PRIVATE HEALTH INSURANCE INCENTIVES ACT 1998
This Act may be cited as the Private Health Insurance Incentives Act 1998. SECTION 1-10 1-10 COMMENCEMENT
This Act commences on the day on which it receives the Royal Assent. SECTION 1-15 IDENTIFICATION OF DEFINED EXPRESSIONS 1-15(1) [Dictionary]
Some of the expressions used in this Act are defined in the Dictionary of defined expressions in Part 8.
1-15(2) [Asterisks]Most defined expressions are identified by an asterisk appearing at the start of the expression. The footnote that goes with the asterisk contains a signpost to the definitions in the Dictionary.
Note:
The expressions you and Medicare Australia CEO are not asterisked.
View history note
Hide history noteOnce a defined expression has been identified by an asterisk, later occurrences of the expression in the same subsection are not usually asterisked.
1-15(4) [Guides and notes]Expressions are not asterisked in Guides and notes contained in this Act.
1-15(5) [``you'']In this Act, you means an individual but does not include an individual in the capacity of a trustee or the capacity of an employer.
Division 2 - Guide to this Act SECTION 2-1 WHAT THIS ACT IS ABOUTChapter 1 deals with some preliminary matters.
Chapter 2 establishes a scheme under which people who, or whose employers on their behalf, pay premiums under certain private health insurance policies can obtain payments from the Commonwealth in return for the payment of the premiums.
Chapter 3 establishes an alternative scheme under which people who are covered by such private health insurance policies can have the premiums payable under those policies reduced.
If, underChapter 3, a premium is reduced, no payment can be received under Chapter 2 in respect of the premium (see subsection 4-5(2)).
If, under Chapter 2, a payment is received in respect of a premium, no reduction is allowed in respect of the premium under Chapter 3 (see subsection 12-5(4)).
Chapter 4 deals with matters that are relevant to both Chapter 2 and Chapter 3.
Note:
The incentive payments scheme and the premiums reduction scheme are complemented by the private health insurance offset provided for by Subdivision 61-H of the Income Tax Assessment Act 1997.
CHAPTER 2 - THE INCENTIVE PAYMENTS SCHEME PART 2 - ENTITLEMENT TO, AND CALCULATION OF, PAYMENTS UNDER INCENTIVE PAYMENTS SCHEME Division 3 - Introduction SECTION 3-1 WHAT THIS PART IS ABOUTThis Part explains who is entitled to payments under the scheme and how the amounts payable are calculated.
| 3 | Introduction |
| 4 | Entitlement to, and calculation of, payments |
You are entitled to a payment under this Chapter if:
(a) you have paid, or your employer has paid as a *fringe benefit for you, a premium under an *appropriate private health insurance policy for the whole or a part of the financial year that began on or after 1 July 1998 and before 1 July 2007; and
(b) the policy was issued by a *health fund.
You are not entitled to a payment under this Chapter in respect of a payment of premium if the premium is less than it would otherwise have been because of the operation of Chapter 3.
SECTION 4-6 RECEIPT FOR PAYMENT OF PREMIUMS 4-6(1) [Receipt to be given]Subject to subsection (2), a *health fund to which a premium has been paid as mentioned in subsection 4-5(1) must, if requested to do so by the person who made the payment, give to the persona receipt for the payment in such form, and containing such information, as are determined in writing by the Medicare Australia CEO.
Subsection (1) does not apply if the premium to which the payment relates has been reduced under Chapter 3.
The amount payable under this Chapter for an amount of premium paid under a policy for the financial year that began on 1 July 1998 depends upon whether or not a person was registered, or eligible to apply for registration, before 1 January 1999 under the Private Health Insurance Incentives Act 1997 in respect of the policy for the financial year.
4-10(2) If no-one registered or eligible for registration.If no person was so registered or eligible to apply for registration, the amount payable is 30% of the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy for the financial year.
