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PRIVATE HEALTH INSURANCE (PRUDENTIAL SUPERVISION) ACT 2015 (NO. 85, 2015) - SECT 168

Review of decisions

What decisions are reviewable?

             (1)  Each of the following decisions is a reviewable decision .

 

Reviewable decisions

Item

Decision

Provision under which decision is made

1

to refuse an application for registration as a private health insurer

section 15

2

to grant an application, subject to terms and conditions, for registration as a private health insurer

section 15

3

to refuse an application for approval for a private health insurer to convert to being registered as a for profit insurer

section 20

4

to refuse to approve the crediting of an amount to a health benefits fund of a private health insurer

subparagraph 27(3)(b)(ii)

5

to refuse to approve a restructure of the health benefits funds of a private health insurer

section 32

6

to refuse to approve a transfer of the health benefits funds of one or more private health insurers

section 33

7

to refuse to approve a termination of the health benefits funds of a private health insurer

section 37

8

to make, vary or revoke a prudential standard referred to in paragraph 92(3)(c)

section 92

9

to give a direction under section 96 on a ground specified in paragraph 96(1)(a), (b) or (c)

section 96

10

to vary, or to refuse to vary or revoke, a direction that was given under section 96 on a ground specified in paragraph 96(1)(a), (b) or (c)

section 99

11

to give a direction to terminate the appointment of a person as appointed actuary

section 115

Reconsideration of decision by APRA

             (2)  A person affected by a reviewable decision who is dissatisfied with the decision may request APRA to reconsider the decision.

             (3)  The request must:

                     (a)  be made by written notice given to APRA within 21 days after the day on which the decision first comes to the notice of the person, or within such longer period as APRA determines in writing; and

                     (a)  set out the reasons for making the request.

             (4)  Upon receiving the request, APRA must reconsider the decision and may confirm or revoke the decision, or vary the decision in a way that APRA considers appropriate.

             (5)  If APRA does not confirm, revoke or vary a decision within 21 days after the day on which APRA received the request, APRA is taken, at the end of that period, to have confirmed the decision under subsection (4).

             (6)  If APRA confirms, revokes or varies a decision before the end of the period referred to in subsection (5), APRA must, by notice served on the person who made the request:

                     (a)  tell the person of the result of APRA's reconsideration of the decision; and

                     (b)  set out the findings on material questions of fact; and

                     (c)  refer to the evidence or other material on which those findings were based; and

                     (d)  give APRA's reasons for confirming, revoking or varying the decision, as the case may be.

AAT review of decision

             (7)  Applications may be made to the Administrative Appeals Tribunal for the review of decisions of APRA that have been confirmed or varied under subsection (4).

             (8)  If a decision is taken, by subsection (5), to be confirmed, section 29 of the Administrative Appeals Tribunal Act 1975 applies as if the prescribed time for making application for review of the decision were the period beginning on the day on which the decision is taken to be confirmed and ending on the 28th day after that day.

Operation and implementation of a decision that is subject to a request for reconsideration

             (9)  If a person makes a request under subsection (2) in respect of a reviewable decision, section 41 of the Administrative Appeals Tribunal Act 1975 applies as if the making of the request were the making of an application to the Administrative Appeals Tribunal for review of that decision.



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