Document ID: chunk:federal_register_of_legislation:F2024C01114:schedule:7:p4
Version: federal_register_of_legislation:F2024C01114
Segment Type: schedule
Provision Reference: sch 7 (pt 4/5)
Character Range: 13502–16480

under the age of 25, dependent children or dependent students and at least one conditional dependent non‑student;
           (g) only one adult and at least one dependent person with a disability and any number of non‑classified dependent people under the age of 25, dependent children, dependent students, dependent non‑students or conditional dependent non‑students;
           (h) only two adults, and at least one non‑classified dependent person under the age of 25, dependent child or dependent student;
           (i) only two adults and any number of non‑classified dependent people under the age of 25, dependent children or dependent students and at least one dependent non‑student;
           (j) only two adults and any number of non‑classified dependent people under the age of 25, dependent children or dependent students and at least one conditional dependent non‑student;
           (k) only two adults and at least one dependent person with a disability and any number of non‑classified dependent people under the age of 25, dependent children, dependent students, dependent non‑students or conditional dependent non‑students.

      (3) If an insurer does not have insured groups in paragraphs 2(e), 2(f), 2(i) or 2(j) for a product, then insured groups in paragraphs 2(d) and 2(h) can include dependent non‑students or conditional dependent non‑students.

      (4) In this rule a conditional dependent non‑student is required to have their own policy covering general treatment with the same insurer that is covering them for hospital treatment.

     5A Psychiatric treatment—limitations

       For the purposes of paragraph 63‑10(g) of the Act, an insurance policy must not reduce a benefit for psychiatric treatment provided to a person if the reduction is because of:
           (a) the number of psychiatric treatments, for which there is or has been an entitlement to a benefit under any policy, provided to the person during a period; or
           (b) the number of a particular kind of such psychiatric treatments provided to the person during a period.

     6. Maximum percentage of discount

      (1) For subparagraph 66‑5 (1) (c) (ii) of the Act, the maximum percentage discount allowed is 12% per annum.

      (2) The discount for a policy is the difference between the full premium and the net premium.

      (3) The full premium for a policy is the premium that would be received by the private health insurer for a policy in the same product subgroup without any reduction due to the circumstances set out in paragraphs 66‑5 (3) (a) to (ea) of the Act.

      (4) The net premium is the full premium less the cost, or the cost foregone, of any of the following:
           (a) incentive payment;
           (b) promotional payment;
           (c) rebate; and
           (d) any other inducement whatsoever,

     made available by the insurer to another person, including to an insured person, in respect of the payment of the premium for