Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p20
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 20/38)
Character Range: 95081–98588

HRF 601.0 series in the order in which they appear in the template.

All definitions that come from current legislation are cited underneath.

Applicable legislation includes:

       * Private Health Insurance Act 2007;

       * Private Health Insurance (Health Insurance Business) Rules 2018;

       * Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 1) 2023;

       * Private Health Insurance (Risk Equalisation Policy) Rules 2015;

       * Private Health Insurance (Risk Equalisation Administration) Rules 2015; and

       * Health Insurance Act 1973.

Terms in the leftmost column show the correct style of use for these terms.

All defined terms are listed in the Index.

Part 1 Policies and insured persons

adult                     Means a person who is not a dependent child.

                          (Schedule 1, Private Health Insurance Act 2007)

cover                        (1)     An insurance policy covers a treatment if, under the policy, the health insurer undertakes liability in respect of some or all loss arising out of a liability to pay fees or charges relating to the provision of goods or a service that is or includes that treatment.

                             (2)     An insurance policy also covers a treatment if the insurer provides an insured person, or arranges for an insured person to be provided with, goods or a service that is or includes that treatment.

                             (3)     If an insurance policy covers a treatment in the way described in subsection (2), this Part applies as if the provision of the goods or service were a benefit provided under the policy.

                          (Division 69, Private Health Insurance Act 2007)

Coverage requirements       (1)  An insurance policy meets the coverage requirements in Division 69 if:
                              (a)   the only treatments the policy covers are:
coverage requirements            (i)      specified treatments that are hospital treatment; or
                                 (ii)     specified treatments that are hospital treatment and specified treatments that are general treatment; or
                                 (iii)    specified treatments that are general treatment but  none that are hospital-substitute treatment; and
                              (b)   if the policy provides a benefit for anything else—the provision of the benefit is authorised by the Private Health               Insurance (Complying Product) Rules.
                            (2)  Despite paragraph (1)(a), the policy must also cover any treatment that a policy of its kind is required by the Private Health Insurance (Complying Product) Rules to cover.
                            (3)  Despite paragraph (1)(a), the policy must not cover any treatment that a policy of its kind is not allowed under the               Private Health Insurance (Complying Product) Rules to cover.
                          (Division 69, Private Health Insurance Act 2007)

dependent child           Means a person

                             (a)        who is:

                                (i)           aged under 18: or
                                (ii)          a dependent child under the rules of the insurer that insures the person; and
                             (b)       who is not aged 25 or over; and
                             (c)        who does not have a partner.
                          (Schedule 1, Private Health Insurance Act