Consideration resumed from 26 March.

Senate’s amendments—

(1)    Clause 23-10, page 10 (line 26), omit “policy to which subsection (1) applied”, substitute “^*complying health insurance policy”.

(2)    Clause 23-10, page 10 (line 28), omit “amount payable”, substitute “reduction”.

(3)    Clause 26-5, page 17 (line 6), omit “policy to which subsection (1) applied”, substitute “^*complying health insurance policy”.

(4)    Heading to clause 50-5, page 31 (lines 18 to 20), omit the heading, substitute:

50-5  Private Health Insurance Rules relevant to this Chapter

(5)    Clause 50-5, page 31 (line 23), after “Rules,”, insert “the Private Health Insurance (Benefit Requirements) Rules,”.

(6)    Clause 55-5, page 32 (line 26), omit “paragraph 66-10(2)(a)”, substitute “subsection 66-10(2)”.

(7)    Clause 63-1, page 35 (line 5), before “A private”, insert “(1)”.

(8)    Clause 63-1, page 35 (after line 7), at the end of the clause, add:

        (2)    However, subsection (1) does not apply in relation to ^*health insurance business of a kind that the Private Health Insurance (Complying Product) Rules specify is excluded from subsection (1).

(9)    Clause 63-5, page 35 (after line 16), after subclause (2), insert:

     (2A)    A product subgroup, of a ^*product, is all the insurance policies in the product:

             (a)    under which the addresses of the people insured, as known to the private health insurer, are located in the same ^*risk equalisation jurisdiction; and

             (b)    under which the same kind of insured group (within the meaning of the Private Health Insurance (Complying Product) Rules) is insured.

      (2B)    The Private Health Insurance (Complying Product) Rules may specify insured groups for the purposes of paragraph (2A)(b). An insured group may be specified by reference to any or all of the number of people in the group, the kind of people in the group, or any other matter. A group may consist of only one person.

(10)  Clause 66-5, page 37 (lines 27 to 29), omit paragraph (1)(a), substitute:

             (a)    is the amount specified for the ^*product subgroup to which the policy belongs in the most recent approval under section 66-10; or

(11)  Clause 66-5, page 38 (line 3), omit subparagraph (1)(c)(ii), substitute:

                  (ii)    because of a discount or discounts allowed under subsection (2), if the total percentage discount (not counting discounts available for the reason in paragraph (3)(f)) does not exceed the percentage specified in the Private Health Insurance (Complying Product) Rules as the maximum percentage discount allowed; or

(12)  Clause 66-5, page 38 (lines 5 to 19), omit subclause (2), substitute:

        (2)    A discount is allowed if:

             (a)    it is for a reason in subsection (3); and

             (b)    the discount is also available for that reason under every policy in the ^*product; and

             (c)    if there are different percentage discounts available for that reason—the same percentage discount is available on the same basis under every policy in the product; and

             (d)    any other conditions set out in the Private Health Insurance (Complying Product) Rules are met.

        (3)    A discount may be for any of these reasons:

             (a)    because premiums are paid at least 3 months in advance;

             (b)    because premiums are paid by payroll deduction;

             (c)    because premiums are paid by pre-arranged automatic transfer from an account at a bank or other financial institution;

             (d)    because the persons insured under the policy have agreed to communicate with the private health insurer, and make claims under the policy, by electronic means;

             (e)    because a person insured under the policy is, under the ^*rules of the private health insurer, treated as belonging to a contribution group;

              (f)    because the insurer is not required to pay a levy in relation to the policy under a law of a State or Territory;

             (g)    for a reason set out in the Private Health Insurance (Complying Product) Rules.

(13)  Clause 66-10, page 38 (line 27) to page 39 (line 9), omit subclause (2), substitute:

        (2)    The application may propose different changes for policies in the ^*product, but the proposed changed amount must be the same for each policy in the product that belongs to the same ^*product subgroup.

(14)  Clause 66-10, page 39 (lines 20 to 22), omit subclause (5).

(15)  Clause 69-1, page 41 (lines 4 to 10), omit subclause (1), substitute:

        (1)    An insurance policy meets the coverage requirements in this Division if:

             (a)    the only treatments the policy ^*covers are:

                   (i)    specified treatments that are ^*hospital treatment; or

                  (ii)    specified treatments that are hospital treatment and specified treatments that are ^*general treatment; or

                 (iii)    specified treatments that are general treatment but none that are hospital-substitute treatment; and

             (b)    if the policy provides a benefit for anything else—the provision of the benefit is authorised by the Private Health Insurance (Complying Product) Rules.

