Bills Digest 76 1996-97 Private Health Insurance Incentives Bill 1996


Numerical Index | Alphabetical Index

WARNING:
This Digest was prepared for debate. It reflects the legislation as introduced and does not canvass subsequent amendments. This Digest does not have any official legal status. Other sources should be consulted to determine the subsequent official status of the Bill.

CONTENTS

Passage History

Private Health Insurance Incentives Bill 1996

Date Introduced: 13 December 1996
House: House of Representatives
Portfolio: Health and Family Services
Commencement: Royal Assent

Purpose

To establish a scheme under which the private health insurance premiums of certain individuals are reduced. The policy objective of the scheme is to stabilise the level of participation in private health insurance.

Background

In an attempt to stabilise the level of coverage of private health insurance in Australia, the Government announced in the Budget a two-pronged strategy which offers means-tested subsidies for people with private health insurance and a penalty through the Medicare levy for higher income people without private health insurance. The incentives element of the strategy is contained in the Private Health Insurance Incentives Bill 1996, the Health Legislation Amendment (Private Health Insurance Incentives) Bill 1996 and the Taxation Laws Amendment (Private Health Insurance Incentives) Bill 1996. The Private Health Insurance Incentives Bill provides for payment of the incentives by way of reduced private health insurance premiums while the Taxation Laws Amendment (Private Health Insurance Incentives) Bill provides for payment of the incentives as a taxation rebate. The penalty element of the strategy is contained in the Medicare Levy Amendment Bill (No. 2) 1996 and the Taxation Laws Amendment (Private Health Insurance Incentives) Bill 1996.

Private Health Insurance Incentives Bill 1996

The incentives contained in this Bill were a central feature of the Government's health policy at the 1996 election. The incentives represent a substantial departure from previous policy in this area, successive Labor governments having tended to avoid explicit subsidies for private health insurance. Several policy decisions taken during the mid to late 1980s (removal of the bed-day subsidy for private hospital utilisation; reduction in the Medicare benefit for in-hospital medical services from 85 per cent to 75 per cent; and the removal of the reinsurance subsidy arrangements) actually had the effect of withdrawing subsidies for private health insurance, amounting to cost shifting from the Commonwealth to the private health insurance funds and their contributors.

What are the incentives?

Single people with an income of less than $35 000 per year will receive up to $125 each year towards the cost of their private health insurance premiums, while couples with a combined income of less than $70 000 per year will receive up to $250 per year. Families with one child and an income of less than $70 000 per year will receive up to $450. The income threshold rises by $3000 for each additional child (this latter provision was not included in the Government's election policy). It should be noted that there are no phasing or 'shade-out' provisions for the income levels at which the incentive payments cut-out, which will result in high effective marginal tax rates at these income levels.

People with single memberships will be eligible for a $100 per year payment for their hospital insurance and a further $25 if they have ancillary insurance (dental, physiotherapy etc) while people with couple memberships will be eligible for a $200 per year payment for their hospital insurance and a further $50 if they have ancillary cover. Families will be eligible for a $350 per year payment for their hospital membership and a further $100 if they have ancillary cover. People can choose to have the money paid directly to their health fund in return for a guaranteed reduction in premiums or they may choose to receive the payment as a taxation rebate after the end of the financial year(1).

It should be noted that the incentive payments are not indexed and therefore their real value will fall over time, which will be exacerbated if private health insurance premiums continue to increase at their current rate. In addition, the income levels which establish eligibility for the incentive payments are similarly not indexed, which means that people will lose entitlements as their incomes increase over time.

The incentives scheme will commence on 1 July 1997.

What are the problems with private health insurance?

Private health insurance is an important component of the Australian health system, contributing over $4 billion annually to total health expenditure. However, private health insurance coverage has steadily declined in Australia since the introduction of Medicare. At 31 March 1983, following the election of the Hawke government, 65.8 per cent of the population were covered by private health insurance. At 31 March 1984, following the commencement of Medicare on 1 February, the proportion of the population covered by private health insurance had fallen to 54.9 per cent. By September 1996 this figure had fallen to 33.5 per cent of the population. The rate of decline appears to have slowed in the latter part of 1996, with the fall between the June and September quarters of 0.1 per cent the lowest for six years. The table below indicates the changes in coverage of private health insurance, by State, since 1984.

