Private Health Insurance (Prostheses) Amendment Rules 2010 (No. 2) (Cth)

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Private Health Insurance (Prostheses) Amendment Rules 2010 (No.2)

I, NICOLA ROXON, Minister for Health and Ageing, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.

Dated 15th December 2010

Nicola Roxon

________________________

Nicola Roxon

Minister for Health and Ageing

1Name of Rules

These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2010 (No.2).

2Commencement

These Rules commence on the day after registration.

3Amendments to the Private Health Insurance (Prostheses Rules) 2010 (No.2)

The Schedule amends the Private Health Insurance (Prostheses) Rules 2010 (No. 2).

Schedule Amendments to the Private Health Insurance (Prostheses) Rules 2010 (No.2)

(rule 3)

[1]Part 1, rule 4, after the definition of Act

insert

certified overnight Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

certified Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.

consultant physician has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

[2]Part 1, rule 4, after the definition of gap permitted prosthesis

insert

implantable cardiac event recorderincludes a component of an implantable cardiac event recorder.

insulin infusion pump includes a component of an insulin infusion pump.

listing application has the same meaning as in subsection 72-10(6) of the

Act.

listing criteriahas the same meaning as in subsection 72-10(6) of the Act.

[3]Part 1, rule 4, after the definition of private hospital

insert

professional attendance has the same meaning as in clause 1.2.3 of the Health Insurance (General Medical Services Table) Regulations 2010.

[4]Part 2, paragraph 5 (b)(ii)

substitute

(ii) the provision of the prosthesis is associated with podiatric treatment by an accredited podiatrist; or

[5]Part 2, after paragraph 5(b)(ii)

insert

  1. (iii)

    for a prosthesis that is an insulin infusion pump:

    (A) the insulin infusion pump is provided during a professional service for which a medicare benefit is payable; and

    (B) the professional service is a professional attendance by a consultant physician in the practice of his or her specialty; and

    (C) the professional service is provided as a certified Type C procedure or certified overnight Type C procedure; and

    (D) the insulin infusion pump is provided for the purpose of administering insulin; and

[6]Part 2, subrule 5(c)

substitute

(c) rule 7 sets out the method for working out the minimum benefit and maximum benefit for hospital-substitute treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis in circumstances where a medicare benefit is payable in respect of the professional service associated with the provision of the prosthesis; and

[7]Part 2, after subrule 5(c)

insert

  1. (d)

    rule 10 sets out listing criteria for the purposes of subsection 72‑10(6) of the Act in relation to the granting of a listing application for listing of a kind of prosthesis on Part C of the Schedule.

[8] Part 2, after rule 9

insert

10.Listing criteria for prostheses to be listed on Part C of the Schedule

For a listing application to list a kind of prosthesis on Part C of the Schedule, the listing criteria are that the kind of prosthesis is an:

(i) insulin infusion pump; or

(ii) implantable cardiac event recorder.

Note: The Minister may refuse to grant a listing application even if the listing criteria are satisfied.

[9]Schedule, after Part B, page 15 of 15

insert as heading

Part C – Other Prostheses Subject to Listing Criteria

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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