Document ID: chunk:federal_register_of_legislation:F2024C01114:clause:7_29:p1
Version: federal_register_of_legislation:F2024C01114
Segment Type: clause
Provision Reference: sch 7 cl 29 (pt 1/7)
Character Range: 39570–42376

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11D. Circumstances in which a person is entitled to age‑based discount
  For paragraph 66‑5 (3) (ea) of the Act, a person is entitled to an age‑based discount for a particular period if:
 (a) the person is insured under an age‑based discount policy during that period; and
 (b) the person is an eligible person in relation to that policy; and
 (c) the person's applicable discount for that period, as calculated in accordance with subrule 11C (2), is not equal to zero.

Part 2B Requirements relating to product tiers for, and names of, insurance policies
Note 1: This Part specifies additional requirements that an insurance policy must meet in order to be a complying health insurance policy, for the purposes of paragraph 63‑10 (g) of the Act.
Note 2: Nothing in this Part affects the operation of Division 72 of the Act (which relates to benefit requirements for policies that cover hospital treatment) or the operation of the Private Health Insurance (Benefit Requirements) Rules for the calculation of minimum benefits where restricted cover is allowed under rule 11G.

11E. Product tiers for insurance policies that cover hospital treatment
 (1) For paragraph 63‑10 (g) of the Act, this rule applies to an insurance policy that covers hospital treatment (whether or not the policy also covers general treatment).
 (2) The policy must be one of the following:
 (a) a gold policy;
 (b) a silver policy;
 (c) a bronze policy;
 (d) a basic policy.

11F. Coverage of treatments for insurance policies that cover hospital treatment

Application of rule
 (1) For paragraph 63‑10 (g) of the Act, this rule applies to an insurance policy that covers hospital treatment (whether or not the policy also covers general treatment).

Treatments that must be covered by policy
 (2) The policy must cover:
 (a) all hospital treatments that are within the scope of cover that is identified, in Schedule 5, for each clinical category in relation to which the policy provides cover (see subrules (5) and (6)); and
 (b) all hospital treatments that are not within the scope of cover of such a clinical category, but that are:
 (i) associated treatments for complications (see subrule (7)); or
 (ii) associated unplanned treatments (see subrule (8)).
 (3) However, the policy is not required to cover cosmetic surgery that is not medically necessary.

Treatments that may be covered by policy
 (4) The policy may also provide either or both of the following:
 (a) accident cover;
 (b) benefits for travel or accommodation relating to a treatment referred to in subrule (2) or paragraph (a).

Interpretation
 (5) For paragraph (2) (a), the scope of cover of a particular clinical category includes, but is not limited to:
 (a) all hospital treatments involving the provision