Percentage of the population covered by hospital insurance

As at
30 June
NSW(a)
%
Vic.
%
Qld
%
SA(a)
%
WA
%
Tas.
%
NT(a)
%
Aust.
%
1983(b) 68.9 73.9 42.4 67.8 69.0 66.0
65.8
1984(b) 56.1 61.0 39.0 57.9 56.6 58.8
54.9
1984 49.3 55.4 36.3 56.3 54.5 53.9
50.0
1985 46.7 53.0 35.0 53.7 51.6 50.4
47.7
1986 50.6 53.9 34.8 52.4 47.6 50.6
48.8
1987 51.4 52.8 34.1 50.2 46.7 50.5
48.3
1988 50.1 51.4 32.8 49.0 45.2 49.7
47.0
1989 47.5 50.8 32.2 48.4 43.2 48.5
45.5
1990 46.8 50.4 31.7 44.4 41.6 47.4
44.5
1991 46.4 47.8 33.1 42.8 41.6 45.5
43.7
1992 44.1 43.0 32.2 38.9 41.1 43.0
41.0
1993 42.3 40.4 32.7 36.7 40.7 41.8
39.5
1994 39.7 37.3 32.6 33.8 38.7 39.2
37.2
1995 37.2 34.2 31.3 34.3 37.3 37.3 13.8 34.9
1996 34.1 33.5 30.9 34.1 36.9 37.1 25.6 33.6
1996(c) 34.0 33.3 30.9 33.9 36.7 36.8 25.9 33.5


Sources: Department of Health, Annual Reports, various years; Private Health Insurance Administration Council, Annual Report 1995-96: Operations of the Registered Health Benefits Organisations.

(a) ACT population included with NSW. NT population was included with SA prior to 1995.
(b) as at 31 March.
(c) September quarter 1996.

Of perhaps more concern for health policy over the longer term is the trend of people aged 65 years and over to increase as a percentage of those insured. People in this age group have increased from 10.2 per cent of those insured in 1989-90 to 14 per cent in 1995-96.

There are several key reasons behind the decline in private health insurance coverage. Principal among these is Medicare itself, a very popular government program which has been widely embraced by the electorate. Medicare provides subsidised access to medical and diagnostic services and free access to public hospital services. Although patients are free to choose their doctor for out-of-hospital consultations, Medicare does not offer choice of doctor for public hospital services. Private health insurance funds are prohibited from providing insurance for medical services (other than the 25 per cent 'gap' between the Medicare rebate and the schedule fee for in-hospital procedures), but are able to offer contributors to hospital insurance choice of doctor and choice of public or private hospital treatment.

Another major factor behind the decline in private health insurance membership is the often high level of out-of-pocket payments for doctor's fees following a hospital episode faced by contributors to private health insurance. In order to address this factor, the previous government legislated to permit private health insurance funds to enter contracts with medical practitioners to provide 100 per cent cover for their contributors. It is fair to say that this measure has not been successful, principally due to concerted opposition from the medical profession.

A third key factor contributing to the decline in private health insurance membership is the rapidly increasing cost of premiums. In order to address this factor, the Government has announced its incentives measures. In addition, the Government has requested the Productivity Commission to inquire into the private health insurance industry, in part to investigate the cost pressures on the industry. The Commission released a draft report on 18 December 1996 and is expected to provide its final report to the Treasurer by 28 February 1997. In its draft report, the Commission identified three principal factors behind the increasing premiums for private health insurance:

  • a switch in usage from public to private hospitals (partly policy induced by legislation in 1995 facilitating contracts between funds and hospitals to provide 100 per cent cover);
  • an increase in average private hospital charges, partly due to changes in technology and clinical practice; and
  • rising hospital usage by private patients, as fund membership becomes older and in greater need of health services.(2)

The Commission noted that three policy decisions (discussed earlier) taken during the Hawke government years (removal of the bed-day subsidy for private hospital utilisation; reduction in the Medicare benefit for in-hospital medical services from 85 per cent to 75 per cent; and the removal of the reinsurance subsidy arrangements) had contributed to the level of premiums, but argued that their effect on the growth in premiums was limited to the period prior to 1989-90 and did not account for the more recent increases in premiums.

