Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 4) (Cth)

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Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 4) 1

I, TRACEY DUFFY, delegate of the Minister for Health, make these Rules under item 3A of the table in section 333-20 of the Private Health Insurance Act 2007.

____________________________________

Tracey Duffy

Assistant Secretary

Private Health Insurance Branch

Medical Benefits Division

Department of Health

21 June 2016

Contents

PART 1PRELIMINARY3

1 Name of Rules 3

2. Commencement 3

3. Authority 3

4. Schedule3

Schedule

– Amendments4

Part 1Preliminary

1.

Name of Rules

These Rules are the Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 4).

2.Commencement

These Rules commence on 1 July 2016.

3.Authority

These Rules are made under item 3A of the table in section 333-20 of the Private Health Insurance Act 2007.

4.Schedule

  1. Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule A ― Amendments

Private Health Insurance (Benefit Requirements) Rules 2011

  1. 1

    Schedule 1, Part 1 – General, 2. Subclause 2. Minimum Benefit, Table 1

    Delete:

    Table 1 – Accommodation at private hospitals in all States/Territories

    Insert:

Table 1 – Accommodation at private hospitals in all States/Territories

Class of patient

Minimum benefit payable per night

Advanced surgical patient

- first 14 days

$415

- over 14 days

$289

Surgical patient or obstetric patient

- first 14 days

$386

- over 14 days

$289

Psychiatric patient

- first 42 days

$386

- 43 – 65 days

$334

- over 65 days

$289

Rehabilitation patient

- first 49 days

$386

- 50 - 65 days

$334

- over 65 days

$289

Other patients

- first 14 days

$334

- over 14 days

$289

  1. 2

    Schedule 1, Part 1 – General, 2. Subclause 2. Minimum Benefit, Table 2

    Delete:

    Schedule 1, Subclause 2 Minimum benefit, Table 2 – Victoria: shared ward accommodation at a public hospital

    Insert:

    1. Table 2 - Victoria:

      shared ward accommodation at a public hospital

Class of patient

Minimum benefit payable per night

Advanced surgical patient

- first 14 days

$415

- over 14 days

$289

Surgical patient or obstetric patient

- first 14 days

$386

- over 14 days

$289

Psychiatric patient

- first 42 days

$386

- 43 – 65 days

$334

- over 65 days

$289

Rehabilitation patient

- first 49 days

$386

- 50 - 65 days

$334

- over 65 days

$289

Other patients

- first 14 days

$334

- over 14 days

$289

  1. 3

    Schedule 1, Part 1 – General, 2. Subclause 2. Minimum Benefit, Table 3

    Delete:

    Schedule 1, Subclause 2 Minimum benefit, Table 3 - Tasmania: shared ward accommodation at a public hospital

    Insert:

Table 3 - Tasmania:

shared ward accommodation at a public hospital

Class of patient

Minimum benefit payable per night

Advanced surgical patient

- first 14 days

$415

- over 14 days

$289

Surgical patient or obstetric patient

- first 14 days

$386

- over 14 days

$289

Psychiatric patient

- first 42 days

$386

- 43 – 65 days

$334

- over 65 days

$289

Rehabilitation patient

- first 49 days

$386

- 50 - 65 days

$334

- over 65 days

$289

Other patients

- first 14 days

$334

- over 14 days

$289

4

Schedule 2, Clause 2 Minimum benefit, Table

Delete:

Schedule 2, Clause 2 Minimum benefit, Table

Insert:

Table

State/Territory

Minimum benefit payable per night

ACT

$343

NSW

$343

Northern Territory

$339

Queensland

$352

South Australia

$343

Western Australia

$343

  1. 5

    Schedule 3, Part 1, Subclause 2 Minimum benefit, Table 1:

Delete:

Schedule 3, Part 1, Subclause 2 Minimum benefit, Table 1

Insert:

Table 1

Public hospitals

Band 1

Band 2

Band 3

Band 4

NSW

$249

$279

$306

$343

ACT

$249

$279

$306

$343

Northern Territory

$246

$281

$326

$339

Queensland

$255

$287

$315

$352

South Australia

$249

$285

$314

$343

Tasmania

$242

$288

$333

$386

Victoria

$244

$289

$335

$386

Western Australia

$283

$283

$283

$283

  1. 6

    Schedule 3, Part 1, Subclause 2 Minimum benefit, Table 2:

Delete:

Schedule 3, Part 1, Subclause 2 Minimum benefit, Table 2

Insert:

Table 2

Band 1

Band 2

Band 3

Band 4

Private Hospitals

$215

$271

$330

$386

Schedule B – Amendments

Private Health Insurance (Benefit Requirements) Rules 2011

1

Schedule 4, Clause 6 Minimum benefit, Table 1

Delete:

ACT $117.65

Insert:

ACT $119.55

Schedule C - Amendments

Private Health Insurance (Benefit Requirements) Rules 2011

  1. 1

    Schedule 1, Part 2 – Type A Procedures, Clause 6 Surgical patient, Subclause (3)

    After ‘41831’ delete ‘41849’ and ‘41852’

  2. 2

    Schedule 3, Part 2 – Type B Procedures, Clause 4 Band 1, Subclause (1)(a), T8: Surgical Operations:

    After ‘32075’ delete ‘32078’ and ‘32081’

    After ‘41674’ delete ‘41680’

  3. 3

    Schedule 3, Part 2 – Type B Procedures, Clause 5 Non-band specific Type B day procedures, (1):

    After ‘41677’ delete ‘41695’

    After ‘41716’ delete ‘41761’

    After ‘41831’ delete ‘41849’ and ‘41852’

  4. 4

    Schedule 3, Part 3 – Type C Procedures, Clause 8. Interpretation, Items in the general medical services table, Category 2 – Diagnostic procedures & investigations, D1:

    After ‘11318’ delete ‘11321’

    After ‘11339’ delete ‘11500’

  5. 5

    Schedule 3, Part 3 – Type C Procedures, Clause 8. Interpretation, Items in the general medical services table, Category 2 – Diagnostic procedures & investigations, T4:

    After ‘16502’ delete ‘16504’

  6. 6

    Schedule 3, Part 3 – Type C Procedures, Clause 8. Interpretation, Items in the diagnostic imaging services table, Category 5 – Diagnostic Imaging Services, I3:

    After ‘58921’ delete ‘58924’

    After ‘59318’ delete ‘59503’

    After ‘59733’ delete ‘59736’

    After ‘59754’ delete ‘59760’

  7. 7

    Schedule 3, Part 3 – Type C Procedures, Clause 8. Interpretation, Items in the diagnostic imaging services table, Category 5 – Diagnostic Imaging Services, I4:

    After ‘61462’ delete ‘61465’

Schedule D - Amendments

Private Health Insurance (Benefit Requirements) Rules 2011

  1. 8

    Schedule 5 – Second-tier default benefits, Clause 4. Facilities, subclause (1)

Substitute

A hospital is a facility for the purposes of this Schedule if it is included in the list of second-tier eligible facilities approved by the Second Tier Advisory Committee existing at the time that the Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No.4) commence.

Notes

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

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