(16)  Clause 69-1, page 41 (line 11), omit “subsection (1)”, substitute “paragraph (1)(a)”.

(17)  Clause 69-1, page 41 (line 14), omit “subsection (1)”, substitute “paragraph (1)(a)”.

(18)  Page 41 (after line 27), at the end of Division 69, add:

69-10  Meaning of hospital-substitute treatment

                 Hospital-substitute treatment means ^*general treatment that:

             (a)    substitutes for an episode of ^*hospital treatment; and

             (b)    is any of, or any combination of, nursing, medical, surgical, podiatric surgical, diagnostic, therapeutic, prosthetic, pharmacological, pathology or other services or goods intended to manage a disease, injury or condition; and

             (c)    is not specified in the Private Health Insurance (Complying Product) Rules as a treatment that is excluded from this definition.

(19)  Clause 72-1, page 43 (cell at table item 1, 3rd column), omit the cell, substitute:

(20)  Clause 72-1, page 44 (cell at table item 4, 3rd column), omit the cell, substitute:

             (a)    at least the amount set out, or worked out using the method set out, in the Private Health Insurance (Prostheses) Rules as the minimum benefit, or method for working out the minimum benefit, for the prosthesis; and

             (b)    if the Private Health Insurance (Prostheses) Rules set out an amount, or a method for working out an amount, as the maximum benefit, or method for working out the maximum benefit, for the prosthesis—no more than that amount or the amount worked out using that method.

(21)  Clause 72-1, page 44 (table item 5), omit the table item, substitute:

(22)  Clause 72-1, page 44 (lines 1 and 2), omit “a policy holder with, or arranges for a policy holder”, substitute “an insured person with, or arranges for an insured person”.

(23)  Clause 72-15, page 46 (line 25), omit “14 days”, substitute “28 days”.

(24)  Page 46 (after line 30), at the end of Division 72, add:

72-20  Other matters

                 The Private Health Insurance (Prostheses) Rules may, in relation to application fees, initial listing fees or ongoing listing fees imposed under the Private Health Insurance (Prostheses Application and Listing Fees) Act 2007, provide for, or for matters relating to, any or all of the following:

             (a)    methods for payment;

             (b)    extending the time for payment;

             (c)    refunding or otherwise applying overpayments.

(25)  Clause 75-1, page 47 (lines 23 and 24), omit “a policy holder with, or arranges for a policy holder”, substitute “an insured person with, or arranges for an insured person”.

(26)  Clause 78-1, page 51 (lines 18 and 19), omit “a policy holder with, or arranges for a policy holder”, substitute “an insured person with, or arranges for an insured person”.

(27)  Clause 84-1, page 53 (line 14), after “treatment”, insert “or provides a benefit for anything else”.

(28)  Clause 93-1, page 58 (line 6), after “each”, insert “^*product subgroup of each”.

(29)  Clause 93-1, page 58 (line 8), after “each”, insert “product subgroup of each”.

(30)  Clause 93-1, page 58 (after line 9), after subclause (1), insert:

     (1A)    A single ^*standard information statement may be the standard information statement for more than one ^*product subgroup of a ^*complying health insurance product if the premiums payable under policies in the subgroups the statement covers are the same.

(31)  Clause 93-1, page 58 (line 10), after “for a”, insert “^*product subgroup of a”.

(32)  Clause 93-1, page 58 (line 14), after “for a”, insert “^*product subgroup of a”.

(33)  Clause 93-1, page 58 (line 18), after “for a”, insert “^*product subgroup of a”.

(34)  Clause 93-5, page 58 (line 25), after “for a”, insert “^*product subgroup of a”.

(35)  Clause 93-5, page 58 (line 26), after “the product”, insert “subgroup”.

(36)  Clause 93-10, page 59 (line 10), omit “product”, substitute “^*product subgroup that is likely to apply to the person”.

(37)  Clause 93-10, page 59 (line 13), after “statement”, insert “for that subgroup”.

(38)  Clause 93-15, page 59 (line 19), omit “that the policy is in”, substitute “subgroup that the policy belongs to”.

(39)  Clause 93-20, page 60 (lines 4 and 5), omit “that the policy is in”, substitute “subgroup that the policy belongs to”.

