Contents
1Short title#
This Act is the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Act 2026.
2Commencement#
(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. Sections 1 to 3 and anything in this Act not elsewhere covered by this table | The day this Act receives the Royal Assent. | 18 September 2026 |
| 2. Schedule 1, Part 1, Divisions 1 and 2 | The day after this Act receives the Royal Assent. | 19 September 2026 |
| 3. Schedule 1, item 3A | At the same time as the provisions covered by table item 2.However, the provision does not commence at all if Schedule 1 to the Health Insurance Amendment (Incentive Payments and Other Measures) Act 2026 commences at or before that time. | 19 September 2026 |
| 4. Schedule 1, item 3B | The later of:(a) the commencement of the provisions covered by table item 2; and(b) immediately after the commencement of Schedule 1 to the Health Insurance Amendment (Incentive Payments and Other Measures) Act 2026.However, the provision does not commence at all if the event mentioned in paragraph (b) does not occur. | 17 October 2026(paragraph (b) applies) |
| 5. Schedule 1, Part 2 | At the same time as the provisions covered by table item 2. | 19 September 2026 |
| 6. Schedule 2 | The later of:(a) immediately after the commencement of the provisions covered by table item 2; and(b) 18 September 2026. | 19 September 2026(paragraph (a) applies) |
Note: This table relates only to the provisions of this Act as originally enacted.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.
3Schedules#
Legislation that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.
Schedule 1 · Transparency by default and information sharing
Part 1 · Transparency by default
Part VE · Publication of information about professional services
124ZXObjects of this Part#
The objects of this Part are:
(a)to improve the transparency of costs associated with the rendering of professional services; and
(b)to promote efficient access to those services; and
(c)to help people make informed decisions about health care.
Note: See also Division 324 of the Private Health Insurance Act 2007 (publication of information about treatments covered by health insurance policies).
124ZYPublication of information about professional services#
(1)The Secretary may publish information relating to professional services:
(a)rendered by, or on behalf of, medical practitioners; and
(b)in respect of which medicare benefits are payable.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
(2)Without limiting subsection (1), the information that may be published by the Secretary includes the following:
(a)information about medicare benefits paid in relation to particular kinds of professional services rendered by or on behalf of particular medical practitioners, including:
(i)the amounts of medicare benefits paid; and
(ii)the extent to which those medicare benefits were assigned under subsection 20A(1);
(b)information about amounts of medical expenses incurred in respect of particular kinds of professional services rendered by or on behalf of particular medical practitioners;
(c)information relating to particular medical practitioners who render professional services, or on whose behalf professional services are rendered, including:
(i)the practitioners’ names; and
(ii)information about the practitioners’ qualifications and specialities; and
(iii)the languages spoken by the practitioners;
(d)information about the locations and hospitals where professional services are rendered by or on behalf of particular medical practitioners.
(3)The Secretary may also publish any information of a kind specified by the Minister under paragraph (5)(a).
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
(4)Information published under this section must be published in the manner, if any, specified by the Minister under paragraph (5)(b).
(5)The Minister may, by legislative instrument, specify any of the following:
(a)for the purposes of subsection (3)—kinds of information that may be published under this section;
(b)for the purposes of subsection (4)—a manner or manners in which information must be published under this section.
(6)The Minister may only specify a kind of information under paragraph (5)(a) if the Minister is satisfied that publishing that kind of information would further the objects of this Part.
(7)Information published under this section must not include personal information about an individual who is not, and has not been, a medical practitioner.
(8)The Secretary may, on the Secretary’s own initiative or as a result of a review under a determination under section 124ZYA, correct, update, alter or remove information published under this section.
(9)If information about amounts of medical expenses incurred in respect of particular kinds of professional services rendered by or on behalf of particular medical practitioners is published under this section, the Secretary must also publish under this section:
(a)if any formulas were used to work out those amounts—those formulas; and
(b)if a material reduction in the amounts of those expenses occurs after publishing the information and the Secretary becomes aware of the reduction—the reduced amounts (as soon as practicable after the Secretary becomes so aware).
124ZYAReview of decision to publish information#
(1)The Minister may, by legislative instrument, determine procedures for reviewing decisions to publish information under section 124ZY (including decisions to correct, update, alter or remove such information).
(2)Without limiting subsection (1), the determination may provide for any of the following:
(a)who may, or may not, apply for review of a decision;
(b)kinds of decisions that are, or are not, subject to review;
(c)circumstances in which an application may, or may not, be made;
(d)who is to review a decision.
124ZZUse and disclosure of information#
Use or disclosure to assist Secretary or reviewer
(a)assisting the Secretary to publish, correct, update, alter or remove information under either or both of the following provisions (the publication provisions):
(i)section 124ZY;
(ii)section 324-5 of the Private Health Insurance Act 2007; or
(b)assisting a person to carry out a review under a determination (a review determination) under:
(i)section 124ZYA; or
(ii)section 324-7 of the Private Health Insurance Act 2007.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
(2)To avoid doubt, the reference to using information in subsection (1) includes a reference to linking or matching information.