4-10(3) If someone registered or eligible for registration.If a person was so registered or eligible to apply for registration, the amount payable is the greater of the amount worked out under paragraph (a) and the amount worked out under paragraph (b):
(a) 30% of:
(i) the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy for the financial year; or
(ii) if, because of the operation of the Private Health Insurance Incentives Act 1997, that amount of premium was less than the amount of premium that would otherwise have been payable - the amount of premium that would otherwise have been payable; and
(b) the *incentive amount for the policy for the financial year. 4-10(4) Financial year 1999-2000 or later financial year.
The amount payable under this Chapter for an amount of premium paid under a policy for a later financial year depends upon whether or not a person was registered, or eligible to apply for registration, before 1 January 1999 under the Private Health Insurance Incentives Act 1997 in respect of the policy for the financial year that began on 1 July 1998.
4-10(5) If no-one registered or eligible to apply for registration.If no person was so registered or eligible to apply for registration, the amount payable is the sum of the following amounts:
(a) 30% of the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later financial year on which no person covered by the policy was aged 65 years or over;
(b) 35% of the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later financial year on which:
(i) at least one person covered by the policy was aged 65 years or over; and
(ii) no person covered by the policy was aged 70 years or over;
(c) 40% of the amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy in respect of days in the later financial year on which at least one person covered by the policy was aged 70 years or over.
If a person was so registered or eligible to apply for registration, the amount payable is the greater of:
(a) the sum of the amounts referred to in paragraphs (5)(a), (b) and (c); and
(b) the *incentive amount for the policy for the later financial year.
The total amount payable under this Chapter for a policy for a financial year is reduced by the amount of any tax offset received under Subdivision 61-H of the Income Tax Assessment Act 1997 for the total amount of the premium paid by you, or by your employer as a *fringe benefit for you, under the policy for that financial year.
4-10(8) Disregard premium that relates to period before 1 January 1999.In working out an amount payable under this Chapter for an amount of premium paid by you, or by your employer as a *fringe benefit for you, under a policy, disregard any part of the amount of the premium paid that relates to a period before 1 January 1999.
4-10(9) Amount payable reduced if premium reduced under 1997 Act.If, because of the operation of the Private Health Insurance Incentives Act 1997, the amount of a premium paid by you, or by your employer as a *fringe benefit for you, under a policy for a period after 31 December 1998 was less than the amount that would otherwise have been payable, the amount payable under this Chapter in respect of the premium is reduced by the amount of the difference.
SECTION 4-12 SAVING PROVISION WHERE A PERSON 65 YEARS OR OVER CEASES TO BE COVERED BY POLICY 4-12(1)This section applies to a person (the first person ) at a particular time (the relevant time ) if:
(a) at any time before the relevant time, the first person was covered by an *appropriate private health insurance policy (the original policy ), other than as a *dependent child; and
(b) at any time when the person was so covered, the amount payable under this Chapter was 35% or 40% of the amount of premium payable under the original policy because of the age of another person (the entitling person ) covered by the policy; and
(c) before the relevant time, the entitling person ceased to be covered by the original policy.
4-12(2)
If, at the relevant time:
(a) the first person is covered by an *appropriate private health insurance policy (which may be either the original policy or another policy); and
(b) each other person (if any) covered, since the entitling person ceased to be covered by the original policy, by an *appropriate private health insurance policy that also covered the first person:
(i) is or was covered as a *dependent child; or
(ii) is a person who was covered by the original policy immediately before that cessation;
subsections 4-10(5) and (6) are taken to apply (other than for the purposes of working out the *incentive amount) as if the entitling person:
(c) were covered by the policy mentioned in paragraph (a); and
(d) were the same age as at that cessation.
4-12(3)
Subsection (2) does not apply if its application would result in the amount payable under subsection 4-10(5) or (6) being less than it would otherwise have been.
SECTION 4-15 4-15 CLAIMS
To get the payment, you must make a claim for it.
Note:
See Division 6 in Part 3 for rules about claims.
