Commonwealth Consolidated Acts

PRIVATE HEALTH INSURANCE ACT 2007 - SECT 121.15

  (1)   An arrangement is an employee health benefits scheme if:

  (a)   the arrangement provides for a person (an employer ) to arrange payment in respect of the whole or part of the fees and charges that an employee of, or a person providing services to, the employer incurred in relation to * hospital treatment or * general treatment; and

  (b)   one or more of the following applies:

  (i)   the employer is a * constitutional corporation;

  (ii)   the employer is a body corporate incorporated in a Territory;

  (iii)   the employer carries on business in a Territory.

  (2)   It does not matter for the purposes of this section whether the arrangement:

  (a)   constitutes a business of undertaking liability by way of insurance; or

  (b)   is a minor or incidental part of the employer's business; or

  (c)   does not require the employee, or person providing services, to pay any contributions; or

  (d)   does not require the employee, or person providing services, to pay contributions that reflect the value of the benefits that the employer is providing under the arrangement; or

  (e)   provides for the employer to make payments in relation to * hospital treatment, or * general treatment, provided to a person other than the employee or person providing services; or

  (f)   confers on the employer or another person a discretion whether to make payments.

  (3)   However, an arrangement:

  (a)   is not an * employee health benefits scheme merely because, under the arrangement, the employer will pay, or will reimburse employees, or persons providing services, for payment of, one or both of the following:

  (i)   the premiums payable by them for * complying health insurance policies;

  (ii)   the difference between benefits payable to them under policies, and amounts that they are liable to pay, for health services provided to them or members of their families; and

  (b)   is not an employee health benefits scheme if the Private Health Insurance (Health Insurance Business) Rules provide that:

  (i)   it is not an employee health benefits scheme; or

  (ii)   arrangements of a class in which it is included are not employee health benefits schemes; and

  (c)   is not an employee health benefits scheme to the extent (if any) that the arrangement constitutes State insurance within the meaning of paragraph   51(xiv) of the Constitution.