What is the likely impact of the incentives?

In its examination of the Government's incentives measures the Commission noted that the rebate will increase affordability and choice but will have a negative budgetary impact because "savings to Medicare will fall considerably short of the costs of the rebate"(3). This is because most of the people who will receive the incentives are already insured and the Commission estimates that people who take up private health insurance as a result of the incentives are likely to be lower users of the public health system.

The Commission has also pointed to the lack of phasing provisions for the rebate which will result in high effective marginal tax rates at the income points where the rebate cuts out and has also noted that the value of the rebates will fall because of the lack of indexation. The Commission has also proposed that the administrative arrangements for the rebates be clarified and that consideration be given to extending the rebate to people who opt to self-insure, noting that the grounds for excluding them "are weak and could be re-examined"(4) . The Commission considers that the rebate would be better confined to hospital insurance only.

Critics of the Government's private health insurance initiatives argue that they will make little difference to the numbers of people with private health insurance because the incentives will offset only a proportion of the cost of premiums. These critics were given ammunition by several private health insurance funds which, exhibiting questionable political judgement, announced premium increases shortly after the Budget. However, there is no doubt that premiums would have increased in 1996 because of the deteriorating financial position of the funds, which faced an overall operating loss of $81.33 million in 1995-96 compared with a profit of $61.81 million in 1994-95(5). The Productivity Commission argues that the view that premium increases have devalued the incentives is misleading because "the rebate still represents a substantial rate of assistance".(6)

The incentives policy is aimed at low and middle income earners but leaves itself open to the criticism that it is unfair to exclude people who opt to self-insure, as well as people with higher incomes.

Various estimates have been made of the effect of the incentives measures on participation in private health insurance. The Department of Health and Family Services has estimated that the measures will add a one-off increase of about 2 percentage points to the level of coverage of private health insurance, which will increase from 32 per cent (expected in July 1997) to 34 per cent. The rate is expected to then stabilise(7). One of the architects of Medicare, Dr John Deeble, has estimated that the effect of the incentives would be to increase participation by up to three per cent(8). The Productivity Commission has estimated that the total effect of the Government's measures (incentives and the penalty Medicare levy) may add some 5.2 percentage points to coverage of private health insurance. The Commission estimates that this is likely to be a one-off increase.(9)

Financial impact

The cost of the incentives measures is considerable. It is estimated by the Department of Health and Family Services that the total cost of the measures will be approximately $1.7 billion over four years. This cost includes payments to offset the cost of health insurance premiums and rebates through the taxation system. A breakdown of the estimated cost by year is as follows:

1996-97 $8 million
1997-98 $491 million
1998-99 $609 million
1999-2000 $616 million

Medicare Levy Amendment Bill (No. 2) 1996

This Bill implements the second element of the Government's strategy to at least stabilise the level of coverage of private health insurance and to perhaps increase participation. The Bill seeks to impose a one per cent Medicare levy surcharge on individuals with taxable incomes above $50 000 per year and families with a combined income greater than $100 000 per year who do not have private health insurance. This measure will increase the Medicare levy for those people affected to 2.5 per cent of their taxable income. The effect of this measure will be that a single person with a taxable income of $50 000 will pay an extra $500 through the Medicare levy while a family with an income of $100 000 will pay an extra $1000 per year if they do not take out private health insurance. Unlike the incentives measure, the levy surcharge was not foreshadowed by the Government in its 1996 election policy.

