Commonwealth: Private Health Insurance (Prudential Supervision) Act 2015 (Cth)

Private Health Insurance (Prudential Supervision) Act 2015 No. 85, 2015 Compilation No. 9 Compilation date: 21 February 2025 Includes amendments: Act No. 14, 2025 About this compilation This compilation This is a compilation of the Private Health Insurance (Prudential Supervision) Act 2015 that shows the text of the law as amended and in force on 21 February 2025 (the compilation date). The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law. Uncommenced amendments The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the Register for the compiled law. Application, saving and transitional provisions for provisions and amendments If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes. Editorial changes For more information about any editorial changes made in this compilation, see the endnotes. Modifications If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the Register for the compiled law. Self‑repealing provisions If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes. Contents Part 1—Introduction Division 1—Preliminary 1 Short title 2 Commencement 3 Simplified outline of this Act 4 Interpretation 5 General administration of Act 5A Norfolk Island Division 2—Constitutional matters 6 Act binds the Crown 7 Act not to apply to State insurance within that State 8 Compensation for acquisition of property Part 2—Registration of private health insurers Division 1—Introduction 9 Simplified outline of this Part Division 2—Prohibition of carrying on health insurance business without registration 10 Carrying on health insurance business without registration 11 Injunctions Division 3—Registration 12 Applying for registration 13 Requiring further information 14 Criteria for registration 15 Deciding the application 16 Notifying the decision 17 APRA can be taken to refuse application 18 APRA to ensure that up‑to‑date record of information about private health insurers is publicly available 19 Changing registration status 20 Conversion to for profit status 21 Cancellation of registration Part 3—Health benefits funds Division 1—Introduction 22 Simplified outline of this Part Division 2—The requirement to have health benefits funds 23 Private health insurers must have health benefits funds 24 Notifying APRA when health benefits funds are established 25 Inclusion of health‑related businesses in health benefits funds Division 3—The operation of health benefits funds 26 Assets of health benefits funds 27 Payments to health benefits funds 28 Expenditure and application of health benefits funds 29 Effect of non‑compliance with section 28 30 Investment of health benefits funds Division 4—Restructure, merger and acquisition of health benefits funds 31 Restriction on restructure, merger or acquisition of health benefits funds 32 Restructure of health benefits funds 33 Merger and acquisition of health benefits funds 34 Consent of policy holders not required Division 5—Termination of health benefits funds Subdivision A—Approving the termination of health benefits funds 35 Applying for termination 36 Requiring further information 37 Deciding the application 38 APRA can be taken to have refused to approve termination Subdivision B—Conducting the termination of health benefits funds 39 The basis of the law relating to termination 40 Conduct of funds during termination process 41 Insurers etc. to give reports to APRA 42 Terminating managers displace management of funds Subdivision C—Ending the termination of health benefits funds 43 Power to end termination Subdivision D—Completing the termination of health benefits funds 44 Completion of the termination process 45 Distribution of remaining assets after completion of the termination process 46 Liability of officers of insurers for loss to terminated funds 47 Reporting by terminating manager 48 Applying for winding up Division 6—External management of health benefits funds Subdivision A—Preliminary 49 Purpose of Division 50 The basis of the law relating to external management Subdivision B—Appointment of external managers 51 APRA may appoint external managers 52 Preconditions for appointment of external managers 53 External managers to displace management of funds Subdivision C—Duties and powers of external managers 54 Duties of external managers 55 Additional powers of external managers 56 Protection of property during external management 57 Rights of chargee, owner or lessor of property of fund under external management Subdivision D—Procedure relating to voluntary deeds of arrangement 58 Matters that may be included in APRA rules Subdivision E—External managers' reports to APRA 59 External managers to give reports to APRA 60 Dealing with reports given to APRA 61 Federal Court orders in respect of schemes of arrangement Subdivision F—Miscellaneous 62 When an external management begins and ends 63 Effect of things done during external management of health benefits funds 64 Disclaimer of onerous property 65 Application of provisions of Corporations Act Division 7—Ordering the termination of health benefits funds 66 Applications by external managers to the Federal Court 67 Orders made on applications for appointments of terminating managers 68 Notice of appointments 69 Application of other provisions if Federal Court orders appointment of a terminating manager Division 8—External managers and terminating managers Subdivision A—Powers of managers 70 Powers of managers 71 Officers etc. not to perform functions etc. while fund is under management 72 Managers act as agents of private health insurers Subdivision B—Information concerning, and records and property of, health benefits funds 73 Directors etc. to help managers 74 Managers' rights to certain records 75 Only manager can deal with property of fund under management 76 Order for compensation where officer involved in void transaction Subdivision C—Provisions incidental to appointment of managers 77 Remuneration and allowances of managers 78 Directions to managers 79 Termination of appointments of managers 80 Acts of managers valid etc. 81 Indemnity 82 Qualified privilege Subdivision D—Miscellaneous 83 Time for doing act does not run while act prevented by this Division or other provisions 84 Continued application of other provisions of Act 85 Modifications of this Act in relation to health benefits funds under management 86 Order of Federal Court to be binding on all persons 87 APRA rules dealing with various matters Division 9—Duties and liabilities of directors etc. 88 Notices to remedy contraventions 89 Liability of directors in relation to non‑compliance with notices 90 APRA may sue in the name of private health insurers Part 4—Prudential standards and directions Division 1—Introduction 91 Simplified outline of this Part Division 2—Prudential standards 92 Prudential standards 93 Additional matters in relation to standards that are not legislative instruments 94 Compliance with prudential standards 95 Notice of contravention of prudential standards or of other matters that materially affect financial position Division 3—Directions 96 APRA's power to give directions 97 The kinds of direction that may be given 98 Power to comply with a direction 99 Varying or revoking a direction 100 When a direction ceases to have effect 101 Direction not grounds for denial of obligations 102 Supply of information about directions 103 Secrecy requirements 104 Non‑compliance with a direction Part 5—Other obligations of private health insurers Division 1—Introduction 105 Simplified outline of this Part Division 2—Appointed actuaries 106 Appointment 107 Terminating an appointment as actuary 108 Notification of appointment etc. 109 Role of appointed actuary 110 Actuary's obligations to inform of matters etc. 111 Appointed actuary may give information or documents to APRA 112 Duty of appointed actuary to give information or documents when required 113 Qualified privilege of appointed actuary 114 Referring matters to professional associations for actuaries 115 APRA may direct removal of actuary Division 3—Disqualified persons 116 Private health insurers not to allow disqualified persons to act as officers or appointed actuaries 117 Disqualified persons must not act for private health insurers 118 Effect of non‑compliance 119 Who is a disqualified person? 