Disclosure to person about whom information is published
(3)The Secretary may disclose information to a person:
(a)in the course of deciding what information to publish about the person under either or both of the publication provisions; or
(b)in the course of deciding whether to correct, update, alter or remove information published about the person under either or both of the publication provisions; or
(c)in order to inform the person about how information published about the person under either or both of the publication provisions was, or is to be, worked out.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
Disclosure in the course of review
(4)A person carrying out a review under a review determination may, in the course of carrying out the review, disclose information to the person who applied for the review.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
Information may relate to other people
(5)To avoid doubt, information disclosed to a person (the disclosee) under subsection (3) or (4) may include information about other people as well as the disclosee, or instead of the disclosee.
124ZZAProtection from civil proceedings#
The Secretary is not liable to civil proceedings for loss, damage or injury of any kind suffered by any person as a result of the publication of information under section 124ZY.
124ZZB Annual report#
(1)The Secretary must, as soon as practicable after the end of each financial year that starts after the commencement of this section, prepare a written report in relation to the information published under section 124ZY before the end of that year.
Note: The report is not limited to information published in that year only.
(2)Without limiting subsection (1), the report must include analysis of any trends in the published information, including, for example, trends in relation to:
(a)changes in the median costs of particular kinds of professional services; and
(b)variations in those costs between different geographical areas where those services are rendered.
(3)The Secretary must give the Minister a copy of the report no later than 3 months after the end of that year.
(4)The Minister must cause a copy of the report to be tabled in each House of the Parliament within 15 sitting days of that House after the Minister receives the report.
Division 324 · Publication of information about treatments covered by health insurance policies etc.
324-1Objects of this Division#
The objects of this Division are:
(a)to improve the transparency of costs associated with the provision of *hospital treatment and *general treatment *covered by *complying health insurance policies; and
(b)to promote efficient access to those treatments; and
(c)to help people make informed decisions about health care.
Note: See also Part VE of the Health Insurance Act 1973 (publication of information about professional services).
324-5Publication of information about treatments covered by complying health insurance policies#
(1)The Secretary of the Department may publish:
(a)information about *complying health insurance policies and *complying health insurance products offered by private health insurers; and
(b)information relating to *hospital treatment and *general treatment (covered treatment) that is *covered by complying health insurance policies and is provided by, or on behalf of, *medical practitioners.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
(2)Without limiting subsection (1), the information that may be published by the Secretary of the Department includes the following:
(a)information about benefits for particular kinds of covered treatment provided by or on behalf of particular *medical practitioners;
(b)information about fees and charges relating to the provision of particular kinds of covered treatment by or on behalf of particular medical practitioners;
(c)information about *medicare benefits paid in relation to particular kinds of covered treatment provided by or on behalf of particular medical practitioners, including:
(i)the amounts of medicare benefits paid; and
(ii)the extent to which those medicare benefits were assigned under subsection 20A(1) of the Health Insurance Act 1973;
(d)information about particular *complying health insurance policies and *complying health insurance products offered by private health insurers, including:
(i)the names of insurers offering the policies and products; and
(ii)the treatments covered by the policies and products; and
(iii)the benefits under the policies and products; and
(iv)the terms and conditions of the policies and products; and
(v)the *risk equalisation jurisdiction of the policies and products;
(e)information about agreements between particular private health insurers and particular medical practitioners for the provision of covered treatment to persons insured by the insurer, including the extent to which particular kinds of agreements apply in relation to particular kinds of treatment;
(f)information about agreements between particular private health insurers and particular *hospitals for the provision of covered treatment to persons insured by the insurer, including the extent to which particular kinds of agreements apply in relation to particular kinds of treatment;
(g)information relating to particular medical practitioners who provide covered treatment, or on whose behalf covered treatment is provided, to persons insured by a private health insurer, including:
(i)the practitioners’ names; and
(ii)information about the practitioners’ qualifications and specialities; and
(iii)the languages spoken by the practitioners;
(h)information about the locations and hospitals where particular kinds of covered treatment are provided by or on behalf of particular medical practitioners, including information about fees, charges and benefits for accommodation at those locations or hospitals relating to such treatment.
(3)The Secretary of the Department may also publish any information of a kind specified by the Minister under paragraph (5)(a).
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
(4)Information published under this section must be published in the manner, if any, specified by the Minister under paragraph (5)(b).
(5)The Minister may, by legislative instrument, specify any of the following:
(a)for the purposes of subsection (3)—kinds of information that may be published under this section;
(b)for the purposes of subsection (4)—a manner or manners in which information must be published under this section.
(6)The Minister may only specify a kind of information under paragraph (5)(a) if the Minister is satisfied that publishing that kind of information would further the objects of this Division.
(7)Information published under this section must not include personal information about an individual who is not, and has not been, a medical practitioner.
(7A)The Secretary of the Department may, on the Secretary’s own initiative or as a result of a review under a determination under section 324-7, correct, update, alter or remove information published under this section.
