Senate

Revised Explanatory Memorandum

(Circulated by authority of the Treasurer, the Hon Peter Costello, MP)

Chapter 3 - Medicare levy surcharge

Outline of Chapter

3.1 Schedule 3 to this Bill will amend the Medicare Levy Act 1986 (MLA 1986) and the A New Tax System (Medicare Levy Surcharge - Fringe Benefits) Act 1999 (the ANTS (MLS - FBT) Act) to ensure that:

•

an appropriate level of private patient hospital cover is held by a person in order to be exempt from the Medicare levy surcharge (the surcharge); and

•

high income earners have an incentive to use the private health system when hospital treatment is required.

Background to the legislation

3.2 The surcharge was introduced to encourage people to take out policies that provide private patient hospital cover.

3.3 Certain policies which are currently available have an amount (a front-end deductible or excess) which is required to be paid by the policy holder in respect of private patient hospital expenses. Some of these policies offer high front-end deductible amounts with premiums that are lower than the surcharge that would be payable if no private patient hospital cover was held.

3.4 High income earners who purchase a high front-end deductible with an annual excess greater than $500 for a single contributor or $1,000 for all other contributors after 24 May 2000 will cease to be excluded from the surcharge from 1 July 2000.

Summary of new law

Purpose of the amendments

3.5 The purpose of the amendments is to ensure that an appropriate level of private patient hospital cover is held in order to be exempted from the surcharge.

3.6 This is achieved by inserting a new qualifying condition for an applicable benefits arrangement, for both single and all other contributors, into both the MLA 1986 and the ANTS (MLS - FBT) Act. An applicable benefits arrangement will only apply if the front-end deductible or excess is:

•

$500 or less where only one person is covered by the policy (single contributor); or

•

$1,000 or less where more than one person is covered by the policy (all other contributors).

Explanation of the amendments

A New Tax System (Medicare Levy Surcharge - Fringe Benefits) Act 1999

Applicable benefits arrangement

3.7 Item 1 will insert a definition of 'covered', such that a person will be covered by an insurance policy that provides private patient hospital cover if they satisfy the conditions of new subsection 4. [Schedule 3, item 1, subsection 3(1)]

3.8 Item 2 will repeal the definition of 'provides',asthis definition is no longer required due to the new definition of 'covered'. [Schedule 3, item 2]

3.9 Item 3 repeals section 4 of the ANTS (MLS - FBT) Act and replaces it with new section 4 of ANTS (MLS - FBT) Act. This new section will amend the existing interpretation of an applicable benefits arrangement in the ANTS (MLS - FBT) Act by inserting a new qualifying condition. This new qualifying condition will place a cap on the amount that a private patient hospital cover policy can have as a front-end deductible or excess. [Schedule 3, item 3, subsections 4(2) and 4(5)]

3.10 For a single contributor, the front-end deductible or excess will be capped at an annual amount of $500. For all other contributors, the front-end deductible or excess will be capped at an annual amount of $1,000. Where the front-end deductible or excess exceeds these amounts, it will be a 'high front-end deductible or excess' and the policy will not be an insurance policy that provides private patient hospital cover. [Schedule 3, item 3, paragraphs 4(2)(b) and 4(5)(b)]

3.11 A contributor to a policy of this type will only be liable to the surcharge from 1 July 2000 if the policy was taken out after 24 May 2000. [Schedule 3, item 3, paragraph 4(3)]

3.12 A contributor to a policy with a front-end deductible or excess which is higher than the new front-end deductible limit, who took out the policy on or before 24 May 2000, will remain exempt from the surcharge until such time that they cease to maintain continuous membership of the policy.

3.13 For example, a contributor who is approved by a health fund to suspend their policy will remain exempt from the surcharge, as suspension does not cease continuous membership.

3.14 However, a contributor who ceases to contribute to the same high front-end deductible policy after 24 May 2000, only to recommence contributions to a high front-end deductible policy at a later date, will be subject to the surcharge from 1 July 2000 or the date they ceased continuous membership of the original front-end deductible policy, whichever is the latter.

Example 3.1

Robert is single and has contributed to a high front-end deductible policy from 1 July 1999. On 1 October 2000 Robert decides to take out an alternative policy which has an annual front-end deductible of $200. On 1 September 2001 Robert reverts to a high front-end deductible policy.

Robert is exempt from the surcharge for the 2000-2001 year of income, as he contributed to a high front-end deductible policy held on or before 24 May 2000 and to an applicable benefits arrangement that provides private patient hospital cover from 1 October 2000.

Robert is exempt from the surcharge for the period 1 July 2001 to 31 August 2001, but will be subject to the surcharge from 1 September 2001.

Front-end deductible or excess

3.15 Under paragraph (ba) of Schedule 1 to the National Health Act 1953, a person may elect to receive reduced benefits under a modified applicable benefits arrangement. The front-end deductible or excess of the policy is equal to the reduction in benefits payable under the policy as a result of making the election.

3.16 A high front-end deductible or excess arises where the reduction in benefits payable under the policy exceeds $500 for a single contributor or $1,000 for all other contributors.