120 Court power of disqualification 121 Court power to revoke or vary a disqualification etc. 122 Privilege against exposure to penalty—disqualification under section 120 Division 4—Miscellaneous 123 Restrictions on payment of pecuniary penalties etc. 124 Giving APRA copies of reports made to policy holders 125 Notifying APRA of name and contact details of officers Part 6—Monitoring and investigation Division 1—Introduction 126 Simplified outline of this Part Division 2—Monitoring 127 Purposes for which powers may be exercised etc. 128 Power to require private health insurer to provide information and reports 129 Power to require production of documents Division 3—Investigation 130 Investigation of private health insurers by inspectors 131 Identity cards for inspectors 132 Powers of inspectors 133 Person may be represented by lawyer when being examined 134 Access to premises 135 General provisions relating to obtaining consent to enter premises 136 Investigation warrants 137 Announcement before entry under investigation warrant 138 Inspector to be in possession of investigation warrant 139 Details of warrant etc. to be given to occupier 140 Right to observe execution of warrant 141 Responsibility to provide facilities and assistance 142 Concealing etc. documents 143 Reports of inspectors 144 Dissemination of reports 145 Liability for publishing reports etc. 146 Powers of magistrates 147 Delegation by inspectors Division 4—Other matters 148 Refusing or failing to comply with requirements 149 Self‑incrimination 150 Protection from liability Part 7—Enforceable undertakings 151 Simplified outline of this Part 152 Enforceable undertakings Part 8—Remedies in the Federal Court 153 Simplified outline of this Part 154 APRA may apply to the Federal Court 155 Declarations of contravention 156 Civil penalty order 157 Compensation order 158 Other order 159 Civil evidence and procedure rules for declarations and orders 160 Civil proceedings after criminal proceedings 161 Criminal proceedings during civil proceedings 162 Criminal proceedings after civil proceedings 163 Evidence given in proceedings for penalty not admissible in criminal proceedings 164 APRA may require person to assist Part 9—Miscellaneous 165 Simplified outline of this Part 166 Relief from liability 167 Annual publication of information relating to health benefits funds 168 Review of decisions 169 Statements to accompany notification of decisions 170 Approvals, determinations etc. by APRA 171 Powers of Federal Court 172 Approved forms, and giving documents not required to be in approved forms 173 Delegation by Minister 174 APRA rules Endnotes Endnote 1—About the endnotes Endnote 2—Abbreviation key Endnote 3—Legislation history Endnote 4—Amendment history An Act to regulate private health insurance, and for related purposes Part 1—Introduction Division 1—Preliminary 1 Short title This Act may be cited as the Private Health Insurance (Prudential Supervision) Act 2015. 2 Commencement (1) Each provision of this Act specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms. Commencement information Column 1 Column 2 Column 3 Provisions Commencement Date/Details 1. The whole of this Act As follows: 1 July 2015 (a) if this Act receives the Royal Assent before 1 July 2015—1 July 2015; (paragraph (a) applies) (b) if this Act receives the Royal Assent on or after 1 July 2015—a single day to be fixed by Proclamation. However, if this Act receives the Royal Assent on or after 1 July 2015, and the provisions do not commence within the period of 6 months beginning on the day this Act receives the Royal Assent, they commence on the day after the end of that period. Note: This table relates only to the provisions of this Act as originally enacted. It will not be amended to deal with any later amendments of this Act. (2) Any information in column 3 of the table is not part of this Act. Information may be inserted in this column, or information in it may be edited, in any published version of this Act. 3 Simplified outline of this Act Only a private health insurer may carry on health insurance business. A private health insurer is a company that is registered under Division 3 of Part 2. A private health insurer must have at least one health benefits fund. There are regimes governing: (a) how health benefits funds are operated; and (b) changing the health benefits fund to which a policy of insurance is referable; and (c) terminating health benefits funds; and (d) external management of health benefits funds. Private health insurers must comply with prudential standards made by APRA, and with directions given by APRA. Private health insurers and their appointed actuaries also have various other obligations. APRA has monitoring and investigative powers in relation to private health insurers. APRA may accept enforceable undertakings, and may seek remedies in the Federal Court in relation to contraventions of enforceable obligations. Note: The Private Health Insurance Act 2007 defines the key concepts of health insurance business and health benefits funds as well as other concepts that relate to health benefits funds. That Act also sets out rules governing private health insurance products and provides incentives to encourage people to have private health insurance. 4 Interpretation (1) In this Act: ADI means an authorised deposit‑taking institution within the meaning of the Banking Act 1959. application provision: see subsection 65(2). applied Corporations Act provision: see subsection 65(3). appointed actuary of a private health insurer means the person appointed as the actuary of the insurer in accordance with Division 2 of Part 5. approved form: see section 172. APRA means the Australian Prudential Regulation Authority. APRA rules: see subsection 174(1). APRA staff member has the same meaning as in the Australian Prudential Regulation Authority Act 1998. assets of a health benefits fund: see section 26. chief executive officer of a private health insurer means the person who is primarily and directly responsible to the directors of the insurer for the general and overall management of the insurer. civil penalty order: see subsection 156(2). complying health insurance policy has the same meaning as in the Private Health Insurance Act 2007. complying health insurance product has the same meaning as in the Private Health Insurance Act 2007. constitutional corporation means a corporation to which paragraph 51(xx) of the Constitution applies. cover, in relation to an insurance policy, has the same meaning as in the Private Health Insurance Act 2007. declaration of contravention means a declaration under subsection 155(1). dependent person has the same meaning as in the Private Health Insurance Act 2007. director has the same meaning as in the Corporations Act 2001. disqualified person: see sections 119 and 121. enforceable obligation means any of the following: (a) a provision of this Act; (b) a direction given under this Act; (c) a provision of the risk equalisation levy legislation; (d) if the registration of a private health insurer is subject to terms and conditions (see subsection 15(1))—those terms and conditions; (e) in the case of a restricted access