(8)For the purposes of this section, a treatment is taken to be provided on behalf of a medical practitioner if, and only if:
(a)it is provided by another person who is not a medical practitioner; and
(b)that other person provides the treatment, in accordance with accepted medical practice, under the supervision of the medical practitioner.
(9)For the purposes of this section, if:
(a)a treatment is provided by a medical practitioner who is a specialist trainee; and
(b)the specialist trainee provides the treatment under the supervision of another medical practitioner who is present at all times while the specialist trainee provides the treatment; and
(c)the treatment would be taken to have been a service rendered by the other medical practitioner under subsection 3(18) of the Health Insurance Act 1973 for the purposes of that Act;
then:
(d)the treatment is taken to have been provided by the other medical practitioner; and
(e)the treatment is taken not to have been provided by the specialist trainee.
(10)In subsection (9):
specialist trainee has the meaning given by subsection 3(20) of the Health Insurance Act 1973.
(11)If information about fees and charges relating to the provision of particular kinds of covered treatment by or on behalf of particular medical practitioners is published under this section, the Secretary must also publish under this section:
(a)if any formulas were used to work out those fees and charges—those formulas; and
(b)if a material reduction in the amounts of those fees and charges occurs after publishing the information and the Secretary becomes aware of the reduction—the reduced amounts (as soon as practicable after the Secretary becomes so aware).
324-7Review of decision to publish information#
(1)The Minister may, by legislative instrument, determine procedures for reviewing decisions to publish information under section 324-5 (including decisions to correct, update, alter or remove such information).
(2)Without limiting subsection (1), the determination may provide for any of the following:
(a)who may, or may not, apply for review of a decision;
(b)kinds of decisions that are, or are not, subject to review;
(c)circumstances in which an application may, or may not, be made;
(d)who is to review a decision.
324-10Use and disclosure of information#
Use or disclosure to assist Secretary or reviewer
(a)assisting the Secretary of the Department to publish, correct, update, alter or remove information under either or both of the following provisions (the publication provisions):
(i)section 324-5;
(ii)section 124ZY of the Health Insurance Act 1973; or
(b)assisting a person to carry out a review under a determination (a review determination) under:
(i)section 324-7; or
(ii)section 124ZYA of the Health Insurance Act 1973.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
(2)To avoid doubt, the reference to *using information in subsection (1) includes a reference to linking or matching information.
Disclosure to person about whom information is published
(3)The Secretary of the Department may *disclose information to a person:
(a)in the course of deciding what information to publish about the person under either or both of the publication provisions; or
(b)in the course of deciding whether to correct, update, alter or remove information published about the person under either or both of the publication provisions; or
(c)in order to inform the person about how information published about the person under either or both of the publication provisions was, or is to be, worked out.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
Disclosure in the course of review
(4)A person carrying out a review under a review determination may, in the course of carrying out the review, *disclose information to the person who applied for the review.
Note: This subsection constitutes an authorisation for the purposes of the Privacy Act 1988 and other laws (including the common law).
Information may relate to other people
(5)To avoid doubt, information disclosed to a person (the disclosee) under subsection (3) or (4) may include information about other people as well as the disclosee, or instead of the disclosee.
324-15Protection from civil proceedings#
The Secretary of the Department is not liable to civil proceedings for loss, damage or injury of any kind suffered by any person as a result of the publication of information under section 324-5.
324-20 Annual report#
(1)The Secretary must, as soon as practicable after the end of each financial year that starts after the commencement of this section, prepare a written report in relation to the information published under section 324-5 before the end of that year.
Note: The report is not limited to information published in that year only.
(2)Without limiting subsection (1), the report must include analysis of any trends in the published information, including, for example, trends in relation to:
(a)changes in the median costs of particular kinds of *hospital treatments and *general treatments *covered by *complying health insurance policies; and
(b)variations in those costs between different geographical areas where those treatments are provided.
(3)The Secretary must give the Minister a copy of the report no later than 3 months after the end of that year.
(4)The Minister must cause a copy of the report to be tabled in each House of the Parliament within 15 sitting days of that House after the Minister receives the report.
2A Subsection 333-1(1)
Omit “(other than section 66-10)”, substitute “(other than a function or power mentioned in subsection (2A))”.
2B After subsection 333-1(2)
Insert:
(2A)For the purposes of subsection (1), the Minister must not delegate any of the following functions or powers:
(a)a function or power under section 66-10 (approval of premiums);
(b)the power to make, vary or revoke a legislative instrument under subsection 324-7(1) (review of decision to publish information).
Division 2—Application provisions#
3 Application of amendments
The amendments made by this Part apply in relation to the publication of information on or after the commencement of this Part, whether the information was obtained or generated before, on or after that commencement.
Health Insurance Act 1973#
3A Subsection 131(1)
Omit all the words after “other than”, substitute:
the following powers:
(a)the power of the Minister to make, vary or revoke a legislative instrument under subsection 124ZYA(1) (review of decision to publish information);
(b)this power of delegation.