While there is little doubt that this is an electorally popular measure, questions could possibly be raised about its fairness. For example, higher income earners face disincentives to self-insure, are penalised if they do not have private health insurance but at the same time are ineligible for the incentives measures. The Productivity Commission has noted that people on higher incomes already contribute tax transfers which are much greater than other groups and that the penalty "is effectively a tax on enrolment in the public system by people who have already contributed to that system far more than the average taxpayer"(10). For example, in 1992-93, the average Medicare levy paid per taxpayer was $383.49 ($461.96 in 1994-95, excluding 'exempt persons') while taxpayers in the top decile of taxable income ($49 181 and over) paid an average of $882.29 through the Medicare levy.

The private health insurance industry has lobbied hard for the adoption of this policy measure over a period of several years, with its peak body, the Australian Health Insurance Association (AHIA) taking a high profile on the issue. The issue has received a considerable amount of attention despite the fact that because people with higher incomes have a much greater level of participation in private health insurance than people on lower and middle incomes, the measure will affect a relatively small number of people. The table below indicates the percentage of the population without private health insurance, by income group:

Family Income
$ (p.a.)
Uninsured
%
0 to 9 999 64.8
10 000 to 19 999 76.2
20 000 to 29 999 53.7
30 000 to 39 999 40.8
40 000 to 49 999 32.9
50 000 to 59 999 27.7
60 000 to 69 999 21.6
70 000 or more 16.3


Source: Schofield, D The Distribution and Determinants of Private Health Insurance in the 1990s, NATSEM, 1996 (incomes are for 1989/90)

The Department of Health and Family Services estimates that some 110 000 single people and 100 000 couples and families will be affected by this measure and that around two-thirds of these people are likely to join private health insurance funds with the remainder choosing to pay the 1 per cent Medicare levy surcharge(11).

The income levels at which the penalty levy takes effect are not indexed and as a result, more people will be affected by this measure each year as their incomes rise.

This measure will apply from 1 July 1997. Revenue projections are low, due to the expectation that the majority of people affected will choose to participate in private health insurance rather than paying the surcharge. It is estimated that the extra 1 per cent Medicare levy surcharge will raise some $60 million in 1998-99 and $75 million in 1999-2000.

Main Provisions

Outline of Main Provisions of Digest

The provisions of this Bill can be broken down into basically two major parts, namely, provisions dealing with the eligibility of people to participate in the incentives scheme, or in other words, eligibility to receive a reduction in insurance premiums in respect of a private health insurance policy, and those dealing with the reimbursement of registered health benefits organisations for reductions they make to insurance premiums under the scheme.

The following main provisions section of this Digest is structured on this two part division and will outline the main provisions of the Bill by posing the following questions:

  • who is and who is not eligible to participate in the incentives scheme?
  • how do people participate in the incentives scheme?
  • by how much are insurance premiums reduced for those eligible to participate in the incentives scheme?
  • how and how much will registered health benefits organisations be reimbursed for reductions they make for insurance premiums under the incentives scheme?

Who Is And Who Is Not Eligible To Participate In The IncentivesScheme?

A person will only be eligible to participate in the incentives scheme and thus receive a reduction in insurance premiums in respect of a private health insurance policy if:

(1) The registered health benefits organisation (hereafter called a health fund) that issued the private health insurance policy (hereafter called a policy) is a 'participating fund'.

How a health fund becomes a participating fund is specified in Division 7 of Part 3 of the Bill (subclauses 7-1 to 7-4). Each financial year a health fund will have to apply to the Minister to become a participating health fund (subclause 7-1). An application will have to be in a form determined by the Minister, include such information as is determined by the Minister, be signed by the public officer of the applicant health fund and include an undertaking from that officer that the applicant will participate in the incentives scheme until the end of the financial year (subclause 7-2). The Minister must approve an application unless the health fund is subject to Part VIA of the National Health Act 1953 (ie. notice has been served on the health fund that it must show grounds why an inspector should not be appointed, the health fund has applied for a judicial winding up, or an order for judicial management is in force), although he or she can still approve the application if satisfied that it is in the public interest to do so.

