Private Health Insurance Act 2007

CHAPTER 6 - ADMINISTRATION  

PART 6-8 - DISCLOSURE OF INFORMATION  

Division 324 - Publication of information about treatments covered by health insurance policies etc.  

SECTION 324-5   PUBLICATION OF INFORMATION ABOUT TREATMENTS COVERED BY COMPLYING HEALTH INSURANCE POLICIES  

324-5(1)    
The Secretary of the Department may publish:

(a)    information about * complying health insurance policies and * complying health insurance products offered by private health insurers; and

(b)    information relating to * hospital treatment and * general treatment ( covered treatment ) that is * covered by complying health insurance policies and is provided by, or on behalf of, * medical practitioners.

Note:

This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).

324-5(2)    
Without limiting subsection (1) , the information that may be published by the Secretary of the Department includes the following:

(a)    information about benefits for particular kinds of covered treatment provided by or on behalf of particular * medical practitioners;

(b)    information about fees and charges relating to the provision of particular kinds of covered treatment by or on behalf of particular medical practitioners;

(c)    information about * medicare benefits paid in relation to particular kinds of covered treatment provided by or on behalf of particular medical practitioners, including:

(i) the amounts of medicare benefits paid; and

(ii) the extent to which those medicare benefits were assigned under subsection 20A(1) of the Health Insurance Act 1973 ;

(d)    information about particular * complying health insurance policies and * complying health insurance products offered by private health insurers, including:

(i) the names of insurers offering the policies and products; and

(ii) the treatments covered by the policies and products; and

(iii) the benefits under the policies and products; and

(iv) the terms and conditions of the policies and products; and

(v) the * risk equalisation jurisdiction of the policies and products;

(e)    information about agreements between particular private health insurers and particular medical practitioners for the provision of covered treatment to persons insured by the insurer, including the extent to which particular kinds of agreements apply in relation to particular kinds of treatment;

(f)    information about agreements between particular private health insurers and particular * hospitals for the provision of covered treatment to persons insured by the insurer, including the extent to which particular kinds of agreements apply in relation to particular kinds of treatment;

(g)    information relating to particular medical practitioners who provide covered treatment, or on whose behalf covered treatment is provided, to persons insured by a private health insurer, including:

(i) the practitioners ' names; and

(ii) information about the practitioners ' qualifications and specialities; and

(iii) the languages spoken by the practitioners;

(h)    information about the locations and hospitals where particular kinds of covered treatment are provided by or on behalf of particular medical practitioners, including information about fees, charges and benefits for accommodation at those locations or hospitals relating to such treatment.

324-5(3)    
The Secretary of the Department may also publish any information of a kind specified by the Minister under paragraph (5)(a) .

Note:

This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).

324-5(4)    
Information published under this section must be published in the manner, if any, specified by the Minister under paragraph (5)(b) .

324-5(5)    
The Minister may, by legislative instrument, specify any of the following:

(a)    for the purposes of subsection (3) - kinds of information that may be published under this section;

(b)    for the purposes of subsection (4) - a manner or manners in which information must be published under this section.

324-5(6)    
The Minister may only specify a kind of information under paragraph (5)(a) if the Minister is satisfied that publishing that kind of information would further the objects of this Division.

324-5(7)    
Information published under this section must not include personal information about an individual who is not, and has not been, a medical practitioner.

324-5(7A)    
The Secretary of the Department may, on the Secretary ' s own initiative or as a result of a review under a determination under section 324-7 , correct, update, alter or remove information published under this section.

324-5(8)    
For the purposes of this section, a treatment is taken to be provided on behalf of a medical practitioner if, and only if:

(a)    it is provided by another person who is not a medical practitioner; and

(b)    that other person provides the treatment, in accordance with accepted medical practice, under the supervision of the medical practitioner.

324-5(9)    
For the purposes of this section, if:

(a)    a treatment is provided by a medical practitioner who is a specialist trainee; and

(b)    the specialist trainee provides the treatment under the supervision of another medical practitioner who is present at all times while the specialist trainee provides the treatment; and

(c)    the treatment would be taken to have been a service rendered by the other medical practitioner under subsection 3(18) of the Health Insurance Act 1973 for the purposes of that Act;

then:

(d)    the treatment is taken to have been provided by the other medical practitioner; and

(e)    the treatment is taken not to have been provided by the specialist trainee.

324-5(10)    
In subsection (9) :

specialist trainee
has the meaning given by subsection 3(20) of the Health Insurance Act 1973 .

324-5(11)    
If information about fees and charges relating to the provision of particular kinds of covered treatment by or on behalf of particular medical practitioners is published under this section, the Secretary must also publish under this section:

(a)    if any formulas were used to work out those fees and charges - those formulas; and

(b)    if a material reduction in the amounts of those fees and charges occurs after publishing the information and the Secretary becomes aware of the reduction - the reduced amounts (as soon as practicable after the Secretary becomes so aware).