Private Health Insurance Act 2007
Note: See section 1-10 .
1 1 DICTIONARYIn this Act:
accessory
has the meaning given by subsection
72-11(3)
.
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ADI
(Repealed by No 87 of 2015)
adjustment factor
for an adjustment year has the meaning given by subsection
22-15(5E)
.
adjustment year
has the meaning given by subsection
22-15(5D)
.
(a) when used outside Part 2-3 - means a person who is not a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent person; or(b) when used in Part 2-3 - means a person who is not:
(i) a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent child; or
(ii) a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent non-student; or
(iii) a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent student.
applicable benefits arrangement
means an applicable benefits arrangement within the meaning of the
National Health Act 1953
as in force before 1 April 2007.
application provision
(Repealed by No 87 of 2015)
applied Corporations Act provision
(Repealed by No 87 of 2015)
appointed actuary
(Repealed by No 87 of 2015)
approved form
is a form that meets the requirements in section
333-10
.
APRA
means the Australian Prudential Regulation Authority.
APRA private health insurance duty, function or power
: see subsection
323-1(1A)
.
assets
(Repealed by No 87 of 2015)
Australia
, when used in a geographical sense, includes Norfolk Island, the Territory of Cocos (Keeling) Islands and the Territory of Christmas Island.
Australian citizen
(Repealed by No 46 of 2011)
authorised disclosure
is defined in subsection
323-1(3)
.
authorised officer
is defined in subsection
313-1(1)
.
base premium
(Repealed by No 26 of 2014)
base premium indexation factor
(Repealed by No 26 of 2014)
base rate
is defined in subsection
34-1(2)
.
capital adequacy direction
(Repealed by No 87 of 2015)
capital adequacy standard
(Repealed by No 87 of 2015)
census day
(Repealed by No 87 of 2015)
Chief Executive Medicare
has the same meaning as in the
Human Services (Medicare) Act 1973
.
Chief Executive Officer
(Repealed by No 87 of 2015)
chief executive officer
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, of a private health insurer, is the person who is primarily and directly responsible to the
[*]
collapsed insurer levy
(Repealed by No 87 of 2015)
Commissioner
(Repealed by No 87 of 2015)
complaints levy
is defined in paragraph
304-10(b)
.
complying health insurance policy
is defined in section
63-10
.
complying health insurance product
is defined in section
63-5
.
constitutional corporation
means a corporation to which paragraph
51(xx)
of the
Constitution
applies.
cost-recovery fee
has the meaning given by subsection
72-15(1)
.
Council
(Repealed by No 87 of 2015)
Council administration levy
(Repealed by No 87 of 2015)
Council-supervised obligation
(Repealed by No 87 of 2015)
cover
has a meaning affected by section
69-5
.
CPI indexation factor
(Repealed by No 26 of 2014)
CPI index number
(Repealed by No 26 of 2014)
declaration of contravention
means a declaration under section
203-5
.
dependent child
means a person who:
(a) is aged under 18; and
(b) does not have a partner.
dependent child non-student
(Repealed by No 60 of 2021)
dependent non-student
means a person who:
(a) is aged between 18 and 31 (inclusive); and
(b) is not receiving full-time education at a school, college or university; and
(c) is a dependent non-student under the [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
rules of the private health insurer that insures the person; and(d) does not have a partner.
(a) a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent child; or(b) a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent non-student; or(c) a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent person with a disability; or(d) a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
dependent student.
dependent person with a disability
means a person:
(a) who is aged 18 or over; and
(b) who is:
(i) a person with a disability within the meaning of the expression person with a disability as defined by the Private Health Insurance (Complying Product) Rules; or
(ii) a person with a disability within the meaning of the expression person with a disability as defined by the [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
rules of the private health insurer that insures the person.
To avoid doubt, a dependent person with a disability may have a partner.
dependent student
means a person who:
(a) is aged between 18 and 31 (inclusive); and
(b) is receiving full-time education at a school, college or university; and
(c) is a dependent student under the [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
rules of the private health insurer that insures the person; and(d) does not have a partner.
Deputy Commissioner
(Repealed by No 87 of 2015)
director
has the same meaning as in the
Corporations Act 2001
.
disqualified person
(Repealed by No 87 of 2015)
employee health benefits scheme
is defined in section
121-15
.
enforceable obligation
is defined in section
185-5
.
external management
(Repealed by No 87 of 2015)
external manager
(Repealed by No 87 of 2015)
family tier 1 threshold
has the meaning given by section
22-40
.
family tier 2 threshold
has the meaning given by section
22-40
.
family tier 3 threshold
has the meaning given by section
22-40
.
