Document ID: chunk:federal_register_of_legislation:C2025C00097:section:5:p16
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 5 (pt 16/56)
Character Range: 122046–125042

health insurers

Part 4‑1—Introduction

Division 110—Introduction

110‑1  What this Chapter is about
      This Chapter defines the key concepts of health insurance business and health benefits funds. It also deals with some related matters and imposes miscellaneous obligations on private health insurers.

Part 4‑2—Health insurance business

Division 115—Introduction

115‑1  What this Part is about
      This Part defines the key concept of health insurance business.
Note: Entities are only permitted to carry on health insurance business if they are registered under Division 3 of Part 2 of the Private Health Insurance (Prudential Supervision) Act 2015.

115‑5  Private Health Insurance (Health Insurance Business) Rules
 (1) The Private Health Insurance (Health Insurance Business) Rules also deal with matters relating to *health insurance business. The provisions of this Part indicate when a particular matter is or may be dealt with in these Rules.
Note: The Private Health Insurance (Health Insurance Business) Rules are made by the Minister under section 333‑20.
 (2) Before making Private Health Insurance (Health Insurance Business) Rules, the Minister must consult *APRA. However, a failure to consult APRA does not affect the validity of those Rules.
Note: This consultation requirement also applies to any repeal or amendment of such Rules: see subsection 33(3) of the Acts Interpretation Act 1901.

115‑10  Whether a business etc. is health insurance business
  The following diagram shows how to work out whether a business or arrangement is *health insurance business:

Division 121—What is health insurance business?

121‑1  Meaning of health insurance business
 (1) Health insurance business is:
 (a) the business of undertaking liability, by way of insurance; or
 (b) an *employee health benefits scheme;
that relates, in a way referred to in subsection (2), to *hospital treatment or *general treatment.
Note: The following kinds of insurance business are not health insurance business:
(a) accident and sickness insurance business (see section 121‑20);
(b) liability insurance business (see section 121‑25);
(c) insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules (see section 121‑30).
 (2) The liability by way of insurance, or the arrangement to make payments under the *employee health benefits scheme, must relate to:
 (a) loss arising out of a liability to pay fees or charges relating to provision in Australia of such treatment; or
 (b) provision in Australia of such treatment; or
 (c) the happening of an occurrence connected with the provision in Australia of such treatment; or
 (d) the happening of an occurrence in Australia that ordinarily requires the provision of such treatment.
 (3) It does not matter for the purposes of paragraph (2)(d) whether payment of benefits to the insured is dependent upon one or more of the following:
 (a) such treatment or benefit being provided to the insured;
 (b) the insured