These rules set out the General Conditions (Fund Rules A to G) and the Schedule of Benefits and Specific Conditions applying to the operation of the Reserve Bank Health Society Limited ABN 91 087 648 735 ("RBHS").
Updated Fund Rules 15 October 2025
To view all the changes to the Fund Rules, you can view the updated copy of the Fund Rules effective on and after 15th October 2025 here.
Private health insurance can be complex, and we’re committed to making sure the information regarding your health cover is clear and easy to understand. Outlined below are key changes (effective 15 October 2025) to the Fund Rules that may be most relevant to your health cover.
- Policy holder obligations: When RBHS sends out important information, we send it to the Policy Holder. We have amended Fund Rule A9 to add an obligation for the Policy Holder to share this important information with everyone else on the Policy if it applies to them.
- Definition of Accident: We have updated the definition of ‘Accident’ in Fund Rule B2 so members know when they are eligible to make a claim. An ‘Accident’ means an unforeseen event, occurring by chance and caused by an external force or object, which causes involuntary bodily injury requiring medical treatment in a Hospital within seven (7) days, but excludes unforeseen conditions attributable to medical causes.
- Other definitions: Several definitions in Fund Rule B2 have been amended or added, to provide further clarity on how RBHS defines these terms.
- Rights of policy holders and members: Fund Rule C1 has been updated to include a minimum age for a policy holder, and information on how a policy holder can authorise another person to operate the policy on their behalf (for example, which members on your policy are entitled to upgrade or downgrade your level of health cover).
- Health cover application rejection: Fund Rule C4 has been amended to include a right for RBHS to reject a membership application (for example, if you have broken our fund rules before and wanted to join us again, we may refuse your application).
- Transfers between health funds: Fund Rule C6 has been updated to clarify the processes relating to transfers to and from RBHS to another health fund, including explaining when waiting periods will and will not apply, and when benefits paid under a previous health cover will be considered.
- Cancellation of health cover: Fund Rule C7 has been updated to include the right for partners or dependants aged at least 16 to leave the Policy, without agreement of the Policy Holder, and to clarify how refunds are issued if a Policy is cancelled within 30 days of purchase.
- Temporary health cover suspension: Fund Rule C9 has been updated to clarify when suspension will be effective, and to clarify the effects of the suspension.
- Benefit payments for treatments: Fund Rules E1, E2 and E3 have been updated to clarify how and when we pay benefits for hospital and general treatments. These updates include the introduction of a process to de-recognise providers in cases such as fraud. If a provider is de-recognised, treatments they deliver will not be eligible for benefit payments.
- Calculation of benefits: Fund Rules E2 and E3 has been amended to provide clarity around how benefits are paid and the factors that impact payment of benefits.
- Recovery of benefits paid in error: Fund Rule E4 has been updated to include a right for RBHS to recover benefits that have been paid to a member by mistake.
- Exclusions: Fund Rule F4 has been amended to include circumstances where benefits are not payable.
- Compensation and provisional payment of claims: Fund Rule F7 has been updated to clarify that benefits are not payable for treatment for which the member has received (or is entitled to receive) compensation in respect of that treatment, and the rights of RBHS and members in relation to the provisional payment of these claims.
- Claim processes: Fund Rule G has been updated to include further information regarding how claims can be made, evidence required and other relevant matters regarding making a claim.