Private Health Insurance Act 2007

S 1-10(6) amended by No 87 of 2015, s 3 and Sch 1 item 42, by repealing table item 1, effective 1 July 2015. For transitional provisions, see note under s 3-15. Table item 1 formerly read:

1

Council

the Dictionary in Schedule 1

S 1-10(6) amended by No 32 of 2011, s 3 and Sch 4 item 506, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" in table item 4, effective 1 July 2011.

S 1-15 inserted by No 59 of 2015, s 3 and Sch 2 item 306, effective 1 July 2016.

S 3-1 amended by No 87 of 2015, s 3 and Sch 1 items 43-45, by substituting "*products." for "*products; and" in para (b), repealing para (c) and inserting the note, effective 1 July 2015. For transitional provisions, see note under s 3-15. Para (c) formerly read:

(c) imposes requirements about how insurers conduct *health insurance business.

S 3-5 amended by No 105 of 2013, s 3 and Sch 2 item 1, repealing para (b), effective 1 July 2013. Para (b) formerly read:

(b) payments by the Commonwealth in relation to premiums paid for complying health insurance policies;

S 3-15 substituted by No 87 of 2015, s 3 and Sch 1 item 46, effective 1 July 2015. No 87 of 2015, s 3 and Sch 2 items 1-43 contain the following transitional provisions:

Part 1 - Introduction

1 Interpretation  
(1)
In this Schedule:

APRA
means the Australian Prudential Regulation Authority.

APRA Act
means the Australian Prudential Regulation Authority Act 1998.

APRA Minister
means the Minister administering the APRA Act.

APRA Special Account
has the same meaning as it has in the APRA Act.

asset
means:

(a) any legal or equitable estate or interest in real or personal property, whether actual, contingent or prospective; and

(b) any right, power, privilege or immunity, whether actual, contingent or prospective.

assets official
, in relation to an asset other than land, means the person or authority who:

(a) under a law of the Commonwealth, a State or a Territory; or

(b) under a trust instrument; or (c) otherwise;

has responsibility for keeping a register in relation to assets of the kind concerned.

collapsed insurer levy
has the same meaning as it had in the PHI Act as in force immediately before the transition time.

Collapsed Insurer Special Account
has the same meaning as it has in the APRA Act as amended by this Act.

Council
means the Private Health Insurance Administration Council.

Council administration levy
has the same meaning as it had in the PHI Act as in force immediately before the transition time.

Council money
: see subitem 16(1).

Council-supervised obligation
has the same meaning as it had in the PHI Act as in force immediately before the transition time.

Federal Court
means the Federal Court of Australia.

Health Minister
means the Minister administering the PHI Act.

imposition day
has the same meaning as it had in section 307-1 of the PHI Act as in force immediately before the transition time.

land
means any legal or equitable estate or interest in real property, whether actual, contingent or prospective.

land registration official
, in relation to land, means the Registrar of Titles or other proper officer of the State or Territory in which the land is situated.

liability
means any liability, duty or obligation, whether actual, contingent or prospective.

PHI Act
means the Private Health Insurance Act 2007.

Prudential Supervision Act
means the Private Health Insurance (Prudential Supervision) Act 2015.

Risk Equalisation Special Account
has the same meaning as it has in the PHI Act as amended by this Act.

Risk Equalisation Trust Fund
has the same meaning as it had in the PHI Act as in force immediately before the transition time.

transferring employee
has the meaning given by subitem 31(2).

transition time
means the commencement of section 1 of the Prudential Supervision Act.

(2)
Unless rules made under item 43 provide otherwise, if this Schedule provides that an Act (or a Part, Division or provision of an Act) as in force immediately before the transition time, continues to apply in relation to a matter, then:
(a) any rules, determinations or other instruments as in force, immediately before the transition time, under or for the purposes of the Act (or the Part, Division or provision) are also taken to continue to apply in relation to the matter; and
(b) that continued application of the rules, determinations or other instruments is subject to the same general modifications (if any) as apply under this Schedule in relation to the Act (or the Part, Division or provision).

Part 2 - Specific transitional provisions

Division 1 - Registration of private health insurers

2 Proceedings for injunctions relating to carrying on health insurance business without registration  
(1)
This item applies if, immediately before the transition time, proceedings for an injunction are pending in the Federal Court under section 118-5 of the PHI Act.

(2)
If the proceedings were commenced by application made by the Health Minister or by the Council, then, from the transition time, the proceedings continue, with APRA substituted for the Health Minister or the Council as a party, as if the proceedings had been commenced by application made by APRA under section 11 of the Prudential Supervision Act.

(3)
If the proceedings were commenced by application made by some other person, then, from the transition time, the proceedings continue as if the person had standing to commence the proceedings under section 11 of the Prudential Supervision Act, and had so commenced the proceedings under that section.
3 Continuing the registration of private health insurers  
(1)
If, immediately before the transition time, the registration of a body is in force under Part 4-3 of the PHI Act then, from the transition time:
(a) the registration is taken to be a registration of the body under Division 3 of Part 2 of the Prudential Supervision Act subject to the same terms and conditions (the body's registration terms and conditions ) as apply immediately before the transition time; and
(b) the body is taken to be registered under that Division as a restricted access insurer if, immediately before the transition time, the body had that status under the PHI Act; and
(c) the body is taken to be registered under that Division as a for profit insurer if, immediately before the transition time, the body had that status under the PHI Act.

(2)
Subitem (1) has effect subject to Division 3 of Part 2 of the Prudential Supervision Act.

Note:

For example, under Division 3 of Part 2 of the Prudential Supervision Act, the status of the body's registration may change, or the body's registration may be cancelled.

(3)
After the transition time, the body may, in writing, request APRA to vary the body's registration terms and conditions by:
(a) amending one or more of those terms and conditions; or
(b) revoking one or more of those terms and conditions.

Note:

A request to impose additional terms and conditions cannot be made under subitem (3).

(4)
If the body makes a request under subitem (3), APRA may, by written notice to the body, vary the body's registration terms and conditions in accordance with the request.
4 Applications for registration as private health insurer  
(1)
If an application for registration that was made under section 126-10 of the PHI Act before the transition time has not been decided by the transition time, the Prudential Supervision Act applies in relation to the application as if it had been made under section 12 of that Act.

(2)
For the purposes of sections 13 and 17 of the Prudential Supervision Act, the application is taken to have been made at the transition time.

(3)
If, before the transition time, the Council gave the applicant notice under section 126-15 of the PHI Act requiring the provision of further information, and that information has not been provided by the transition time, the notice is taken to have been given by APRA, at the transition time, under section 13 of the Prudential Supervision Act.
5 Conversion to for profit status  
(1)
An approval that is in force under section 126-42 of the PHI Act immediately before the transition time has effect from the transition time as if it were an approval by APRA under section 20 of the Prudential Supervision Act.

(2)
If an application made to the Council before the transition time under section 126-42 of the PHI Act has not been decided by the transition time, then:
(a) the Prudential Supervision Act applies in relation to the application as if the application had been made under section 20 of the Prudential Supervision Act; and
(b) if, before the transition time, the Council caused a notice to be published in relation to the application in accordance with paragraph 126-42(4)(a) of the PHI Act, then APRA is taken to have complied with paragraph 20(4)(a) of the Prudential Supervision Act in relation to the application; and
(c) if, before the transition time:

(i) the Council gave the applicant a notice under paragraph 126-42(4)(b) of the PHI Act requiring the applicant to provide further information; and

(ii) that information has not been provided to the Council by the transition time;

then the notice is taken to have been given by APRA under paragraph 20(4)(b) of the Prudential Supervision Act.

Division 2 - Health benefits funds - restructures, mergers and acquisitions, and terminating and external management

6 Restructures of health benefits funds  
(1)
An approval that is in force under section 146-1 of the PHI Act immediately before the transition time has effect from the transition time as if it were an approval by APRA under section 32 of the Prudential Supervision Act.

(2)
If an application made to the Council before the transition time under section 146-1 of the PHI Act has not been decided by the transition time, the Prudential Supervision Act applies in relation to the application as if it had been made under section 32 of the Prudential Supervision Act.
7 Mergers and acquisitions of health benefits funds  
(1)
An approval that is in force under section 146-5 of the PHI Act immediately before the transition time has effect from the transition time as if it were an approval by APRA under section 33 of the Prudential Supervision Act.

(2)
If an application made to the Council before the transition time under section 146-5 of the PHI Act has not been decided by the transition time, the Prudential Supervision Act applies in relation to the application as if it had been made under section 33 of the Prudential Supervision Act.
8 Terminating management and external management of health benefits funds  
Approvals of termination of health benefits funds

(1)
An approval that is in force under section 149-10 of the PHI Act immediately before the transition time has effect from the transition time as if it were an approval by APRA under section 37 of the Prudential Supervision Act.

Applications for approval of termination of health benefits funds

(2)
If an application made to the Council before the transition time under section 149-1 of the PHI Act has not been decided by the transition time, the Prudential Supervision Act applies in relation to the application as if it had been made under section 35 of the Prudential Supervision Act.

(3)
For the purposes of sections 36 and 38 of the Prudential Supervision Act, the application is taken to have been made at the transition time.

(4)
If, before the transition time, the Council gave the applicant notice under section 149-5 of the PHI Act requiring the provision of further information, and that information has not been provided by the transition time, the notice is taken to have been given by APRA, at the transition time, under section 36 of the Prudential Supervision Act.

Appointments of terminating managers and external managers

(5)
An appointment of a terminating manager that is in force under the PHI Act immediately before the transition time has effect from the transition time as if it were:
(a) if the appointment was made under section 149-10 of the PHI Act - an appointment made under section 37 of the Prudential Supervision Act; or
(b) if the appointment was made under Division 220 of the PHI Act - an appointment made under Division 7 of Part 3 of the Prudential Supervision Act.

