Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 1) (Cth)

Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 1)

I, Lyndall Moore, delegate of the Minister for Health, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.

Dated 15th April 2015

Lyndall Moore

Lyndall Moore

Acting Assistant Secretary

Private Health Insurance Branch

Medical Benefits Division

Department of Health

Contents

PART 1PRELIMINARY

3. Authority 3

SCHEDULE – AMENDMENTS 4

Part 1Preliminary

1.Name of Rules

These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 1).

2.Commencement

These Rules commence on 1 May 2015.

3.Authority

These Rules are made under the Private Health Insurance Act 2007.

4.Schedules

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 Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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

Private Health Insurance (Prostheses) Rules 2015 (No. 1)

1. [1]

   Schedule, Part A, Group 01.09.06 – Intraocular Silicone Oils, after entry for Billing Code SO053

insert the heading “01.10.01 – Foldable”

under that heading insert the subheading “Spectrum Surgical”

under that subheading insert the contents of Item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum Benefit
1	SO076	HumanOptics Artificial Iris	One sterile, foldable Artificial Iris made of silicone, with or without fibre and custom made specific to the patient.	Custom made	$6,213.00

1. [2]

   Schedule, Part A, SubGroup 02.01.04.01 - Sound Processor, entry for Billing Code CO073

delete the contents of Item 1 of the table from the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum Benefit
1	CO073	Cochlear™ Baha® 4 Sound Processor	The Cochlear Baha 4 Sound Processor is a wireless-enabled, fully programmable head-worn digital sound processor for the Baha Implantable Bone Conduction	One size.	$6,500.00

1. [3]

   Schedule, Part A, SubGroup 02.01.04.01 - Sound Processor, after entry for Billing Code OI029

insert the subheading “Programmable, Wireless enabled”

under that subheading insert the subheading “Cochlear Limited”

under that subheading insert the contents of Item 1of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum Benefit
1	CO073	Cochlear™ Baha® 4 Sound	The Cochlear Baha 4 Sound Processor is a wireless-enabled, fully programmable head-worn digital sound processor for the Baha Implantable Bone Conduction	One size	$6,825.00

1. [4]

   Schedule, Part A, Group 05.04.01.02 - ≥ 500 sq cm, after entry for CT020

insert the subheading “Johnson & Johnson Medical Medical Pty Ltd”

under that subheading insert the contents of Item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum Benefit
1	JJ789	GYNECARE GYNEMESH	Pelvic floor reconstructive material, lightweight mesh	25 x 25 cm	$677.00

1. [5]

   Schedule, Part A, Group 06.03.15.03 – Ceramic, >10cc – 20cc, after entry for Billing Code ER159

delete the subheading “Eupharma”

delete the contents of Item 1 of the table from the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum Benefit
1	EH004	ELIZ Bone Graft Substitute	Synthetic HA / TCP Bone graft Substitute	Granules (1.0 - 4.0 mm) (0.8 - 1.5mm) (0.5 - 1.0mm) Volume / Vial ( 15.0 cc to 20.0cc)	$1,500.00

1. [6]

   Schedule, Part A, SubGroup 06.03.15.04 – Ceramic, >20cc, after entry for Billing Code ER160

delete the subheading “Eupharma”

delete the contents of Item 1 of the table from the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum Benefit
1	EH005	ELIZ Bone Graft Substitute	Synthetic HA / TCP Bone Graft	Granules (1.0 - 4.0 mm) (0.8 - 1.5mm)(0.5 - 1.0mm) Volume / Vial (25.0 cc to 30.0cc)	$1,560.00

1. [7]

   Schedule, Part A, Group 09.02.03 – Non-Stented, after entry for Billing Code MC015

insert the heading “09.02.04 - Rapid Deployment Aortic Valve with dedicated single use tools”

under that heading insert the subheading “b”

under that subheading insert the subheading “Sorin Group Australia Pty Ltd”

under that subheading insert the contents of Item 1 of the table in the columns indicated:

Item	Billing Code	Product	Description	Size	Minimum Benefit
1	SA170	Perceval S Sutureless Aortic Heart Valve	Sutureless Aortic Pericardial Heart Valve	S (19-21mm), M (21-23mm), L (23-25mm), XL (25-27mm)	$9,450.00