(2) The person is eligible to apply under Division 4 for registration in respect of a private health insurance policy.

To be eligible to participate in the incentives scheme a person must be registered with the Health Insurance Commission (the Commission). Under subclause 4-2, any person who is covered by a private health insurance policy for a financial year (other than a dependent child) is eligible to apply for registration in respect of the policy. Where a person covered by a policy is a dependent child at any time during that period, any of their parents is eligible to apply.

A person will not be eligible to apply for registration in respect of their policy if someone else has already applied for registration in respect of that policy and the Commission has not refused to register that person or revoked their person's registration. A decision of the Commission refusing to register a person is reviewable by the Administrative Appeals Tribunal under subclause 13-1.

Note: The term 'dependent child' is defined to be a person covered by a private health insurance policy and whom the health fund accepts as a dependent child for the purposes of the policy. A dependent child does not include: a person who is the partner of another person; a person (other than a full-time student) who is 18 or older; or a full-time student over 25.

The term 'parent', in relation to a dependent child, is defined to mean: a person who has the right, either alone or jointly with another to have the daily care and control of the child and make decisions about the daily care and control of the child. If the dependent child is a full-time student 18 or older, the parent is a person who is primarily responsible, either alone or jointly with another, for their maintenance and support.

(3) The health insurance policy provides appropriate private health insurance cover.

What constitutes 'appropriate health insurance cover' is specified in subclause 3-2. A policy provides appropriate private health insurance cover if it provides 'hospital cover', 'ancillary cover', or 'combined cover'.

Each of the above terms is defined in subclause 3-2. A key feature of the definitions of 'hospital cover' and 'ancillary cover' is a requirement that the policy be of a specified minimum value. In other words, a person will not be eligible to participate in the incentives scheme unless they purchase a policy with an annual premium at or above the specified levels.

In respect to 'hospital cover', the annual premium payable for a policy where it covers only one person must not be less than $250, or an amount determined by the Minister. In the case of a policy which covers more than one person, the annual premium payable must not be less than $500, or an amount determined by the Minister.

In respect to 'ancillary cover', the annual premium payable for a policy where it cover only one person, must not be less than $125, or an amount determined by the Minister. In the case of a policy which covers more than one person, the annual premium payable must not be less than $250, or an amount determined by the Minister.

A policy provides 'combined cover' where it provides both hospital and ancillary cover. Ministerial determinations as to the minimum annual premium payable for a policy will be subject to disallowance by the Parliament.

(4) The income test is satisfied.

The provisions dealing with the income test which must be satisfied in order for a person to be eligible for a reduction in private health insurance premium are contained in subclauses 3-3 and 3-4.

Subclause 3-3 deals with the income test for policies covering one person in respect of a financial year. The income test will be satisfied if:

the sum of the taxable incomes of the following persons:

  • if the person covered by the policy is not a dependent child, that person and their partner (if any); or
  • if the person covered by the policy is a dependent child, any parent of theirs, and the partner (if any) of the parent, but only if the parent or their partner made one or more payments of premiums, or another person made one or more such payments under an arrangement entered into with the parent or partner;

is less than:

  • $35 000 where the person covered by the policy is not a dependent child and is not the partner of another person;
  • $70 000 where the person covered by the policy is not a dependent child and is the partner of another person; or
  • $70 000 where the person covered by the policy is a dependent child.

The term 'partner' in relation to another person is defined to mean: a person who is legally married to the other person and is not living separately and apart from the other person on a permanent basis; or a person who, although not legally married to the other person, lives with the other person on a bona fide domestic basis as the husband or wife of the other person.

