Document ID: chunk:federal_register_of_legislation:C2025C00097:section:3:p14
Version: federal_register_of_legislation:C2025C00097
Segment Type: section
Provision Reference: s 3 (pt 14/18)
Character Range: 67217–70059

health insurance policy is an insurance policy that meets:
 (a) the community rating requirements in Division 66; and
 (b) the coverage requirements in Division 69; and
 (c) if the policy *covers *hospital treatment—the benefit requirements in Division 72; and
 (d) the waiting period requirements in Division 75; and
 (e) the portability requirements in Division 78; and
 (f) the quality assurance requirements in Division 81; and
 (g) any requirements set out in the Private Health Insurance (Complying Product) Rules for the purposes of this paragraph.

Division 66—Community rating requirements

66‑1  Community rating requirements
 (1) An insurance policy meets the community rating requirements in this Division if:
 (a) the policy prohibits the private health insurer that issued the policy from breaching the principle of community rating in section 55‑5 in relation to a person insured under the policy; and
 (b) the policy has no terms or conditions that would allow the insurer to *improperly discriminate against a person insured under the policy; and
 (c) the only discounts (if any) available under the policy are discounts allowed under subsection 66‑5(2); and
 (d) unless the policy is issued under a new *product (see subsection (2))—the premiums payable under the policy meet the premium requirement in section 66‑5.
 (2) For the purposes of paragraph (1)(d), an insurance policy is issued under a new *product if the amount of premiums charged under policies in the product has not changed since the first policy in the product was issued.

66‑5  Premium requirement
 (1) For the purposes of paragraph 66‑1(1)(d), the premiums payable under an insurance policy for a period meet the premium requirement in this section if the amount of premiums payable under the policy for the period:
 (a) is the amount specified for the *product subgroup to which the policy belongs in the most recent approval under section 66‑10; or
 (b) is the proportion, for the period, of that amount; or
 (c) would be the amount mentioned in paragraph (a) or (b) except that a different amount is payable:
 (i) because of the application of Part 2‑3 (lifetime health cover); or
 (ii) because of a discount or discounts allowed under subsection (2), if the total percentage discount (not counting discounts available for the reason in paragraph (3)(f)) does not exceed the percentage specified in the Private Health Insurance (Complying Product) Rules as the maximum percentage discount allowed; or
 (iii) because of a combination of subparagraphs (i) and (ii).
 (2) A discount is allowed if:
 (a) it is for a reason in subsection (3); and
 (b) the discount is also available for that reason under every policy in the *product; and
 (c) if there are different percentage discounts available for that reason—the same percentage discount is available