Document ID: chunk:federal_register_of_legislation:C2010C00643:clause:3_4:p1
Version: federal_register_of_legislation:C2010C00643
Segment Type: clause
Provision Reference: sch 3 cl 4 (pt 1/2)
Character Range: 5419–8127

4  When does a person have private patient hospital cover?

 (1) For the purposes of this Act, a person is covered by an insurance policy that provides private patient hospital cover if the policy is an applicable benefits arrangement, within the meaning of section 5A of the National Health Act 1953, to which paragraph 5A(1)(a) of that Act applies.

 (2) However, for the purposes of this Act a person is not covered by an insurance policy that provides private patient hospital cover if:
 (a) the insurance policy that covers the person is an applicable benefits arrangement that:
 (i) is modified in accordance with an election described in paragraph (ba) of Schedule 1 to the National Health Act 1953; and
 (ii) is associated with a health benefits fund conducted by a registered organization under that Act; and
 (b) the difference between the lesser benefits mentioned in that paragraph and the benefits payable in accordance with a corresponding applicable benefits arrangement not modified in accordance with such an election is more than:
 (i) $1,000; or
 (ii) $500, if there is only one contributor (as defined in that Act) to the health benefits fund for the applicable benefits arrangement mentioned in paragraph (a) of this subsection and benefits are not payable under the arrangement in respect of the contributor's dependants (as defined in that Act), if any.

 (3) Subsection (2) does not prevent a person from being covered by an insurance policy that provides private patient hospital cover if:
 (a) the person has been covered by the policy continuously since the end of 24 May 2000; and
 (b) the election mentioned in subparagraph (2)(a)(i) was made before the end of 24 May 2000.

 (4) For the purposes of this Act, a person is also covered by an insurance policy that provides private patient hospital cover if:
 (a) the policy is issued by a person to whom subsection 67(3) of the National Health Act 1953 applies; and
 (b) if the person referred to in paragraph (a) were a registered organization within the meaning of that Act—the policy would be an applicable benefits arrangement, within the meaning of section 5A of that Act, to which paragraph 5A(1)(a) of that Act would apply.

 (5) However, for the purposes of this Act a person is not covered by an insurance policy that provides private patient hospital cover if:
 (a) the person is covered by an insurance policy described in subsection (4); and
 (b) under subsection (2), the person would not be covered by an insurance policy that provides private patient hospital cover for the purposes of this Act, assuming that:
 (i) the policy mentioned in paragraph (a) of this subsection were a policy described in subsection (1);