3B Subsection 131(1)
Omit all the words after “other than”, substitute:
the following powers:
(a)a power under Subdivision A of Division 6 of Part V;
(b)the power of the Minister to make, vary or revoke a legislative instrument under subsection 124ZYA(1) (review of decision to publish information);
(c)this power of delegation.
Part 2 · Authorising appropriate information sharing
Private Health Insurance Act 2007#
4 Paragraph 282-25(a)
Omit “uses, makes a record of, or discloses or communicates”, substitute “*uses, or *discloses”.
5 Paragraph 282-25(b)
6 Section 323-1
Repeal the section, substitute:
323-1Prohibition on disclosure of protected information#
Offence
(1)A person commits an offence if:
(a)the person has, or has at any time had, a duty, function or power (other than an *APRA private health insurance duty, function or power) under this Act; and
(b)the person *uses or *discloses information; and
(c)the information is *protected information.
Penalty: Imprisonment for 2 years or 120 penalty units, or both.
(2)Subsection (1) does not apply if the *use or *disclosure is:
(a)required or authorised under a provision of this Act; or
(b)otherwise required or authorised under an Australian law.
Note 1: The defendant bears an evidential burden in relation to the matter in this subsection. See subsection 13.3(3) of the Criminal Code.
Note 2: Provisions of this Act that authorise the use or disclosure of information include sections 323-5, 323-10, 323-15, 323-20, 323-30, 323-33, 323-35, 324-5 and 324-10.
Meaning of APRA private health insurance duty, function or power
(3)An APRA private health insurance duty, function or power is a duty, function or power of *APRA, or that a person has in the person’s capacity as an officer (within the meaning of section 56 of the Australian Prudential Regulation Authority Act 1998), under any of the following:
(a)this Act;
(b)the Private Health Insurance (Prudential Supervision) Act 2015;
(c)the Financial Institutions Supervisory Levies Collection Act 1998, as that Act applies in relation to levies imposed on private health insurers;
(d)the Financial Sector (Collection of Data) Act 2001, as that Act applies in relation to private health insurers.
Note: The disclosure of information regime for information obtained under APRA private health insurance duties, functions and powers is Part 6 of the Australian Prudential Regulation Authority Act 1998 (rather than this Division).
Meaning of protected information
(4)Information is protected information if the information:
(a)relates to a person (including a deceased person) other than the person who obtained or generated the information; and
(b)either:
(i)is obtained or generated by a person in the course of performing or exercising a duty, function or power under this Act (other than an *APRA private health insurance duty, function or power); or
(ii)was information to which subparagraph (i) applied and is obtained by a person by way of a *disclosure under section 323-10, 323-15 or 323-20.
7 Section 323-5
Omit “For the purposes of subsection 323-1(3), a person”, substitute “A person”.
8 At the end of section 323-5
Add:
; or (e) in the course of performing or exercising a duty, function or power under Part VE of the Health Insurance Act 1973; or
(f)to the Minister for the purpose of the Minister’s performance of the Minister’s functions.
9 Subsection 323-10(1A)
Omit “For the purposes of subsection 323-1(3), a person”, substitute “A person”.
10 Subsection 323-15(1)
Omit “For the purposes of subsection 323-1(3), a person”, substitute “A person”.
11 Paragraphs 323-15(1)(d) and (e)
Repeal the paragraphs, substitute:
(d)the disclosure is, or is a kind of disclosure, certified by the Secretary by written instrument to be in the public interest.
12 Subsection 323-15(2)
Repeal the subsection.
13 Subsection 323-20(1)
Omit “For the purposes of subsection 323-1(3), a person”, substitute “A person”.
14 Paragraphs 323-20(1)(d) and (e)
Repeal the paragraphs, substitute:
(d)the disclosure is, or is a kind of disclosure, certified by the Secretary by written instrument to be in the public interest.
15 Subsection 323-20(2)
Repeal the subsection.
16 After section 323-20
Insert:
323-23Terms and conditions on subsequent use or disclosure following an authorised disclosure under section 323-15 or 323-20#
(1)The Secretary of the Department may, by instrument in writing, specify terms and conditions subject to which information that is *disclosed to a person under section 323-15 or 323-20 may be *used or disclosed by the person.
(3)An instrument under subsection (1) is not a legislative instrument.
17 Section 323-25
Repeal the section.
18 Section 323-30
Omit “For the purposes of subsection 323-1(3), a person”, substitute “A person”.
19 After section 323-30
Insert:
323-33Authorised disclosure: other permitted disclosures#
A person may *disclose information to another person if:
(a)the information is lawfully in the public domain; or
(b)the person to whom the information relates has expressly or impliedly consented to the disclosure; or
(c)the information has lawfully been disclosed to that other person previously; or
(d)the information relates to that other person; or
(e)the disclosure of the information is for the purposes of obtaining or providing legal advice.
