Document ID: chunk:federal_register_of_legislation:C2025C00097:section:3:p17
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 3 (pt 17/18)
Character Range: 75010–77955

of its kind is not allowed under the Private Health Insurance (Complying Product) Rules to cover.

69‑5  Meaning of cover
 (1) An insurance policy covers a treatment if, under the policy, the insurer undertakes liability in respect of some or all loss arising out of a liability to pay fees or charges relating to the provision of goods or a service that is or includes that treatment.
 (2) An insurance policy also covers a treatment if the insurer provides an insured person, or arranges for an insured person to be provided with, goods or a service that is or includes that treatment.
 (3) If an insurance policy *covers a treatment in the way described in subsection (2), this Part applies as if the provision of the goods or service were a benefit provided under the policy.

69‑10  Meaning of hospital‑substitute treatment
  Hospital‑substitute treatment means *general treatment that:
 (a) substitutes for an episode of *hospital treatment; and
 (b) is any of, or any combination of, nursing, medical, surgical, podiatric surgical, diagnostic, therapeutic, prosthetic, pharmacological, pathology or other services or goods intended to manage a disease, injury or condition; and
 (c) is not specified in the Private Health Insurance (Complying Product) Rules as a treatment that is excluded from this definition.

Division 72—Benefit requirements for policies that cover hospital treatment

72‑1  Benefit requirements
 (1) An insurance policy that *covers *hospital treatment meets the benefit requirements in this Division if:
 (a) the policy meets the requirements in the table in subsection (2); and
 (b) the policy meets any requirements specified in the Private Health Insurance (Complying Product) Rules to be benefit requirements; and
 (c) the policy does not provide benefits for:
 (i) the cost of care and accommodation in an aged care service (within the meaning of the Aged Care Act 1997); or
 (ii) a charge for a pharmaceutical benefit supplied under Part VII of the National Health Act 1953, unless the circumstances of the charge are covered by section 92B of that Act; or
 (iii) any other treatment specified in the Private Health Insurance (Complying Product) Rules as a treatment for which benefits must not be provided; and
 (d) the *rules of the private health insurer that issues the policy meet the rules requirement in section 72‑5.
 (2) These are the requirements that a policy must meet for the purposes of paragraph (1)(a):

Requirements that a policy that *covers *hospital treatment must meet
Item                                                                   There must be a benefit for ...                                                                                                                                                                                                                                                                                        The amount of the benefit must be ...