(40)  Clause 93-20, page 60 (line 10), omit “statement”, substitute “statements”.

(41)  Clause 93-20, page 60 (line 16), after “statement”, insert “for the ^*product subgroup that the policy belongs to”.

(42)  Clause 93-20, page 60 (lines 23 to 30), omit subclause (4) (including the note), substitute:

        (4)    If a private health insurer changes the ^*health benefits fund to which a ^*complying health insurance policy of the insurer is ^*referable, the insurer must ensure that:

             (a)    before the change takes effect, an ^*adult insured under the policy is given a statement identifying the health benefits fund to which the policy will be referable as a result of the change; or

             (b)    within 2 weeks after the change takes effect, an adult insured under the policy is given a statement identifying the health benefits fund to which the policy is referable as a result of the change.

Note:   The health benefits fund to which a policy is referable may change in accordance with Division 146.

(43)  Clause 96-1, page 62 (line 11), omit “statement”, substitute “statements”.

(44)  Clause 96-1, page 62 (lines 12 and 13), omit “an ^*up to date copy of the statement”, substitute “^*up to date copies of the statements”.

(45)  Clause 96-5, page 62 (lines 16 to 18), omit “a copy of the ^*standard information statement for a ^*complying health insurance product of the insurer is”, substitute “copies of the ^*standard information statements for a ^*complying health insurance product of the insurer are”.

(46)  Clause 96-10, page 62 (lines 26 and 27), omit “statement for a ^*complying health insurance product of the insurer is updated, a copy of the updated statement is”, substitute “statements for a ^*complying health insurance product of the insurer are updated, copies of the updated statements are”.

(47)  Clause 99-1, page 65 (after line 24), after subclause (2), insert:

     (2A)    A private health insurer must not request a certificate except in the circumstances set out in subsection (2).

(48)  Clause 121-5, page 75 (line 16), omit “^*policy holders of”, substitute “persons insured under ^*complying health insurance products that are ^*referable to”.

(49)  Clause 121-5, page 75 (after line 16), after paragraph (7)(e), insert:

           (ea)    if the Minister is deciding whether to revoke such a declaration—any contravention of conditions to which the declaration is subject; and

(50)  Page 75 (after line 21), after clause 121-5, insert:

121-7  Conditions on declarations of hospitals

        (1)    A declaration under paragraph 121-5(6)(a) that a facility is a hospital is subject to:

             (a)    any conditions specified under subsection (2); and

             (b)    any conditions that the Minister specifies under subsection (3) in relation to the facility.

Note:   Decisions by the Minister to specify conditions in relation to particular facilities are reviewable under Part 6-9.

        (2)    The Private Health Insurance (Health Insurance Business) Rules may specify conditions to which declarations under paragraph 121-5(6)(a) are subject. Any conditions so specified apply to all such declarations, whether or not the declarations were made before the conditions were so specified.

        (3)    The Minister may specify:

             (a)    in a declaration under paragraph 121-5(6)(a) relating to a facility; or

             (b)    in a written notice given to a facility for which such a declaration is already in force;

conditions, or additional conditions, to which the declaration is subject.

        (4)    A contravention of a condition to which a declaration under paragraph 121-5(6)(a) is subject does not cause the declaration to cease to have effect.

Note:   Contraventions are taken into consideration in deciding whether to revoke a declaration.

(51)  Clause 126-40, page 83 (line 30) to page 84 (line 7), omit subclause (2), substitute:

        (2)    If:

             (a)    because of subsection (1) or otherwise, a private health insurer is not ^*registered as a for profit insurer; and

             (b)    the Council approves under section 126-42 an application by the insurer for the insurer to convert to being registered as a for profit insurer;

the insurer is taken, from the day specified in the Council’s approval, to be registered as a for profit insurer for the purposes of this Act.

(52)  Page 84 (after line 34), after clause 126-40, insert:

126-42  Conversion to for profit status

        (1)    A private health insurer may apply to the Council for approval to convert to being ^*registered as a for profit insurer.

        (2)    The application:

             (a)    must be in the ^*approved form; and

             (b)    must include a conversion scheme that is:

                   (i)    in the approved form; and

                  (ii)    accompanied by such further information as is specified in the Private Health Insurance (Registration) Rules; and

             (c)    must be given to the Council at least 90 days before the day specified in the application as the day on which the insurer proposes that it become ^*registered as a for profit insurer.