323-35Authorised use: use of information for authorised disclosure#
A person may *use information for the purpose of *disclosing the information under section 323-5, 323-10, 323-15, 323-20, 323-30, 323-33, 324-5 or 324-10.
20 Paragraph 323-40(b)
Omit “an *authorised disclosure”, substitute “a *disclosure”.
21 Paragraph 323-40(d)
Repeal the paragraph, substitute:
(d)the disclosure by the person is not:
(i)required or authorised under a provision of this Act; or
(ii)otherwise required or authorised under an Australian law.
22 Section 323-45 (heading)
Repeal the heading, substitute:
323-45Offence: soliciting disclosure of protected information#
23 Paragraph 323-45(d)
Repeal the paragraph, substitute:
(d)the disclosure by the person would not be:
(i)required or authorised under a provision of this Act; or
(ii)otherwise required or authorised under an Australian law.
24 Section 323-50 (heading)
Repeal the heading, substitute:
323-50Offence: use etc. of protected information after unauthorised disclosure#
25 Paragraphs 323-50(c) and (d)
Repeal the paragraphs, substitute:
(c)the disclosure to the person is not:
(i)required or authorised under a provision of this Act; or
(ii)otherwise required or authorised under an Australian law; and
(d)the person knows, or ought reasonably to know, that the disclosure to the person is not so required or authorised; and
26 Subparagraph 323-50(e)(iii)
Omit “uses”, substitute “*uses”.
27 Paragraph 323-55(c)
Repeal the paragraph, substitute:
(c)the supply by the person would not be:
(i)required or authorised under a provision of this Act; or
(ii)otherwise required or authorised under an Australian law.
28 Clause 1 of Schedule 1 (definition of APRA private health insurance duty, function or power)
Omit “323-1(1A)”, substitute “323-1(3)”.
29 Clause 1 of Schedule 1 (definition of authorised disclosure)
Repeal the definition.
30 Clause 1 of Schedule 1
Insert:
disclose, in relation to information, includes divulge or communicate.
31 Clause 1 of Schedule 1 (definition of protected information)
Repeal the definition, substitute:
use, in relation to information, includes make a record of.
33 Amendments of listed provisions—references to disclose
| References to disclose | ||||
|---|---|---|---|---|
| Item | Provision | Omit | Substitute | |
| 1 | Paragraph 203-20(1)(a) | disclose | *disclose | |
| 2 | Section 323-5 | disclose | *disclose | |
| 3 | Paragraph 323-10(1)(b) | disclosed | *disclosed | |
| 4 | Paragraph 323-10(1A) | disclose | *disclose | |
| 5 | Subsection 323-15(1) | disclose | *disclose | |
| 6 | Subsection 323-20(1) | disclose | *disclose | |
| 7 | Section 323-30 | disclose | *disclose | |
| 8 | Paragraph 323-45(a) | disclosure | *disclosure | |
| 9 | Paragraph 323-50(a) | disclosed | *disclosed |
Division 2—Application provisions#
35 Application of amendments
The amendments made by this Part apply in relation to the use or disclosure of information on or after the commencement of this Part, whether the information was obtained or generated before, on or after that commencement.
36 Transitional provision—public interest certificates
(1) A certificate made by the Minister under paragraph 323-15(1)(d) of the Private Health Insurance Act 2007 that is in force immediately before the commencement of this Part continues in force (and may be dealt with) as if it had been made by the Secretary under paragraph 323-15(1)(d) as amended by this Part (subject to any conditions specified in the certificate).
(2) A certificate made by the Minister under paragraph 323-20(1)(d) of the Private Health Insurance Act 2007 that is in force immediately before the commencement of this Part continues in force (and may be dealt with) as if it had been made by the Secretary under paragraph 323-20(1)(d) as amended by this Part (subject to any conditions specified in the certificate).
Schedule 2 · Regulating premiums
Part 1 · Amendments
Private Health Insurance Act 2007#
1 Paragraph 55-5(2)(d)
Omit “subsection 66-10(2)”, substitute “subsection 66-8(3) or 66-10(3)”.
2 Subsection 66-1(1)
Omit “(1)”.
3 Paragraph 66-1(1)(d)
Repeal the paragraph, substitute:
(d)the premiums payable under the policy meet the premium requirement in section 66-5.
4 Subsection 66-1(2)
Repeal the subsection.
5 Subsection 66-5(1)
Omit “66-1(1)(d)”, substitute “66-1(d)”.
6 Subsection 66-5(1)
After “premium requirement in this section if”, insert “there is an approval in effect under section 66-8 or 66-10 for the *product subgroup of the *product to which the policy belongs, and”.
7 Paragraph 66-5(1)(a)
Repeal the paragraph, substitute:
(a)is the amount specified in the approval for the product subgroup to which the policy belongs; or
8 Section 66-10
Repeal the section, substitute:
66-6Meaning of approved application period#
(1)The approved application period for an application under section 66-8 or 66-10 is:
(a)if the Minister has not determined a period for a year under subsection (2)—the period of 55 days beginning on the third Friday in September of that year; or
(b)if the Minister has determined one or more periods for a year under subsection (2)—that period or those periods.