insurer—a provision included in the insurer's constitution or rules in order to comply with subsection 15(3). Note: References to this Act include prudential standards and APRA rules (see the definition of this Act in this subsection). external administration means administration or control (however described) by an external administrator. external administrator means: (a) any of the following, within the meaning of the Corporations Act 2001: (i) a liquidator or provisional liquidator; (ii) a receiver, manager, managing controller, receiver and manager or other controller; (iii) an administrator or a scheme manager; or (b) a person who performs a similar role to a person referred to in subparagraph (a)(i), (ii) or (iii), whether under a law of the Commonwealth, or of a State or Territory, or otherwise; but does not include an external manager or terminating manager. external management means management, by an external manager, under Divisions 6 and 8 of Part 3. external manager, in relation to a health benefits fund, means a person appointed under section 51 as the external manager of the fund. Federal Court means the Federal Court of Australia. for profit insurer means a private health insurer that is registered under Division 3 of Part 2 as a for profit insurer. health benefits fund has the same meaning as in the Private Health Insurance Act 2007. Health Department means the Department administered by the Health Minister. health insurance business has the same meaning as in the Private Health Insurance Act 2007. Health Minister means the Minister administering the Private Health Insurance Act 2007. health‑related business has the same meaning as in the Private Health Insurance Act 2007. Health Secretary means the Secretary of the Health Department. improper discrimination has the same meaning as in the Private Health Insurance Act 2007. inspector means a person appointed under section 130 to be an inspector. insurance has the same meaning as in paragraph 51(xiv) of the Constitution. investigation warrant: see subsection 136(1). lawyer means a duly qualified legal practitioner and, in relation to a person, means such a practitioner acting for the person. makes a permitted capital payment: see subsection 27(3). manager, in relation to a health benefits fund, means an external manager or terminating manager of the fund. net asset position of a health benefits fund means the difference between: (a) the assets of the fund; and (b) the policy liabilities and other liabilities of the fund that the private health insurer conducting the fund has incurred for the purposes of the fund. officer of a private health insurer means: (a) a director of the insurer; or (b) a chief executive officer of the insurer; or (c) any other person who has or exercises senior management responsibilities (within the meaning of prudential standards) for the insurer. penalty includes forfeiture or punishment. personal information has the same meaning as in the Privacy Act 1988. policy group of a health benefits fund: see subsection 32(7). policy holder of a health benefits fund has the same meaning as in the Private Health Insurance Act 2007. policy liability of a private health insurer means: (a) a liability that has arisen under an insurance policy; or (b) a liability that, subject to the terms and conditions of an insurance policy, will arise on the happening of an event, or at a time, specified in the policy. premises includes the following: (a) a structure, building, vehicle, vessel or aircraft; (b) a place (whether or not enclosed or built on); (c) a part of a thing referred to in paragraph (a) or (b). Private Health Insurance Ombudsman has the same meaning as in the Private Health Insurance Act 2007. private health insurer means a body that is registered under Division 3 of Part 2. proceeding means: (a) a proceeding in a court; or (b) a proceeding or hearing before, or an examination by or before, a tribunal; whether the proceeding, hearing or examination is of a civil, administrative, criminal, disciplinary or other nature. prudential matters: see subsection 92(2). prudential standards: see subsection 92(1). referable has the same meaning as in the Private Health Insurance Act 2007. responsible insurer means: (a) for a health benefits fund that is under external management—the private health insurer that was conducting the fund prior to the appointment of the external manager of the fund; or (b) for a health benefits fund that is under terminating management—the private health insurer that was conducting the fund prior to the appointment of the terminating manager of the fund. restricted access group: see subsection 15(4). restricted access insurer means a private health insurer that is registered under Division 3 of Part 2 as a restricted access insurer. risk equalisation jurisdiction has the same meaning as in the Private Health Insurance Act 2007. risk equalisation levy legislation means any of the following: (a) the Private Health Insurance (Risk Equalisation Levy) Act 2003; (b) the provisions of the Private Health Insurance Act 2007, as they apply in relation to: (i) levy imposed under the Private Health Insurance (Risk Equalisation Levy) Act 2003; or (ii) the Risk Equalisation Special Account. Risk Equalisation Special Account has the same meaning as in the Private Health Insurance Act 2007. rules of a private health insurer has the same meaning as in the Private Health Insurance Act 2007. search powers means powers to search for, inspect, take extracts from, and make copies of, documents. State insurance has the same meaning as in paragraph 51(xiv) of the Constitution. statutory functions and duties of an actuary of a private health insurer: see subsection 107(2). terminating management means management, by a terminating manager, under Divisions 5 and 8 of Part 3. terminating manager, in relation to the health benefits funds of a private health insurer, means a person appointed under Division 5 or 7 of Part 3 as the terminating manager of the funds. termination day, in relation to the health benefits funds of a private health insurer: see subsection 40(2). this Act includes prudential standards and APRA rules. voluntary deed of arrangement means: (a) a deed of arrangement agreed on at a meeting of a kind referred to in section 58; or (b) such a deed as varied in accordance with APRA rules made for the purpose of this paragraph. (2) To avoid doubt, a reference in this Act to another Act includes a reference to any regulations, rules, standards or other instruments made, and to any conditions imposed, under that other Act. Note: For example: (a) a reference to the Private Health Insurance Act 2007 includes a reference to rules made under that Act; and (b) a reference to the Financial Sector (Collection of Data) Act 2001 includes a reference to reporting standards made under that Act. 5 General administration of Act APRA has the general administration of this Act. 5A Norfolk Island This Act extends to Norfolk Island. Division 2—Constitutional matters 6 Act binds the Crown Subject to section 7, this Act binds the Crown in each of its capacities. 7 Act not to apply to State insurance within that State This Act does not apply with respect to State insurance that does not extend beyond the limits of the State concerned. 