Document ID: chunk:federal_register_of_legislation:C2025C00097:section:5:p21
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 5 (pt 21/56)
Character Range: 135194–138152

the arrangement, the employer will pay, or will reimburse employees, or persons providing services, for payment of, one or both of the following:
 (i) the premiums payable by them for *complying health insurance policies;
 (ii) the difference between benefits payable to them under policies, and amounts that they are liable to pay, for health services provided to them or members of their families; and
 (b) is not an employee health benefits scheme if the Private Health Insurance (Health Insurance Business) Rules provide that:
 (i) it is not an employee health benefits scheme; or
 (ii) arrangements of a class in which it is included are not employee health benefits schemes; and
 (c) is not an employee health benefits scheme to the extent (if any) that the arrangement constitutes State insurance within the meaning of paragraph 51(xiv) of the Constitution.

121‑20  Exception: accident and sickness insurance business
 (1) Despite section 121‑1, *health insurance business does not include the business of undertaking liability, by way of insurance, to pay a lump sum, or to make periodic payments, on the happening of a personal accident, disease or sickness.
 (2) However, this section does not apply to:
 (a) business where liability is undertaken with respect to loss arising out of a liability to pay fees or charges in relation to the provision in Australia of *hospital treatment or *general treatment; or
 (b) business of a kind specified in the Private Health Insurance (Health Insurance Business) Rules for the purposes of this paragraph.

121‑25  Exception: liability insurance business
  Despite section 121‑1, *health insurance business does not include the business of undertaking liability, by way of insurance, with respect to any loss arising out of a liability to pay compensation or damages, including:
 (a) a liability to pay compensation or damages because of the use of a motor vehicle; or
 (b) a liability to pay compensation or damages to an employee because of an event occurring in connection with the employee's employment.

121‑30  Exception: insurance business excluded by the Private Health Insurance (Health Insurance Business) Rules
  Despite section 121‑1, *health insurance business does not include a business of a kind that the Private Health Insurance (Health Insurance Business) Rules state not to be a health insurance business.

Part 4‑4—Health benefits funds

Division 131—Health benefits funds

131‑1  What this Part is about

      This Part defines the key concept of a health benefits fund.
      This Part also defines the concepts of health‑related business and risk equalisation jurisdictions, and deals with some related matters (including the operation of health‑related businesses through health benefits funds).
Note: The Private Health Insurance (Prudential Supervision) Act 2015 requires private health insurers to have health benefits funds. Health benefits funds must be operated in accordance