(2)For the purposes of paragraph (1)(b), the Minister may, by legislative instrument, determine a period that is an approved application period.
(2A)Without limiting subsection 33(3A) of the Acts Interpretation Act 1901, a determination under subsection (2) of this section may be expressed to apply in relation to a specified class of application. Such a determination does not affect the operation of paragraph (1)(a) of this section in relation to other classes of application.
(3)Section 42 (disallowance) of the Legislation Act 2003 does not apply to a legislative instrument made under subsection (2).
66-7Meaning of designated change#
(1)A designated change to a *complying health insurance product is any of the following:
(a)subject to subsection (2), a change that results in a reduction in, or removal of, a treatment covered by the product;
(b)a change:
(i)that results, or might result, in a benefit under the product being reduced; and
(ii)that is of a kind specified in the Private Health Insurance (Product Premium) Rules for the purposes of this subparagraph;
(c)a change:
(i)to any other term or condition of the product that results, or might result, in the value to persons insured under a policy that belongs to the product being reduced; and
(ii)that is of a kind specified in the Private Health Insurance (Product Premium) Rules for the purposes of this subparagraph.
(2)The Private Health Insurance (Product Premium) Rules may provide that paragraph (1)(a) does not apply in relation to a change of a kind specified in those Rules for the purposes of this subsection.
66-8Minister’s approval of premiums charged under new product subgroups#
Application for approval of premiums charged under new product subgroups
(1)A private health insurer that proposes to make one or more *product subgroups of a *product available must, before the insurer first begins to make the product subgroups available, apply to the Minister for approval of the proposed premiums to be charged under the product subgroups.
Requirements for application
(2)The application must:
(a)be in the *approved form; and
(b)be accompanied by the fee (if any) specified in the Private Health Insurance (Product Premium) Rules.
Note: The Private Health Insurance (Product Premium) Rules are made by the Minister under section 333-20.
(3)The application may propose different premiums for policies in a *product, but the proposed premiums must be the same for each policy in the product that belongs to the same *product subgroup.
Minister must make decision on application
(4)The Minister must, by written notice to the insurer, either approve or refuse to approve the proposed premiums.
Minister’s decision—applications made within approved application period
(5)If the application is made within an *approved application period, the Minister must approve the proposed premiums, unless the Minister is satisfied that approving the proposed premiums would be contrary to the public interest.
Minister’s decision—applications made outside approved application period
(6)If the application is not made within an *approved application period, the Minister must:
(a)approve the proposed premiums if, and only if, the Minister is satisfied that approving the proposed premiums is in the public interest; or
(b)otherwise, refuse to approve the proposed premiums.
Matters relating to the approval of premiums
(7)If the Minister approves the proposed premiums, the approval has effect, in relation to a *product subgroup to which the application relates, from the day specified in the approval until the earlier of the following:
(a)the day when an approval for the *product subgroup under section 66-10 takes effect;
(b)if the insurer makes a *designated change to the product without an approval under section 66-10 being in effect in relation to the change—the time when the insurer makes the designated change.
(8)The day specified in the approval as the day from which the approval has effect must be a day that is after the day on which the Minister approves the proposed premiums.
Tabling of reasons for refusal to approve premiums
(9)If the Minister refuses to approve the proposed premiums, the Minister must table the Minister’s reasons for refusal in each House of the Parliament no later than 15 sitting days of that House after the refusal.
Other matters
(10)A notice under subsection (4) is not a legislative instrument.
(11)A fee specified for the purposes of paragraph (2)(b):
(a)must not amount to taxation; and
(b)must not exceed the amount the Minister estimates to be the reasonable costs of processing an application made under subsection (1).
Delegation
(12)If the Minister delegates the Minister’s powers under this section to a delegate:
(a)the delegate may approve the proposed premiums in accordance with this section; or
(b)if the delegate considers that the proposed premiums should not be approved, the delegate:
(i)must not make a final decision refusing to approve the proposed premiums; and
(ii)must refer the application to the Minister for the Minister’s consideration.
Note: For delegation by the Minister, see subsection 333-1(1).
66-10Minister’s approval if certain changes are made to premiums or products#
Application for approval of changes
(1)A private health insurer must apply to the Minister for approval of:
(a)the premiums to be charged under one or more *product subgroups of a *complying health insurance product, if the insurer proposes to change the premiums to be charged under the product subgroups; or
(b)the premiums to be charged under each product subgroup of a complying health insurance product, if the insurer proposes to make a *designated change to the *product (whether or not the insurer proposes to change the premiums when the designated change is made).
Requirements for application
(2)The application must:
(a)be in the *approved form; and
(b)be accompanied by the fee (if any) specified in the Private Health Insurance (Product Premium) Rules.
Note: The Private Health Insurance (Product Premium) Rules are made by the Minister under section 333-20.