8 Compensation for acquisition of property (1) If the operation of this Act would result in an acquisition of property (within the meaning of paragraph 51(xxxi) of the Constitution) from a person otherwise than on just terms (within the meaning of that paragraph), the Commonwealth is liable to pay a reasonable amount of compensation to the person. (2) If the Commonwealth and the person do not agree on the amount of the compensation, the person may institute proceedings in the Federal Court for the recovery from the Commonwealth of such reasonable amount of compensation as the Court determines. Part 2—Registration of private health insurers Division 1—Introduction 9 Simplified outline of this Part Only a private health insurer may carry on health insurance business. A private health insurer is a company that is registered under Division 3 of this Part. Note: Part 4‑2 of the Private Health Insurance Act 2007 defines the concept of health insurance business. There are 2 kinds of special status that some private health insurers may have. They are: (a) a for profit insurer; and (b) a restricted access insurer. Division 2—Prohibition of carrying on health insurance business without registration 10 Carrying on health insurance business without registration (1) A person commits an offence if: (a) the person carries on health insurance business; and (b) the person is not a private health insurer. Penalty: Imprisonment for 2 years or 120 penalty units, or both. Note: If a body corporate is convicted of an offence against this subsection, subsection 4B(3) of the Crimes Act 1914 allows a court to impose a fine of up to 5 times the penalty stated above. (2) A person who contravenes subsection (1) commits a separate offence in respect of each day (including the day of conviction for any such offence or any later day) during which the contravention continues. Note: This subsection is not intended to imply that section 4K of the Crimes Act 1914 does not apply to offences against this Act. 11 Injunctions (1) The Federal Court may grant an injunction in such terms as it determines to be appropriate if, on the application of APRA, the Court is satisfied that a person has engaged, or is proposing to engage, in conduct that constitutes or would constitute a contravention of section 10. (2) The Federal Court may grant an interim injunction pending determination of an application under subsection (1). (3) The Federal Court must not require an applicant for an injunction to give an undertaking as to damages as a condition of granting an interim injunction. (4) The Federal Court may discharge or vary an injunction granted under subsection (1) or (2). (5) The power of the Federal Court to grant an injunction restraining a person from engaging in conduct may be exercised: (a) whether or not it appears to the Court that the person intends to engage again, or to continue to engage, in conduct of that kind; and (b) whether or not the person has previously engaged in conduct of that kind. (6) The power of the Federal Court to grant an injunction requiring a person to do an act or thing may be exercised: (a) whether or not it appears to the Court that the person intends to refuse or fail again, or to continue to refuse or fail, to do that act or thing; and (b) whether or not the person has previously refused or failed to do that act or thing. Division 3—Registration 12 Applying for registration (1) A body that is: (a) a company within the meaning of the Corporations Act 2001; and (b) a constitutional corporation; may apply to APRA for registration as a private health insurer. (2) The application: (a) must be in the approved form; and (b) must be accompanied by a copy of the applicant's proposed rules; and (c) if the applicant is seeking to be registered as a for profit insurer—must state that fact; and (d) if the applicant is seeking to be registered as a restricted access insurer—must state that fact. 13 Requiring further information Within 90 days after the application is made, APRA may, by written notice to the applicant, require the applicant to give APRA such further information relating to the application as is specified in the notice. 14 Criteria for registration APRA rules may set out criteria for the registration of bodies as private health insurers. 15 Deciding the application (1) APRA may, in writing, grant the application, subject to such terms and conditions as APRA considers appropriate. Note: Refusals of applications, and granting of applications subject to terms and conditions, are reviewable under section 168. (2) If APRA grants the application: (a) the applicant is taken to be, or have been, registered as a private health insurer under this Division from the date of effect specified in the instrument granting the application (which may be a date that occurred before the application was made); and (b) if the grant is subject to terms and conditions—the registration is taken to be subject to those terms and conditions from the day on which the applicant is notified of the granting of the application; and (c) if the applicant sought to be registered as a for profit insurer—the registration is taken to be registration of the applicant as a for profit insurer; and (d) if the applicant sought to be registered as a restricted access insurer and the applicant's constitution or rules satisfy subsection (3)—the registration is taken to be registration of the applicant as a restricted access insurer. Note: An insurer's registration status as being (or not being) a for profit insurer or a restricted access insurer may change after the insurer's initial registration, but only as provided for in section 19. (3) For the registration to be taken to be as a restricted access insurer, the applicant's constitution or rules must: (a) describe the restricted access group to whom the applicant's complying health insurance products are, or will be, available; and (b) prohibit the applicant from issuing a complying health insurance policy to a person who does not belong to the group; and (c) prohibit the applicant from ceasing to insure a person for the reason that the person has ceased to belong to the group. (4) A restricted access group is a group of people who all belong to a particular group, based on whether they: (a) are or were employed in a particular profession, trade, industry or calling; or (b) are or were employed by a particular employer or by an employer who belongs to a particular class of employers; or (c) are or were members of a particular profession, professional association or union; or (d) are or were members of the Defence Force or part of the Defence Force; or (e) are or were part of any group described in APRA rules made for the purpose of this paragraph. The partners and dependent persons of people who belong to such a group are also taken to belong to that group. (5) APRA rules made for the purpose of paragraph (4)(e) may describe a group as consisting of one or more classes of people (whether or not the class or classes are described by reference to matters of a kind referred to in paragraphs (4)(a) to (d)). 16 Notifying the decision (1) If APRA grants the application, APRA must: (a) give the applicant written notice of the grant, and of the terms and conditions (if any) to which the grant is subject; and (b) within one month after granting the application, publish in the Gazette a notification of the grant setting out: (i) the applicant's name; and (ii) the date of effect of the applicant's registration; and (iii) the terms and conditions (if any) to which the grant is subject. (2) If APRA refuses the application, APRA must give the applicant written notice of the refusal. 17 APRA can be taken to refuse application APRA is taken, for the purposes of section 168, to have refused the application if APRA does not give the applicant written notice of its decision on the application: (a) within 90 days after the application was made; or (b) if APRA has given the applicant a notice under section 13 requiring the applicant to give further information relating to the application—within 90 days after the applicant gives that information to APRA; whichever is later. 