Federal Court
means the Federal Court of Australia.
fringe benefit
(Repealed by No 87 of 2015)
general interest charge
means the charge worked out under Part
IIA
of the
Taxation Administration Act 1953
.
general treatment
is defined in section
121-10
.
gold card
is defined in subsection
34-15(3)
.
health benefits fund
is defined in section
131-10
.
(a) a person who provides goods or services as, or as part of, [*]
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; or(b) a person who manufactures or supplies goods provided as, or as part of, hospital treatment or general treatment.
health insurance business
is defined in Division
121
.
health-related business
is defined in section
131-15
.
holder
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, of an insurance policy, means a person who is insured under the policy and who is not a
[*]
hospital
is defined in subsection
121-5(5)
.
hospital cover
is defined in section
34-15
.
hospital-substitute treatment
is defined in section
69-10
.
hospital treatment
is defined in section
121-5
.
Human Services Department
(Repealed by No 87 of 2015)
Human Services Minister
(Repealed by No 87 of 2015)
human tissue product
has the meaning given by section
72-12
.
(a) in relation to an insurer who is not a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
restricted access insurer - has the meaning given by subsection 55-5(2) ; and(b) in relation to a restricted access insurer - has the meaning given by subsection 55-5(2) as affected by subsection 55-5(3) .
incentive amount
(Repealed by No 26 of 2012)
incentive payments scheme
(Repealed by No 105 of 2013)
income for surcharge purposes
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, of a person for a financial year, means the income for surcharge purposes (within the meaning of the
Income Tax Assessment Act 1997
) for the person for the
[*]
income year
has the meaning given by the
Income Tax Assessment Act 1997
.
indexation factor
has the meaning given by section
22-45
.
index number
has the meaning given by section
22-45
.
ineligible for Medicare
, in relation to a person, means not an eligible person within the meaning of the
Health Insurance Act 1973
.
inspector
(Repealed by No 87 of 2015)
insurance
is defined in section
5-1
.
late payment penalty
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
means a late payment penalty incurred under section
307-5
in respect of a
[*]
levy-related document
is defined in subsection
313-1(3)
.
lifetime health cover base day
is defined in section
34-25
.
makes a capital payment
(Repealed by No 87 of 2015)
manager
(Repealed by No 87 of 2015)
medical device
has the meaning given by section
72-11
.
medical devices and human tissue products levy
is defined in paragraph
304-10(da)
.
medical practitioner
means a medical practitioner within the meaning of the
Health Insurance Act 1973
.
Medicare Australia CEO
(Repealed by No 32 of 2011)
medicare benefit
means a medicare benefit under Part II of the
Health Insurance Act 1973
.
medicare eligibility day
is defined in subsection
34-25(5)
.
medicare program
has the same meaning as in the
Human Services (Medicare) Act 1973
.
member
(Repealed by No 87 of 2015)
national joint replacement register levy
is defined in paragraph
304-10(e)
.
net asset position
(Repealed by No 87 of 2015)
new arrival
(Repealed by No 63 of 2010)
occupier
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, of
[*]
(a) the person in charge or control, or apparently in charge or control, of the premises; or
(b) a person who represents, or apparently represents, that person.
officer
, of a private health insurer, means:
(a) a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
director of the insurer; or(b) a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
chief executive officer of the insurer; or(c) a person who makes, or participates in making, decisions that affect the whole, or a substantial part, of the business of the insurer.
officer
(Repealed by No 57 of 2015)
old Schedule 2
is defined in subsection
34-10(5)
.
overseas
has a meaning affected by section
34-30
.
participant
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, in relation to the
[*]
(a) a person who is registered as a participant in the scheme under subsection 23-15(3) ; or
(b) a person who has applied to be registered as a participant in the scheme under subsection 23-15(1) and whose application has not been refused.
(a) a private health insurer approved by the Minister under subsection 279-5(2) ; or
(b) a private health insurer that has applied under subsection 279-5(1) to be approved and whose application has not been rejected.
permitted days without hospital cover
is defined in section
34-20
.
personal information
has the same meaning as in the
Privacy Act 1988
.
PHIIB
(short for
Private Health Insurance Incentive Beneficiary
) has the meaning given by section
22-5
.
PHII benefit
(short for
Private Health Insurance Incentive benefit
) has the meaning given by section
22-10
.
policy group
(Repealed by No 87 of 2015)
policy holder
To find definitions of asterisked terms, see the Dictionary in Schedule
1
. To find definitions of asterisked terms, see the Dictionary in Schedule
1
. To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, of a
[*]
policy liability
(Repealed by No 87 of 2015)
pre-existing condition
is defined in section
75-15
.
premises
includes the following:
(a) a structure, building, vehicle or vessel;
(b) a place (whether enclosed or built on);
(c) a part of a thing referred to in paragraph (a) or (b).
premium indexation factor
(Repealed by No 26 of 2014)
premiums reduction scheme
means the scheme provided for by Division
23
.