Other things done in relation to the terminating management or external management of health benefits funds

(6)
Subject to subitem (7), if a health benefits fund is under terminating management or external management immediately before the transition time, then the terminating management or external management continues after the transition time, under the Prudential Supervision Act, as if:
(a) a thing done, by or in relation to the Council for the purposes of the terminating management or external management, under a provision of the PHI Act had been done, by or in relation to APRA, under the corresponding provision of the Prudential Supervision Act; and
(b) a thing done, by or in relation to the terminating manager or external manager, under a provision of the PHI Act had been done, by or in relation to the terminating manager or external manager, under the corresponding provision of the Prudential Supervision Act.

(7)
Rules made under item 43 may make provision for or in relation to how a terminating management or external management is to continue under the Prudential Supervision Act.

Division 3 - Other obligations of private health insurers

9 Directions  
(1)
This item applies in relation to a direction given to a private health insurer, under any of the following provisions of the PHI Act, that is in force immediately before the transition time:
(a) section 140-20 (solvency directions);
(b) section 143-20 (capital adequacy directions);
(c) section 163-15 (directions to comply with standards);
(d) section 200-1 (other directions).

(2)
The direction has effect from the transition time as if it were a direction given by APRA to the private health insurer under section 96 of the Prudential Supervision Act. However, section 104 (non-compliance with a direction) does not apply in relation to the direction unless it was given under section 163-15 of the PHI Act.

Note:

The direction may be varied or revoked under section 99 of the Prudential Supervision Act.

(3)
If the direction specifies a period for which it remains in force, the direction ceases to have effect at the end of the specified period.
10 Actuaries  
10
An appointment of a person as the actuary of a private health insurer that is in force under section 160-1 of the PHI Act immediately before the transition time has effect from the transition time as if it were an appointment under section 106 of the Prudential Supervision Act. 11 Disqualified persons  
(1)
The Prudential Supervision Act has effect as if the definition of disqualified person in subsection 119(1) of that Act also included a person in relation to whom a disqualification under section 166-20 of the PHI Act was in force immediately before the transition time.

(2)
Subitem (1) ceases to apply if APRA revokes the disqualification under subitem (3).

(3)
APRA may revoke the disqualification on application by the person or on its own initiative. A revocation takes effect on the day on which it is made.

(4)
APRA must give the person written notice of a revocation of the disqualification, or of a refusal to revoke the disqualification. APRA may also give notice of the revocation or refusal in any other way that it considers appropriate.

(5)
Section 168 of the Prudential Supervision Act (review of decisions) applies to a decision under this item to refuse to revoke the disqualification as if the decision were a reviewable decision as defined in that section.

Division 4 - Enforcement

12 Investigations  
Continuation of investigations in progress under PHI Act at the transition time

(1)
If an investigation commenced by the Council under Division 194 of the PHI Act before the transition time has not been completed by that time, then Division 194 of the PHI Act, as in force immediately before the transition time, is taken to continue to apply in relation to the investigation (despite the amendments of that Division made by this Act), as if:
(a) references in the Division to the Council (other than references that are to a Council-supervised obligation) were instead references to APRA; and
(b) a thing done, by or in relation to the Council, under a provision of the Division before the transition time had been done, by or in relation to APRA, under that provision.

(2)
If an investigation commenced by the Council under Division 214 of the PHI Act before the transition time has not been completed by that time, then Division 214 of the PHI Act, as in force immediately before the transition time, is taken to continue to apply in relation to the investigation (despite the repeal of that Division by this Act), as if:
(a) references in the Division to the Council were instead references to APRA; and
(b) a thing done, by or in relation to the Council, under a provision of the Division before the transition time had been done, by or in relation to APRA, under that provision.

(3)
Without limiting subitem (2), an appointment of an inspector under subsection 214-1(1) of the PHI Act that is in force immediately before the transition time has effect, after the transition time, as if it were an appointment of the inspector by APRA under that subsection as it continues to apply because of subitem (2).

(4)
Rules made under item 43 may make provision for or in relation to how an investigation to which subitem (1) or (2) applies is to continue after the transition time.

Use of powers in Prudential Supervision Act to investigate breaches of Council-supervised obligations

(5)
Division 3 of Part 6 of the Prudential Supervision Act has effect as if the reference in paragraph 130(1)(b) of that Act to an enforceable obligation included a reference to a Council-supervised obligation.
13 Enforceable undertakings  
13
An enforceable undertaking that was accepted by the Council under subsection 197-1(2) of the PHI Act before the transition and that is in force immediately before that time has effect, from the transition time, as if it had been accepted by APRA under subsection 152(1) of the Prudential Supervision Act. 14 Federal Court remedies  
Continuation of proceedings under Division 203 of the PHI Act

(1)
If, immediately before the transition time, proceedings commenced by the Council are pending in the Federal Court under Division 203 of the PHI Act, then the proceedings continue after the transition time in accordance with subitem (2), with APRA substituted for the Council as a party.

(2)
Division 203 of the PHI Act, as in force immediately before the transition time, is taken to continue to apply (despite the amendments of that Division made by this Act) in relation to the proceedings as if:
(a) references in the Division to the Council (other than references that are to a Council-supervised obligation) were instead references to APRA; and
(b) a thing done, by or in relation to the Council, under a provision of the Division before the transition time had been done, by or in relation to APRA, under that provision.

Applying Part 8 of the Prudential Supervision Act to contraventions of Council-supervised obligations

(3)
Part 8 of the Prudential Supervision Act has effect as if references in that Part to enforceable obligations also included references to Council-supervised obligations.
15 Proceedings for injunctions relating to non-complying policies  
15
If, immediately before the transition time:
(a) proceedings for an injunction are pending in the Federal Court under section 84-10 of the PHI Act; and
(b) the proceedings were commenced by application made by the Council;

then, from the transition time, the proceedings continue, but with the Health Minister substituted for the Council as a party.

Division 5 - Financial matters

16 Crediting of Council money to special accounts  
(1)
Council money means all money held by the Council immediately before the transition time.

(2)
Amounts equal to the following amounts must be credited to the Risk Equalisation Special Account after the transition time:
(a) the amount (if any) that, immediately before the transition time, stood to the credit of the Risk Equalisation Trust Fund;
(b) any amounts of Council money that, before the transition time, were required, by section 318-5 of the PHI Act, to be paid to the Risk Equalisation Trust Fund but that had not been so paid by the transition time;
(c) any other amount of Council money that consists of a repayment to the Council of a payment made, before the transition time, for the purpose of helping to meet liabilities as described in section 6 of the Private Health Insurance (Collapsed Insurer Levy) Act 2003.

(3)
Amounts equal to the following amounts must be credited to the Collapsed Insurer Special Account after the transition time:
(a) any amount of Council money that consists of collapsed insurer levy, or related late payment penalty, received by the Council before the transition time;
(b) any amount of Council money that consists of the proceeds from investments made using collapsed insurer levy, or related late payment penalty.

(4)
An amount equal to all Council money that is not covered by subitem (2) or (3) must be credited to the APRA Special Account after the transition time.
17 Collection and recovery of Council administration levy and collapsed insurer levy imposed before the transition time  
(1)
This item applies if the imposition day for an amount (the levy amount ) of Council administration levy, or collapsed insurer levy, is before the transition time, but the amount has not been paid by that time.

(2)
The following provisions of the PHI Act as in force immediately before the transition time:
(a) Division 307;
(b) section 328-5 as it relates to decisions made under Division 307;

are taken to continue to apply in relation to the levy amount (despite the amendments made by this Act), as if references in sections 307-10, 307-15, 307-20 and 307-25 to the Council were instead references to APRA (acting for and on behalf of the Commonwealth).

(3)
If:
(a) the levy amount is Council administration levy; and
(b) an amount is paid to, or recovered by, APRA in respect of the levy amount or related late payment penalty;

an amount equal to the amount so paid or recovered must be credited to the APRA Special Account.

(4)
If:
(a) the levy amount is collapsed insurer levy; and
(b) an amount is paid to, or recovered by, APRA in respect of the levy amount or related late payment penalty;

an amount equal to the amount so paid or recovered must be credited to the Collapsed Insurer Special Account.

18 Entitlements to be paid an amount out of the Risk Equalisation Trust Fund 
(1)
This item applies if, immediately before the transition time, a private health insurer has an entitlement to be paid an amount out of the Risk Equalisation Fund that has not been met.

(2)
APRA must, after the transition time, pay that amount to the private health insurer. The amount paid must be debited from the Risk Equalisation Special Account.

Division 6 - Other matters

19 Secrecy obligations  
19
For sections 323-1 and 323-40 of the Private Health Insurance Act 2007, a disclosure of information is an authorised disclosure if the disclosure is:
(a) made in the course of performing or exercising an APRA private health insurance duty, function or power (within the meaning of section 323-1 of that Act); or
(b) one that the person would have been able to make under section 56 of the APRA Act, had the information been obtained in the course of performing such a duty, function or power. 20 Report on operations of private health insurers before transition time  
(1)
This item applies if, in relation to a financial year ending at or before the transition time, the Council has not, by the transition time, given a report in relation to that year under section 264-15 of the PHI Act as in force immediately before the transition time.

(2)
That section of the PHI Act is taken to continue in force in relation to that financial year, as if the reference to the Council were instead a reference to APRA.

Part 3 - General transitional provisions

Division 1 - Transitional functions

21 Transitional function for Council and APRA  
(1)
During the transition period, the functions of the Council include the function of taking such steps as may be necessary or convenient to prepare for or give effect to, or assist APRA or the Commonwealth to prepare for or give effect to:
(a) the abolition of the Council; and
(b) the operation of this Schedule; and
(c) the enactment of this Act and the Prudential Supervision Act.

