Document ID: chunk:federal_register_of_legislation:F2024C01114:clause:7_9aa:p3
Version: federal_register_of_legislation:F2024C01114
Segment Type: clause
Provision Reference: sch 7 cl 9AA (pt 3/6)
Character Range: 29995–32958

The new policy's coverage of specialist psychiatric treatment must start no later than the admission day.

             Example: A person is admitted to hospital for specialist psychiatric treatment. The person's insurance policy provides minimum benefits for psychiatric treatment. 3 business days later, the person upgrades to a new policy and chooses to have the upgrade treated in accordance with subrules (4) to (8). The higher benefits under the new policy for specialist psychiatric treatment must apply from the day of the admission.

      (8) Subrule (7) does not prevent the new policy from applying a waiting period in accordance with subrule (4). The reference in paragraph (5)(a) to the upgrade is taken to be a reference to the start of the new policy's coverage of specialist psychiatric treatment.

     9B Specialist psychiatric treatment—choice to have upgrade treated in accordance with rule 9A

      (1) A person may choose to have an upgrade in relation to psychiatric treatment treated in accordance with subrules 9A(4) to (8) if the person has not previously made such a choice in relation to any such upgrade.

      (2) If:
           (a) a person transfers to an insurance policy (the new policy), and the transfer is an upgrade in relation to psychiatric treatment; and
           (b) a claim is made under the new policy for a benefit for specialist psychiatric treatment provided to the person; and
           (c) a benefit of the amount claimed is only payable under the new policy for the treatment if the person chooses to have the upgrade treated in accordance with subrules 9A(4) to (8);

       the making of the claim is sufficient evidence of the person choosing to have the upgrade treated in accordance with those subrules.

      (3) For the purposes of paragraph (2)(c) of this rule, disregard any co‑payment or excess that is required to be paid under the new policy in respect of psychiatric treatment.

     10. Transfer certificates

       For section 99‑1 of the Act, the following periods are set out:
            (a) for subsection 99‑1 (1), certificate for the insured person―14 days;
            (b) for subsection 99‑1 (2), certificate for the new insurer―14 days;
            (c) for subsection 99‑1 (3), old insurer to provide a certificate to the new insurer on request―14 days.

     11. Performance indicators

       For subsection 188‑1 (1) of the Act, the following performance indicators are set out:
           (a) the number and kind of complaints made to the Private Health Insurance Ombudsman about private health insurers;
           (b) changes in the number of insured persons in particular age groups;
           (c) changes in the number of episodes of hospital treatment and hospital‑substitute treatment, and the average number of episodes of each, for particular age groups;
           (d) changes in the nature of the episodes of hospital treatment and hospital‑substitute treatment, for