Quick Links
In this section...
Legislation
In 1989, the Private Health Insurance Administration Council (PHIAC) was established as a body corporate under section 82B of the National Health Act 1953 (NH Act). The Private Health Insurance Act 2007 (PHI Act) came into effect from 1 April 2007. The functions of the Council pursuant to section 264-10 of this Act are:
General
(1) The functions of the Council are:
(a) to administer the *Risk Equalisation Trust Fund; and
(b) to administer the registration of private health insurers under Part 4-3; and
(c) the information collection function under subsection (2); and
(d) the compliance functions under subsection (3); and
(e) the enforcement functions under subsection (4); and
(f) the public information functions under subsection (5); and
(g) the agency cooperation functions under subsection (6); and
(h) to advise the Minister about the financial operations and affairs of private health insurers; and
(i) functions incidental to any other functions of the Council; and
(j) any other functions conferred on the Council by this, or any other, Act.
Information collection function
(2) The information collection function of the Council is to obtain from each private health insurer regular reports about the insurer’s operations, including reports supported by actuarial certification.
Compliance functions
(3) The compliance functions of the Council are:
(a) to establish a *solvency standard and a *capital adequacy standard to be complied with by private health insurers, and to give *solvency directions and *capital adequacy directions to private health insurers; and
Note: The solvency standard and the capital adequacy standard are established by the Private Health Insurance (Health Benefits Administration) Rules.
(b) to exercise powers and discretions under the *prudential standards, and to give directions to private health insurers relating to compliance with the prudential standards; and
Note: The prudential standards are established by the Private Health Insurance (Insurer Obligations) Rules.
(c) to consider, in accordance with Division 160, whether persons should, or should not, be *appointed actuaries; and
(d) to consider, in accordance with Division 166, whether persons should, or should not, be *disqualified persons; and
(e) to examine, from time to time, the financial affairs of private health insurers, by the inspection and analysis of the records, books and accounts of the insurers and any other relevant information; and
(f) to review, by carrying out independent actuarial assessment, the value of the assets and liabilities of each *health benefits fund; and
(g) if it is necessary, for the purpose of making a proper examination of the financial affairs of a private health insurer, for the Council to incur unusually high costs—to impose an appropriate fee on the private health insurer concerned.
Enforcement functions
(4) The enforcement functions of the Council are:
(a) to take action under Part 5-2 to monitor compliance with, and to encourage or compel compliance with, *Council-supervised obligations; and
(b) to appoint, under section 214-1, *inspectors for the purpose of investigating the affairs of private health insurers under Division 214, and to exercise other related powers and functions of the Council under that Division; and
(c) to appoint, under Subdivision 217-B, persons as *external managers of *health benefits funds, and to exercise other related powers and functions of the Council under Division 217 and 220.
Public information functions
(5) The public information functions of the Council are:
(a) to make statistics, and other financial information, relating to a private health insurer or private health insurers, publicly available in accordance with the Private Health Insurance (Council) Rules; and
(b) to collect and disseminate information about private health insurance, for the purpose of enabling people to make informed choices about private health insurance.
Agency cooperation functions
(6) The agency cooperation functions of the Council are:
(a) to cooperate with other regulatory agencies on matters affecting private health insurers and the private health insurance industry generally; and
(b) to provide the Private Health Insurance Ombudsman, from time to time, with information in the Council’s possession that the Council considers likely to be of use in production of the State of the Health Funds Reports referred to in paragraph 238-5(c).
(*Terms with an asterisk are explained in the Dictionary in Schedule 1 of the PHI Act.)