Private Health Insurance Act 2007

CHAPTER 4 - HEALTH INSURANCE BUSINESS, HEALTH BENEFITS FUNDS AND MISCELLANEOUS OBLIGATIONS OF PRIVATE HEALTH INSURERS  

PART 4-2 - HEALTH INSURANCE BUSINESS  

Division 121 - What is health insurance business?  

SECTION 121-1   MEANING OF HEALTH INSURANCE BUSINESS  

121-1(1)    
Health insurance business is:

(a)    the business of undertaking liability, by way of insurance; or

(b)    an ^[*]

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

employee health benefits scheme;

that relates, in a way referred to in subsection (2) , to ^[*]

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 .

general treatment.

Note:

The following kinds of insurance business are not health insurance business:

(a) accident and sickness insurance business (see section 121-20 );

(b) liability insurance business (see section 121-25 );

(c) insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules (see section 121-30 ).

121-1(2)    
The liability by way of insurance, or the arrangement to make payments under the ^[*]

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

employee health benefits scheme, must relate to:

(a)    loss arising out of a liability to pay fees or charges relating to provision in Australia of such treatment; or

(b)    provision in Australia of such treatment; or

(c)    the happening of an occurrence connected with the provision in Australia of such treatment; or

(d)    the happening of an occurrence in Australia that ordinarily requires the provision of such treatment.

121-1(3)    
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:

(a)    such treatment or benefit being provided to the insured;

(b)    the insured requiring such treatment or benefit;

(c)    fees or charges being payable by the insured in relation to the provision of such treatment or benefit.