Private Health Insurance Act 2007
View history note
Hide history note[ CCH Note: S 23-15 heading will be amended by No 54 of 2025, s 3 and Sch 2 item 1, by substituting " Application to register " for " Registration " , 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 .]
A person may apply to a private health insurer, in the [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
approved form, to become a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
participant in the [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
premiums reduction scheme in respect of a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
complying health insurance policy issued by the insurer if: (a) the insurer is a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
participating insurer; and (b) the person is a [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
PHIIB in respect of a premium paid or payable under the policy; and (c) the person meets any requirements specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph.23-15(2)
A private health insurer that receives an application under subsection (1) must notify the Chief Executive Medicare of the application, in the [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
approved form, no more than 14 days (or any other period determined by the Chief Executive Medicare) after receiving the application.[ CCH Note: S 23-15(2) will be amended by No 54 of 2025, s 3 and Sch 2 item 2, by substituting " no more than 7 business days (or any other period determined by the Chief Executive Medicare under subsection (4)) " for " , in the * approved form, no more than 14 days (or any other period determined by the Chief Executive Medicare) " , 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 .]
23-15(3)
If notified of an application and satisfied that paragraphs (1)(a) , (b) and (c) apply, the Chief Executive Medicare must register the applicant as a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
participant in respect of the policy.[ CCH Note: S 23-15(3) will be substituted by No 54 of 2025, s 3 and Sch 2 item 3, 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 23-15(3) will read:
]
23-15(3)
A notice under subsection (2) must:
(a) be given electronically in accordance with the electronic system approved by the Chief Executive Medicare under section 333-16 for the purposes of this paragraph; and
(b) include the information required by that system to be included in the notice; and
(c) be accompanied by any documents required by that system to accompany the notice.
23-15(4)
The Chief Executive Medicare must notify the private health insurer that issued the policy if the Chief Executive Medicare registers a person as a [*]
To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
participant in the [*]To find definitions of asterisked terms, see the Dictionary in Schedule 1 .
premiums reduction scheme in respect of the policy.[ CCH Note: S 23-15(4) will be substituted by No 54 of 2025, s 3 and Sch 2 item 3, 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 23-15(4) will read:
]
23-15(4)
The Chief Executive Medicare may, by legislative instrument, determine a different period for the purposes of subsection (2) .
[
CCH Note:
S 23-16 will be inserted by No 54 of 2025, s 3 and Sch 2 item 4, 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 23-16 will read:
A decision under this subsection is able to be automated by a computer program: see section
333-17
.
SECTION 23-16 REGISTRATION OF PARTICIPANTS
23-16(1)
If a private health insurer notifies the Chief Executive Medicare of an application made under subsection
23-15(1)
in respect of a
*
complying health insurance policy issued by the insurer, the Chief Executive Medicare must register the applicant as a
*
participant in respect of the policy if:
(a)
the notice complies with subsection
23-15(3)
; and
(b)
the criteria (if any) specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph are met in relation to the application.
Note:
Notification of proposed refusal
23-16(2)
If the Chief Executive Medicare proposes to refuse to register the applicant as a * participant in respect of the policy, the Chief Executive Medicare must:
(a) notify the private health insurer of the proposed refusal and the reasons for the proposed refusal; and
(b) give the private health insurer an opportunity to amend and resubmit the notice given to the Chief Executive Medicare in relation to the application before the end of the period that applies in relation to section 23-20 .
Notification of registration
23-16(3)
If the Chief Executive Medicare registers the applicant as a * participant in the * premiums reduction scheme in respect of the policy, the Chief Executive Medicare must notify the private health insurer of the decision.
]
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