Private Health Insurance Act 2007

Ch 4 heading substituted by No 87 of 2015, s 3 and Sch 1 item 54, effective 1 July 2015. For transitional provisions, see note under s 3-15 . The heading formerly read:

CHAPTER 4 - PRIVATE HEALTH INSURERS

Div 146 repealed by No 87 of 2015, s 3 and Sch 1 item 65, effective 1 July 2015. For transitional provisions, see note under s 3-15 .

S 146-1 repealed by No 87 of 2015, s 3 and Sch 1 item 65, effective 1 July 2015. For transitional provisions, see note under s 3-15 . S 146-1 formerly read:

SECTION 146-1 RESTRUCTURE OF HEALTH BENEFITS FUNDS  
146-1(1)
A private health insurer may restructure its *health benefits funds so that insurance policies that are *referable to a health benefits fund (a transferring fund ) of the insurer become referable to one or more other health benefits funds ( receiving funds ) of the insurer (whether existing or proposed) if:
(a) the insurance policies concerned are all of the policies that, immediately before the restructure, were referable to the transferring fund and belonged to one or more *policy groups of that fund; and
(b) the insurer applies to the Council, in the *approved form, for approval of the restructure; and
(c) the Council approves the restructure in writing; and
(d) the insurer complies with any requirements that the Private Health Insurance (Health Benefits Fund Administration) Rules impose on the insurer in relation to the restructure.

146-1(2)
Subject to subsection (3), the Council must approve the restructure if, and only if, it is satisfied that:
(a) the *assets and liabilities that would be transferred to the receiving fund or funds represent a reasonable estimate of what would, immediately before the restructure, be the *net asset position of the transferring fund; and
(aa) if there is more than one receiving fund - those assets and liabilities would be fairly distributed between the receiving funds; and
(b) the restructure will not result in any breach of the *solvency standard or the *capital adequacy standard.

146-1(2A)
For the purposes of paragraph (2)(a), in working out the *net asset position of the transferring fund, disregard the net asset position of the fund to the extent that it relates to insurance policies that do not belong to a *policy group referred to in paragraph (1)(a).

146-1(3)
The Council must not approve the application if:
(a) it considers that the restructure will result in unfairness to the *policy holders of a *health benefits fund of the insurer as that fund exists immediately before the restructure, when those policy holders are viewed as a group; or
(b) it considers that the restructure will result in unfairness to the persons who would be policy holders of a health benefits fund of the insurer as that fund would exist immediately after the restructure, when those persons are viewed as a group; or
(c) the insurer is being wound up when the application is made.

Note:

Refusals to approve restructures are reviewable under Part 6-9.

146-1(4)
The Private Health Insurance (Health Benefits Fund Administration) Rules may provide for the following:
(a) criteria for approving or refusing to approve applications under subsection (1);
(aa) how to work out reasonable estimates of the kind referred to in paragraph (2)(a);
(ab) criteria for deciding, for the purposes of paragraph (2)(aa), whether assets and liabilities would be fairly distributed;
(b) requirements to notify interested persons of the outcomes of such applications;
(c) matters connected with how restructures take place, including the following:

(i) insurance policies becoming *referable to a receiving fund or funds;

(ii) *policy liabilities and other liabilities incurred for the purposes of a transferring fund becoming treated as policy liabilities and other liabilities incurred for the purposes of a receiving fund or funds;

(iii) *assets of a transferring fund becoming assets of a receiving fund or funds;

(iv) the timing of restructures;

(v) if a receiving fund is a proposed new *health benefits fund - the establishment of that fund;

(d) requirements for private health insurers to give the Council information following restructures.

146-1(5)
A policy group , of a *health benefits fund, is all of the insurance policies:
(a) that are *referable to the fund; and
(b) the addresses of the *holders of which, as known to the private health insurer conducting the fund, are located in the same *risk equalisation jurisdiction.

The Private Health Insurance (Health Benefits Fund Administration) Rules may provide for how to work out the policy group for a policy that has 2 or more holders whose addresses are not all located in the same risk equalisation jurisdiction.

146-1(6)
An area is a risk equalisation jurisdiction if the Private Health Insurance (Health Benefits Fund Administration) Rules so provide.