(2)
During the transition period, APRA's functions include the function of taking such steps as may be necessary or convenient to prepare for or give effect to, or assist the Council or the Commonwealth to prepare for or give effect to:
(a) the abolition of the Council; and
(b) the operation of this Schedule; and
(c) the enactment of this Act and the Prudential Supervision Act.

(3)
In this item:

transition period
means the period:
(a) starting on the day on which this Act receives the Royal Assent; and
(b) ending immediately before the transition time.

Division 2 - Transfer of assets and liabilities

22 Vesting of assets  
(1)
This item applies to the assets of the Council immediately before the transition time.

Assets vesting in APRA

(2)
At the transition time, the assets cease to be assets of the Council and become assets of APRA, without any conveyance, transfer or assignment. APRA becomes the successor in law in relation to the assets.

Assets vesting in the Commonwealth

(3)
Before the transition time, the APRA Minister may determine, in writing, that a specified asset to which this item applies is to become an asset of the Commonwealth.

Note:

For specification by class, see subsection 33(3AB) of the Acts Interpretation Act 1901.

(4)
If the APRA Minister makes a determination under subitem (3), then, at the transition time and despite subitem (2), the asset ceases to be an asset of the Council and becomes an asset of the Commonwealth, without any conveyance, transfer or assignment. The Commonwealth becomes the successor in law in relation to the asset.

(5)
A determination made under subitem (3) is not a legislative instrument.
23 Vesting of liabilities  
(1)
This item applies to the liabilities of the Council immediately before the transition time.

Liabilities vesting in APRA

(2)
At the transition time, the liabilities cease to be liabilities of the Council and become liabilities of APRA without any conveyance, transfer or assignment. APRA becomes the successor in law in relation to the liabilities.

Liabilities vesting in the Commonwealth

(3)
Before the transition time, the APRA Minister may determine, in writing, that a specified liability to which this item applies is to become a liability of the Commonwealth.

Note:

For specification by class, see subsection 33(3AB) of the Acts Interpretation Act 1901.

(4)
If the APRA Minister makes a determination under subitem (3), then, at the transition time and despite subitem (2), the liability ceases to be a liability of the Council and becomes a liability of the Commonwealth, without any conveyance, transfer or assignment. The Commonwealth becomes the successor in law in relation to the liability.

(5)
A determination made under subitem (3) is not a legislative instrument.
24 Transfers of land may be registered  
(1)
This item applies if:
(a) any land vests in APRA or the Commonwealth under this Division; and
(b) there is lodged with a land registration official a certificate that:

(i) is signed by the APRA Minister; and

(ii) identifies the land, whether by reference to a map or otherwise; and

(iii) states that the land has become vested in APRA or the Commonwealth under this Division.

(2)
The land registration official may:
(a) register the matter in a way that is the same as, or similar to, the way in which dealings in land of that kind are registered; and
(b) deal with, and give effect to, the certificate.

(3)
A certificate under paragraph (1)(b) is not a legislative instrument.
25 Certificates relating to vesting of assets other than land  
(1)
This item applies if:
(a) an asset other than land vests in APRA or the Commonwealth under this Division; and
(b) there is lodged with an assets official a certificate that:

(i) is signed by the APRA Minister; and

(ii) identifies the asset; and

(iii) states that the asset has become vested in APRA or the Commonwealth under this Division.

(2)
The assets official may:
(a) deal with, and give effect to, the certificate as if it were a proper and appropriate instrument for transactions in relation to assets of that kind; and
(b) make such entries in the register in relation to assets of that kind as are necessary, having regard to the effect of this Division.

(3)
A certificate made under paragraph (1)(b) is not a legislative instrument.

Division 3 - Transfer of other matters

26 Things done by, or in relation to, the Council  
(1)
This item applies to anything done by, or in relation to, the Council before the transition time.

Attributing things to APRA

(2)
At and after the transition time, the thing has effect as if it had been done by, or in relation to, APRA.

Attributing things to the Commonwealth

(3)
The APRA Minister may determine, in writing, that:
(a) a specified thing to which this item applies is taken, at and after the transition time, to have been done by, or in relation to, the Commonwealth; or
(b) this item does not apply to a specified thing.

(4)
A determination made under subitem (3) has effect accordingly, despite subitem (2).

(5)
The APRA Minister may make a determination under subitem (3) before or after the transition time.

(6)
A determination made under subitem (3) is not a legislative instrument.

(7)
This item does not limit the operation of items 22 and 23.
27 References in certain instruments to the Council  
(1)
This item applies to an instrument that:
(a) is in force immediately before the transition time; and
(b) contains a reference to the Council.

Attributing references in instruments to APRA

(2)
If the instrument relates to:
(a) an asset or liability of the Council that, as a result of the operation of item 22 or 23, becomes an asset or liability of APRA; or
(b) a thing done by, or in relation to, the Council, that, as a result of the operation of item 26, is taken to have been done by, or in relation to, APRA;

then the reference to the Council has effect, at and after the transition time, as if it were a reference to APRA.

Attributing references in instruments to the Commonwealth

(3)
If the instrument relates to:
(a)an asset or liability of the Council that, as a result of the operation of item 22 or 23, becomes an asset or liability of the Commonwealth; or
(b) a thing done by, or in relation to, the Council, that, as a result of the operation of item 26, is taken to have been done by, or in relation to, the Commonwealth;

then the reference to the Council has effect, at and after the transition time, as if it were a reference to the Commonwealth.

APRA Minister may attribute references

(4)
The APRA Minister may determine, in writing, that the reference to the Council has effect, at and after the transition time, as if it were a reference to APRA or the Commonwealth.

(5)
A determination made under subitem (4) has effect accordingly, despite subitems (2) and (3) (if otherwise applicable).

(6)
The APRA Minister may make a determination under subitem (4) before or after the transition time.

(7)
A determination made under subitem (4) is not a legislative instrument.

Definitions

(8)
In this item:

instrument
:

(a) includes:

(i) a contract, undertaking, deed or agreement; and

(ii) a notice, authority, order or instruction; and

(iii) an instrument made under an Act or under a legislative instrument; but

(b) does not include:

(i) an Act; or

(ii) an instrument made under this Act; or

(iii) a contract of employment; or

(iv) an instrument specified in rules made under item 43.

28 Legal proceedings of the Council  
(1)
This item applies if any proceedings to which the Council was a party were pending in any court or tribunal immediately before the transition time.

Substituting APRA as party to proceedings

(2)
APRA is substituted for the Council, from the transition time, as a party to those proceedings.

Substituting the Commonwealth as party to proceedings

(3)
The APRA Minister may determine, in writing, that the Commonwealth is substituted for the Council as a party to those proceedings.

(4)
A determination under subitem (3) has effect accordingly, despite subitem (2).

(5)
The APRA Minister may make a determination under subitem (3) before or after the transition time.

(6)
A determination made under subitem (3) is not a legislative instrument.
29 Transfer of Council's records and documents  
(1)
This item applies to any records or documents that were in the possession of the Council immediately before the transition time.

Transferring records and documents to APRA

(2)
The records and documents are to be transferred to APRA after the transition time.

Transferring records and documents to the Commonwealth

(3)
The APRA Minister may determine, in writing, that a record or document to which this item applies is to be transferred after the transition time to the Commonwealth.

(4)
A determination made under subitem (3) has effect accordingly, despite subitem (2).

(5)
The APRA Minister may make a determination under subitem (3) before or after the transition time.

(6)
A determination made under subitem (3) is not a legislative instrument.

(7)
Sections 37 and 41 of the Public Governance, Performance and Accountability Act 2013 apply in relation to records or documents transferred to an entity (within the meaning of that Act) under this item as if the records or documents related to that entity.

Note:

Records and documents transferred under this item are Commonwealth records for the purposes of the Archives Act 1983.

30 Transfer of Ombudsman investigations  
30
If:
(a) before the transition time, a complaint was made to the Ombudsman, or the Ombudsman began an investigation, under the Ombudsman Act 1976 in relation to an action taken by the Council; and
(b) by the transition time, the Ombudsman had not finally disposed of the matter in accordance with the Ombudsman Act 1976;

the Ombudsman Act 1976 applies after the transition time as if that action had been taken by APRA.

Division 4 - Staff and officers of the Council

31 Transferring employees - transfer to APRA  
(1)
At the transition time, a transferring employee:
(a) ceases to be employed by the Council; and
(b) is taken to have been appointed as an employee under subsection 45(1) of the APRA Act.

(2)
A person is a transferring employee if the person was employed by the Council under subsection 273-15(1) of the PHI Act immediately before the transition time.

(3)
A transferring employee is not entitled to receive any payment or other benefit merely because he or she stopped being an employee of the Council as a result of this item.
32 Transferring employees - terms and conditions of employment with APRA  
(1)
A transferring employee is entitled to terms and conditions of appointment as an employee of APRA that are no less favourable, considered on an overall basis, than the terms and conditions of employment to which the employee was entitled, immediately before the transition time, as an employee of the Council.

(2)
Subitem (1) ceases to have effect on the next occasion when an enterprise agreement (within the meaning of the Fair Work Act 2009) comes into operation that is:
(a) made on or after the transition time; and
(b) expressed to cover persons appointed under subsection 45(1) of the APRA Act.

(3)
The first determination (if any) that the Chair of APRA makes under subsection 45(2) of the APRA Act for a transferring employee may:
(a) be made before or after the transition time; and
(b) take effect from the transition time or a later time.

(4)
To avoid doubt:
(a) the Chair of APRA may determine different terms and conditions of appointment under subsection 45(2) of the APRA Act for different transferring employees; and
(b) a transferring employee may be covered by any of the following instruments (whether made before or after the transition time) that is expressed to cover a class of persons appointed under subsection 45(1) of the APRA Act that includes the transferring employee:

(i) a fair work instrument (within the meaning of the Fair Work Act 2009);

(ii) a transitional instrument (within the meaning of the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009);

(iii) a determination made under subsection 45(2) of the APRA Act.

