Private Health Insurance Act 2007

CHAPTER 3 - COMPLYING HEALTH INSURANCE PRODUCTS  

PART 3-3 - REQUIREMENTS FOR COMPLYING HEALTH INSURANCE PRODUCTS  

Division 72 - Benefit requirements for policies that cover hospital treatment  

SECTION 72-5   RULES REQUIREMENT IN RELATION TO PROVISION OF BENEFITS  

72-5(1)    
For the purposes of paragraph 72-1(1)(d) , the ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

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) .

72-5(2)    
The effect required is that if, under an agreement or arrangement with a private health insurer, a particular ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

health care provider (other than a ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

medical practitioner) provides particular ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

hospital treatment or ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

hospital-substitute treatment to people insured under the same ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

complying health insurance product of the insurer, any charge for the treatment:

(a)    that is payable by an insured person; and

(b)    which is not recoverable by a benefit under the product;

must be the same for all of the people insured under the product, irrespective of:

(c)    the frequency with which that provider provides that particular treatment to people insured under that product; or

(d)    any other matter.

72-5(3)    
The Private Health Insurance (Complying Product) Rules may modify the effect required by subsection (2) in relation to all or particular kinds of ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

complying health insurance products, benefits, treatments or ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

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.