PART 3 - CLAIMS FOR PAYMENTS UNDER INCENTIVE PAYMENTS SCHEME Division 5 - Introduction SECTION 5-1 WHAT THIS PART IS ABOUTThis Part explains how claims may be made for payments under the scheme and how claims are determined.
| 5 | Introduction |
| 6 | Claims for payments |
If you want to be paid an amount to which you are entitled under section 4-5, you must make a proper claim for payment of the amount. SECTION 6-10 FORM OF CLAIM 6-10(1) [Lodging a proper claim]
To be a proper claim, a claim must:
(a) be in a form (including an electronic form) approved by the Medicare Australia CEO; and
(b) provide all the information, and be accompanied by any documents, required by the form; and
(c) be sent to or lodged at an office of Medicare Australia, or a place approved by the Medicare Australia CEO; and
(d) be so sent or lodged in the financial year in which the payment of the premium to which the claim relates was made or the next financial year.
The Medicare Australia CEO must not approve a form under paragraph (1)(b) that requires you to provide the *tax file number of any person.
You may at any time, by writing sent to or lodged at an office of Medicare Australia, or a place approved by the Medicare Australia CEO, withdraw a claim.
The Medicare Australia CEO must make a decision granting or refusing the claim within 14 days after the day on which the claim is made.
If the claim is granted, the Medicare Australia CEO must pay to you the amount to which you are entitled.
If the claim is refused, the Medicare Australia CEO must cause to be served on you a notice stating that the claim has been refused and setting out the reasons for the refusal.
If the claim is refused, you may apply to the Medicare Australia CEO for the Medicare Australia CEO to reconsider the decision.
(a) be in writing; and
(b) set out the reasons for the application. 6-25(3) [28 day deadline]
The application must be made within:
(a) 28 days after the day on which you are notified of the decision; or
(b) if, either before or after the end of that period of 28 days, the Medicare Australia CEO extends the period within which the application may be made - the extended period for making the application.
Upon receiving such an application, the Medicare Australia CEO must:
(a) reconsider the decision; and
(b) either affirm or revoke the decision.
If the Medicare Australia CEO revokes the decision, the revocation is taken to be a decision granting the claim.
The Medicare Australia CEO must give to you a notice stating his or her decision on the reconsideration together with a statement of his or her reasons for the decision.
The Medicare Australia CEO must make his or her decision on reconsideration of a decision within 28 days after the day on which he or she received an application for reconsideration.
6-35(2) [Effect of delay]The Medicare Australia CEO is taken, for the purposes of this Division, to have made a decision confirming the original decision if the Medicare Australia CEO has not told the applicant of the decision on the reconsideration before the end of the period of 28 days.
Note:
A decision confirming the original decision is reviewable under section 19-10.
This Part is about the obtaining of information by the Medicare Australia CEO for the purposes of this Chapter.
| 7 | Introduction |
| 8 | Notification requirements |
If you have made a claim under section 6-5 for a payment of an amount and:
(a) a matter, event or circumstance occurs that affects your entitlement to a payment for which the claim is made; or
(b) a change occurs in the premium, or in the amounts or frequency of the payments in respect of the premium, under the policy;
you must, within 30 days after the occurrence of the matter, event, circumstance or change, give notice to the Medicare Australia CEO containing particulars of it.
You are guilty of an offence if:
(a) you are required by subsection (1) to give a notice to the Medicare Australia CEO containing particulars of a matter, event, circumstance or change referred to in that subsection; and
(b) you fail to comply with the requirement.
Maximum penalty: 60 penalty units.
Note:
Chapter 2 of the Criminal Code sets out the general principles of criminal responsibility.
Section 4K of the Crimes Act 1914 does not apply to the obligation to provide information pursuant to subsection (1).
SECTION 8-10 8-10 NOTIFICATION REQUIREMENTS - HEALTH FUNDS(Repealed by No 159 of 1999)
[ CCH Note: Chapter 3 is not reproduced.]