Subclause 3-4 deals with the income test for policies covering more than one person in respect of a financial year. The income test will be satisfied if:

the sum of the taxable incomes of the following persons:

  • each person covered by the policy who is not a dependent child; and
  • the partner (if any) of each such person; and
  • if all the persons covered by the policy are dependent children, any parent of any of them, and the partner (if any) of the parent, but only if the parent, or their partner, made one or more payments of premiums, or another person made one or more such payments under an arrangement entered into with the parent or partner;

is less than:

  • $70 000, where the persons covered by the policy does not include 2 or more dependent children; or
  • $70 000, plus $3 000 multiplied by the number of dependent children minus 1 dependent child (eg. if a policy covers a family that has four dependent children, the income calculation would be $70 000 plus $3 000 multiplied by 4 children minus 1 child, which gives an income threshold of $79 000).

(5) An eligible person within the meaning of sections 3 and 6 of the Health Insurance Act 1973.

Section 3 of the Health Insurance Act 1973 defines the term 'eligible person' to mean an Australian resident or an eligible overseas representative. Section 6 of the Act provides the Minister with power to declare a specified person, or persons included in a specified class of persons, as having been or as being an eligible person for the purposes of the Act. The term is important because it is a condition of qualifying for a Medicare benefit that a person be an eligible person.

How Do People Participate In The Incentives Scheme?

To participate in the incentives scheme people must be registered with the Commission. Under subclause 4-1, persons who are eligible to apply for registration in respect of a policy may apply to the health fund that issued the policy to be registered by the Commission in respect of their policy. Where a health fund receives an application for registration, it must notify the Commission of the application. Where the Commission receives notice of an application, it must register the person unless satisfied the person is not eligible to participate in the incentives scheme, or information contained in the notice is incorrect.

In respect to eligibility to apply for registration, under subclause 4-2 any person who is covered by a policy for a financial year (other than a dependent child) is eligible to apply for registration. Where every person covered by the policy is a dependent child at any time during that period, any of their parents is eligible to apply. A person will be ineligible to apply for registration if someone else has already applied for registration in respect of the policy and the Commission has not refused to register that person or revoked their registration.

In respect to applications for registration, subclause 4-3 sets out the requirements. These include that the application be in a form approved by the Minister and contain a statutory declaration that the applicant has estimated the sum of taxable incomes for that financial year for all people that must be taken into account under the income test provisions of the incentives scheme, and the applicant believes he or she will be eligible to participate in the incentives scheme for that year. An application must contain certain details, including: the applicant's full name, date of birth and address; the applicant's Medicare card number; and any other information determined by the Minister. The power of the Minister to determined what other information must be contained in an application expressly does not include the power to specify the disclosure of a persons tax file number, or any other information about the applicant's income, or income of any other person, other than that the applicant believes the incentive scheme's income test is satisfied in respect of their policy.

In respect to notifying the Commission of an application, subclause 4-4 sets out the process and requirements which a health fund must follow. Significant requirements imposed on health funds by this subclause include a requirement that:

  • the Commission be notified of applications received on or before the 21st day of a month no later than the first business day of the following month, or where an application is received on or after the 22nd day of a month, the first business day of the second month after the day on which the application was made; and
  • the notice of receipt of an application contain such details as the Managing Director of the Commission determines (determinations are subject to disallowance by Parliament).

Where the Commission refuses to register an applicant notice and reasons for a refusal must be given to the applicant and the health fund that issued the policy (subclause 4-5).

The Commission must revoke a person's registration in the following circumstances:

  • the person becomes registered for another policy;
  • the Commission has been given notice by the health fund that the estimated sum of the taxable incomes of persons whose income must be taken into account under the incentive scheme's income test for that year changes and to such an extent that the person knows or ought reasonably to expect that the income test will not be satisfied; or
  • the Commission is satisfied that the person is not eligible to participate in the incentives scheme for that year (subclause 4-6).

A decision of the Commission to revoke a person's registration is reviewable by the Administrative Appeals Tribunal under subclause 13-1.

Registered persons must notify the health fund with whom they hold a policy of the following events:

  • where they know or ought reasonably to have expected that they will not satisfy the incentive scheme's income test; and
  • of changes in their application for registration and relating to the number of people covered by the policy, or to whether any of those people are dependent children which they ought reasonably to expect would affect the annual incentive amount for their policy for the relevant year (subclause 4-7).

