Private Health Insurance Act 2007

CHAPTER 6 - ADMINISTRATION

PART 6-9 - REVIEW OF DECISIONS

Division 328 - Review of decisions

SECTION 328-5

328-5 ART REVIEW OF DECISIONS
An application may be made to the Administrative Review Tribunal for the review of any of the following decisions:

Reviewable decisions
Item	Decision	Provision under which decision is made
1	To reject an application for registration of a person in respect of a health insurance policy	section 23-20
2	To revoke a person ' s registration in respect of a health insurance policy	section 23-35
3	(Repealed by No 105 of 2013)
4	To refuse to make a declaration, or to revoke a declaration, that a facility is a ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . hospital	subsection 121-5(6)
4A	To specify a condition, in relation to a particular facility, to which a declaration that a facility is a ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . hospital is subject	paragraph 121-7(1)(b)
5	To decide that a ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . hospital does not satisfy the assessment criteria set out in the Private Health Insurance (Health Insurance Business) Rules	section 121-8A
6	To decide to revoke a ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . hospital ' s inclusion in a class set out in the Private Health Insurance (Health Insurance Business) Rules	section 121-8C
7 - 30	(Repealed by No 87 of 2015)
31	To direct a private health insurer not to make a change that it proposes to make to its ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . rules	subsection 169-10(2)
32	To refuse a request for a longer period for a private health insurer to respond to a request for an explanation	subsection 191-1(3)
33	To refuse to consent to a private health insurer withdrawing or varying an undertaking	subsection 197-1(3)
34	To give a direction to a private health insurer	section 200-1
35	To revoke a private health insurer ' s status as a ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . participating insurer	section 206-1
36 - 37	(Repealed by No 57 of 2015)
38	To reject an application to become a ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . participating insurer	section 279-5
39	On reconsideration of a decision notifying a private health insurer in relation to a claim for payment under Division 279	section 279-45
40	(Repealed by No 105 of 2013)
41	To affirm an original decision by the Chief Executive Medicare that an amount is recoverable as a debt under paragraph 282-1(1)(h) in respect of a payment made to an individual	section 282-15
42	To affirm an original decision by the Chief Executive Medicare to set off a debt against an amount otherwise payable to a person or his or her estate	section 282-15
43	Not to waive, or to waive only a part of, an amount of ^[*] To find definitions of asterisked terms, see the Dictionary in Schedule 1 . late payment penalty	section 307-20
44	(Repealed by No 87 of 2015)

View history note

History

S 328-5 amended by No 38 of 2024, s 3 and Sch 12 item 46, by substituting " Administrative Review Tribunal " for " Administrative Appeals Tribunal " , effective 14 October 2024.

S 328-5 amended by No 87 of 2015, s 3 and Sch 1 items 158 - 160, by repealing table items 5 to 30, omitting " (other than late payment penalty in respect of an amount of *collapsed insurer levy) " after " *late payment penalty " from table item 43 and repealing table item 44, effective 1 July 2015. For transitional provisions, see note under s 3-15 . Table items 5 to 30 and 44 formerly read:

5 To refuse an application for registration as a private health insurer subsection 126-20(1)

6 To grant an application, subject to terms and conditions, for registration as a private health insurer subsection 126-20(1)

6A To refuse an application for approval for a private health insurer to convert to being *registered as a for profit insurer subsection 126-42(5)

7 To refuse to make a declaration that the *solvency standard does not apply to a particular private health insurer subsection 140-15(2)

8 To impose conditions on a declaration that the *solvency standard does not apply to a particular private health insurer subsection 140-15(3)

9 To refuse to revoke or vary a declaration that the *solvency standard does not apply to a particular private health insurer subsection 140-15(6) or (7)

10 To refuse to revoke or vary conditions imposed on a declaration that the *solvency standard does not apply to a particular private health insurer subsection 140-15(6) or (7)

11 To refuse to revoke or vary a *solvency direction subsection 140-20(8) or (9)

12 To refuse to make a declaration that the *capital adequacy standard does not apply to a particular private health insurer subsection 143-15(2)

13 To impose conditions on a declaration that the *capital adequacy standard does not apply to a particular private health insurer subsection 143-15(3)

14 To refuse to revoke or vary a declaration that the *capital adequacy standard does not apply to a particular private health insurer subsection 143-15(6) or (7)

15 To refuse to revoke or vary conditions imposed on a declaration that the *capital adequacy standard does not apply to a particular private health insurer subsection 143-15(6) or (7)

16 To refuse to revoke or vary a *capital adequacy direction subsection 143-20(8) or (9)

17 To refuse to approve a restructure of the *health benefits funds of a private health insurer subsection 146-1(3)

18 To refuse to approve a transfer of the *health benefits funds of one or more private health insurers subsection 146-5(3)

19 To refuse to approve a restructure of the *health benefits funds of a private health insurer section 149-10

20 To refuse to approve the appointment of a person as a private health insurer ' s actuary subsection 160-1(5)

21 To declare under the Private Health Insurance (Insurer Obligations) Rules that a person is not eligible for appointment as a private health insurer ' s actuary subsection 160-5(2)

22 To give a prudential direction to a private health insurer subsection 163-15(1)

23 To refuse to revoke a *prudential direction subsection 163-15(3)

24 To disqualify a person from being or acting as a *director or *senior manager of a private health insurer subsection 166-20(1)

25 To refuse to revoke a disqualification of a *disqualified person subsection 166-20(3)

26 To refuse to determine that a person is not a *disqualified person subsection 166-25(3)

27 To specify conditions in a determination that a person is not a *disqualified person subsection 166-25(4)

28 To specify additional conditions to which determination that a person is not a *disqualified person is to be subject subsection 166-25(4)