        (3)    The Council must approve the application if the Council is satisfied, within 30 days after the application was made, that the conversion scheme would not in substance involve the demutualisation of the insurer.

        (4)    If subsection (3) does not apply:

             (a)    the Council must, at least 45 days before the day specified in the application, cause a notice of the application to be published in a national newspaper, or in a newspaper circulating in each jurisdiction where the insurer has its registered office or carries on business; and

             (b)    the Council may, within 90 days after the application is made, give the insurer written notice requiring the insurer to give the Council such further information relating to the application as is specified in the notice.

        (5)    If subsection (3) does not apply, the Council must approve the application if:

             (a)    the insurer has complied with subsection (2) in relation to the application, and given to the Council such further information as the Council has required under paragraph (4)(b); and

             (b)    the Council is satisfied that the conversion scheme would not result in a financial benefit to any person who is not a ^*policy holder of, or another person insured through, a ^*health benefits fund conducted by the insurer; and

             (c)    the Council is satisfied that the conversion scheme would not result in financial benefits from the scheme being distributed inequitably between such policy holders and insured persons.

        (6)    The Private Health Insurance (Registration) Rules may provide for criteria for deciding, for the purposes of subsection (3), whether a conversion scheme would not in substance involve the demutualisation of the insurer.

        (7)    The Council must cause the insurer to be notified in writing of the Council’s decision on the application.

Note:   Refusals of applications are reviewable under Part 6-9.

(53)  Clause 137-1, page 90 (after line 21), after subclause (4), insert:

     (4A)    The assets of a ^*health benefits fund:

             (a)    include assets that, in accordance with a restructure or arrangement approved under Division 146, are to be assets of the fund; but

             (b)    do not include assets that, in accordance with such a restructure or arrangement, are no longer to be assets of the fund.

(54)  Clause 137-10, page 92 (lines 7 to 9), omit subparagraph (2)(a)(i), substitute:

                   (i)    meeting ^*policy liabilities and other liabilities, or expenses, incurred for the purposes of the business of the fund (including policy liabilities and other liabilities that are treated, in accordance with a restructure or arrangement approved under Division 146, as policy liabilities and other liabilities incurred for the purposes of the fund); or

(55)  Clause 137-10, page 92 (after line 12), at the end of paragraph (2)(a), add:

                 (iv)    a purpose specified in the Private Health Insurance (Health Benefits Fund Policy) Rules for the purposes of this subparagraph; or

(56)  Clause 137-10, page 92 (line 19), omit “other” (second occurring).

(57)  Clause 140-20, page 99 (line 16), omit “organisation”, substitute “insurer”.

(58)  Clause 140-20, page 99 (line 26), omit “issuing”, substitute “giving”.

(59)  Clause 143-20, page 104 (line 18), omit “organisation”, substitute “insurer”.

(60)  Clause 143-20, page 104 (line 30), omit “issuing”, substitute “giving”.

(61)  Clause 146-1, page 106 (lines 5 to 15), omit subclause (1), substitute:

        (1)    A private health insurer may restructure its ^*health benefits funds so that insurance policies that are ^*referable to a health benefits fund (a transferring fund) of the insurer become referable to one or more other health benefits funds (receiving funds) of the insurer (whether existing or proposed) if:

             (a)    the insurance policies concerned are all of the policies that, immediately before the restructure, were referable to the transferring fund and belonged to one or more ^*policy groups of that fund; and

             (b)    the insurer applies to the Council, in the ^*approved form, for approval of the restructure; and

             (c)    the Council approves the restructure in writing; and

             (d)    the insurer complies with any requirements that the Private Health Insurance (Health Benefits Fund Administration) Rules impose on the insurer in relation to the restructure.

(62)  Clause 146-1, page 106 (line 17), after “if”, insert “, and only if,”.

(63)  Clause 146-1, page 106 (lines 18 and 19), omit paragraph (2)(a), substitute:

             (a)    the ^*assets and liabilities that would be transferred to the receiving fund or funds represent a reasonable estimate of what would, immediately before the restructure, be the ^*net asset position of the transferring fund; and

           (aa)    if there is more than one receiving fund—those assets and liabilities would be fairly distributed between the receiving funds; and

(64)  Clause 146-1, page 106 (after line 21), after subclause (2), insert:

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

(65)  Clause 146-1, page 106 (lines 25 and 26), omit “(a transferring fund)”.

(66)  Clause 146-1, page 106 (line 31), omit “(a receiving fund)”.