Private Health Insurance Act 2007

CHAPTER 3 - COMPLYING HEALTH INSURANCE PRODUCTS  

PART 3-3 - REQUIREMENTS FOR COMPLYING HEALTH INSURANCE PRODUCTS  

Division 78 - Portability requirements  

SECTION 78-1   PORTABILITY REQUIREMENTS  

78-1(1)    
An insurance policy meets the portability requirements in this Division if the policy meets the requirements in subsections (2) , (3) , (4) and (5A) .

78-1(2)    
An insurance policy meets the requirement in this subsection if the ^[*]

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

waiting period that applies to a person who ^[*]

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

transferred to the policy (the new policy ) from another policy (the old policy ) is no longer than:

(a)    for a benefit for ^[*]

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 that was not ^[*]

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

covered under the old policy - the period allowed under section 75-1 ; and

(b)    for a benefit for hospital treatment or hospital-substitute treatment that was covered under the old policy - the balance of any unexpired waiting period for that benefit that applied to the person under the old policy.

78-1(3)    
An insurance policy meets the requirement in this subsection if the policy does not impose on a person who ^[*]

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

transferred to the policy any period (other than a ^[*]

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

waiting period allowed under subsection (2) ) during which the amount of a benefit in relation to any 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 is less than the amount the person would be eligible for during any other period.

78-1(4)    
An insurance policy meets the requirement in this subsection if, in relation to a benefit for ^[*]

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:

(a)    that was ^[*]

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

covered under the old policy; and

(b)    in respect of which a higher excess or higher co-payment applied under the old policy than is the case under the new policy;

any period during which the higher excess or higher co-payment continues to apply under the new policy to a person who ^[*]

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

transferred to the policy is no longer than the ^[*]

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

waiting period allowed under section 75-1 for a benefit for that treatment.

78-1(5)    
In working out:

(a)    for the purposes of subsection (2) or (4) , whether a treatment was ^[*]

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

covered under an old policy; or

(b)    for the purposes of subsection (3) , whether the amount of a benefit under a new policy during a period is less than the amount it would be during another period;

disregard the existence or otherwise of contracts between the insurer in relation to either of the policies and particular ^[*]

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

health care providers or groups of health care providers.

78-1(5A)    
An insurance policy meets the requirement in this subsection if:

(a)    the policy forms part of a ^[*]

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

complying health insurance product or belongs to a ^[*]

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

product subgroup of a complying health insurance product; and

(b)    the ^[*]

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

product or product subgroup is being terminated by the private health insurer, and as a consequence, an ^[*]

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

adult insured under the policy is to be transferred to a new policy; and

(c)    the insurer informs the adult insured under the policy, in writing, of the matters set out in the Private Health Insurance (Complying Product) Rules; and

(d)    the adult insured under the policy is informed of those matters a reasonable time before the transfer to the new policy is to take effect.

Note:

See also section 55-10 .

78-1(6)    
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.

Note:

If a private health insurer provides an insured person with, or arranges for an insured person to be provided with, treatment, it is treated as a benefit for the purposes of this Division (see subsection 69-5(3) ).