In turn, a health fund must notify the Commission of the above information (subclause 4-8).

Subclause 4-10 deals with the retention of applications for registration. Applications must be kept by a health fund for five years. Applications may be kept in any form approved by the Managing Director of the Commission and an application retained in an approved form must be received in all courts and tribunals as the original.

By How Much Are Insurance Premiums Reduced For Those Eligible To Participate In The Incentives Scheme?

The provisions of the Bill which specify by how much insurance premiums are to be reduced for eligible participants in the incentives scheme are set out in division 5 (clauses 5-1 to 5-6).

The amounts by which a health fund must reduce the premiums payable on a policy are set out in the table to subclause 5-3. These amounts (called annual incentive amounts) are:

  • Where the policy covers one person: $125 where the policy provides combined cover, $100 where the policy provides hospital cover but not ancillary cover, or $25 where the policy provides ancillary cover but not hospital cover.
  • Where the policy covers two people neither of whom are dependent children: $250 where the policy provides combined cover, $200 where the policy provides hospital cover but not ancillary cover, or $50 where the policy provides ancillary cover but not hospital cover.
  • Where the policy covers one dependent child and one other person: $450 where the policy provides combined cover, $350 where the policy provides hospital cover but not ancillary cover, or $100 where the policy provides ancillary cover but not hospital cover.
  • Where the policy covers three or more people: $450 where the policy provides combined cover, $350 where the policy provides hospital cover but not ancillary cover, or $100 where the policy provides ancillary cover but not hospital cover.

Subclause 5-3 also provides the Minister, subject to disallowance by Parliament, with the power to determine incentive amounts other than those specified above.

Reductions in premiums are pro-rata'd, under subclause 5-1, according to the period for which the policy holder pays for the policy.

How And How Much Will Registered Health Benefits Organisations Be Reimbursed For Reductions They Make For Insurance Premiums Under The Incentives Scheme?

Division 8 (subclauses 8-1 to 8-6) of the Bill deals with how health funds are reimbursed by the Commission for reducing premiums under the incentives scheme. In order to be reimbursed a health fund must make a claim for reimbursement to the Commission. Requirements for a claim for reimbursement are specified in subclause 8-2 and include:

  • such details as the Managing Director of the Commission determines. Such determinations are subject to disallowance by Parliament; and
  • details about policies in respect of which persons were participants in the incentives scheme.

Health funds may make claims for reimbursement for each month they are a participating fund (subclause 8-1). Under subclause 8-3, the amount payable to a health fund in respect of a month is one twelfth the sum of the annual incentive amount for each policy they issue and which on the first day of that month covers a person who is a participant in the incentives scheme.

For the purposes of the above calculation, the annual incentive for a policy is the amount that would be the annual incentive amount if those covered by the relevant policy and the number of those who are dependent children were as stated in the most recent application for registration. This formula will only apply if the amount worked out using it is less than the annual incentive amount under subclause 5-3.

Notice and reasons must be given by the Commission where it decides not to reimburse a health fund in respect of a policy (subclause 8-4). A two tier review process is provided by the Bill in respect to such decisions. First, an internal review process under subclause 8-5. Secondly, review by the Administrative Appeals Tribunal under subclause 13-1.

General Administrative Provisions

Divisions 10-13 (subclauses 10-1 to 13-4) deal primarily with the administration of the incentives scheme. In particular, they deal with the auditing of health funds, recovery of payments and protection of personal information.

The Commission is accorded a power under subclause 10-2 to audit, at any time, the accounts and records of a participating fund. Such an audit must relate only to accounts and records dealing with participation by persons in the incentives scheme, reductions of premiums payable, or reimbursement from the Commission. Notice must be given to a health fund that an audit is to be carried out. Health funds must ensure that the Commission has full and free access to all accounts, records, documents and papers relevant to the audit.