This Part contains general provisions that relate to both Chapters 2 and 3.
| 17 | Introduction |
| 18 | When and how payments can be recovered |
| 19 | Miscellaneous |
The following amounts are recoverable as debts due to the Commonwealth:
(a) a payment made to a person under Part 3 to which the person was not entitled;
(b) a payment made to a person under Part 3 in respect of a premium that was afterwards refunded;
(ba) a payment made to a person under Part 3 in respect of a claim that has been withdrawn under section 6-15;
(c) so much of a payment made under section 15-5 or 15-24 as relates to an *appropriate private health insurance policy that covers a person who was:
(i) a *participant in the premiums reduction scheme for the financial year concerned in respect of the policy; and
(ii) not eligible to participate in that scheme in respect of that policy;
(ca) so much of a payment made under section 15-5 or 15-24 as relates to a premium for which a reduction was not allowable under section 12-5;
(d) 150% of so much of a payment made under section 15-5 or 15-24 as:
(i) is not reflected in reductions in premiums payable under *appropriate private health insurance policies issued by the *health fund concerned; or
(ii) relates to a person whose application under section 11-15 has not been retained by the health fund as required by section 11-50; or
(iii) relates to a person whose application under section 11-15 has been so retained, but has not been produced to the Medicare Australia CEO by the health fund in accordance with a requirement made by the Medicare Australia CEO under section 16-10;
(e) so much of a payment purportedly made under section 15-5 or 15-24 as was not payable under that section;
(f) interest payable under subsection 18-10(2).
The amounts are recoverable from:
(a) if paragraph (1)(a), (b) or (ba) applies - the person referred to in that paragraph or that person's estate; or
(b) if paragraph (1)(c), (ca), (d) or (e) applies - the *health fund to which the payment concerned was made; or
(c) if paragraph (1)(f) applies:
(i) if the payment was made to a health fund - that fund; or
(ii) if the payment was made to an individual - the individual or his or her estate.
An amount recoverable under subsection (1) is recoverable whether or not any person has been convicted of an offence relating to the payment.
SECTION 18-10 INTEREST ON AMOUNTS RECOVERABLE 18-10(1) [Interest is payable after set period]If the Medicare Australia CEO has served on an individual from whom an amount is recoverable or the legal personal representative of such an individual, or on a *health fund from which an amount is recoverable, under subsection 18-5(1) a notice claiming an amount as a debt due to the Commonwealth and:
(a) an arrangement for the repayment of the amount has been entered into between the Medicare Australia CEO and the individual or the individual's legal personal representative, or the health fund, as the case may be, within the period referred to in subsection (3), and there has been a default in payment of an amount required to be paid under the arrangement; or
(b) at the end of the period such an arrangement has not been entered into and all or part of the amount remains unpaid;
then, from and including the day after the end of the period, interest becomes payable on so much of the amount as from time to time remains unpaid.
(a) at the rate specified in the regulations; or
(b) if no rate is so specified - at the rate of 15% per annum. 18-10(3) [Period term]
The period for entering into an arrangement under paragraph (1)(a) is the period of 3 months following the service of the notice under subsection (1), or such longer period as the Medicare Australia CEO allows.
Despite subsection (1), in any proceedings instituted by the Commonwealth for the recovery of an amount due under paragraph 18-5(1)(f), the court may order that the interest payable under that paragraph is, and is taken to have been, so payable from and including a day later than the day referred to in subsection (1).
SECTION 18-15 WRITE OFF, WAIVER AND PAYMENT BY INSTALMENTS 18-15(1) [CEO's powers]The Medicare Australia CEO may, on behalf of the Commonwealth, make a written determination:
(a) writing off an amount that a person or *health fund is required to pay to the Commonwealth under section 18-5; or
(b) waiving the right of the Commonwealth to recover from a person or health fund the whole or a part of an amount that the person or fund is required to pay to the Commonwealth under that section; or
(c) allowing a person who, or health fund which, is required to pay an amount to the Commonwealth under that section to pay that amount by such instalments as are specified in the determination.
Without limiting subsection (1), the Medicare Australia CEO may make a determination under paragraph (1)(b) if the Medicare Australia CEO is of the opinion that information given by or on behalf of:
(a) the Commonwealth; or
(b) a *health fund;
to a person from whom an amount is recoverable about that person's entitlements under this Act was incorrect or misleading in a material particular.
A determination under subsection (1) takes effect according to its terms:
(a) on the day specified in the determination, being the day on which the determination is made or any day before or after that day; or
(b) if no day is so specified - on the day on which the determination is made. 18-15(3) [Notice of determination]
If a determination is made under subsection (1) in relation to a person or *health fund, the Medicare Australia CEO must cause notice of the determination to be served on the person or fund.