private health information statement
is defined in section
93-5
.
private health insurance arrangement
includes any of the following:
(a) a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
private health insurance policy or a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
product;(b) an agreement or arrangement between a private health insurer and a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
health care provider;(c) an agreement or arrangement between a private health insurer and another person (other than a health care provider) that relates to insurance in relation 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;(d) an agreement or arrangement between two or more health care providers that relates to insurance in relation to hospital treatment or general treatment;
(e) Private Health Insurance (Complying Product) Rules made for the purposes of item 1 or 5 of the table in subsection 72-1(2) ;
(f) 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) ;
(g) an arrangement between a private health insurer and a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
private health insurance broker;(h) an arrangement between a private health insurance broker and a person seeking to become insured under a private health insurance policy.
private health insurance broker
means a person:
(a) who deals (otherwise than by carrying on [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
health insurance business) in insurance policies that [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
cover [*]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 or both; and(b) who acts on behalf of persons seeking to become insured under those policies.
private health insurance levy
is defined in section
304-10
.
Private Health Insurance Ombudsman
means the Private Health Insurance Ombudsman established by section 20C of the
Ombudsman Act 1976
.
private health insurance policy
To find definitions of asterisked terms, see the Dictionary in Schedule
1
. To find definitions of asterisked terms, see the Dictionary in Schedule
1
. To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
means an insurance policy that
[*]
private health insurer
means a body that is registered under Division 3 of Part 2 of the
Private Health Insurance (Prudential Supervision) Act 2015
.
product
is defined in subsection
63-5(2)
.
product subgroup
is defined in subsection
63-5(2A)
.
protected information
is defined in subsection
323-1(2)
.
prudential direction
(Repealed by No 87 of 2015)
prudential matters
(Repealed by No 87 of 2015)
prudential standard
(Repealed by No 87 of 2015)
quarter
has the meaning given by the
Income Tax Assessment Act 1997
.
records
(Repealed No 57 of 2015)
referable
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
: an insurance policy is referable to a
[*]
(a) the fund is identified under paragraph 93-15(c) as the fund to which the policy is referable (and the policy has not been made referable to another [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
health benefits fund under Division 4 of Part 3 of the Private Health Insurance (Prudential Supervision) Act 2015 ); or(b) the policy has been made referable to the fund under Division 4 of Part 3 of the Private Health Insurance (Prudential Supervision) Act 2015 .
reference premium
(Repealed by No 26 of 2014)
registered as a for profit insurer
(Repealed by No 87 of 2015)
responsible insurer
(Repealed by No 87 of 2015)
restricted access group
(Repealed by No 87 of 2015)
restricted access insurer
has the same meaning as in the
Private Health Insurance (Prudential Supervision) Act 2015
.
risk equalisation jurisdiction
is defined in subsection
131-20(1)
.
risk equalisation levy
is defined in paragraph
304-10(d)
.
Risk Equalisation Special Account
: see subsection
318-1(1)
.
Risk Equalisation Trust Fund
(Repealed by No 87 of 2015)
rules
To find definitions of asterisked terms, see the Dictionary in Schedule
1
. To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, of a private health insurer, means the body of rules established by the insurer that relate to the day-to-day operation of the insurer
'
s
[*]
schedule fee
means the Schedule fee within the meaning of Part II of the
Health Insurance Act 1973
.
search powers
means powers to search for, inspect, take extracts from, and make copies of, documents.
senior manager
(Repealed by No 87 of 2015)
share of the PHII benefit
has the meaning given by sections
22-15
,
22-20
and
22-25
.
singles tier 1 threshold
has the meaning given by section
22-35
.
singles tier 2 threshold
has the meaning given by section
22-35
.
singles tier 3 threshold
has the meaning given by section
22-35
.
solvency direction
(Repealed by No 87 of 2015)
solvency standard
(Repealed by No 87 of 2015)
standard information statement
(Repealed by No 101 of 2018)
tax file number
means a tax file number as defined in section
202A
of the
Income Tax Assessment Act 1936
.
terminating management
(Repealed by No 87 of 2015)
terminating manager
(Repealed by No 87 of 2015)
termination day
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, in relation to the
[*]
tier 1 earner
has the meaning given by section
22-30
.
tier 2 earner
has the meaning given by section
22-30
.
tier 3 earner
has the meaning given by section
22-30
.
transfer
, in relation to a person, is defined in section
75-10
.
up to date
To find definitions of asterisked terms, see the Dictionary in Schedule
1
.
, in relation to a
[*]
voluntary deed of arrangement
means:
(a) a deed of arrangement agreed on at a meeting of a kind referred to in section 217-45 ; or
(b) such a deed as varied in accordance with the Health Benefits Fund Enforcement Rules.
waiting period
is defined in section
75-5
.
weighted average ratio
(Repealed by No 26 of 2014)
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