Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 8) (Cth)

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Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 8)

I, NICOLA ROXON, the Minister for Health and Ageing, make these Rules under item 3A of the table in section 333-20 of the Private Health Insurance Act 2007.

Dated 25 November 2010

____________________________________

NICOLA ROXON

Minister for Health and Ageing

Part 1Preliminary

1Name of Rules

These Rules are the Private Health Insurance (Benefit Requirements) Amendment Rules 20 10.

2.Commencement

These Rules commence on the day after registration.

3.Amendment of the Private Health Insurance (Benefit Requirements) Rules 2010

The Schedule amends the Private Health Insurance (Benefit Requirements) Rules 2010.

Schedule ― Amendments

[1]Part 1, rule 3

Insert

negotiated agreement means an agreement entered into between a hospital and an insurer, that includes provisions to the effect that, except to the extent (if any) provided in the agreement, the hospital agrees to accept payment by the insurer in satisfaction of any amount that would, apart from the agreement, be owed to the hospital, in relation to an episode of hospital treatment, by an insured person under a policy.

[2]Part 2, subrule 5(2)

Omit and substitute

(2) Despite subsection (1), if a policy covers a type of hospital treatment, other than treatment referred to in rule 4, and the insurer for that policy has a negotiated agreement with the hospital in which the treatment is provided, the minimum benefit for that treatment is the amount specified for the treatment in the negotiated agreement.

(3) Despite subrules (1) and (2), the minimum benefit for the treatment may be reduced by the amount of any co-payment or excess that is required to be paid under the insured person’s policy in respect of that treatment.

[3]Schedule 5, subclause 1(1), definition of negotiated agreement

Repeal the definition.

[4]Schedule 5, subclauses 3(1) and 3(2)

Omit the subsections and substitute

(1) Despite anything in Schedules 1, 2 or 3, but subject to subclause (2) of this clause, the minimum benefit for hospital treatment provided in the circumstances described in clause 2 of this Schedule is the amount worked out in accordance with this clause.

(2) Where hospital treatment is provided in the circumstances described in clause 2 of this Schedule, but:

(a) the minimum benefit worked out in accordance with this clause for the hospital treatment is below the amount determined in accordance with Schedules 1, 2 or 3 of these Rules; or

(b) an amount for the hospital treatment cannot be worked out in accordance with this clause,

the minimum benefit for that hospital treatment is the amount worked out in accordance with Schedules 1, 2 or 3 for that hospital treatment.

Note

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003.See

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