Private Health Insurance Act 2007

CHAPTER 2 - INCENTIVES  

PART 2-2 - PREMIUMS REDUCTION SCHEME  

Division 22 - PHIIB, PHII benefit and related concepts  

Subdivision 22-A - PHIIB, PHII benefit and related concepts  

SECTION 22-15   MEANING OF SHARE OF THE PHII BENEFIT - SINGLE PHIIB  

22-15(1)    
If there is only one ^[*]

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

PHIIB in respect of the premium or amount, the amount of the ^[*]

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

PHIIB ' s share of the PHII benefit , in respect of the premium or amount, is the sum of:

(a)    30% of the amount of the premium, or of the amount in respect of a premium, paid or payable in respect of days in the premium period on which no person insured under the policy was aged 65 years or over; and

(b)    35% of the amount of the premium, or of the amount in respect of a premium, paid or payable in respect of days in the premium period on which:

(i) at least one person insured under the policy was aged 65 years or over; and

(ii) no person insured under the policy was aged 70 years or over; and

(c)    40% of the amount of the premium, or of the amount in respect of a premium, paid or payable in respect of days in the premium period on which at least one person insured under the policy was aged 70 years or over.

Private health insurance tiers

22-15(2)    
Reduce the amount of each percentage specified in subsection (1) (as affected by subsection (5A) ) by 10 percentage points if the ^[*]

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

PHIIB is a ^[*]

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

tier 1 earner for the financial year mentioned in section 22-1 .

22-15(3)    
Reduce the amount of each percentage specified in subsection (1) (as affected by subsection (5A) ) by 20 percentage points if the ^[*]

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

PHIIB is a ^[*]

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

tier 2 earner for the financial year mentioned in section 22-1 .

22-15(4)    
Reduce the amount of each percentage specified in subsection (1) (as affected by subsection (5A) ) to nil if the ^[*]

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

PHIIB is a ^[*]

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

tier 3 earner for the financial year mentioned in section 22-1 .

22-15(5)    
For the purposes of applying subsections (2) , (3) and (4) in relation to the premium or amount, treat the table in subsection 22-30(1) as applying to the ^[*]

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

PHIIB for the financial year if he or she is a PHIIB in respect of the premium or amount because of subsection 22-5(3) or (4) .

Note 1:

The table in subsection 22-30(1) sets out the private health insurance tiers for families.

Note 2:

Subsections 22-5(3) and (4) apply if the only persons insured under the policy are dependent persons.

Annual adjustment of percentages

22-15(5A)    
For each adjustment year, each percentage specified in subsection (1) , (2) or (3) is replaced by the percentage worked out as follows:

(a)    for the adjustment year starting on 1 April 2014 - multiply the specified percentage by the adjustment factor for the adjustment year;

(b)    for a later adjustment year - multiply the specified percentage, as worked out under this subsection for the preceding adjustment year, by the adjustment factor for the later adjustment year.

22-15(5B)    
Percentages are to be worked out under subsection (5A) to 3 decimal places (rounding up if the fourth decimal place is 5 or more).

22-15(5C)    
The percentages worked out under subsection (5A) for an adjustment year apply in relation to premiums, or amounts in respect of premiums, that were paid, or that are payable, at any time in the adjustment year.

22-15(5D)    
Each of the following is an adjustment year :

(a)    the period of 12 months starting on 1 April 2014;

(b)    the period of 12 months starting on each later 1 April.

22-15(5E)    
The adjustment factor for an adjustment year is to be determined in accordance with the Private Health Insurance (Incentives) Rules. However, if the factor so determined for an adjustment year is more than 1, the adjustment factor for that year is instead taken to be 1.

Lifetime health cover loading

22-15(6)    
For the purposes of applying paragraphs (1)(a) , (b) and (c) , reduce the amount of the premium, or the amount in respect of a premium, by any part of that amount that is attributable to an increase in the premium in accordance with Division 34 .