(3)The application may propose different premiums for policies in a *product, but the proposed premiums must be the same for each policy in the product that belongs to the same *product subgroup.
Minister must make decision on application
(4)The Minister must, by written notice to the insurer, either approve or refuse to approve the proposed premiums.
Minister’s decision—applications made within approved application period
(5)If the application is made within an *approved application period, the Minister must approve the proposed premiums, unless:
(a)the insurer proposes to increase the premiums to be charged under one or more *product subgroups, or proposes to make a *designated change to the *product, or both; and
(b)the Minister is satisfied that approving the proposed premiums would be contrary to the public interest.
Minister’s decision—applications made outside approved application period
(6)If the application is not made within an *approved application period, the Minister must:
(a)approve the proposed premiums if, and only if, either:
(i)the insurer does not propose to increase the premiums to be charged under any *product subgroups, and does not propose to make a *designated change to the *product; or
(ii)the insurer proposes to increase the premiums to be charged under one or more product subgroups, or proposes to make a *designated change to the *product, or both, and the Minister is satisfied that approving the proposed premiums is in the public interest; or
(b)otherwise, refuse to approve the proposed premiums.
Matters relating to the approval of proposed premiums
(7)If the Minister approves the proposed premiums, the approval has effect, in relation to a *product subgroup to which the application relates, from the day specified in the approval until the earlier of the following:
(a)the day when another approval for the product subgroup under this section takes effect;
(b)if the insurer makes a *designated change to the *product without an approval under this section being in effect in relation to the change—the time when the insurer makes the designated change.
(8)The day specified in the approval as the day from which the approval has effect must be a day that is after the day on which the Minister approves the proposed premiums.
Tabling of reasons for refusal to approve premiums
(9)If the Minister refuses to approve the proposed premiums, the Minister must table the Minister’s reasons for refusal in each House of the Parliament no later than 15 sitting days of that House after the refusal.
Other matters
(10)A notice under subsection (4) is not a legislative instrument.
(11)A fee specified for the purposes of paragraph (2)(b):
(a)must not amount to taxation; and
(b)must not exceed the amount the Minister estimates to be the reasonable costs of processing an application made under subsection (1).
Delegation
(12)If the Minister delegates the Minister’s powers under this section to a delegate:
(a)the delegate may approve the proposed premiums in accordance with this section; or
(b)if the delegate considers that the proposed premiums should not be approved, the delegate:
(i)must not make a final decision refusing to approve the proposed premiums; and
(ii)must refer the application to the Minister for the Minister’s consideration.
Note: For delegation by the Minister, see subsection 333-1(1).
66-11Further information about applications under sections 66-8 and 66-10#
(1)The Minister may, by written notice, request a private health insurer to give the Minister, within the period specified in the notice, specified information about an application made by the insurer under section 66-8 or 66-10.
(2)The Minister may refuse to consider the application until the earlier of the following times:
(a)the time when the insurer gives the Minister the specified information;
(b)the end of the period specified in the notice.
(3)The Minister must have regard to any information provided by an insurer, in accordance with a notice under subsection (1), in deciding whether to approve or refuse to approve the application.
(4)If the insurer does not give the specified information within the period specified in the notice, the Minister may deal with the application on the basis of the information contained in the application.
(5)The Minister may give more than one notice under subsection (1) to an insurer in relation to an application made by the insurer.
66-12When Minister must invite resubmission etc. of applications under sections 66-8 and 66-10#
(1)If the Minister proposes to refuse to approve an application made by a private health insurer under 66-8 or 66-10, the Minister must give the insurer a written notice that the Minister is proposing to refuse the application.
(2)The notice must:
(a)invite the insurer to do either or both of the following:
(i)amend the application and resubmit the application;
(ii)give the Minister a submission, in writing, setting out the reasons why the insurer should not be required to resubmit the application; and
(b)specify a period within which the insurer must do either or both of the things mentioned in paragraph (a); and
(c)set out the effects of subsections (3) and (4).
(3)The Minister may refuse to consider the application until the earlier of the following times:
(a)the time when the insurer resubmits the application in accordance with the notice;
(b)the time when the insurer gives the Minister a submission in accordance with the notice.
(4)If the insurer does not do one of the things mentioned in paragraph (2)(a) within the period specified in the notice, the Minister may deal with the application on the basis of the information contained in the application.
(5)Before deciding whether to approve or refuse to approve the application, the Minister must consider:
(a)any application resubmitted in accordance with the notice; and
(b)any submission given in accordance with the notice.
(6)If a private health insurer receives a notice under this section in relation to an application (the original application), and the insurer resubmits the application in accordance with the notice, the resubmitted application is taken, for the purposes of section 66-8 or 66-10 (as the case may be), to have been submitted on the same day as the original application.
(7)The Minister may give more than one notice under subsection (1) to an insurer in relation to an application made by the insurer.
66-13 Annual report#
(1)The Minister must, as soon as practicable after the end of each financial year that starts after the commencement of this section, cause a review to be conducted of any changes during that year to *products and premiums payable under policies in products.
