Document ID: chunk:federal_register_of_legislation:F2024C01114:schedule:7:p3
Version: federal_register_of_legislation:F2024C01114
Segment Type: schedule
Provision Reference: sch 7 (pt 3/5)
Character Range: 10249–13761

8 of the Private Health Insurance (Accreditation) Rules as made from time to time.

     silver policy means an insurance policy that:

          (a) covers hospital treatment; and

          (b) covers at least the treatments in all of the clinical categories indicated for a silver policy in Schedule 4; and

          (c) is not a gold policy.

     specialist psychiatric treatment means psychiatric treatment provided to a person who is:

          (a)  an admitted patient of a hospital; and

          (b)  under the care of an addiction medicine specialist or consult psychiatrist.
     State, when used in Schedule 1, Schedule 2 or Schedule 3, means a risk equalisation jurisdiction.

          Note: The risk equalisation jurisdictions are set out in the Private Health Insurance (Health Benefits Fund Policy) Rules 2015. Under those rules, the area specified in each of the following paragraphs is a risk equalisation jurisdiction:
               (a) Australian Capital Territory, Norfolk Island and New South Wales;
               (b) Northern Territory;
               (c) Queensland;
               (d) South Australia;
               (e) Tasmania;
               (f) Victoria;
               (g) Western Australia and the Territory of Christmas Island and the Territory of Cocos (Keeling) Islands.

     upgrade, in relation to psychiatric treatment, has the meaning given by subrules 9A(2) and (3).
            Note: Unless the contrary intention appears, 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:
            adult
            applicable benefits arrangement
            complying health insurance policy
            complying health insurance product
            cover
            dependent non‑student
            dependent person
            dependent person with a disability
            dependent student
            general treatment
            hospital cover
            hospital‑substitute treatment
            hospital treatment
            medical practitioner
            medicare benefit
            policy holder
            private health information statement
            private health insurer
            product
            product subgroup
            risk equalisation jurisdiction
            rules [of an insurer]
            transfer
            waiting period

Part 2 General

     5. Insured groups

      (1) In this rule a non‑classified dependent person is a person under the age of 25, that is not a dependent student or dependent non‑student by the rules of the insurer.

      (2) For the purposes of paragraph 63‑5 (2A) (b) of the Act, the following insured groups are specified:
           (a) only one person;
           (b) only two adults;
           (c) two or more dependent people and no adults;
           (d) only one adult and at least one non‑classified dependent person under the age of 25, dependent child or dependent student;
           (e) only one adult and any number of non‑classified dependent people under the age of 25, dependent children or dependent students and at least one dependent non‑student;
           (f) only one adult and any number of non‑classified dependent people under the age of 25, dependent children or dependent students and at least one conditional dependent non‑student;
           (g) only one adult and at least one dependent person with a disability and any number of non‑classified dependent people under the age