PHI 72/11

This circular issued by the Private Health Insurance Branch contains information on Private Health Insurance (Complying Product) Rules – Pilot Projects

Page last updated: 02 November 2012

Printable version of 72/11 (PDF 31 KB)

29 September 2011

Private Health Insurance (Complying Product) Rules – Pilot Projects

The Minister for Health and Ageing has amended the Private Health Insurance (Complying Product) Rules 2010 (No.2) to allow private health insurers to conduct pilot projects in accordance with section 55-15 of the Private Health Insurance Act 2007. Section 55-15 of the Private Health Insurance Act 2007 provides that private health insurers may run pilot projects in accordance with the Private Health Insurance (Complying Product) Rules.

The purpose of the Private Health Insurance (Complying Product) Amendment Rules 2011 (No.5) (the Amendment Rules) is to allow private health insurers to conduct pilot projects to test innovative products with a limited group of policy holders in the interests of developing better and more cost effective health outcomes for consumers without risking breaching the community rating requirements of the Private Health Insurance Act 2007.

The Amendment Rules have been registered with the Federal Register of Legislative Instruments and take effect on 29 September 2011.

The Amendment Rules and the associated explanatory statement can be found on the ComLaw website.

The pilot projects that an insurer can offer are limited to the kind stated in the Amendment Rules and must meet the requirements as specified in the Amendment Rules.

The kinds of pilot projects permitted are projects that enable an insurer to trial and develop, with a limited group of policy holders, new models of service delivery or health care. The objectives of the pilot project must be for any or all of the following:
  1. to increase the value to consumers of their health insurance products by better meeting their needs;
  2. to prolong health, improve quality of life and reduce expenditure on hospital benefits by preventing and reducing disease and prevent the need for hospitalisation;
  3. to produce products that better reflect advances in medical knowledge and service delivery models.
Pilot project are to be conducted in accordance with all the following requirements:
  1. an insurer must not charge a person to participate in the project;
  2. participation in a pilot project must be voluntary;
  3. a pilot project may be conducted for a maximum of two years;
  4. an insurer may only limit participation in a pilot project on the basis of where a person lives;
  5. an insurer must develop a written plan for a pilot project, including a timeline and evaluation process;
  6. written notice of the details of the project, including a copy of the written plan referred to in (e), must be provided to the Department at least 28 days before the pilot project commences.
If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch

For more information visit 2011 Private Health Insurance (PHI) Circulars.

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