33 Transferring employees - accrued leave and prior service  
(1)
APRA must recognise leave accrued by a transferring employee immediately before the transition time, in relation to a transferring employee's employment by the Council, as if it were leave in relation to periods of service as an employee of APRA appointed under section 45 of the APRA Act.

(2)
The service of a transferring employee as an employee of the Council is taken, for all purposes, to have been continuous with his or her service as an employee of APRA appointed under section 45 of the APRA Act.
34 Transferring employees - processes begun before transition time  
(1)
Without limiting item 43, rules made under that item may provide for:
(a) staffing procedures of the Council to apply, or to continue to apply, in relation to:

(i) processes begun before, but not completed by, the transition time; or

(ii) things done by, for or in relation to the Council or a transferring employee before that time; or

(b) staffing procedures of APRA to apply in relation to:

(i) processes begun before, but not completed by, the transition time; or

(ii) things done by, for or in relation to the Council or a transferring employee before that time.

(2)
In this item:

staffing procedures
includes procedures and policies related to:
(a) recruitment, promotion or performance management; or
(b) inefficiency, misconduct, forfeiture of position, fitness for duty or loss of essential qualifications; or
(c) disciplinary action, grievance processes or reviews of or appeals against staffing decisions; or
(d) transfers, resignations or termination of employment; or
(e) leave.

35Safety, Rehabilitation and Compensation Act 1988  
(1)
This item applies in relation to a person if:
(a) the person was employed by the Council under subsection 273-15(1) of the PHI Act at any time before the transition time (whether or not the person is a transferring employee); and
(b) the person was an employee (within the meaning of the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act )) of the Council when the person was employed as mentioned in paragraph (a); and
(c) the person suffered an injury (within the meaning of that Act) before the transition time.

(2)
The SRC Act applies, after the transition time, as if the person had been an employee of APRA appointed under subsection 45(1) of the APRA Act during the period that the person was employed by the Council as mentioned in paragraph (1)(a).

(3)
This item does not limit item 26 or 27 of this Schedule.
36 No transfer of Council officers or consultants  
Council officers

(1)
Nothing in this Part produces the result that the appointment of a Council officer immediately before the transition time has effect at or after the transition time as if it were an appointment of the person in relation to APRA or the Commonwealth.

(2)
Each of the following is a Council officer :
(a) the Commissioner of Private Health Insurance Administration;
(b) any other member of the Council;
(c) the Chief Executive Officer of the Council.

Consultants

(3)
Nothing in this Part produces the result that a person engaged as a consultant to the Council under subsection 273-15(3) of the PHI Act immediately before the transition time becomes engaged at or after that time as a consultant under subsection 47(1) of the APRA Act.

Division 5 - Annual reporting obligation

37 Final annual report for the Council  
(1)
The Chair of APRA must prepare and give to the APRA Minister, for presentation to the Parliament, a report (the final report ) on the activities of the Council during the final reporting period.

(2)
Sections 39, 40, 42, 43 and 46 of the Public Governance, Performance and Accountability Act 2013, and rules made for the purposes of those sections, apply subject to this item in relation to the Council and the final reporting period as if:
(a) references in those sections and rules to an annual report for a Commonwealth entity were references to the final report; and
(b) references in those sections and rules to a reporting period for a Commonwealth entity were references to the final reporting period; and
(c) references in those sections and rules to a Commonwealth entity were references to the Council; and
(d) references in those sections and rules to the accountable authority for a Commonwealth entity were references to the Chair of APRA; and
(e) references in those sections and rules to the responsible Minister for a Commonwealth entity were references to the APRA Minister.

(3)
The Chair of APRA must give the final report to the APRA Minister by the 15th day of the fourth month after the end of the final reporting period. The APRA Minister may grant an extension of time in special circumstances.

(4)
The APRA Minister must table the final report in each House of the Parliament as soon as practicable after receiving the report.

(5)
APRA must publish the final report on its website as soon as practicable after the report is tabled in the House of Representatives.

(6)
In this item:

annual report
means a report under section 46 of the Public Governance, Performance and Accountability Act 2013.

final reporting period
means the period:
(a) beginning:

(i) if, by the transition time, no annual report for the Council has been given to the Health Minister for the most recent reporting period for the Council that ended before the transition time - at the start of that reporting period; or

(ii) otherwise - at the start of the reporting period for the Council that includes the transition time; and

(b) ending immediately before the transition time.

reporting period
for the Council means the reporting period for the Council under the Public Governance, Performance and Accountability Act 2013.

Part 4 - Miscellaneous

38 Relationship between Part 3 and other provisions  
38
Part 3 has effect subject to Part 2 and any rules made under item 43. 39 Exemption from stamp duty and other State or Territory taxes  
(1)
No stamp duty or other tax is payable under a law of a State or a Territory in respect of an exempt matter, or anything connected with an exempt matter.

(2)
For the purposes of this item, an exempt matter is:
(a) the vesting of an asset or liability under this Schedule; or
(b) the operation of this Schedule in any other respect.

(3)
The APRA Minister may certify in writing:
(a) that a specified matter is an exempt matter; or
(b) that a specified thing was connected with a specified exempt matter.

(4)
In all courts, and for all purposes (other than for the purposes of criminal proceedings), a certificate under subitem (3) is prima facie evidence of the matters stated in the certificate.

(5)
A certificate under subitem (3) is not a legislative instrument.
40 Certificates taken to be authentic  
40
A document that appears to be a certificate made or issued under a particular provision of this Schedule:
(a) is taken to be such a certificate; and
(b) is taken to have been properly given;

unless the contrary is established.

41 Delegation by APRA Minister  
(1)
The APRA Minister may, by writing, delegate all or any of his or her powers and functions under this Schedule to:
(a) the Secretary of the Department responsible for administering the APRA Act; or
(b) an SES employee, or acting SES employee, in that Department.

Note:

The expressions SES employee and acting SES employee are defined in the Acts Interpretation Act 1901.

(2)
In exercising powers or functions under a delegation, the delegate must comply with any directions of the APRA Minister.

(3)
Subitem (1) does not apply to a power to make, vary or revoke a legislative instrument.
42 Compensation for acquisition of property  
(1)
If the operation of this Act would result in an acquisition of property (within the meaning of paragraph 51(xxxi) of the Constitution) from a person otherwise than on just terms (within the meaning of that paragraph), the Commonwealth is liable to pay a reasonable amount of compensation to the person.

(2)
If the Commonwealth and the person do not agree on the amount of the compensation, the person may institute proceedings in a court of competent jurisdiction for the recovery from the Commonwealth of such reasonable amount of compensation as the court determines.
43 Transitional rules  
(1)
The APRA Minister may, by legislative instrument (and subject to subitem (3)), make rules prescribing matters of a transitional nature (including prescribing any saving or application provisions) relating to:
(a) the amendments or repeals made by this Act; or
(b) the enactment of this Act or the Prudential Supervision Act.

(2)
The rules may allow the APRA Minister or APRA to determine matters in relation to anything in relation to which rules may be made.

(3)
To avoid doubt, the rules may not do the following:
(a) create an offence or civil penalty provision;
(b) provide:

(i) powers of arrest or detention; or

(ii) powers relating to entry, search or seizure;

(c) impose a tax;
(d) set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;
(e) directly amend the text of this Act.

(4)
This Act (other than subitem (3)) does not limit the rules that may be made for the purposes of subitem (1).

S 3-15 formerly read:

SECTION 3-15 PRIVATE HEALTH INSURERS (CHAPTER 4)  
3-15
Chapter 4 requires registration of anyone carrying on *health insurance business, and imposes obligations aimed at ensuring health insurance businesses, and in particular *health benefits funds, are conducted appropriately.

S 15-1 amended by No 105 of 2013, s 3 and Sch 2 item 2, by omitting para (b), effective 1 July 2013. Para (b) formerly read:

(b) payments in return for payments of premiums under complying health insurance policies (see Division 26);

Pt 2-2 heading substituted by No 105 of 2013, s 3 and Sch 2 item 3, effective 1 July 2013. The heading formerly read:

PART 2-2 - PREMIUMS REDUCTION AND INCENTIVE PAYMENTS SCHEMES

S 20-1 substituted by No 105 of 2013, s 3 and Sch 2 item 4, effective 1 July 2013. S 20-1 formerly read:

SECTION 20-1 WHAT THIS PART IS ABOUT  
20-1

To encourage people to take out, and continue to hold, private health insurance, this Part provides that people may either:

(a) reduce the premiums payable for their complying health insurance policies by participating in the premiums reduction scheme in Division 23; or
(b) receive a payment from the Commonwealth under Division 26 in partial reimbursement for a payment of premiums under a complying health insurance policy.

Note:

The premiums reduction scheme and the incentive payments scheme are complemented by the private health insurance offset provided for by Subdivision 61-G of the Income Tax Assessment Act 1997.

S 20-1 amended by No 32 of 2007, s 3 and Sch 3 item 9D, by substituting "Subdivision 61-G" for "Subdivision 61-H" in the note, effective 1 July 2007.

S 20-5 amended by No 105 of 2013, s 3 and Sch 2 item 5, by omitting "and the *incentive payments scheme" after "*premiums reduction scheme", effective 1 July 2013.

Div 22inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

Subdiv 22-A inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-1 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-5(2) amended by No 60 of 2021, s 3 and Sch 1 item 3, by substituting "*dependent persons" for "*dependent children", effective 1 April 2021.

S 22-5(3) amended by No 60 of 2021, s 3 and Sch 1 item 4, by substituting "*dependent persons" for "*dependent children", effective 1 April 2021.

S 22-5(4) amended by No 60 of 2021, s 3 and Sch 1 item 5, by substituting "*dependent person" for "*dependent child" in para (c), effective 1 April 2021.