Clause 10-4 requires the Commission, within 60 days of the end of each financial year, to provide the Commissioner of Taxation with certain information, including:

  • the name, date of birth and address of each person who was a participant in the incentives scheme for that financial year;
  • the name of the health fund that issued the policy for a person who was a participant in the incentives scheme;
  • the type of cover provided by a policy;
  • the total amount of payments to a health fund for a policy; and
  • the name and date of birth of any person whose income was taken into account in determining whether the incentives scheme's income test was satisfied for that policy.

Subclause 11-1 deals with the recovery of payments made under the incentives scheme. The following payments made under the incentives scheme are recoverable by the Commonwealth:

  • Payments made to a health fund as a reimbursement in respect of a policy that covers a person who was a participant in the incentives scheme and not eligible to so participate. Such payments are recoverable from the participant or their estate.
  • 150% of payments made to a health fund as a reimbursement in respect of a policy which is not reflected in reductions in premiums.
  • 150% of payments made to a health fund as a reimbursement in respect of a person whose application for registration has not been kept by the health fund.
  • 150% of payments made to a health fund as a reimbursement in respect of a person whose application for registration has been kept but not provided to the Commission as required under subclause 10-3.
  • Payments purportedly made to a health fund as a reimbursement but were not payable.

The latter four payments are recoverable from the health fund to which the payment in question was made.

Where the Managing Director of the Commission has served a notice on a person or their estate for the recovery of a payment, and:

  • within 3 months of service of the notice, or such period as the Director allows, an arrangement for repayment has been entered into between Director and the person or estate for repayment and the person or estate has defaulted under the arrangement; or
  • within 3 months of service of the notice, or such period as the Director allows, an arrangement has not be entered into between the Director and person or estate for repayment and all or part of the amount to be repaid remains unpaid;

interest is payable on the amount to be repaid at a rate of 15% per annum or rate specified in the regulations (subclause 11-2).

The Managing Director of the Commission is given a discretion under subclause 11-3 to waive, in whole or in part, or allow payment in specified instalments of an amount recoverable. A decision of the Director not to exercise his or her discretion is reviewable by the Administrative Appeals Tribunal under subclause 13-1.

Division 12 (subclauses 12-1 to 12-2) deals with the regulation of personal information under the Bill. Subclause 12-1 allows the Minister, subject to disallowance by Parliament, to make principles, which health funds must comply with, relating to the acquisition of personal information under the Bill and the storage of, security of, access to, correction of, use of and disclosure of such information. Subclause 12-2 makes it an offence, punishable by a maximum fine of 5 penalty units ($500) for a person who uses, makes a record of or discloses or communicates to any person any information relating to the affairs of another person that was acquired under or for the purposes of this Bill. No offence will have been committed if the conduct was carried out in performance of a function or obligation under this Bill.

Endnotes

  1. Health and Family Services Portfolio Budget Facts Sheet 1996-97.
  2. Industry Commission, Private Health Insurance: discussion draft, December 1996.
  3. Ibid: 314-5
  4. Ibid: 318
  5. Private Health Insurance Administration Council, Annual Report 1995-96: iii
  6. Industry Commission, Private Health Insurance: discussion draft, December 1996: 314
  7. Health and Family Services Portfolio, Portfolio Budget Statements 1996-97: 145
  8. Morero, P "Weighing the bill of health", Australian Financial Review, 27 November 1996.
  9. Industry Commission, Private Health Insurance: discussion draft, December 1996: 68.
  10. Ibid: 316
  11. Health and Family Services Portfolio, Budget Facts Sheet 1996-97.

Contact Officer and Copyright Details

Ian Ireland (Digest Purpose and Main Provisions)

Paul Mackey (Digest Background)


24 January 1997
Bills Digest Service
Information and Research Services

This Digest does not have any official legal status. Other sources should be consulted to determine whether the Bill has been enacted and, if so, whether the subsequent Act reflects further amendments.

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ISSN 1323-9031
© Commonwealth of Australia 1997

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Published by the Department of the Parliamentary Library, 1997.

This page was prepared by the Parliamentary Library, Commonwealth of Australia
Last updated: 29 April 1997


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