Private Health Insurance Act 2007

For the purposes of paragraph 72‑1(1)(d), the *rules of the private health insurer that issues the policy meet the rules requirement in this section if the rules have the effect required by subsection (2).

The effect required is that if, under an agreement or arrangement with a private health insurer, a particular *health care provider (other than a *medical practitioner) provides particular *hospital treatment or *hospital‑substitute treatment to people insured under the same *complying health insurance product of the insurer, any charge for the treatment:

that is payable by an insured person; and

which is not recoverable by a benefit under the product;

the frequency with which that provider provides that particular treatment to people insured under that product; or

any other matter.

The Private Health Insurance (Complying Product) Rules may modify the effect required by subsection (2) in relation to all or particular kinds of *complying health insurance products, benefits, treatments or *health care providers. To the extent the Rules do so, the rules requirement is taken to be met if the conditions in the Rules are met.