(2)Without limiting subsection (1), the review must consider:
(a)applications made during that year under section 66-8 (about new product subgroups); and
(b)applications made during that year under section 66-10 (about changes to premiums and products); and
(c)any *designated changes to *complying health insurance products made during that year; and
(d)whether, and to what extent, insurers engaged in any product phoenixing during that year.
(3)The person or persons conducting the review must give the Minister a written report of the review no later than 3 months after the end of that year.
(4)The Minister must cause a copy of the report to be tabled in each House of the Parliament within 15 sitting days of that House after the Minister receives the report.
(5)If the report includes any recommendations, the Minister must:
(a)prepare a written statement setting out the Commonwealth Government’s response to each recommendation; and
(b)cause a copy of the statement to be tabled in each House of the Parliament within 6 months after receiving the report.
9 Paragraph 66-15(b)
Omit “66-1(1)(b)”, substitute “66-1(b)”.
10 Paragraph 333-1(2A)(a)
Repeal the paragraph, substitute:
(a)a function or power under subsection 66-6(2) (*approved application periods for applications under section 66-8 or 66-10);
(aa)a function or power under subsection 66-8(9) or 66-10(9) (tabling reasons for refusing to approve applications under section 66-8 or 66-10);
12 Subsection 333-20(1) (after table item 3A)
Insert:
| 3B | Private Health Insurance (Product Premium) Rules | Part 3-3 |
13 Clause 1 of Schedule 1
Insert:
approved application period, for an application under section 66-8 or 66-10: see section 66-6.
designated change, to a *complying health insurance product: see section 66-7.
Part 2 · Application provisions
14 Definitions
In this Part:
commencement day means the day this Schedule commences.
old Act means the Private Health Insurance Act 2007 as in force immediately before the commencement of this Schedule.
15 Application of amendments
Application provisions
(1) The amendments of sections 66-1 and 66-5 of the Private Health Insurance Act 2007 made by this Schedule apply on and after the commencement day in relation to:
(a) a policy that belongs to a product subgroup that is first made available on or after the commencement day; and
(b) a complying health insurance policy that belongs to a product subgroup of a complying health insurance product for which an approval under section 66-10 of the old Act was in effect immediately before the commencement day; and
(c) a policy:
(i) that belongs to a product subgroup that was first made available before the commencement day; and
(ii) for which there was no approval in effect under section 66-10 of the old Act immediately before the commencement day;
at and after the earlier of:
(iii) the first time, on or after the commencement day, that the premiums charged under the product subgroup change; or
(iv) the first time, on or after 2 April 2027, that a designated change is made to the product.
(2) Section 66-8 of the Private Health Insurance Act 2007, as inserted by this Schedule, applies in relation to a product subgroup that is first made available on or after the commencement day.
(3) Section 66-10 of the Private Health Insurance Act 2007, as substituted by this Schedule, applies in relation to:
(a) a proposed change to the premiums to be charged under one or more product subgroups of a complying health insurance product if an insurer proposes to make the change on or after the commencement day (whether or not the insurer proposes to make a designated change at the same time); and
(b) a designated change that an insurer proposes to make to a complying health insurance product on or after 2 April 2027.
(4) Sections 66-11 and 66-12 of the Private Health Insurance Act 2007, as inserted by this Schedule, apply in relation to an application that is made on or after the commencement day.
Pending applications for approval
(5) If:
(a) before the commencement day, a private health insurer applied, under section 66-10 of the old Act, for an approval of a change in premiums; and
(b) immediately before the commencement day, the Minister had not decided to either approve or refuse to approve the proposed changed amount or amounts;
then:
(c) the application lapses at the start of the commencement day; and
(d) that section ceases to apply in relation to the application.
Operation of first approved application period
(6) If the commencement day is a day in the period, for the 2026 calendar year, mentioned in paragraph 66-6(1)(a) of the Private Health Insurance Act 2007, as inserted by this Schedule, the approved application period for 2026 is taken to:
(a) begin on the commencement day; and
(b) end at the end of the period of 55 days beginning on 18 September 2026.
(7) The approved application period mentioned in subitem (6) does not apply to an application that relates to a designated change that is proposed to be made on or after 2 April 2027 (whether or not the application also relates to a change in premiums).
17 Savings provisions
(1) Subject to item 15, section 66-1 of the old Act continues to apply in relation to a policy that was issued under a new product, within the meaning of that section of the old Act, before the commencement day.
(2) An approval that was in effect under section 66-10 of the old Act immediately before the commencement day continues in effect (and may be dealt with) on and after the commencement day as if it were an approval in effect under section 66-10 of the Private Health Insurance Act 2007 as substituted by this Schedule.
[Minister’s second reading speech made in—
House of Representatives on 12 February 2026
Senate on 29 June 2026]
(13/26)
Sourced from the Federal Register of Legislation at legislation.gov.au, © Commonwealth of Australia, licensed under CC BY 4.0. Compilations may have been reformatted.