18 APRA to ensure that up‑to‑date record of information about private health insurers is publicly available An up‑to‑date record of the following must be publicly available on APRA's website: (a) the names of all private health insurers; (b) in relation to each private health insurer: (i) its address, telephone number and website address; and (ii) the States and Territories in which it operates; and (iii) if the insurer is registered as a restricted access insurer—the restricted access group to whom the insurer's complying health insurance products are, or will be, available. 19 Changing registration status For profit insurer (1) A private health insurer that: (a) because of subsection (2) or otherwise, is registered as a for profit insurer; and (b) notifies APRA in the approved form, that it does not wish to be registered as a for profit insurer; is taken, from the day after the day on which APRA receives the notice, not to be registered as a for profit insurer. (2) If: (a) because of subsection (1) or otherwise, a private health insurer is not registered as a for profit insurer; and (b) APRA approves under section 20 an application by the insurer for the insurer to convert to being registered as a for profit insurer; the insurer is taken, from the day specified in APRA's approval, to be registered as a for profit insurer. (3) If a private health insurer is taken under this section to be, or not to be, registered as a for profit insurer, APRA must, as soon as practicable, given written notice of that fact to: (a) the Health Secretary; and (b) the Private Health Insurance Ombudsman; and (c) the Commissioner of Taxation. Restricted access insurer (4) A private health insurer that: (a) because of subsection (5) or otherwise, is registered as a restricted access insurer; and (b) notifies APRA, in the approved form, that it does not wish to be registered as a restricted access insurer; is taken, from the day after the day on which APRA receives the notice, not to be registered as a restricted access insurer. (5) Subject to subsection 15(3), a private health insurer that: (a) because of subsection (4) of this section or otherwise, is not registered as a restricted access insurer; and (b) notifies APRA, in the approved form, that it wishes to be registered as a restricted access insurer; is taken, from the day after the day on which APRA receives the notice, to be registered as a restricted access insurer. (6) If a private health insurer is taken under this section to be, or not to be, registered as a restricted access insurer, APRA must, as soon as practicable, give written notice of that fact to: (a) the Health Secretary; and (b) the Private Health Insurance Ombudsman. 20 Conversion to for profit status Application for conversion to for profit status (1) A private health insurer may apply to APRA for approval to convert to being registered as a for profit insurer. (2) The application: (a) must be in the approved form and must contain, or be accompanied by, a conversion scheme as required by the approved form; and (b) must be given to APRA at least 90 days before the day specified in the application as the day on which the insurer proposes that it become registered as a for profit insurer. How APRA decides an application (3) APRA must, in writing, approve the application if APRA is satisfied, within 30 days after the application was made, that: (a) the application complies with subsection (2); and (b) the conversion scheme would not in substance involve the demutualisation of the insurer. (4) If subsection (3) does not apply: (a) APRA must, at least 45 days before the day specified in the application, cause a notice of the application to be published in a manner that results in the notice being accessible to the public and reasonably prominent; and (b) within 90 days after the application is made, APRA may, by written notice to the insurer, require the insurer to give APRA such further information relating to the application as is specified in the notice. (5) If subsection (3) does not apply, APRA must, in writing, approve the application if: (a) APRA is satisfied that the application complies with subsection (2); and (b) the insurer has given APRA such further information (if any) as APRA has required under paragraph (4)(b); and (c) APRA is satisfied that the conversion scheme would not result in a financial benefit to any person who is not a policy holder of, or another person insured through, a health benefits fund conducted by the insurer; and (d) APRA is satisfied that the conversion scheme would not result in financial benefits from the scheme being distributed inequitably between such policy holders and insured persons. (6) APRA rules may set out criteria for deciding, for the purposes of subsection (3), whether a conversion scheme would not in substance involve the demutualisation of the insurer. (7) An approval under this section is not a legislative instrument. Notification of APRA's decision (8) APRA must notify the insurer in writing of APRA's decision on the application. Note: Refusals of applications are reviewable under section 168. 21 Cancellation of registration (1) APRA must, in writing, cancel the registration of a private health insurer if: (a) the insurer has not conducted health insurance business during the preceding 12 months; or (b) the insurer's health benefits funds have been terminated under Division 5 of Part 3; or (c) the insurer ceases to be a company within the meaning of the Corporations Act 2001. (1A) APRA may, in writing, cancel the registration of a private health insurer if APRA is satisfied that the private health insurer has failed to comply with a requirement of the Financial Accountability Regime Act 2023. (2) APRA must: (a) give the insurer written notice of the cancellation; and (b) within one month after the cancellation, publish in the Gazette a notification of the cancellation. Part 3—Health benefits funds Division 1—Introduction 22 Simplified outline of this Part A private health insurer must have at least one health benefits fund. Note: Part 4‑4 of the Private Health Insurance Act 2007 defines the concept of a health benefits fund as well as other key concepts related to health benefits funds. There are regimes governing: (a) how health benefits funds are operated; and (b) changing the health benefits fund to which a policy of insurance is referable; and (c) terminating health benefits funds; and (d) external management of health benefits funds. APRA may require private health insurers to remedy contraventions of this Part. Division 2—The requirement to have health benefits funds 23 Private health insurers must have health benefits funds (1) A private health insurer must at all times have at least one health benefits fund in respect of: (a) its health insurance business; or (b) its health insurance business and some or all of its health‑related businesses. (2) A private health insurer may have more than one health benefits fund, but must not have more than one in respect of a particular risk equalisation jurisdiction. (3) Despite subsection (2), a private health insurer may have more than one health benefits fund in respect of a particular risk equalisation jurisdiction if: (a) each of those funds is a fund (a pre‑1 April 2007 fund): (i) that existed on 1 April 2007; and (ii) that, immediately before that day, was conducted by a registered organization (within the meaning of the National Health Act 1953 as in force before that day); or (b) each of those funds, other than one of them, is a pre‑1 April 2007 fund and that one other fund was established in connection with a restructure of funds approved under: (i) Division 4 of this Part; or (ii) Division 146 of the Private Health Insurance Act 2007 as in force before the commencement of this section. (4) Despite subsection (2), a private health insurer may have more than one health benefits fund in respect of a particular risk equalisation jurisdiction in circumstances specified in Private Health Insurance (Health Benefits Fund Policy) Rules made for the purpose of subsection 131‑20(2) of the Private Health Insurance Act 2007. 