3.17 The new annual limit on front-end deductible products applies whether or not the excess is payable in one or more stages through the year and whether or not the registered health benefits organisation can reduce or waive all or part of the excess.

Example 3.2

Robyn, who is the only person covered by her policy, goes to hospital in August 2000, November 2000 and March 2001. Her policy requires her to pay the first $400 of expenses for each episode of treatment. As Robyn actually pays $1,200 in excess during the year she is not exempt from the surcharge as the excess for the year of income is greater than $500.

Kevin, who is the only person covered by his policy, has an annual policy with a per calendar year front-end deductible of $400. During the period 1 January 2001 to 30 June 2002, Kevin goes to hospital in September 2001 and again in March 2002. Although Kevin has paid $800 excess in the 2001-2002 year of income, he is exempt from the surcharge as his annual excess is limited to $400.

Co-payment not a front-end deductible

3.18 A co-payment, which is an out of pocket expense dependent on the cost of hospital treatment, is not a front-end deductible. A co-payment arises due to the difference between the amount the health fund is prepared to pay, as specified in the applicable benefits arrangement and the cost of treatment determined by the hospital.

Example 3.3

Alan, who is the only person covered by his policy, goes to hospital and has an applicable benefits arrangement with a $400 per annum front-end deductible. The hospital charges $15,000 for the treatment and the health fund is willing to pay $14,500. Although Alan actually has $900 out of pocket expenses he would not be levied the surcharge because the front-end deductible or excess is below $500.

Medicare Levy Act 1986

3.19 Similar amendments to those made to the ANTS (MLS - FBT) Act are also made to the MLA 1986.

Applicable benefits arrangement

3.20 Items 4 and 5 amend the existing interpretation of an applicable benefits arrangement in the MLA 1986 by inserting a new qualifying condition. This new qualifying condition will place a cap on the amount that a private patient hospital cover policy can have as a front-end deductible or excess. [Schedule 3, item 4, subsection 3(5A), item 5, subsection 3(7)]

3.21 For a single contributor, the front-end deductible or excess will be capped at an annual amount of $500. For all other contributors, the front-end deductible or excess will be capped at an annual amount of $1,000. Where the front-end deductible or excess exceeds these amounts, it will be a 'high front-end deductible or excess' and the policy will not be a policy that provides private patient hospital cover. [Schedule 3, item 4, paragraph 3(5A)(b), item 5, paragraph 3(7)(b]

3.22 A contributor to a policy of this type will only be liable to the surcharge from 1 July 2000 if the policy was taken out after 24 May 2000. [Schedule 3, item 4, subsection 3(5B)]

3.23 A contributor to a policy with a front-end deductible or excess which is higher than the new front-end deductible limit who took out the policy on or before 24 May 2000, will remain exempt from the surcharge until such time that they cease to maintain continuous membership of the policy.

3.24 For example, a contributor who is approved by a health fund to suspend his/her policy will remain exempt from the surcharge, as suspension does not cease continuous membership.

3.25 However, a contributor who ceases to contribute to the same high front-end deductible policy after 24 May 2000, only to recommence contributions to a high front-end deductible policy at a later date, will be subject to the surcharge from 1 July 2000 or the date they ceased continuous membership of the original front-end deductible policy whichever is the latter.

Application and transitional provisions

3.26 The amendments are to apply from 1 July 2000. [Schedule 3, item 6]

3.27 Contributors who hold a high front-end deductible policy which commenced on or before 24 May 2000 will remain exempt from the surcharge, while ever they maintain continuous membership of the policy.

Regulation impact statement

Policy objective

3.28 This measure aims:

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to ensure that an appropriate level of private patient hospital cover is held by high income earners in order to exempt them from the Medicare levy surcharge; and

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to give high income earners the incentive to use the private health system when hospital treatment is required.

Background

3.29 The introduction of the surcharge from 1 July 1997 aimed to encourage high income earners to take out private patient hospital cover rather than rely on the public health care system, especially for elective procedures.

3.30 The surcharge is currently implemented through sections 8B, 8C and 8D of the MLA 1986 and sections 12, 13 and 14 of ANTS (MLS - FBT) Act. The Medicare levy is increased by 1% if private patient hospital cover is not held and the sum of taxable income and reportable fringe benefits exceed $50,000 for single contributors and $100,000 for all other family types. The threshold level of $100,000 is adjusted for dependent children. For the purpose of the above legislation and this amendment people with taxable income in excess of these limits are referred to as high income groups.

3.31 Private patient hospital cover is defined as an applicable benefits arrangement within the meaning of section 5A of the National Health Act 1953 , to which paragraph 5A(1A) of that Act applies.

3.32 A problem with this current legislation has arisen because some health funds have developed applicable benefits arrangements (hospital cover) with high front-end deductibles (also known as excesses) which are much cheaper to purchase than the minimum potential surcharge applicable.

