Document ID: chunk:federal_register_of_legislation:F2016C00821:body:0:p2
Version: federal_register_of_legislation:F2016C00821
Segment Type: other
Provision Reference: 
Character Range: 2799–5985

2007.

5.                      Definitions

     In these rules:

     Act means the Private Health Insurance Act 2007.

           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:

            assets
           general treatment
           health benefits fund
           hospital treatment
           medicare benefit
           policy holder
           private health insurer

          Part 2 Meaning of health-related business

6.                      Overseas treatment
(1)        For the purposes of paragraph 131-15 (1) (d) of the Act, the business described in subrule (2) is specified.
(2)        The business is the undertaking of liability by way of insurance for the provision outside Australia of treatment that is intended to manage a disease, injury or condition, but only when:
(a)                    the disease, injury or condition is chronic and permanent; and
(b)                    the liability is confined to treatment that would be required routinely, whether or not the person had remained in Australia; and
(c)                    the amount of the liability incurred by the insurer for any particular treatment does not exceed the amount of the liability that would be incurred by the insurer for that treatment if it were provided in Australia; and
(d)                    the liability does not extend to any treatment administered to a person more than 60 days after the person last departed from Australia.

7.                      Agency business
(1)        For the purposes of paragraph 131-15 (1) (d) of the Act, the business described in subrule (2) is specified.
(2)        The business is the offering of goods, services or benefits by a private health insurer under an agency arrangement.
(3)        In this rule agency arrangement means a written arrangement between a person (the agent) and another person (the principal) under which:
(a)                    the agent is permitted to act on behalf of the principal to create legal relations between the principal and a third person in transactions to provide goods, services or benefits; and
(b)                    the principal assumes liability for the transaction to the third person, including for the provision of the goods, services or benefits; and
(c)                    the agent assumes no liability in respect of the transaction, other than to perform its obligations under the arrangement for and on behalf of the principal.
           Note: an example of the specified business is a private health insurer offering travel insurance policies under an arrangement with an overseas travel insurance company where the principal assumes the insurable risks under the policy and responsibility for the provision of benefits under the policy, and the private health insurer takes on no such liability, except to duly perform its obligations under the contract or agreement between it and the overseas travel insurance company which establishes the agency arrangement.

          Part 3 Risk equalisation jurisdictions

8.                      Areas that are risk equalisation jurisdictions
For