S 22-5 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-10 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-15(2) amended by No 26 of 2014, s 3 and Sch 1 item 1, by substituting "specified in subsection (1) (as affected by subsection (5A))" for "mentioned in subsection (1)", effective 9 April 2014.

S 22-15(3) amended by No 26 of 2014, s 3 and Sch 1 item 1, by substituting "specified in subsection (1) (as affected by subsection (5A))" for "mentioned in subsection (1)", effective 9 April 2014.

S 22-15(4) amended by No 26 of 2014, s 3 and Sch 1 item 1, by substituting "specified in subsection (1) (as affected by subsection (5A))" for "mentioned in subsection (1)", effective 9 April 2014.

S 22-15(5) amended by No 60 of 2021, s 3 and Sch 1 item 6, by substituting "dependent persons" for "dependent children" in note 2, effective 1 April 2021.

S 22-15(5A) inserted by No 26 of 2014, s 3 and Sch 1 item 2, effective 9 April 2014.

S 22-15(5B) inserted by No 26 of 2014, s 3 and Sch 1 item 2, effective 9 April 2014.

S 22-15(5C) inserted by No 26 of 2014, s 3 and Sch 1 item 2, effective 9 April 2014.

S 22-15(5D) inserted by No 26 of 2014, s 3 and Sch 1 item 2, effective 9 April 2014.

S 22-15(5E) inserted by No 26 of 2014, s 3 and Sch 1 item 2, effective 9 April 2014.

S 22-15(6) inserted by No 105 of 2013, s 3 and Sch 1 item 2, applicable in relation to a premium, or an amount in respect of a premium, paid on or after 1 July 2013 under a complying health insurance policy, to the extent that the premium or amount relates to one or more days that are on or after 1 July 2013.

S 22-15 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-20 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-25(1) amended by No 60 of 2021, s 3 and Sch 1 item 7, by substituting "*dependent person" for "*dependent child" in para (b), effective 1 April 2021.

S 22-25(2) amended by No 60 of 2021, s 3 and Sch 1 item 8, by substituting "*dependent person" for "*dependent child", effective 1 April 2021.

S 22-25 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

Subdiv 22-B inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-30(1) amended by No 60 of 2021, s 3 and Sch 1 item 9, by substituting "*dependent person" for "*dependent child" in para (b), applicable in relation to the following days: (a) 1 April 2021; (b) each later day.

S 22-30 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-35 substituted by No 52 of 2021, s 3 and Sch 1 item 1, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. S 22-35 formerly read:

SECTION 22-35 PRIVATE HEALTH INSURANCE SINGLES THRESHOLDS  
22-35(1)
A person's singles tier 1 threshold for the 2008-09 financial year is $70,000. This amount is indexed annually.

22-35(2)
A person's singles tier 2 threshold for the 2010-11 financial year is $90,000. This amount is indexed annually.

22-35(3)
A person's singles tier 3 threshold for the 2010-11 financial year is $120,000. This amount is indexed annually.

Note 1:

A person may be a tier 1 earner, tier 2 earner or tier 3 earner if his or her income for surcharge purposes exceeds the applicable threshold for that tier: see section 22-30.

Note 2:

Section 22-45 shows how to index amounts.

S 22-35 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-40(4) amended by No 52 of 2021, s 3 and Sch 1 item 2, by substituting the example, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. The example formerly read:

Example:

If the person has 3 such dependants who are children, his or her family tier 2 threshold for the 2010-11 financial year is:

$180,000 + ($1,500 × 2) = $183,000

S 22-40 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 22-45(1) substituted by No 52 of 2021, s 3 and Sch 1 item 3, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. S 22-45(1) formerly read:

22-45(1)
This section applies in relation to an amount mentioned in section 22-35 (Private health insurance singles thresholds).

S 22-45(2) substituted by No 52 of 2021, s 3 and Sch 1 items 4 and 5, by substituting para (a) and examples 1 and 2, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. Para (a), examples 1 and 2 formerly read:

(a) firstly:

(i) if the amount is mentioned in subsection 22-35(1) (singles tier 1 threshold) - multiplying the amount for the 2008-2009 financial year by its *indexation factor mentioned in subsection (4); or

(ii) if the amount is mentioned in subsection 22-35(2) or (3) (singles tier 2 threshold or singles tier 3 threshold) - multiplying the amount for the 2010-2011 financial year by its indexation factor mentioned in subsection (5); and

EXAMPLES

Example 1:

If the amount to be indexed is $90,000 and the indexation factor increases this to an indexed amount of $90,500, the indexed amount is rounded back down to $90,000.

Example 2:

If the amount to be indexed is $120,000 and the indexation factor increases this to an indexed amount of $121,500, the indexed amount is rounded down to $121,000.

S 22-45(3) substituted by No 52 of 2021, s 3 and Sch 1 item 6, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. S 22-45(3) formerly read:

22-45(3)
Do not index the amount if its indexation factor mentioned in subsection (4) or (5) is 1 or less.

S 22-45(3A) substituted by No 52 of 2021, s 3 and Sch 1 item 6, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. S 22-45(3A) formerly read:

22-45(3A)
Do not index the amount for the 2015-16, 2016-17, 2017-18, 2018-19, 2019-20 or 2020-21 financial year.

S 22-45(3A) amended by No 55 of 2016, s 3 and Sch 6 item 1, by substituting ", 2017-18, 2018-19, 2019-20 or 2020-21" for "or 2017-18", effective 17 September 2016.

S 22-45(3A) inserted by No 123 of 2014, s 3 and Sch 1 item 1, effective 26 November 2014.

S 22-45(3B) repealed by No 52 of 2021, s 3 and Sch 1 item 6, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. S 22-45(3B) formerly read:

22-45(3B)
If the amount is not indexed for a financial year because of the operation of subsection (3A), the amount for the financial year is the amount for the most recent financial year for which the amount was indexed.

S 22-45(3B) inserted by No 123 of 2014, s 3 and Sch 1 item 1, effective 26 November 2014.

S 22-45(4) substituted by No 52 of 2021, s 3 and Sch 1 item 7, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. S 22-45(4) formerly read:

Indexation factor

22-45(4)
For indexation of the amount on an annual basis in accordance with subparagraph (2)(a)(i), the indexation factor is:

*Index number mentioned in subsection (7) for the *quarter ending on 31 December just before the start of the relevant financial year

*Index number mentioned in subsection (7) for the *quarter ending on 31 December 2007

S 22-45(5) repealed by No 52 of 2021, s 3 and Sch 1 item 8, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years. S 22-45(5) formerly read:

Indexation factor

22-45(5)
For indexation of the amount on an annual basis in accordance with subparagraph (2)(a)(ii), the indexation factor is:

*Index number mentioned in subsection (7) for the *quarter ending on 31 December just before the start of the relevant financial year

*Index number mentioned in subsection (7) for the *quarter ending on 31 December 2009

S 22-45(6) amended by No 52 of 2021, s 3 and Sch 1 item 9, by omitting "mentioned in subsection (4) or (5)" after "*indexation factor, effective 1 July 2021 and applicable in relation to the 2021-22 financial year and later financial years.

S 22-45 inserted by No 26 of 2012, s 3 and Sch 1 item 10, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

Subdiv 22-C repealed by No 26 of 2014, s 3 and Sch 1 item 3, effective 9 April 2014.

Subdiv 22-C inserted by No 106 of 2013, s 3 and Sch 1 item 4, effective 29 June 2013.

S 22-50 repealed by No 26 of 2014, s 3 and Sch 1 item 3, effective 9 April 2014. S 22-50 formerly read:

SECTION 22-50 MEANING OF BASE PREMIUM  
Product subgroups available on or before 1 April 2013

22-50(1)
The base premium for a *product subgroup that was first made available on or before 1 April 2013 is the premium (expressed as an amount per day) charged under policies belonging to the product subgroup on that day (taking into account any change in the premium under section 66-10 that took effect on that day).

22-50(2)
A *base premium referred to in subsection (1) is indexed on 1 April 2014, and 1 April in each later year.

Note:

Section 22-55 shows how to index a base premium.

Product subgroups that become available after 1 April 2013

22-50(3)
The base premium for a *product subgroup that is first made available after 1 April 2013 is the premium (expressed as an amount per day) charged under a policy belonging to the subgroup when the subgroup is first made available, multiplied by the *weighted average ratio for the subgroup.

22-50(4)
A *base premium for a *product subgroup referred to in subsection (3) is indexed on each 1 April after the subgroup is first made available.

Note:

Section 22-55 shows how to index a base premium.

Weighted average ratio

22-50(5)
The weighted average ratio for a *product subgroup is to be determined in accordance with the Private Health Insurance (Incentives) Rules.

22-50(6)
Without limiting subsection (5), the Private Health Insurance (Incentives) Rules may:
(a) provide for the *weighted average ratio for different classes of *product subgroups to be determined in different ways; and
(b) provide for the Council to have a role in determining the weighted average ratio for a product subgroup; and
(c) require a private health insurer to give the Council information relevant to determining the weighted average ratio for a product subgroup.

Disregard certain changes in premiums

22-50(7)
For the purposes of subsections (1) and (3), disregard any change in a premium resulting from:
(a) the application of Division 23 (premiums reduction scheme); or
(b) the application of Part 2-3 (lifetime health cover); or
(c) any discounts allowed under subsection 66-5(2).

S 22-50 inserted by No 106 of 2013, s 3 and Sch 1 item 4, effective 29 June 2013.

S 22-55 repealed by No 26 of 2014, s 3 and Sch 1 item 3, effective 9 April 2014. S 22-55 formerly read:

SECTION 22-55 INDEXATION  
22-55(1)
This section sets out how a *base premium for a *product subgroup is to be indexed on a1 April, as required by subsection 22-50(2) or (4).