3.33 Front-end deductible products are permitted under paragraph (ba) of Schedule 1 of the National Health Act 1953 and under a Ministerial Direction issued pursuant to paragraph 73BE(1) (b) and subsection 73BE(5) of the National Health Act 1953 . The level of allowable excess is currentlycapped at $1,000 per annum for single contributors and $2,000 per annum for all other membership categories. It has been claimed that some front-end deductible products within these limits are so inexpensive and tokenistic they are designed specifically to appeal to high income earners who seek only to avoid the surcharge with no intention of using the private health care system.

Implementation options

3.34 The simplest option for implementing this decision would be to amend the Ministerial Direction from the present caps of $1,000/$2,000 to the new caps of $500/$1,000. However, this option would affect all persons wishing to utilise front-end deductible policies whereas the intent is to target only high income earners who might use the policies to avoid the surcharge.

3.35 Therefore, the only implementation option which achieves the policy objective while still allowing registered health benefits organisations to offer high front-end deductible products is to add a further condition to the definition of 'private patient hospital cover' that must be held by high income earners to be exempt from the surcharge. This will require an amendment to the meaning of an applicable benefits arrangement for the purposes of both the MLA 1986 and the ANTS (MLS - FBT) Act.

3.36 The amendment will mean that an applicable benefits arrangement will only occur where the front-end deductible or excess of that arrangement is less than or equal to $500 for a single contributor, or less than or equal to $1,000 for other contributors. These caps are annual amounts and can apply in respect of single or multiple payments, and single and multiple members where appropriate. This additional condition for exemption from the surcharge will apply from 1 July 2000. Policies with front-end deductibles higher than these amounts are known as 'high front-end deductibles'.

Transitional arrangements

3.37 High income earners who take out a high front-end deductible policy on or before 24 May 2000 will be exempt from the surcharge while ever they maintain continuous membership to the same table.

3.38 These transitional arrangements recognise high income earners who have purchased hospital insurance prior to this new measure taking effect, did so in good faith based on the information available to them at the time.

Assessment of impacts of the implementation option

Impact group identification

3.39 The proposed new measure will affect the following groups:

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high income groups and their tax advisers;

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registered health benefits organisations;

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public and private hospitals;

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the Commonwealth Government; and

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the Australian Taxation Office (ATO).

Analysis of costs

High income groups

3.40 The compliance cost to high income groups and their tax advisers will be minimal and will be limited to the time costs associated with learning about the new limit on front-end deductible hospital cover eligible for exemption from the surcharge.

Registered health benefits organisations

3.41 All new members that purchase a high front-end deductible after 24 May 2000 will need to be advised by health funds of the new arrangements at the time of purchase. Those eligible for grandfathering under the transitional arrangements should also be advised at this time.

3.42 No later than the beginning of the 2001 tax year, registered health benefits organisations (health funds) will need to advise all members of applicable benefits arrangements of the new limit on front-end deductibles eligible for exemption from the surcharge.

3.43 For the purpose of preparing tax returns, health funds already provide members with a Private Health Insurance Statement. For the year of income ending 30 June 2001 this statement will need to provide additional information on the level of front-end deductible policy held and the number of days covered by the policy. Where a contributor had been a member of more than one applicable benefits arrangement during the tax year, the front-end deductible details of each table will need to be specified, together with the period of membership.

3.44 The compliance cost to health funds will be moderate. No change is required to health fund product design and no restrictions imposed on product availability. However, health funds will face information dissemination costs to ensure all existing and new members are aware of the new arrangements including:

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mailout to all existing health fund members;

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fact sheets distributed through health fund offices targeted to new members who join after 24 May 2000;

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revised health fund brochures and publicity material including update to web sites; and

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update to Private Health Insurance Statement to include information on the level of front-end deductible product held by each member.

3.45 Other than those administrative costs, the impact on health funds is likely to be small - principally on those few funds that in the past have attracted new high income customers with high front-end deductible policies and will, in future, be less able to do so.

Administrative Costs - ATO

3.46 The ATO will not incur any additional costs beyond those already allocated to processing returns.

3.47 The amount of new material needed to explain the change, including additional information through TaxPack, will be very small.

Benefits

Public and private hospitals

3.48 This new measure will provide incentives for high income earners to take out comprehensive private hospital cover and use the private health system when hospital treatment is required. The public hospital system will benefit as some pressure on resources is transferred to the private health system. Private hospitals will benefit through increased demand for their services.

The Commonwealth Government

3.49 The Commonwealth Government will benefit from the enhanced integrity of the taxation system.

Government revenue

3.50 To the extent that high income earners do not meet the new requirements for exemption from the Medicare levy surcharge from 1 July 2000, taxation revenue will increase.

3.51 This will, however, be offset by a potential increase in Government outlays through the 30% Rebate on private health insurance premiums as high income earners transfer from low premium products to more comprehensive hospital cover with higher premiums.

3.52 The net impact on Government revenue cannot be quantified as it is not possible to predict the proportion of high income groups that will fail to meet the new requirements and incur the surcharge. For those high income groups that do upgrade their cover, it is not possible to predict which level of cover high income groups will move to, or health fund pricing behaviour.

Consultation

3.53 Health funds have also been advised of this broad detail at various meetings between the Department of Health and Aged Care and health funds. Details on transitional arrangements have not been discussed due to the need to manage the public notification of this issue.