Private Health Insurance Act 2007

[ CCH Note: S 333-16 to 333-18 will be inserted by No 54 of 2025, s 3 and Sch 2 item 21, effective 4 May 2026 or a single day to be fixed by Proclamation. However, if the provisions do not commence within the period of 6 months beginning on the day this Act receives the Royal Assent, they commence on the day after the end of that period. For application, transitional and validation provisions, see note under s 279-1 . S 333-16 to 333-18 will read:

SECTION 333-16 APPROVED ELECTRONIC SYSTEM  
333-16
The Chief Executive Medicare may, by notifiable instrument, approve one or more electronic systems for the purposes of paragraphs 23-15(3)(a) , 23-30(2A)(b) and 279-10(2)(b) .

SECTION 333-17 AUTOMATION OF ADMINISTRATIVE ACTION  

333-17(1)
The Chief Executive Medicare may, in writing, arrange for the use, under the Chief Executive Medicare ' s oversight, of computer programs to take administrative action that must be taken by the Chief Executive Medicare under this Act.

333-17(2)
Administrative action is:

(a) making, or refusing or failing to make, a decision under a provision mentioned in subsection (3) ; or

(b) exercising, or refusing or failing to exercise, a power under a provision mentioned in subsection (3) ; or

(c) performing, or refusing or failing to perform, a function or duty under a provision mentioned in subsection (3) ; or

(d) doing, or refusing or failing to do, anything (including giving a notice) related to making a decision, exercising a power or performing a function or duty under a provision mentioned in subsection (3) .

333-17(3)
For the purposes of subsection (2) , the provisions are the following provisions of the Act:

(a) subsection 23-16(1) (which deals with registering a person as a * participant in the * premiums reduction scheme);

(b) subsection 23-30(3) (which deals with revoking a person ' s registration as a participant in the premiums reduction scheme);

(c) subsection 23-40(2) (which deals with variations to registrations);

(d) subsection 279-11(1) (which deals with reimbursement claims);

(e) a provision of this Act prescribed by the Private Health Insurance (Incentives) Rules.

Chief Executive Medicare is treated as having taken administrative action

333-17(4)
Administrative action taken by the operation of a computer program under an arrangement under subsection (1) is treated, for all purposes, as administrative action taken by the Chief Executive Medicare.

Substituting administrative action

333-17(5)
The Chief Executive Medicare may take administrative action (the substituted action ) in substitution for administrative action the Chief Executive Medicare is treated as having taken under subsection (4) if the Chief Executive Medicare is satisfied that the administrative action taken by the operation of the computer program is not correct.

333-17(6)
The substituted action takes effect on:

(a) if the Chief Executive Medicare specifies a day on which the substituted action takes effect - that specified day; or

(b) otherwise - the day of the administrative action taken by the operation of the computer program.

333-17(7)
The day specified under paragraph (6)(a) may be earlier than the day the substituted action is taken but not earlier than the day of the administrative action taken by the operation of the computer program.

Chief Executive Medicare may still take administrative action

333-17(8)
An arrangement under subsection (1) does not prevent the Chief Executive Medicare from taking administrative action under the provisions referred to in subsection (3) .

333-17(9)
Subsection (5) does not limit any other provision of this Act that provides for the review or reconsideration of an administrative action.

Arrangement not a legislative instrument

333-17(10)
An arrangement under subsection (1) is not a legislative instrument.

SECTION 333-18 OVERSIGHT AND SAFEGUARDS FOR AUTOMATION OF ADMINISTRATIVE ACTION  
Chief Executive Medicare to ensure administrative action is action that could be validly taken

333-18(1)
The Chief Executive Medicare must take all reasonable steps to ensure that administrative action taken by the operation of a computer program under an arrangement under subsection 333-17(1) is administrative action that the Chief Executive Medicare could validly take under this Act.

333-18(2)
Without limiting subsection (1) , the Chief Executive Medicare must do the things (if any) prescribed by the Private Health Insurance (Incentives) Rules for the purposes of this subsection.

Note:

Administrative action may still be invalid even if subsections (1) and (2) are complied with.

333-18(3)
A failure to comply with subsection (1) or (2) does not affect the validity of the administrative action taken by the operation of a computer program under an arrangement under subsection 333-17(1) .

Notification of substituted decisions

333-18(4)
If, under subsection 333-17(5) , the Chief Executive Medicare makes a decision in substitution for a decision the Chief Executive Medicare is treated as having taken under subsection 333-17(4) , the Chief Executive Medicare must, within 14 days of the making of the substituted decision, cause the person who is the subject of the substituted decision to be notified in writing:

(a) of the substituted decision and of the fact that the substituted decision was made by the Chief Executive Medicare; and

(b) of the person ' s right (if any) to apply for reconsideration of the substituted decision.

333-18(5)
A failure to comply with subsection (4) does not affect the validity of the substituted decision.

Publication

333-18(6)
If the Chief Executive Medicare makes an arrangement under subsection 333-17(1) in relation to particular provisions of this Act, the Chief Executive Medicare must cause a statement to be published on Services Australia ' s website:

(a) to the effect that the Chief Executive Medicare has made such an arrangement; and

(b) setting out those particular provisions.

Details in annual report

333-18(7)
The Chief Executive Officer of Services Australia, when preparing Services Australia ' s annual report under section 46 of the Public Governance, Performance and Accountability Act 2013 for a period, must include the following information in that report:

(a) the total number of substituted actions taken by the Chief Executive Medicare under subsection 333-17(5) in that period;

(b) the kind of substituted actions so taken;

(c) the kind of administrative action taken by the operation of the computer program that the Chief Executive Medicare was satisfied was not correct.

333-18(8)
The Chief Executive Officer of Services Australia may also include in the report any other information (other than personal information within the meaning of the Privacy Act 1988 ) about the operation of section 333-17 and this section in that period that the Chief Executive Officer of Services Australia considers appropriate.