Indexing base premiums

22-55(2)
Index the *base premium by:
(a) firstly, multiplying the base premium by its *base premium indexation factor; and
(b) next, rounding the result in paragraph (a) down to the nearest cent.

22-55(3)
To avoid doubt, the *base premium is indexed even if its *base premium indexation factor is less than 1.

Base premium indexation factor

22-55(4)
The base premium indexation factor for the *base premium on 1 April in a particular year is the lesser of the following numbers:
(a) the *premium indexation factor for the *product subgroup for that 1 April;
(b) the *CPI indexation factor for that 1 April.

S 22-55 inserted by No 106 of 2013, s 3 and Sch 1 item 4, effective 29 June 2013.

S 22-60 repealed by No 26 of 2014, s 3 and Sch 1 item 3, effective 9 April 2014. S 22-60 formerly read:

SECTION 22-60 PREMIUM INDEXATION FACTOR  
22-60(1)
The premium indexation factor for a *product subgroup for 1 April in a particular year is the number worked out by dividing the premium charged under policies belonging to the subgroup on that 1 April (taking into account any change in the premium under section 66-10 that took effect on that day) by the *reference premium for the subgroup in relation to that year.

22-60(2)
The reference premium for a *product subgroup in relation to a year is:
(a) if the subgroup was first made available on or before 1 April in the immediately preceding year - the premium charged under policies belonging to the subgroup on 1 April in that preceding year (taking into account any change in the premium under section 66-10 that took effect on that day); or
(b) otherwise - the premium charged under policies belonging to the subgroup when the subgroup was first made available.

22-60(3)
Work out a *premium indexation factor to 3 decimal places (rounding up if the fourth decimal place is 5 or more).

Disregard certain changes in premiums

22-60(4)
For the purposes of subsections (1) and (2), disregard any change in a premium resulting from:
(a) the application of Division 23 (premiums reduction scheme); or
(b) the application of Part 2-3 (lifetime health cover); or
(c) any discounts allowed under subsection 66-5(2).

S 22-60 inserted by No 106 of 2013, s 3 and Sch 1 item 4, effective 29 June 2013.

S 22-65 repealed by No 26 of 2014, s 3 and Sch 1 item 3, effective 9 April 2014. S 22-65 formerly read:

SECTION 22-65 CPI INDEXATION FACTOR  
22-65(1)
The CPI indexation factor for 1 April in a particular year is the number worked out by dividing the *CPI index number for the December quarterimmediately preceding that year by the CPI index number for the December quarter preceding the first-mentioned December quarter.

22-65(2)
The CPI index number for a quarter is the All Groups Consumer Price Index number, being the weighted average of the 8 capital cities, published by the Australian Statistician in respect of that quarter.

22-65(3)
Work out a *CPI indexation factor to 3 decimal places (rounding up if the fourth decimal place is 5 or more).

22-65(4)
In working out the *CPI indexation factor for 1 April in a particular year:
(a) use only the *CPI index numbers published in terms of the most recently published reference base for the Consumer Price Index; and
(b) disregard CPI index numbers published in substitution for previously published CPI index numbers (except where the substituted numbers are published to take account of changes in the reference base).

S 22-65 inserted by No 106 of 2013, s 3 and Sch 1 item 4, effective 29 June 2013.

Subdiv 23-A substituted by No 26 of 2012, s 3 and Sch 1 item 11, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 23-1 substituted by No 26 of 2012, s 3 and Sch 1 item 11, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 23-1 formerly read:

SECTION 23-1 REDUCTION IN PREMIUMS  
23-1(1)
The amount of premiums payable under a *complying health insurance policy in respect of a financial year is reduced in accordance with this section if a person is a *participant in the *premiums reduction scheme in respect of the policy.

23-1(2)
The amount of the reduction is the sum of:
(a) 30% of the amount of premiums payable under the policy in respect of days in the financial year on which no person covered by the policy was aged 65 years or over; and
(b) 35% of the amount of premiums payable under the policy in respect of days in the financial year on which:

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

(ii) no person covered by the policy was aged 70 years or over; and

(c) 40% of the amount of premiums payable under the policy in respect of days in the financial year on which at least one person covered by the policy was aged 70 years or over.

23-1(3)
However, if, before 1 January 1999, a person was registered or eligible to be registered under the Private Health Insurance Incentives Act 1997 in respect of the policy, the amount of the reduction is the greater of:
(a) the amount worked out under subsection (2); and
(b) the *incentive amount for the policy for the financial year.

23-1(4)
If the amount of premiums is payable in respect of only part of a financial year, the amount of the reduction is worked out using this formula:

Whole year reduction	×	Part of year
		365

where:

part of year
means the number of days in the part of the financial year.

whole year reduction
means the amount that would have been the reduction if the premium had been payable in respect of the whole financial year.

S 23-5 repealed by No 26 of 2012, s 3 and Sch 1 item 11, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 23-5 formerly read:

SECTION 23-5 MEANING OF INCENTIVE AMOUNT  
23-5(1)
The incentive amount for a *complying health insurance policy for a financial year is the amount worked out under this table:

Incentive amount
Item	Number and kinds of people covered by the policy	Policy covers *hospital treatment but not *general treatment	Policy covers *general treatment but not *hospital treatment	Policy covers *hospital treatment and *general treatment
1	3 or more people	$350	$100	$450
2	One *dependent child and one other person	$350	$100	$450
3	2 people neither of whom is a *dependent child	$200	$50	$250
4	One person	$100	$25	$125

23-5(2)
If the amount of premiums is payable in respect of only part of a financial year, the incentive amount is worked out using this formula:

Amount worked out under subsection (1)	×	Number of days in that part of the financial year
		365

S 23-10 substituted by No 26 of 2012, s 3 and Sch 1 item 11, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 23-10 formerly read:

SECTION 23-10 REDUCTION AFTER A PERSON 65 YEARS OR OVER CEASES TO BE COVERED BY POLICY  
23-10(1)
if:
(a) at any time, premiums under an insurance policy (the original policy ) were reduced by 35% or 40% because a person aged 65 years or over (the entitling person ) was insured under the original policy; and
(b) at that time, another person (other than a *dependent child) was also insured under the original policy; and
(c) the entitling person subsequently ceases to be insured under the original policy;

subsections 23-1(2) and (3) apply in relation to a *complying health insurance policy (whether or not the original policy) under which the other person is insured (other than for the purposes of working out the *incentive amount) as if:

(d) the entitling person were also insured under that policy; and
(e) the entitling person were the same age as the age at which he or she ceased to be insured under the original policy.

23-10(2)
Subsection (1) ceases to apply if a person (other than a *dependent child) who was not insured under the original policy at the time the entitling person ceased to be insured under it becomes insured under the *complying health insurance policy.

23-10(3)
Subsection (1) does not apply if its application would result in the reduction under subsection 23-1(2) or (3) being less than it would otherwise have been.

23-10(4)
Paragraph (1)(a) applies in relation to premiums reduced by 35% or 40% whether the reduction was under this Part or under Chapter 3 of the Private Health Insurance Incentives Act 1998.

S 23-15(1) amended by No 26 of 2012, s 3 and Sch 1 item 12, by substituting para (b), applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. Para (b) formerly read:

(b) either or both of the following apply:

(i) the person has paid, or the person's employer has paid as a *fringe benefit on the person's behalf, a premium under the policy in respect of a financial year;

(ii) the person is insured under the policy (and is not a *dependent child); and

S 23-15 amended by No 32 of 2011, s 3 and Sch 4 item 507, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 23-20 amended by No 32 of 2011, s 3 and Sch 4 item 507, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 23-25 repealed by No 26 of 2012, s 3 and Sch 1 item 13, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 23-25 formerly read:

SECTION 23-25 PRE-1999 PARTICIPANTS MUST KEEP INFORMATION UP TO DATE  
23-25(1)
If, before 1 January 1999, a person was registered or eligible to be registered under the Private Health Insurance Incentives Act 1997 in respect of the policy, a *participant in respect of the policy must notify the private health insurer that issued the policy if there is a change in a detail:
(a) stated in an application under subsection 23-15(1); or
(b) relating to the number of people insured under the policy, or to whether any of those people are *dependent children;

that the participant should reasonably expect will affect the *incentive amount for the policy for a financial year. The participant must give the notice no more than 30 days after the change occurs.

23-25(2)
A person commits an offence if:
(a) the person is required by subsection (1) to give a notice to a private health insurer if a detail mentioned in that subsection changes as mentioned in that subsection; and
(b) the person fails to comply with the requirement.

Penalty: 60 penalty units.

23-25(3)
Subsection 4K(2) of the Crimes Act 1914 does not apply to the obligation to provide information under subsection (1).

23-25(4)
A private health insurer must notify the Chief Executive Medicare of each notice the insurer receives under subsection (1), in the *approved form and no more than 14 days (or any other period determined by the Chief Executive Medicare) after receiving the notice.

S 23-25 amended by No 32 of 2011, s 3 and Sch 4 item 507, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 23-30 amended by No 32 of 2011, s 3 and Sch 4 item 507, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 23-35 amended by No 32 of 2011, s 3 and Sch 4 item 507, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 23-40 amended by No 32 of 2011, s 3 and Sch 4 item 507, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 23-45 amended by No 32 of 2011, s 3 and Sch 4 item 507, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

Div 26 repealed by No 105 of 2013, s 3 and Sch 2 item 6, effective 1 July 2013. For saving provisions, see note under s 328-5.

Subdiv 26-A repealed by No 105 of 2013, s 3 and Sch 2 item 6, effective 1 July 2013. For saving provisions, see note under s 328-5.