Note:
Decisions not to make determinations under this section are reviewable under section 19-10.
Despite any other provision of this Act, if:
(a) except for this section, an amount would be payable by the Medicare Australia CEO to a person or his or her estate, or to a *health fund, under this Act; and
(b) an amount is recoverable under section 18-5 by the Commonwealth from the person or his or her estate, or from the fund, as the case may be;
the Medicare Australia CEO may set off the whole or a part of the amount referred to in paragraph (b) against the amount referred to in paragraph (a).
If the Medicare Australia CEO decides to make such a set-off in respect of a person or his or her estate, the Medicare Australia CEO must serve on the person or his or her legal personal representative or the legal personal representative of his or her estate a notice of the decision.
If the Medicare Australia CEO makes such a set-off:
(a) the Medicare Australia CEO is liable to pay to the person or his or her estate, or to the fund, only the amount remaining after the set-off; and
(b) the amount referred to in paragraph (1)(b) is reduced by the amount set off.
You may apply to the Medicare Australia CEO for the Medicare Australia CEO to reconsider the following decisions:
(a) a decision that an amount is recoverable as a debt due to the Commonwealth under:
(i) paragraph 18-5(1)(a) or (b); or
(ii) paragraph 18-5(1)(f) in respect of a payment made to an individual; or
(b) a decision under subsection 18-20(1) to set off a debt against an amount otherwise payable to a person or his or her estate.
(a) be in writing; and
(b) set out the reasons for the application. 18-25(3) [Deadline]
The application must be made within:
(a) 28 days after the day on which you are notified of the decision; or
(b) if, either before or after the end of that period of 28 days, the Medicare Australia CEO extends the period within which the application may be made - the extended period for making the application.
Upon receiving such an application, the Medicare Australia CEO must:
(a) reconsider the decision; and
(b) either affirm or revoke the decision.
If the Medicare Australia CEO revokes the decision, the revocation is taken to be a decision:
(a) in the case of a decision mentioned in paragraph (1)(a) - to waive the debt; or
(b) in the case of a decision mentioned in paragraph (1)(b) - not to set off a debt against an otherwise payable amount.
The Medicare Australia CEO must give you a notice stating his or her decision on the reconsideration together with a statement of his or her reasons for the decision.
The Medicare Australia CEO must make his or her decision on reconsideration of a decision within 28 days after the day on which he or she received an application for reconsideration.
The Medicare Australia CEO is taken, for the purposes of this Division, to have made a decision confirming the original decision if the Medicare Australia CEO has not told the applicant of his or her decision on the reconsideration before the end of the period of 28 days.
The Medicare Australia CEO may, by notice given to a *health fund, require the fund to provide information specified in the notice about a person who:
(a) is covered at any time during a financial year specified in the notice by an *appropriate private health insurance policy issued by the fund; or
(b) paid premiums under such a policy.
The information that the Medicare Australia CEO may require the *health fund to provide is information relating to any of the following:
(a) the name, residential address and date of birth of each such person;
(b) the fund membership number of the policy;
(c) the name, residential address and date of birth of the person covered by the policy whom the health fund treats as the contributor in respect of the policy;
(d) the name, residential address and date of birth of any person who is a *partner of a person covered by the policy;
(e) whether the policy provides *hospital cover, *ancillary cover or *combined cover;
(f) the date on which the policy was issued;
(g) whether the policy has terminated or been suspended, and, if it has, the date on which it terminated or was suspended;
(h) the amount of the premium under the policy;
(i) the period to which the premium relates;
(j) any increase or decrease in the premium;
(k) whether a payment in respect of a premium that was due within a period specified by the Medicare Australia CEO was not paid;
(l) any other information relevant to the operation of Chapter 2 or 3 that is determined in writing by the Medicare Australia CEO.
For the purposes of paragraph (2)(l), the Medicare Australia CEO must not make a determination requiring the *health fund to provide:
(a) the *tax file number of any person; or
(b) information about the physical, psychological or emotional health of any person.
