EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (1)(bj)
(HIB 01/2007)
Schedule 1, paragraph (1)(bj) of the National Health Act 1953 (the Act) provides that the Minister may determine the minimum levels of benefits payable by a registered health benefits organization (RHBO) for hospital treatment provided to contributors, other than in emergencies, in a hospital or day hospital facility with which the RHBO does not have a hospital purchaser-provider agreement (HPPA) which covers such treatment. These benefits are known in the industry as “default benefits”.
The current Determination, dated 19 September 2006 (HIB20/2006) (as amended), is comprised of seven schedules setting out the minimum benefit levels payable for a range of hospital treatment.
This Determination amends HIB20/2006 by omitting Schedule 5 and substituting with a new Schedule 5.
Amendments to Schedule 5
Schedule 5 requires a RHBO to pay second tier default benefits for most episodes of hospital treatment provided in private hospitals and private day hospital facilities that are specified in Schedule 5 with which the RHBO does not have a HPPA. Schedule 5 sets a higher minimum level of benefit (for overnight treatment and day only treatment provided in specified facilities) than the minimum benefit set for such treatment by Schedules 1, 2, 3 and 7 of HIB20/2006.
This determination specifies eight new facilities that are entitled to second tier default benefits. The new facilities are:
1. | The Hornsby Sleep Disorder and Diagnostic Centre | Waitara | NSW |
2. | Holroyd Private Hospital | Guildford | NSW |
3. | Kawana Private Hospital | Birtinya | QLD |
4. | Eye-Tech Day Surgeries | Spring Hill | QLD |
5. | Eye-Tech Day Surgeries Southside | Upper Mt Gravatt | QLD |
6. | Bethesda Hospital | Claremont | WA |
7. | The Sydney Private Hospital | Ashfield | NSW |
8. | Townsville Day Surgery | Townsville | QLD |
Consultation
Consultation for changes to Schedule 5 occurred with industry through the Second Tier Advisory Committee, which includes equal representation from both the private hospital and health insurance fund sectors.
This determination commences on the day after registration on the Federal Register of Legislative Instruments.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
JANUARY 2007