S 26-1 repealed by No 105 of 2013, s 3 and Sch 2 item6, effective 1 July 2013. For saving provisions, see note under s 328-5. S 26-1 formerly read:

SECTION 26-1 PAYMENT IN RELATION TO PREMIUMS  
Entitlement to payment

26-1(1)
A person is entitled to a payment under this subsection if:
(a) a premium was paid (whether or not by the person) under a *complying health insurance policy in respect of a period; and
(b) the person is a *PHIIB in respect of the premium; and
(c) the amount of the premium was not reduced under Division 23; and
(d) the person meets any requirements specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph.

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S 26-1(1) substituted by No 26 of 2012, s 3 and Sch 1 item 14, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. No 26 of 2012, s 3 and Sch 1 item 15 contains the following saving provision:

15 Saving provision - Private Health Insurance (Incentives) Rules  
(1)
This item applies to a requirement specified in the Private Health Insurance (Incentive) Rules if:
(a) the requirement was specified for the purposes of paragraph 26-1(1)(c) of the Private Health Insurance Act 2007; and
(b) the requirement was in force immediately before the commencement of this item.

(2)
The requirement has effect, on and after the commencement of this item, as if it had been made for the purposes of paragraph 26-1(1)(d) of that Act as amended by this Schedule.

S 26-1(1) formerly read:

26-1(1)
A person is entitled to a payment under this Division if:
(a) the person has paid, or a person's employer has paid as a *fringe benefit for the person, premiums under a *complying health insurance policy for the whole or a part of a financial year; and
(b) the amount of premiums was not reduced under Division 23; and
(c) the person meets any requirements specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph.

Amount of payment

26-1(2)
The amount of the payment is the *PHII benefit in respect of the premium.

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S 26-1(2) substituted by No 26 of 2012, s 3 and Sch 1 item 14, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

S 26-1(2) formerly read:

26-1(2)
The amount of the payment is the sum of:
(a) 30% of the amount of the premium paid by a person, or by a person's employer as a *fringe benefit for the person, under the policy in respect of days in the financial year on which no person covered by the policy was aged 65 years or over;
(b) 35% of the amount of the premium paid by a person, or by a person's employer as a fringe benefit for the person, under the policy in respect of days in the financial year on which:

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

(ii) no person covered by the policy was aged 70 years or over;

(c) 40% of the amount of the premium paid by a person, or by a person's employer as a fringe benefit for the person, under the policy in respect of days in the financial year on which at least one person covered by the policy was aged 70 years or over.

26-1(12A)
However, if there is more than one *PHIIB in respect of the premium, the amount of the payment is the *PHII benefit in respect of the premium divided by the number of those PHIIBs.

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S 26-1(2A) inserted by No 26 of 2012, s 3 and Sch 1 item 14, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012.

Payment if there is more than one PHIIB

26-1(3)
If subsection (2A) applies and the person is paid the amount to which he or she is entitled under subsection (1) in respect of the premium:
(a) the person is also to be paid each amount to which another person is entitled under subsection (1) in respect of the premium because the other person is one of those *PHIIBs; and
(b) if the person is paid an amount in accordance with paragraph (a) - he or she is liable to account for that amount to the other person mentioned in that paragraph.

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S 26-1(3) substituted by No 26 of 2012, s 3 and Sch 1 item 14, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 26-1(3) formerly read:

26-1(3)
However, if, before 1 January 1999, a person was registered, or eligible to be registered, under the Private Health Insurance Incentives Act 1997 in respect of the policy, the amount of the payment is the greater of:
(a) the amount worked out under subsection (2); and
(b) the *incentive amount for the policy for the financial year.

Reduction in amount payable

26-1(4)
A person's entitlement under subsection (1) in respect of the premium is reduced to the extent that:
(a) a previous payment was made under this section in relation to that entitlement; or
(b) the person has received a tax offset under Subdivision 61-G of the Income Tax Assessment Act 1997 in respect of the premium.

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S 26-1(4) substituted by No 26 of 2012, s 3 and Sch 1 item 14, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 26-1(4) formerly read:

26-1(4)
The total amount payable under this Division for a policy for a financial year is reduced by the amount of any tax offset received under Subdivision 61-G of the Income Tax Assessment Act 1997 for the total amount of the premium paid by a person, or by a person's employer as a *fringe benefit for the person, under the policy for that financial year.

S 26-1(4) amended by No 32 of 2007, s 3 and Sch 3 item 9E, by substituting "Subdivision 61-G" for "Subdivision 61-H", effective 1 July 2007.

26-1(5)
A private health insurer must give a person a receipt, in the *approved form, for a payment of an amount of premiums (other than an amount that has been reduced under Division 23) if the person requests it.

S 26-5 repealed by No 26 of 2012, s 3 and Sch 1 item 16, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 26-5 formerly read:

SECTION 26-5 PAYMENT AFTER A PERSON 65 YEARS OR OVER CEASES TO BE COVERED BY POLICY  
26-5(1)
If:
(a) at any time, a payment of an amount of 35% or 40% of the premiums payable under an insurance policy (the original policy ) was made to a person because a person aged 65 years or over (the entitling person ) was insured under the original policy; and
(b) at that time, another person (other than a *dependent child) was insured under the original policy; and
(c) the entitling person subsequently ceases to be insured under the original policy;

subsections 26-1(2) and (3) apply in relation to a *complying health insurance policy (whether or not the original policy) under which the other person is insured (other than for the purposes of working out the *incentive amount) as if:

(d) the entitling person were also insured under that policy; and
(e) the entitling person were the same age as the age at which he or she ceased to be insured under the original policy.

26-5(2)
Subsection (1) ceases to apply if a person (other than a *dependent child) who was not insured under the original policy at the time the entitling person ceased to be insured under it becomes insured under the *complying health insurance policy.

26-5(3)
Subsection (1) does not apply if its application would result in the amount payable under subsection 26-1(2) or (3) being less than it would otherwise have been.

26-5(4)
Paragraph (1)(a) applies in relation to a payment of an amount of 35% or 40% of the premiums payable under an insurance policy whether the payment was made under this Part or under Chapter 2 of the Private Health Insurance Incentives Act 1998.

Subdiv 26-B repealed by No 105 of 2013, s 3 and Sch 2 item 6, effective 1 July 2013. For saving provisions, see note under s 328-5.

S 26-10 repealed by No 105 of 2013, s 3 and Sch 2 item 6, effective 1 July 2013. For saving provisions, see note under s 328-5. S 26-10 formerly read:

SECTION 26-10 CLAIM FOR PAYMENT UNDER INCENTIVE PAYMENTS SCHEME  
26-10(1)
To be paid an amount to which a person is entitled under section 26-1, the person must make a claim in the *approved form.

26-10(2)
The claim must be sent to or lodged at an office of the *Human Services Department (other than an office specified in an instrument under subsection (3)), or a place approved by the Chief Executive Medicare, in:
(a) the financial year in which the payment of premiums to which the claim relates was made; or
(b) the next financial year.

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S 26-10(2) amended by No 32 of 2011, s 3 and Sch 4 item 508, by substituting "an office of the *Human Services Department (other than an office specified in an instrument under subsection (3)), or a place approved by the Chief Executive Medicare" for "an office of Medicare Australia, or a place approved by the Medicare Australia CEO", effective 1 July 2011.

26-10(3)
The Chief Executive Medicare may, by written instrument, specify one or more offices of the *Human Services Department for the purposes of subsection (2).

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S 26-10(3) inserted by No 32 of 2011, s 3 and Sch 4 item 509, effective 1 July 2011.

26-10(4)
An instrument under subsection (3) is not a legislative instrument.

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S 26-10(4) inserted by No 32 of 2011, s 3 and Sch 4 item 509, effective 1 July 2011.

S 26-15 repealed by No 105 of 2013, s 3 and Sch 2 item 6, effective 1 July 2013. For saving provisions, see note under s 328-5. S 26-15 formerly read:

SECTION 26-15 WITHDRAWAL OF CLAIM  
26-15(1)
A claimant may at any time, by writing sent to or lodged at:
(a) an office of the *Human Services Department (other than an office specified in an instrument under subsection (2)); or
(b) a place approved by the Chief Executive Medicare;

withdraw a claim.

26-15(2)
The Chief Executive Medicare may, by written instrument, specify one or more offices of the *Human Services Department for the purposes of paragraph (1)(a).

26-15(3)
An instrument under subsection (2) is not a legislative instrument.

S 26-15 substituted by No 32 of 2011, s 3 and Sch 4 item 510, effective 1 July 2011. S 26-15 formerly read:

SECTION 26-15 WITHDRAWAL OF CLAIM  
26-15
A claimant may at any time, by writing sent to or lodged at an office of Medicare Australia, or a place approved by the Medicare Australia CEO, withdraw a claim.

S 26-20 repealed by No 105 of 2013, s 3 and Sch 2 item 6, effective 1 July 2013. For saving provisions, see note under s 328-5. S 26-20 formerly read:

SECTION 26-20 DETERMINATION OF CLAIM AND PAYMENT OF AMOUNT  
26-20(1)
The Chief Executive Medicare must make a decision granting or refusing the claim within 14 days after the day on which the claim is made.

26-20(2)
If the claim is granted, the Chief Executive Medicare must pay to the claimant the amount to which the claimant is entitled.

26-20(3)
If the claim is refused, the Chief Executive Medicare must give the claimant a notice stating that the claim has been refused and setting out the reasons for the refusal.

S 26-20 amended by No 32 of 2011, s 3 and Sch 4 item 511, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 26-25 repealed by No 105 of 2013, s 3 and Sch 2 item 6, effective 1 July 2013. For saving provisions, see note under s 328-5. S 26-25 formerly read:

SECTION 26-25 Reconsideration of decision refusing a claim  
26-25(1)
If a claim is refused, the claimant may apply to the Chief Executive Medicare for the Chief Executive Medicare to reconsider the decision.