29 To vary conditions to which determination that a person is not a *disqualified person is to be subject subsection 166-25(4)

30 To revoke a determination that a person is not a *disqualified person subsection 166-25(8)

44 Not to waive, or to waive only a part of, an amount of *collapsed insurer levy or *late payment penalty in respect of an amount of collapsed insurer levy section 307-25

S 328-5 amended by No 57 of 2015, s 3 and Sch 1 item 20, by repealing table items 36 and 37, effective 1 July 2015. For transitional provisions, see note under s 323-10(1A) . Table items 36 and 37 formerly read:

36 To refuse to extend a period to report to the Private Health Insurance Ombudsman subsection 241-40(3)

37 To refuse to extend a period to give a record or information to the Private Health Insurance Ombudsman subsection 250-1(5)

S 328-5 amended by No 105 of 2013, s 3 and Sch 2 items 19 and 20, by repealing table items 3 and 40, effective 1 July 2013. No 105 of 2013, s 3 and Sch 2 item 28 contain the following saving provisions:

28 Saving provisions
(1)
Despite the amendments made by items 6 and 19, Division 26 and section 328-5 of the Private Health Insurance Act 2007 (as in force immediately before the commencement of those items) continue to apply on and after that commencement in relation to claims made under section 26-10 of that Act before that commencement.

(2)
Despite the amendments made by items 13 to 18 and 20, Division 282 and section 328-5 of the Private Health Insurance Act 2007 (as in force immediately before the commencement of those items) continue to apply on and after that commencement in relation to payments made under Division 26 of that Act before, on or after that commencement.

…

Table items 3 and 40 formerly read:

3 To affirm an original decision of the Chief Executive Medicare rejecting a claim to be paid an amount under Division 26 section 26-25

40 To affirm an original decision by the Chief Executive Medicare that an amount is recoverable as a debt under paragraph 282-1(1)(a) or (b) section 282-15

S 328-5 amended by No 32 of 2011, s 3 and Sch 4 item 537, by substituting " Chief Executive Medicare " for " Medicare Australia CEO " in table items 3, 40, 41 and 42, effective 1 July 2011.

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5	To refuse an application for registration as a private health insurer	subsection 126-20(1)
6	To grant an application, subject to terms and conditions, for registration as a private health insurer	subsection 126-20(1)
6A	To refuse an application for approval for a private health insurer to convert to being *registered as a for profit insurer	subsection 126-42(5)
7	To refuse to make a declaration that the *solvency standard does not apply to a particular private health insurer	subsection 140-15(2)
8	To impose conditions on a declaration that the *solvency standard does not apply to a particular private health insurer	subsection 140-15(3)
9	To refuse to revoke or vary a declaration that the *solvency standard does not apply to a particular private health insurer	subsection 140-15(6) or (7)
10	To refuse to revoke or vary conditions imposed on a declaration that the *solvency standard does not apply to a particular private health insurer	subsection 140-15(6) or (7)
11	To refuse to revoke or vary a *solvency direction	subsection 140-20(8) or (9)
12	To refuse to make a declaration that the *capital adequacy standard does not apply to a particular private health insurer	subsection 143-15(2)
13	To impose conditions on a declaration that the *capital adequacy standard does not apply to a particular private health insurer	subsection 143-15(3)
14	To refuse to revoke or vary a declaration that the *capital adequacy standard does not apply to a particular private health insurer	subsection 143-15(6) or (7)
15	To refuse to revoke or vary conditions imposed on a declaration that the *capital adequacy standard does not apply to a particular private health insurer	subsection 143-15(6) or (7)
16	To refuse to revoke or vary a *capital adequacy direction	subsection 143-20(8) or (9)
17	To refuse to approve a restructure of the *health benefits funds of a private health insurer	subsection 146-1(3)
18	To refuse to approve a transfer of the *health benefits funds of one or more private health insurers	subsection 146-5(3)
19	To refuse to approve a restructure of the *health benefits funds of a private health insurer	section 149-10
20	To refuse to approve the appointment of a person as a private health insurer ' s actuary	subsection 160-1(5)
21	To declare under the Private Health Insurance (Insurer Obligations) Rules that a person is not eligible for appointment as a private health insurer ' s actuary	subsection 160-5(2)
22	To give a prudential direction to a private health insurer	subsection 163-15(1)
23	To refuse to revoke a *prudential direction	subsection 163-15(3)
24	To disqualify a person from being or acting as a director or senior manager of a private health insurer	subsection 166-20(1)
25	To refuse to revoke a disqualification of a *disqualified person	subsection 166-20(3)
26	To refuse to determine that a person is not a *disqualified person	subsection 166-25(3)
27	To specify conditions in a determination that a person is not a *disqualified person	subsection 166-25(4)
28	To specify additional conditions to which determination that a person is not a *disqualified person is to be subject	subsection 166-25(4)
29	To vary conditions to which determination that a person is not a *disqualified person is to be subject	subsection 166-25(4)
30	To revoke a determination that a person is not a *disqualified person	subsection 166-25(8)
44	Not to waive, or to waive only a part of, an amount of collapsed insurer levy or late payment penalty in respect of an amount of collapsed insurer levy	section 307-25

36	To refuse to extend a period to report to the Private Health Insurance Ombudsman	subsection 241-40(3)
37	To refuse to extend a period to give a record or information to the Private Health Insurance Ombudsman	subsection 250-1(5)

3	To affirm an original decision of the Chief Executive Medicare rejecting a claim to be paid an amount under Division 26	section 26-25
40	To affirm an original decision by the Chief Executive Medicare that an amount is recoverable as a debt under paragraph 282-1(1)(a) or (b)	section 282-15