Commonwealth Numbered Acts Commonwealth Numbered ActsObligation to draw matters to attention of private health insurer or its directors
(1) The appointed actuary of a private health insurer must draw to the attention of the insurer, or the directors of the insurer, any matter that comes to the attention of the actuary and that the actuary considers requires action to be taken by the insurer or its directors:
(a) to avoid a contravention of this Act, the Private Health Insurance Act 2007 or the Financial Sector (Collection of Data) Act 2001 ; or
(b) to avoid prejudice to the interests of policy holders of a health benefits fund conducted by the insurer.
Obligation to inform APRA of matters
(2) If the appointed actuary of a private health insurer considers:
(a) that the insurer, or an officer of the insurer, may have contravened this Act or any other law; and
(b) that the contravention is of such a nature that it may affect significantly the interests of policy holders of a health benefits fund conducted by the insurer;
the appointed actuary must immediately inform APRA in writing of:
(c) his or her opinion; and
(d) the information on which it is based.
(3) Subsection (2) does not apply to the appointed actuary of a private health insurer in relation to a contravention if:
(a) an officer of the private health insurer informs the actuary that the private health insurer has informed APRA in writing of the contravention; and
(b) the actuary has no reason to disbelieve the officer.
(4) A person commits an offence if:
(a) the person is an officer of a private health insurer; and
(b) the person knows that:
(i) there are reasonable grounds for believing that the insurer, or an officer of the insurer, may have contravened this Act or any other law; and
(ii) the contravention is of such a nature that it may affect significantly the interests of policy holders of a health benefits fund conducted by the insurer; and
(c) the person informs the appointed actuary of the private health insurer that the private health insurer has informed APRA in writing of the contravention; and
(d) the private health insurer has not so informed APRA.
Penalty: Imprisonment for 12 months or 60 penalty units, or both.
Note: If a body corporate is convicted of an offence against this subsection, subsection 4B(3) of the Crimes Act 1914 allows a court to impose a fine of up to 5 times the penalty stated above.
(5) If:
(a) the appointed actuary of a private health insurer has drawn to the attention of the insurer, or of an officer of the insurer, a matter that the actuary considers requires action to be taken by the insurer or its directors:
(i) to avoid a contravention of this Act, the Private Health Insurance Act 2007 or the Financial Sector (Collection of Data) Act 2001 ; or
(ii) to avoid prejudice to policy holders of a health benefits fund conducted by the insurer; and
(b) the appointed actuary is satisfied that there has been reasonable time for the taking of the action but the action has not been taken;
the appointed actuary must inform APRA in writing of the matter referred to in paragraph (a).
(6) If:
(a) a person becomes subject to an obligation under subsection (2) or (5) to inform APRA of anything; and
(b) before the person informs APRA, the person ceases to be the appointed actuary of the private health insurer concerned;
the person remains subject to the obligation as if he or she were still the appointed actuary of the insurer.