26-25(2)
The application must:
(a) be in writing; and
(b) set out the reasons for the application.

26-25(3)
The application must be made within:
(a) 28 days after the day on which the claimant was notified of the decision; or
(b) if, either before or after the end of that period of 28 days, the Chief Executive Medicare extends the period within which the application may be made - the extended period for making the application.

26-25(4)
The Chief Executive Medicare must:
(a) reconsider the decision; and
(b) either affirm or revoke the decision;

within 28 days after receiving the application for reconsideration.

Note:

Decisions affirming original decisions are reviewable under Part 6-9.

26-25(5)
If the Chief Executive Medicare revokes the decision, the revocation is taken to be a decision granting the claim.

26-25(6)
The Chief Executive Medicare must give the claimant a notice stating his or her decision on the reconsideration together with a statement of his or her reasons for the decision.

26-25(7)
The Chief Executive Medicare is taken, for the purposes of this Subdivision, to have made a decision affirming the original decision if the Chief Executive Medicare has not told the claimant of the decision on the reconsideration before the end of the period of 28 days.

S 26-25 amended by No 32 of 2011, s 3 and Sch 4 item 511, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 26-30 repealed by No 26 of 2012, s 3 and Sch 1 item 17, applicable in relation to premiums, and amounts in respect of premiums, paid on and after 1 July 2012. S 26-30 formerly read:

SECTION 26-30 CLAIMANTS TO KEEP INFORMATION UP TO DATE  
26-30(1)
If, after a claimant has made a claim under section 26-10 for a payment of an amount:
(a) a matter, event or circumstance occurs that affects the claimant's entitlement to the payment; or
(b) a change occurs in the premium, or in the amounts or frequency of the payments in respect of the premium, under the policy;

the claimant must, within 30 days after the occurrence of the matter, event, circumstance or change, notify the Chief Executive Medicare of the details of the matter, event, circumstance or change.

26-5(2)
A person commits an offence if:
(a) the person is required by subsection (1) to notify the Chief Executive Medicare of the details of a matter, event, circumstance or change mentioned in that subsection; and
(b) the person fails to comply with the requirement.

Penalty: 60 penalty units.

26-5(3)
Subsection 4K(2) of the Crimes Act 1914 does not apply to the obligation to provide information under subsection (1).

S 26-30 amended by No 32 of 2011, s 3 and Sch 4 item 511, by substituting "Chief Executive Medicare" for "Medicare Australia CEO" (wherever occurring), effective 1 July 2011.

S 34-25(1) amended by No 59 of 2015, s 3 and Sch 2 item 307, by substituting ", (4) and (4A)" for "and (4)", effective 1 July 2016.

S 34-25(3) amended by No 46 of 2011, s 3 and Sch 2 item 923, by substituting "Australian citizen" for "*Australian citizen", effective 27 December 2011. No 46 of 2011, s 3 and Sch 3 items 10 and 11 contain the following saving and transitional provisions:

10 Saving - appointments  
10
The amendments made by Schedule 2 do not affect the validity of an appointment that was made under an Act before the commencement of this item and that was in force immediately before that commencement. 11 Transitional regulations  
11
The Governor-General may make regulations prescribing matters of a transitional nature (including prescribing any saving or application provisions) relating to the amendments and repeals made by Schedules 1 and 2.

S 34-25(4A) inserted by No 59 of 2015, s 3 and Sch 2 item 308, effective 1 July 2016.

S 34-25(4B) inserted by No 59 of 2015, s 3 and Sch 2 item 308, effective 1 July 2016.

S 34-25(5) amended by No 32 of 2011, s 3 and Sch 4 item 512, by substituting "Chief Executive Medicare" for "Medicare Australia CEO", effective 1 July 2011.

S 34-25 substituted by No 63 of 2010, s 3 and Sch 2 item 1, effective 1 July 2010. S 34-25 formerly read:

SECTION 34-25 MEANING OF LIFETIME HEALTH COVER BASE DAY  
34-25(1)
A person's lifetime health cover base day is the day worked out by using this diagram:

Working out a person's lifetime health cover base day

34-25(2)
A person is a new arrival if:
(a) the person entered Australia for the first time on or after 1 July 2000; and
(b) the person was not an Australian citizen or permanent resident of Australia at the time of the entry.

34-25(3)
A person's medicare eligibility day is the day on which the person is registered by the Medicare Australia CEO as an eligible person within the meaning of section 3 of the Health Insurance Act 1973.

34-25(4)
Despite subsection (1), if:
(a) on or before 1 April 2007, a person's Schedule 2 application day had arrived for the purposes of the National Health Act 1953; and
(b) the person had *hospital cover on 1 April 2007; and
(c) the person has had hospital cover continuously since that day;

the person's lifetime health cover base day is the person's Schedule 2 application day. For this purpose, a day on which the person has hospital cover does not include a *permitted day without hospital cover or a day on which the person would otherwise be taken to have hospital cover because of subsection 34-15(2).

S 34-30(1) amended by No 59 of 2015, s 3 and Sch 2 item 309, by substituting para (a), effective 1 July 2016. Para (a) formerly read:

(a) a person who lives on Norfolk Island is taken, while the person is living there, to be overseas; and

S 34-30 amended by No 63 of 2010, s 3 and Sch 2 items 2-4, by substituting "(1) Without" for "Without", omitting "and" after "overseas;" from para (b) and repealing para (c), effective 1 July 2010. Para (c) formerly read:

(c) a person is taken to have returned from overseas if the person returns to Australia for a period of at least 90 days.

S 34-30(2) inserted by No 63 of 2010, s 3 and Sch 2 item 5, effective 1 July 2010.

S 37-5 amended by No 46 of 2011, s 3 and Sch 2 item 924, by substituting "Australian citizen" for "*Australian citizen" in para (aa)(i), effective 27 December 2011. For saving and transitional provisions, see note under s 34-25(3).

S 37-5 amended by No 63 of 2010, s 3 and Sch 2 item 6, by inserting para (aa), effective 1 July 2010.

S 37-7 inserted by No 63 of 2010, s 3 and Sch 2 item 7, effective 1 July 2010.

Pt 2-4 inserted by No 101 of 2018, s 3 and Sch 1 item 1, effective 1 April 2019 and applicable in relation to the 2018-19 income year and later income years.

Div 42 inserted by No 101 of 2018, s 3 and Sch 1 item 1, effective 1 April 2019 and applicable in relation to the 2018-19 income year and later income years.

S 42-1 inserted by No 101 of 2018, s 3 and Sch 1 item 1, effective 1 April 2019 and applicable in relation to the 2018-19 income year and later income years.

Div 45 inserted by No 101 of 2018, s 3 and Sch 1 item 1, effective 1 April 2019 and applicable in relation to the 2018-19 income year and later income years.

S 45-1 inserted by No 101 of 2018, s 3 and Sch 1 item 1, effective 1 April 2019 and applicable in relation to the 2018-19 income year and later income years.

S 50-5 amended by No 8 of 2023, s 3 and Sch 1 item 1, by substituting "Private Health Insurance (Medical Devices and Human Tissue Products) Rules" for "Private Health Insurance (Prostheses) Rules", effective 1 July 2023. For application and transitional provisions, see note under s 72-11.

S 55-5(2) amended by No 101 of 2018, s 3 and Sch 5 item 1, by substituting para (d), effective 1 April 2019. Para (d) formerly read:

(d) where a person lives, except to the extent allowed under subsection 66-10(2) or section 66-20; or

S 55-5(2) amended by No 101 of 2018, s 3 and Sch 2 item 1, by substituting para (c), effective 1 April 2019. Para (c) formerly read:

(c) the age of a person, except to the extent allowed under Part 2-3 (lifetime health cover) or subsection 63-5(4); or

S 55-5(2) amended by No 66 of 2009, s 3 and Sch 1 item 2, by inserting "or subsection 63-5(4)" in para (c), effective 1 July 2009.

S 55-5(3) amended by No 54 of 2008, s 3 and Sch 2 item 1, by inserting "or *rules", effective 25 June 2008.

S 55-5(4) inserted by No 54 of 2008, s 3 and Sch 4 item 1, effective 25 June 2008.

S 55-5(5) inserted by No 54 of 2008, s 3 and Sch 4 item 1, effective 25 June 2008.

S 55-10 substituted by No 101 of 2018, s 3and Sch 5 item 33, effective 22 September 2018. S 55-10 formerly read:

SECTION 55-10 CLOSED PRODUCTS  
55-10
The principle of community rating in section 55-5 does not prevent a private health insurer from refusing to make available to a person a *complying health insurance product that the insurer is no longer making available to anyone.

S 55-15 inserted by No 54 of 2008, s 3 and Sch 5 item 1, effective 25 June 2008.

S 63-5(4) amended by No 60 of 2021, s 3 and Sch 1 items 10-12, by substituting "*dependent non-student or *dependent person with a disability" for "*dependent child non-student", inserting "or *dependent students" and substituting "dependent non-student or dependent person with a disability" for "dependent child non-student" (last occurring), effective 1 April 2021.

S 63-5(4) inserted by No 66 of 2009, s 3 and Sch 1 item 3, effective 1 July 2009.

S 63-5(5) repealed by No 60 of 2021, s 3 and Sch 1 item 13, effective 1 April 2021. S 63-5(5) formerly read:

63-5(5)
A dependent child non-student is a *dependent child who:
(a) is aged between 18 and 24 (inclusive); and
(b) is not receiving full-time education at a school, college or university.

S 63-5(5) inserted by No 66 of 2009, s 3 and Sch 1 item 3, effective 1 July 2009.

S 66-5(3) amended by No 101 of 2018, s 3 and Sch 2 item 2, by inserting para (ea), effective 1 April 2019.

S 66-25 inserted by No 101 of 2018, s 3 and Sch 5 item 2, effective 1 April 2019.