence if the insurer fails to comply with a request under subsection (1) or (2).

Strict liability applies to subsection (4).

(1) A person (an authorised officer) who is authorised in writing by the Minister for this purpose may enter any *premises for the purpose of exercising *search powers in relation to *levy-related documents if:

(2) A levy-related document is a document (including a copy of a document) that contains information relevant to:

Before obtaining the consent of the *occupier, the *authorised officer must inform the occupier that he or she may refuse consent.

An entry by an *authorised officer with the consent of the *occupier is not lawful if the consent of the occupier is not voluntary.

The *authorised officer must leave the *premises if the *occupier asks the officer to do so.

If an *authorised officer has reason to believe that there are *levy-related documents on particular *premises, the officer may apply to a magistrate for a warrant authorising the officer to enter the premises for the purpose of exercising *search powers in relation to the documents.

If the magistrate is satisfied by information on oath or affirmation that there are reasonable grounds for believing that there are *levy-related documents on the *premises, the magistrate may issue a warrant.

The warrant must:

The *authorised officers do not have to be named in the warrant.

This section applies if:

The *authorised officer must:

The *occupier, or a person nominated by the occupier who is readily available, is entitled to observe the execution of the warrant.

The right to observe the execution of the warrant ceases if the *occupier or the nominated person impedes that execution.

Subsection (3) does not prevent the execution of the warrant in 2 or more areas of the *premises at the same time.

Occupier to provide reasonable facilities and assistance

An *occupier commits an offence if the occupier fails to provide the *authorised officer and any person assisting that officer with all reasonable facilities and assistance for the effective exercise of their powers under the warrant.

For the purposes of this Division, the Secretary of the Department must issue an identity card to an *authorised officer in the *approved form. It must contain a recent photograph of the authorised officer.

A person commits an offence if:

Strict liability applies to subsection (2).

An *authorised officer must carry the identity card at all times when exercising powers or performing functions under this Division as an authorised officer.

(1) The Private Health Insurance Risk Equalisation Special Account (the Risk Equalisation Special Account) is established by this section.

(2) The *Risk Equalisation Special Account is a special account for the purposes of the Public Governance, Performance and Accountability Act 2013.

The purpose of the *Risk Equalisation Special Account is for *APRA to make payments to private health insurers in accordance with the Private Health Insurance (Risk Equalisation Policy) Rules.

The Private Health Insurance (Risk Equalisation Policy) Rules must specify:

Before making Private Health Insurance (Risk Equalisation Policy) Rules, the Minister must consult *APRA. However, a failure to consult APRA does not affect the validity of those Rules.

A person commits an offence if:

(1A) An APRA private health insurance duty, function or power is a duty, function or power of *APRA, or that a person has in the person’s capacity as an officer (within the meaning of section 56 of the Australian Prudential Regulation Authority Act 1998), under any of the following:

(2) Information is protected information if the information:

(3) A disclosure of information is an authorised disclosure if the disclosure is one that the person may make under section 323-5, 323-10, 323-15, 323-20, 323-25 or 323-30.

This section applies to information if the information:

For the purposes of subsection 323-1(3), a person to whom subsection (2) applies may disclose the information to:

This subsection applies to the following persons:

For the purposes of subsection 323-1(3), a person may disclose information to another person if:

The Minister may specify conditions in a certificate under paragraph (1)(d) relating to the application of the certificate.

A certificate under paragraph (1)(d) is not a legislative instrument.

For the purposes of subsection 323-1(3), a person may disclose information to another person if:

The Minister may specify conditions in a certificate under paragraph (1)(d) relating to the application of the certificate.

A certificate under paragraph (1)(d) is not a legislative instrument.