24 Notifying APRA when health benefits funds are established (1) If a private health insurer establishes a health benefits fund, the insurer must give APRA written notice of: (a) the establishment of the fund; and (b) the day on which the fund was established; and (c) such other matters as are specified in APRA rules made for the purpose of this paragraph. (2) The notice must be in the approved form. (3) This section does not apply if the fund is established in accordance with a restructure or arrangement approved under Division 4. 25 Inclusion of health‑related businesses in health benefits funds (1) If a private health insurer has a health benefits fund in respect of its health insurance business and some or all of its health‑related businesses, the dominant purpose of the fund must relate to its health insurance business. (2) If APRA is satisfied that a private health insurer is contravening subsection (1): (a) APRA may, by written notice to the insurer, give the insurer such directions relating to divesting the fund of health‑related businesses as APRA considers necessary to ensure the insurer's compliance with subsection (1); and (b) the insurer must comply with those directions. (3) APRA may, by written notice to a private health insurer, vary or revoke a direction given to the insurer under subsection (2). (4) A direction under subsection (2) ceases to have effect if APRA revokes the direction. (5) Sections 98, 101, 102 and 103 apply in relation to a direction under subsection (2) as if: (a) a reference in those sections to a direction under section 96 were a reference to a direction under subsection (2) of this section; and (b) the reference in subsection 101(3) to a direction of a kind referred to in paragraph 97(1)(l) were omitted. Note: The matters dealt with in the sections applied by this subsection are as follows: (a) section 98—power to comply with a direction; (b) section 101—a direction is not grounds for denial of obligations; (c) section 102—supply of information about directions; (d) section 103—secrecy requirements. Division 3—The operation of health benefits funds 26 Assets of health benefits funds Assets of a health benefits fund to be kept separate from other assets (1) A private health insurer must keep assets of a health benefits fund distinct and separate from assets of other health benefits funds and from all other money, assets or investments of the insurer. (2) A private health insurer must maintain a separate account with an ADI for each health benefits fund that it conducts. What are the assets of a health benefits fund? (3) The assets of a health benefits fund at a particular time are the following: (a) the balance of money represented by amounts credited to the fund in accordance with section 27; (b) assets of the insurer obtained as a result of the expenditure or application of money credited to the fund; (c) investments held by the insurer as a result of the expenditure or application of money credited to the fund; (d) other money, assets or investments of the insurer transferred to the fund, whether under this Act or otherwise. (4) Assets or investments obtained by the application of assets of a health benefits fund are themselves assets of the fund. (5) The assets of a health benefits fund: (a) include assets that, in accordance with a restructure or arrangement approved under Division 4, are to be assets of the fund; but (b) do not include assets that, in accordance with such a restructure or arrangement, are no longer to be assets of the fund. (6) Despite paragraphs (3)(b) and (c) and subsection (4), assets or investments obtained by the expenditure of money of, or the application of other assets of, a health benefits fund are not assets of the fund if: (a) the private health insurer conducting the fund is a for profit insurer; and (b) the expenditure or application was not done for the purposes of the fund. Act does not have effect of making insurer etc. a trustee of assets of a health benefits fund (7) To avoid doubt, nothing in this Act is intended to have the effect of making a private health insurer or its directors a trustee or trustees of the assets of the health benefits funds of the insurer. 27 Payments to health benefits funds (1) A private health insurer must credit the following amounts to a health benefits fund: (a) premiums payable under policies of insurance that are referable to the fund; (b) amounts paid to the insurer in relation to a liability under Division 9 in relation to the fund; (c) income from the investment of assets of the fund; (d) money paid to or by the insurer under a judgment of a court relating to any matter concerning the business of the fund or any failure to comply with this Part in relation to the fund; (e) any other money received by the insurer in connection with its conduct of the business of the fund; (f) any other amounts specified in APRA rules made for the purpose of this paragraph. (2) This Act does not prevent a private health insurer from making a permitted capital payment to a health benefits fund. (3) A private health insurer makes a permitted capital payment to a health benefits fund if it credits to the fund an amount that: (a) is not required to be credited to the fund under subsection (1); and (b) either: (i) does not represent any part of the assets of another health benefits fund; or (ii) is credited to the fund with APRA's written approval. Note: Refusals to approve the crediting of an amount to a fund are reviewable under section 168. (4) An approval under subparagraph (3)(b)(ii) is not a legislative instrument. 28 Expenditure and application of health benefits funds Assets of health benefits funds not to be applied or dealt with except in accordance with this Division (1) A private health insurer must not apply, or deal with, assets of a health benefits fund, whether directly or indirectly, except in accordance with this Division. Application of assets: general rules (2) The assets of a health benefits fund must not be applied: (a) for any purpose other than: (i) meeting policy liabilities and other liabilities, or expenses, incurred for the purposes of the business of the fund including policy liabilities and other liabilities that are treated, in accordance with a restructure or arrangement approved under Division 4, as policy liabilities and other liabilities incurred for the purposes of the fund; or (ii) making investments in accordance with section 30; or (iii) making a distribution under Division 5; or (iv) a purpose specified in APRA rules made for the purpose of this subparagraph; or (b) for a purpose specified in APRA rules made for the purpose of this paragraph. Mortgaging or charging assets (3) A private health insurer must not mortgage or charge any of the assets of a health benefits fund except: (a) to secure an overdraft from an ADI; or (b) for such other purposes, and subject to such conditions, as are specified in APRA rules made for the purpose of this paragraph. Borrowing money (4) A private health insurer must not borrow money for the purposes of the business of a health benefits fund except in accordance with APRA rules made for the purpose of this subsection. Application of assets: for profit insurers (5) Despite subsection (2), if a private health insurer is a for profit insurer, the assets of a health benefits fund conducted by the insurer may be applied for any purpose, except an application of the assets that is inconsistent with: (a) prudential standards relating to capital adequacy or solvency that apply in relation to the fund; or (b) a direction given to the insurer under section 96 that relates to the fund. Section does not apply to certain transfers of assets (6) This section does not apply to the transfer of assets: (a) from one health benefits fund to another in accordance with a restructure or arrangement approved under Division 4; or (b) in accordance with a direction under subsection 25(2). 