Determinations under paragraph (2)(l) are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.
19-1(5) [Provision of information]The information required by a notice under subsection (1) is to be provided:
(a) in a form (including an electronic form) approved by the Medicare Australia CEO; and
(b) within the period specified in the notice.
A *health fund is guilty of an offence if:
(a) the fund is required by a notice under subsection (1) to provide information within a specified period about a person or matter; and
(b) the fund fails to comply with the requirement.
Maximum penalty: 20 penalty units.
Note 1:
Chapter 2 of the Criminal Code sets out the general principles of criminal responsibility.
Note 2:
The obligation to provide information pursuant to a notice under subsection (1) is a continuing obligation and a health fund is guilty of an offence for each day, after the period specified in the notice, until the information is provided (see section 4K of the Crimes Act 1914).
A notice under this Act by the Minister or the Medicare Australia CEO to a *health fund or a notice, request or application by a health fund to the Minister or the Medicare Australia CEO may be given, served or made in writing or in an electronic form.
A notice under this Act by the Medicare Australia CEO to a person other than a *health fund or a notice, request or application by a person other than a health fund to the Medicare Australia CEO must be in writing.
In determining for the purposes of this Act whether a person covered by a *private health insurance policy is an eligible person within the meaning of section 3 of the Health Insurance Act 1973, or is treated as such a person because of section 6 or 7 of that Act, the Medicare Australia CEO may use any information that he or she has obtained under that Act in determining whether the person was eligible to receive medicare benefits.
A person is guilty of an offence if:
(a) the person uses, makes a record of, or discloses or communicates to any person, any information that relates to the affairs of another person and was acquired under or for the purposes of this Act; and
(b) the use, making of the record, disclosure or communication was not carried out in the performance of a function or obligation, or the exercise of a power, under this Act.
Maximum penalty: Imprisonment for 2 years.
Note:
Chapter 2 of the Criminal Code sets out the general principles of criminal responsibility.
SECTION 19-6 PRINCIPLES RELATING TO PERSONAL INFORMATION 19-6(1) [Information principles]The Minister may, in writing, make principles relating to:
(a) the acquiring of personal information under or for the purposes of this Act; and
(b) the storage of, security of, access to, correction of, use of and disclosure of such personal information. 19-6(2) [Compliance]
A *health fund must comply with the principles.
19-6(3) [Disallowable instruments]The principles are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.
19-6(4) [Interpretation]In this section:
personal information
has the same meaning as in the Privacy Act 1988.
Application may be made to the Administrative Appeals Tribunal for review of the following decisions:
(a) a decision by the Medicare Australia CEO under section 6-30 confirming a decision under section 6-20 refusing a claim;
(b) a decision by the Medicare Australia CEO refusing to register a person under section 11-25 in respect of an *appropriate private health insurance policy;
(c) a decision by the Medicare Australia CEO under subsection 11-40(1) to revoke a person's registration in respect of an appropriate private health insurance policy (other than a decision made as a result of a notice given by the person under subsection 11-30(4));
(d) a decision by the Minister under section 14-15 to reject an application by a *health fund to become a *participating fund;
(da) a decision by the Minister under section 14A to revoke a health fund's status as a participating fund;
(e) a decision by the Medicare Australia CEO under subsection 15-25(3) on reconsideration of a decision that a claim under section 15-10, or an additional amount sought under section 15-21 or 15-22 is incorrect;
(f) a decision by the Medicare Australia CEO not to make a determination under section 18-15 in relation to an amount;
(g) a decision by the Medicare Australia CEO under section 18-25 on reconsideration of a decision:
(i) that an amount is recoverable as a debt due to the Commonwealth under:
(A) paragraph 18-5(1)(a) or (b); or
(B) paragraph 18-5(1)(f) in respect of a payment made to an individual; or
(ii) under subsection 18-20(1) to set off a debt against an amount otherwise payable to a person or his or her estate.
Note:
Under section 27A of the Administrative Appeals Tribunal Act 1975, the decision-maker must notify persons whose interests are affected by the making of the decision and of their right to have the decision reviewed. In notifying any such persons, the decision-maker must have regard to the Code of Practice determined under section 27B of that Act.
