Private Health Insurance (Risk Equalisation Administration) Rules 2015 (Cth)

Private Health Insurance (Risk Equalisation Administration) Rules 2015

I, Ian Laughlin, delegate of APRA make these Rules under subsection 333-25, for the purposes of section 318-15, of the Private Health Insurance Act 2007.

This instrument takes effect on the day item 166 of Schedule 1 to the Private Health Insurance (Prudential Supervision) (Consequential Amendments and Transitional Provisions) Act 2015 commences.

Dated: 26 June 2015

[Signed]

Ian Laughlin Deputy Chairman

Contents Part 1 – Preliminary 1. Name of Rules 2. Commencement 3. Interpretation Part 2 – Requirement for records to be kept 4. General records 5. High cost claimants pool records Part 3 – Transition 6. Transition Part 1 – Preliminary

1. Name of Rules These Rules are the Private Health Insurance (Risk Equalisation Administration) Rules 2015.

2. Commencement These Rules commence on the day item 166 of Schedule 1 to the Private Health Insurance (Prudential Supervision) (Consequential Amendments and Transitional Provisions) Act 2015 commences.

3. Interpretation Note: Terms used in these Rules have the same meaning as in the Act – see section 13 of the Legislative Instruments Act 2003. These terms include: APRA complying health insurance policy cover health benefits fund officer policy holder private health insurer risk equalisation jurisdiction (1) In these Rules: Act means the Private Health Insurance Act 2007. adult is as defined in the Act. Business Rules means the Private Health Insurance (Health Insurance Business) Rules 2013 made under the Act. chronic disease management program or CDMP: (a) has the same meaning as in the Business Rules; and (b) for hospital treatment, includes a program similar to a chronic disease management program as referred to in the definition of 'eligible benefit' in the Risk Equalisation Policy Rules. fund means a health benefits fund. general treatment is as defined in the Act. hospital cover is as defined in the Act. hospital‑substitute treatment is as defined in the Act. hospital treatment is as defined in the Act. medicare benefit is as defined in the Act. insured person, in relation to a policy, means a person covered by the policy. insurer means a private health insurer. PHIAC means the Private Health Insurance Administration Council continued in existence under subsection 264-1(1) of the Act, as it existed immediately prior to the commencement of the Private Health Insurance (Prudential Supervision) Act 2015. policy means a complying health insurance policy. quarter means a period of 3 months ending on 31 March, 30 June, 30 September or 31 December in a year. quarterly return means a return required under the Financial Sector (Collection of Data) Act 2001 relating to risk equalisation information. Risk Equalisation Policy Rules means the Private Health Insurance (Risk Equalisation Policy) Rules 2007 made under the Act. (2) In these Rules, a category of policy is to be identified as follows: (a) for a policy under which only one person is insured – as 'single'; (b) for a policy under which 2 adults are insured (and no‑one else) – as 'couple'; (c) for a policy under which 2 or more people are insured, none of whom is an adult – as '2 + persons, no adults'; (d) a policy under which 2 or more people are insured, only one of whom is an adult – as 'single parent'; (e) a policy under which 3 or more people are insured, only 2 of whom are adults – as 'family'; (f) a policy under which 3 or more adults are insured – as '3 + adults'. (3) In these Rules, the following terms relevant to the high cost claimants pool have the same meaning as in the Risk Equalisation Policy Rules: age based pool (ABP) designated threshold high cost claimants pool (HCCP) gross benefit. Part 2 – Requirement for records to be kept