29 Effect of non‑compliance with section 28 General principle (1) A transaction entered into in contravention of section 28 is of no effect unless: (a) the Federal Court makes an order under subsection (2); or (b) it is included in a class of transactions specified in APRA rules, made for the purpose of this paragraph, to be transactions to which this section applies, and the Court has not made an order under subsection (6). Order declaring the transaction to be effective (2) The Federal Court, on application by a party to the transaction, may make an order declaring that the transaction is effective, and is to be taken always to have been effective, for all purposes. (3) The Federal Court must not make an order under subsection (2) unless it is satisfied that the applicant entered into the transaction in good faith and without knowledge of the contravention. (4) In deciding whether to make an order under subsection (2), the Federal Court may have regard to any hardship that would be caused to the applicant if the order were not made. (5) Subsection (4) is not intended to limit the matters to which the Federal Court may have regard on an application under subsection (2). Order declaring the transaction to be of no effect (6) The Federal Court, on application by APRA, may make an order declaring that a particular transaction that: (a) was entered into in contravention of section 28; and (b) is included in a class of transactions of a kind referred to in paragraph (1)(b) of this section; is, and is to be taken always to have been, of no effect for any purpose. (7) The Federal Court must not make an order under subsection (6) if it is satisfied that the effect of the order (if made) would be to cause hardship to a person who entered into the transaction in good faith and without knowledge of the contravention. 30 Investment of health benefits funds (1) A private health insurer may invest assets of a health benefits fund in any way that is likely to further the business of the fund. (2) However: (a) nothing in this Act authorises a private health insurer to make an investment the insurer would otherwise be prohibited from making; and (b) nothing in this Act authorises a private health insurer to make an investment the insurer would not otherwise have power to make; and (c) a private health insurer must not invest assets of a health benefits fund, or keep such assets invested, if the investment, or the retention of the investment, as the case requires, is prohibited by APRA rules made for the purpose of this paragraph, or by prudential standards. (3) A transaction is not ineffective merely because it involves a contravention of paragraph (2)(c). Division 4—Restructure, merger and acquisition of health benefits funds 31 Restriction on restructure, merger or acquisition of health benefits funds A private health insurer must not change the health benefits fund to which a policy of insurance is referable unless the change is made in accordance with this Division. 32 Restructure of health benefits funds When an insurer may restructure its health benefits funds (1) A private health insurer may restructure its health benefits funds so that insurance policies that are referable to a health benefits fund (a transferring fund) of the insurer become referable to one or more other health benefits funds (receiving funds) of the insurer (whether existing or proposed) if: (a) the insurance policies concerned are all of the policies that, immediately before the restructure, were referable to the transferring fund and belonged to one or more policy groups of that fund; and (b) the insurer applies to APRA, in the approved form, for approval of the restructure; and (c) APRA approves the restructure in writing; and (d) the insurer complies with any requirements imposed on the insurer in relation to the restructure by APRA rules made for the purpose of this paragraph. How APRA decides whether to approve the restructure (2) Subject to subsection (4), APRA must approve the restructure if it is satisfied that: (a) the assets and liabilities that would be transferred to the receiving fund or funds represent a reasonable estimate of what would, immediately before the restructure, be the net asset position of the transferring fund; and (b) if there is more than one receiving fund—those assets and liabilities would be fairly distributed between the receiving funds; and (c) the restructure will not result in any contravention of prudential standards. (3) For the purposes of paragraph (2)(a), in working out the net asset position of the transferring fund, disregard the net asset position of the fund to the extent that it relates to insurance policies that do not belong to a policy group referred to in paragraph (1)(a). (4) APRA must not approve the restructure if: (a) it considers that the restructure will result in unfairness to the policy holders of a health benefits fund of the insurer as that fund exists immediately before the restructure, when those policy holders are viewed as a group; or (b) it considers that the restructure will result in unfairness to the persons who would be policy holders of a health benefits fund of the insurer as that fund would exist immediately after the restructure, when those persons are viewed as a group; or (c) the insurer is being wound up when the application is made. Note: Refusals to approve restructures are reviewable under section 168. APRA rules may provide for various matters (5) APRA rules may provide for the following: (a) criteria for the approval of applications under subsection (1); (b) how to work out reasonable estimates of the kind referred to in paragraph (2)(a); (c) criteria for deciding under paragraph (2)(b) whether assets and liabilities would be fairly distributed; (d) requirements to notify interested persons of the outcomes of such applications; (e) matters connected with how restructures take place, including the following: (i) insurance policies becoming referable to a receiving fund or funds; (ii) policy liabilities and other liabilities incurred for the purposes of a transferring fund becoming treated as policy liabilities and other liabilities incurred for the purposes of a receiving fund or funds; (iii) assets of a transferring fund becoming assets of a receiving fund or funds; (iv) the timing of restructures; (v) if a receiving fund is a proposed new health benefits fund—the establishment of that fund; (f) requirements for private health insurers to give APRA information following restructures. Approval is not a legislative instrument (6) An approval under this section is not a legislative instrument. Definition (7) A policy group of a health benefits fund, is all of the insurance policies: (a) that are referable to the fund; and (b) the addresses of the policy holders of which, as known to the private health insurer conducting the fund, are located in the same risk equalisation jurisdiction. APRA rules may provide for how to work out the policy group for a policy that has 2 or more holders whose addresses are not all located in the same risk equalisation jurisdiction. 