Private Health Insurance Act 2007

CHAPTER 4 - HEALTH INSURANCE BUSINESS, HEALTH BENEFITS FUNDS AND MISCELLANEOUS OBLIGATIONS OF PRIVATE HEALTH INSURERS  

PART 4-2 - HEALTH INSURANCE BUSINESS  

Division 121 - What is health insurance business?  

SECTION 121-15   EXTENSION TO EMPLOYEE HEALTH BENEFITS SCHEMES  

121-15(1)    
An arrangement is an employee health benefits scheme if:

(a)    the arrangement provides for a person (an employer ) to arrange payment in respect of the whole or part of the fees and charges that an employee of, or a person providing services to, the employer incurred in relation to ^[*]

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

hospital treatment or ^[*]

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

general treatment; and

(b)    one or more of the following applies:

(i) the employer is a ^[*]

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

constitutional corporation;

(ii) the employer is a body corporate incorporated in a Territory;

(iii) the employer carries on business in a Territory.

121-15(2)    
It does not matter for the purposes of this section whether the arrangement:

(a)    constitutes a business of undertaking liability by way of insurance; or

(b)    is a minor or incidental part of the employer ' s business; or

(c)    does not require the employee, or person providing services, to pay any contributions; or

(d)    does not require the employee, or person providing services, to pay contributions that reflect the value of the benefits that the employer is providing under the arrangement; or

(e)    provides for the employer to make payments in relation to ^[*]

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

hospital treatment, or ^[*]

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

general treatment, provided to a person other than the employee or person providing services; or

(f)    confers on the employer or another person a discretion whether to make payments.

121-15(3)    
However, an arrangement:

(a)    is not an ^[*]

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

employee health benefits scheme merely because, under the arrangement, the employer will pay, or will reimburse employees, or persons providing services, for payment of, one or both of the following:

(i) the premiums payable by them for ^[*]

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

complying health insurance policies;

(ii) the difference between benefits payable to them under policies, and amounts that they are liable to pay, for health services provided to them or members of their families; and

(b)    is not an employee health benefits scheme if the Private Health Insurance (Health Insurance Business) Rules provide that:

(i) it is not an employee health benefits scheme; or

(ii) arrangements of a class in which it is included are not employee health benefits schemes; and

(c)    is not an employee health benefits scheme to the extent (if any) that the arrangement constitutes State insurance within the meaning of paragraph 51(xiv) of the Constitution .