Document ID: chunk:federal_register_of_legislation:C2025C00097:section:5:p25
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 5 (pt 25/56)
Character Range: 145834–148896

Division 84).

Part 5‑2—General enforcement methods

Division 185—What this Part is about

185‑1  Introduction

      This Part gives the Minister powers to enable him or her to find out whether a private health insurer is complying with its enforceable obligations and to encourage or compel an insurer to comply with those obligations.
      The Minister can:
             (a) set performance indicators for insurers; or
             (b) seek explanations from insurers; or
             (c) investigate insurers; or
             (d) obtain enforceable undertakings from insurers; or
             (e) direct insurers to do particular things; or
             (f) seek remedies in the Federal Court; or
             (g) revoke an insurer's entitlement to offer tax rebates as premium reductions.

185‑5  Meaning of enforceable obligation
  All of the following provisions are enforceable obligations:
 (a) a provision of this Act;
 (b) a provision of any Private Health Insurance Rules made under section 333‑20;
 (c) a provision of the regulations;
 (d) a direction given to a private health insurer under this Act;
 (e) if the insurer is a *restricted access insurer—a provision included in the insurer's constitution or *rules in order to comply with subsection 15(3) of the Private Health Insurance (Prudential Supervision) Act 2015.

Division 188—Performance indicators

188‑1  Performance indicators
 (1) The Private Health Insurance (Complying Product) Rules may set out performance indicators to be used by the Minister in monitoring private health insurers' compliance with the principle of community rating in section 55‑5 and the community rating requirements in Division 66.
 (2) The performance indicators are to be framed:
 (a) to assist the Minister in detecting breaches of the principle of community rating in section 55‑5 or the community rating requirements in Division 66; and
 (b) to alert the Minister to any practices of a private health insurer in relation to community rating that may require investigation; and
 (c) to alert the Minister to any practices of one or more private health insurers in relation to community rating that may be contrary to government health policy and may require a regulatory response.

Division 191—Explanation of private health insurer's operations

191‑1  Minister may seek an explanation from a private health insurer
 (1) If, having regard to information available to the Minister or to any performance indicators under the Private Health Insurance (Complying Product) Rules, the Minister believes that a private health insurer may have contravened an *enforceable obligation, the Minister may write to the private health insurer:
 (a) explaining the Minister's concerns; and
 (b) asking the insurer to explain its operations in relation to those concerns; and
 (c) specifying the period within which the Minister requires the insurer's response.
 (2) The private health insurer must respond within the specified period, or any longer period that the Minister, in writing before the end of the specified