33 Merger and acquisition of health benefits funds When an arrangement may be entered into (1) A private health insurer (the transferee insurer) may enter into an arrangement with one or more other private health insurers (transferor insurers) under which: (a) insurance policies that are referable to a health benefits fund or funds (transferring funds) of the transferor insurer or transferor insurers become referable to a health benefits fund or funds (receiving funds) of the transferee insurer; and (b) in relation to each of the transferring funds, the insurance policies concerned are: (i) all of the insurance policies that are referable to the transferring fund; or (ii) all of the insurance policies that are referable to the transferring fund and that belong to one or more policy groups of the fund. (2) However, the arrangement must not take effect unless: (a) the insurers referred to in subsection (1) apply jointly to APRA, in the approved form, for approval of the arrangement; and (b) APRA approves the arrangement in writing; and (c) the insurers comply with any requirements imposed on the insurers in relation to the arrangement by APRA rules made for the purpose of this paragraph. How APRA decides whether to approve the arrangement (3) APRA must approve the arrangement if it is satisfied that: (a) the assets and liabilities that would be transferred, under the arrangement, to the receiving fund or funds represent a reasonable estimate of what would, immediately before the restructure, be: (i) if there is only one transferring fund—the net asset position of the fund; or (ii) if there is more than one transferring fund—the sum of the net asset positions of each of the funds; and (b) if, under the arrangement, there would be more than one receiving fund—those assets and liabilities would be fairly distributed between the receiving funds; and (c) if subparagraph (1)(b)(i) applies to any transferring fund—the net asset position of the fund immediately after the arrangement takes effect will not be greater than zero; and (d) the arrangement will not result in any contravention of prudential standards if it takes effect. Note: Refusals to approve transfers are reviewable under section 168. (4) For the purposes of paragraph (3)(a), in working out the net asset position of a transferring fund to which subparagraph (1)(b)(ii) applies, disregard the net asset position of the fund to the extent that it relates to insurance policies that do not belong to a policy group referred to in that subparagraph. APRA rules may provide for various matters (5) APRA rules may provide for the following: (a) criteria for the approval of applications under subsection (2); (b) how to work out reasonable estimates of the kind referred to in paragraph (3)(a); (c) criteria for deciding under paragraph (3)(b) whether assets and liabilities would be fairly distributed; (d) requirements to notify interested persons of the outcomes of such applications; (e) matters connected with how arrangements take effect, including the following: (i) insurance policies becoming referable to a health benefits fund or funds of the transferee insurer; (ii) policy liabilities and other liabilities incurred for the purposes of a health benefits fund or funds of a transferor insurer becoming treated as policy liabilities and other liabilities incurred for the purposes of a health benefits fund or funds of the transferee insurer; (iii) assets of a health benefits fund or funds of a transferor insurer becoming assets of a health benefits fund or funds of the transferee insurer; (iv) the timing of arrangements; (f) requirements for private health insurers to give APRA information following arrangements taking effect. Notice to be given if arrangement takes effect (6) The transferee insurer must, within 28 days after the arrangement takes effect, notify APRA of the arrangement. The notice must comply with any requirements specified in APRA rules made for the purpose of this subsection. Effect of arrangement (7) For the purposes of this Act and the Private Health Insurance Act 2007, an insurance policy that becomes referable to a health benefits fund of the transferee insurer as a result of the arrangement is treated, after the arrangement takes effect, as if it were an insurance policy issued by the transferee insurer. Approval is not a legislative instrument (8) An approval under this section is not a legislative instrument. 34 Consent of policy holders not required The consent of the policy holders of a health benefits fund is not required for any: (a) restructuring health benefits funds as provided for in section 32; or (b) entering into arrangements of a kind referred to in section 33, or implementing such arrangements; unless the constitution of the private health insurer conducting the fund provides otherwise. Division 5—Termination of health benefits funds Subdivision A—Approving the termination of health benefits funds 35 Applying for termination A private health insurer may apply to APRA, in the approved form, for approval of the termination of each of its health benefits funds. Note: Termination of health benefits funds may also occur if the Federal Court orders the appointment of a terminating manager under Division 7. 36 Requiring further information Within 28 days after the application is made, APRA may, by written notice to the applicant, require the applicant to give APRA such further information relating to the application as is specified in the notice. 37 Deciding the application (1) APRA must, in writing, approve the termination if it is satisfied that: (a) the insurer is not in the process of being wound up; and (b) each of its health benefits funds complies with prudential standards relating to capital adequacy or solvency that apply in relation to the funds; and (c) in relation to each of the funds, termination of the fund will not result in unfairness to the policy holders of the fund, when those policy holders are viewed as a group; and is satisfied as to such other matters as are specified in APRA rules made for the purpose of this subsection. (2) If APRA approves the termination, APRA: (a) may, in writing, appoint a person other than the applicant as the terminating manager of the funds; and (b) must give the insurer written notice: (i) of the approval of the termination; and (ii) if paragraph (a) applies—of the appointment of the terminating manager. (3) If APRA refuses to approve the termination, APRA must give the insurer written notice of the refusal. Note: Refusals to approve terminations are reviewable under section 168. (4) An approval under this section is not a legislative instrument. 38 APRA can be taken to have refused to approve termination APRA is taken, for the purposes of section 168, to have refused to approve the termination if APRA does not notify the applicant of its decision on the application: (a) within 90 days after the application was made; or (b) if APRA has given the applicant a notice under section 36 requiring the applicant to give further information relating to the application—within 90 days after the applicant gives that information to APRA; whichever is later. Subdivision B—Conducting the termination of health benefits funds 39 The basis of the law relating to termination (1) A health benefits fund cannot be wound up or otherwise terminated except in accordance with this Part. (2) Subject to this Part, any provisions of a law of the Commonwealth, or of a State or Territory, that, but for this section, would relate to the winding up or termination of such a fund cease, by force of this section, to apply in relation to the fund. 40 Conduct of funds during termination process (1) A private health insurer must not, after being notified under subsection 37(2) that termination of its health benefits funds has been approved: (a) enter into an insurance policy that is referable to any of its funds w