Comply with Private Health Insurance Act 2007 + APRA rules
Private health insurers regulated by APRA + PHIO; community rating, complaints + claims rules apply.
Who must comply
Private health insurers.
What triggers it
Carrying on private health insurance business.
When due
Continuous.
Evidence required
Product disclosure statements, complaint records, APRA reporting, PHIO engagement.
Max penalty
APRA enforcement, civil penalties under PHI Act, registration consequences
Summary
The Private Health Insurance Act 2007 sets community rating, lifetime health cover loading, product disclosure + complaint-handling rules. APRA supervises prudential aspects; the Private Health Insurance Ombudsman handles individual complaints.
Enforced by
Source legislation
Industries
Topics
Related obligations
- CWLTHComply with claims handling + settling as a financial service (s 766A)From 1 January 2022, insurance claims handling is a financial service requiring AFSL authorisation.
- CWLTHComply with General Insurance Code of Practice (ICA)ICA Code binds member insurers on conduct + claims + complaints.
- CWLTHManage business interruption claim definitions (post-pandemic precedent)BI insurance policies must clearly define pandemic exclusions per Federal Court guidance.
- CWLTHGeneral Insurance Code of Practice 2020ICA member insurers bound by service standards + claims handling timeframes.
- CWLTHLife Insurance Code of Practice 2.0FSC member life insurers bound by Code 2.0 (commenced 1 July 2023).
- CWLTHPHI Prudential Standards (APRA)Private health insurers must meet capital + governance standards.
Frequently asked questions
- Who must comply with Private Health Insurance Act 2007 + APRA rules?
- Private health insurers.
- What triggers Private Health Insurance Act 2007 + APRA rules?
- Carrying on private health insurance business.
- When is Private Health Insurance Act 2007 + APRA rules due?
- Continuous.
- What is the maximum penalty for Private Health Insurance Act 2007 + APRA rules?
- APRA enforcement, civil penalties under PHI Act, registration consequences
- What evidence is required for Private Health Insurance Act 2007 + APRA rules?
- Product disclosure statements, complaint records, APRA reporting, PHIO engagement.
Source: https://apra.gov.au/private-health-insurance. Rules Mate is not a law firm. Always verify against the live regulator source before acting.