The Medicare Australia CEO must, within 120 days after the end of each financial year, give the following information to the Commissioner:
(a) the name, date of birth and residential address of each person who:
(i) paid a premium under an *appropriate private health insurance policy for that financial year; or
(ii) received a payment under Chapter 2 in respect of such a premium; or
(iii) was a *participant in the premiums reduction scheme in respect of an appropriate private health insurance policy for that financial year;
(b) the name of the *health fund that issued the policy;
(ba) the fund membership number of the policy;
(bb) the identification code of the fund that issued the policy;
(bc) the type of membership provided by the fund in respect of the policy;
(bd) whether the policy has been terminated or is suspended;
(be) if the policy has been terminated or is suspended, the date of the termination or suspension;
(c) the *type of cover provided by the policy;
(d) the total amount of payments to a health fund in respect of the policy;
(e) the period in respect of which those payments were made;
(f) the name and date of birth of any other person covered by the policy in respect of which those payments were made;
(g) whether any person covered by the policy was a *dependent child at any time during that financial year;
(h) the total amounts paid by the Medicare Australia CEO under Chapters 2 and 3 for the financial year;
(i) any other information that the Commissioner determines in writing.
For the purposes of paragraph (1)(i), the *Commissioner must not make a determination requiring the Medicare Australia CEO to provide:
(a) the *tax file number of any person; or
(b) information about the physical, psychological or emotional health of any person.
Determinations under paragraph (1)(i) are disallowable instruments for the purposes of section 46A of the Acts Interpretation Act 1901.
The Minister may, by writing, delegate all or any of his or her powers under this Act to:
(a) the Secretary to the Department; or
(b) the Medicare Australia CEO; or
(c) an officer of, or person employed in, the Department; or
(d) an employee of Medicare Australia.
The Medicare Australia CEO may, by writing, delegate all or any of his or her powers under this Act to an employee of Medicare Australia.
(Repealed by No 111 of 2005)
SECTION 19-20 19-20 EXCLUSION OF CERTAIN STATE INSURANCE
This Act does not apply with respect to State insurance that does not extend beyond the limits of the State concerned. SECTION 19-25 19-25 FALSE OR MISLEADING INFORMATION
A person is guilty of an offence if the person gives to the Medicare Australia CEO or to a *health fund under this Act any information that the person knows to be false or misleading in a material particular.
Maximum penalty: Imprisonment for 12 months.
Note:
Chapter 2 of the Criminal Code sets out the general principles of criminal responsibility.
Chapter 2 of the Criminal Code applies to all offences under this Act. SECTION 19-35 19-35 APPROPRIATION
The Consolidated Revenue Fund is appropriated for the purpose of making payments under this Act. SECTION 19-40 19-40 REGULATIONS
The Governor-General may make regulations prescribing matters:
(a) required or permitted by this Act to be prescribed; or
(b) necessary or convenient to be prescribed for carrying out or giving effect to this Act. PART 8 - DICTIONARY OF DEFINED EXPRESSIONS Division 20 - Defined expressions SECTION 20-5 20-5 DEFINITIONS
In this Act, unless the contrary intention appears:
ancillary cover
a *private health insurance policy provides ancillary cover if people covered by the policy are covered (wholly or partly) for liability to pay fees and charges for ancillary health benefits within the meaning of section 67 of the National Health Act 1953.
appropriate private health insurance policy
means a *private health insurance policy that satisfies the following conditions:
(a) it provides *hospital cover, *ancillary cover or *combined cover;
(b) the person, or each of the persons, covered by it is an eligible person within the meaning of section 3 of the Health Insurance Act 1973, or is treated as such a person because of section 6 or 7 of that Act.
business day
means a day other than a Saturday, a Sunday or a public holiday in the place concerned.
combined cover
a *private health insurance policy provides combined cover if it provides both *hospital cover and *ancillary cover.
