Document ID: chunk:federal_register_of_legislation:C2025C00097:section:3:p13
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 3 (pt 13/18)
Character Range: 64716–67482

are the only kind of insurance that private health insurers are allowed to make available as part of their health insurance business (see section 63‑1 and Division 84). This Part sets out the requirements that an insurance policy must meet in order to be a complying health insurance policy.

Division 63—Basic rules about complying health insurance products

63‑1  Obligation to ensure products are complying products
 (1) A private health insurer must ensure that the only kind of insurance that it makes available as part of its *health insurance business is insurance in the form of *complying health insurance products.
 (2) However, subsection (1) does not apply in relation to *health insurance business of a kind that the Private Health Insurance (Complying Product) Rules specify is excluded from subsection (1).

63‑5  Meaning of complying health insurance product
 (1) A complying health insurance product is a *product made up of *complying health insurance policies.
 (2) A product is all the insurance policies issued by a private health insurer:
 (a) that *cover the same treatments; and
 (b) that provide benefits that are worked out in the same way; and
 (c) whose other terms and conditions are the same as each other.
 (2A) A product subgroup, of a *product, is all the insurance policies in the product:
 (a) under which the addresses of the people insured, as known to the private health insurer, are located in the same *risk equalisation jurisdiction; and
 (b) under which the same kind of insured group (within the meaning of the Private Health Insurance (Complying Product) Rules) is insured.
 (2B) The Private Health Insurance (Complying Product) Rules may specify insured groups for the purposes of paragraph (2A)(b). An insured group may be specified by reference to any or all of the number of people in the group, the kind of people in the group, or any other matter. A group may consist of only one person.
 (3) Different premiums may be payable under policies in the same *product.
 (4) A premium payable for a policy that covers an insured group of 2 or more people that includes a *dependent non‑student or *dependent person with a disability may be higher than a premium payable for a policy in the same *product that covers an insured group of 2 or more people that includes one or more *dependent children or *dependent students but no dependent non‑student or dependent person with a disability.

63‑10  Meaning of complying health insurance policy
  A complying health insurance policy is an insurance policy that meets:
 (a) the community rating requirements in Division 66; and
 (b) the coverage requirements in Division 69; and
 (c) if the policy *covers *hospital treatment—the benefit requirements in Division 72; and
 (d)