Commissioner
means the Commissioner of Taxation.
dependent child
, in relation to an *appropriate private health insurance policy, means a person:
(a) who is covered by the policy; and
(b) whom the *health fund that issued the policy accepts as a dependent child for the purposes of the policy;
but does not include:
(c) a person who is the *partner of another person; or
(d) a person (other than a full-time student) who is 18 years of age or older; or
(e) a full-time student who is 25 years of age or older.
employee of Medicare Australia
means an employee within the meaning of the Medicare Australia Act 1973.
(a) a fringe benefit as defined by subsection 136(1) of the Fringe Benefits Tax Assessment Act 1986; and
(b) a benefit that would be a fringe benefit (as defined by subsection 136(1) of that Act) if paragraphs (d) and (e) of the definition of employer in that subsection of that Act were omitted.
health fund
means a registered organisation within the meaning of Part VI of the National Health Act 1953.
(Repealed by No 111 of 2005)
hospital cover
a *private health insurance policy provides hospital cover if it is an applicable benefits arrangement, within the meaning of section 5A of the National Health Act 1953, to which paragraph 5A(1)(a) of that Act applies.
hospital treatment
has the meaning given by section 3 of the Health Insurance Act 1973.
incentive amount
has the meaning given by section 20-10.
incentive payments scheme
means the scheme provided for by Chapter 2.
known gap policy
means a private health insurance policy that covers all but a specified amount or percentage of the full cost of hospital treatment and associated professional attention for the person or persons insured.
(Repealed by No 111 of 2005)
Medicare Australia CEO
means the Chief Executive Officer of Medicare Australia.
no gap policy
means a private health insurance policy that covers the full cost of hospital treatment and associated professional attention for the person or persons insured.
notification period
, in relation to a month, means the period starting on the first day of the month and finishing on the seventh day of the month.
parent
of a dependent child means:
(a) unless the dependent child is a full-time student who is 18 years of age or older - a person who has the right (whether alone or jointly with another person):
(i) to have the daily care and control of the child; and
(ii) to make decisions about the daily care and control of the child; or
(b) if the dependent child is a full-time student who is 18 years of age or older - a person who is primarily responsible (whether alone or jointly withanother person) for the maintenance and support of the student.
participant in the premiums reduction scheme
has the meaning given by section 12-10.
participating fund
means a *health fund referred to in subsection 14-5(1) or (3) other than such a fund whose status as a participating fund has been revoked under subsection 14A-1(1).
partner
, in relation to another person, means:
(a) a person who is legally married to the other person and is not living separately and apart from the other person on a permanent basis; or
(b) a person who, although not legally married to the other person, lives with the other person on a bona fide domestic basis as the husband or wife of the other person.
pay
a premium includes make a payment in respect of a premium.
premiums reduction scheme
means the scheme provided for by Chapter 3.
private health insurance policy
means a contract of insurance that was entered into by a *health fund in the course of carrying on a health insurance business within the meaning of section 67 of the National Health Act 1953.
professional attention
has the meaning given by section 3 of the Health Insurance Act 1973.
tax file number
means a tax file number as defined in section 202A of the Income Tax Assessment Act 1936.
type of cover
, in relation to a private health insurance policy, means:
(a) *hospital cover; or
(b) *ancillary cover; or
(c) *combined cover.
you
see subsection 1-15(5).
For the purposes of this Act, the incentive amount for an *appropriate private health insurance policy for a financial year is worked out in accordance with the following table:
| Incentive amounts | ||||
| Item | Number and kinds of people covered by the policy | Policy provides *hospital cover but not *ancillary cover | Policy provides *ancillary cover but not *hospital cover | Policy provides *combined cover |
| 1 | 3 or more people | $350 | $100 | $450 |
| 2 | One dependent child and one other person | $350 | $100 | $450 |
| 3 | 2 people neither of whom is a dependent child | $200 | $50 | $250 |
| 4 | One person | $100 | $25 | $125 |
If the amount of the premium paid by a person, or by a person's employer as a *fringe benefit for the person, under the *appropriate private health insurance policy is for part only of the financial year, the incentive amount is worked out using the following formula:
| Incentive amount
from subsection (1) |
× | Number of days in that part
of the financial year 365 |