EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (1)(bj)
(HIB 02/2007)
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”.
This determination is comprised of seven schedules setting out the minimum levels of benefit which are payable for a range of hospital treatment. Namely, benefits for overnight accommodation (Schedules 1 and 2), same day accommodation (Schedule 3), nursing home type patients (Schedule 4), second tier default benefits (Schedule 5), care plans and case conferencing (Schedule 6) and outreach services (Schedule 7).
This determination revokes and remakes HIB20/2006 (as amended) to incorporate amendments to Schedule 5.
Amendments to Schedule 5
Schedule 5 of this determination 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 Schedule 1, paragraph (1)(bj) of the Act.
Changes to Facilities Specified as Eligible for Second Tier Default Benefits
This determination specifies two new facilities to be entitled to second tier default benefits and amends the name of the currently specified facility Pendlebury Clinic to Pendlebury Clinic Private Hospital. The new facilities are:
1. | Delmar Private Hospital | Dee Why | NSW |
2. | Wolper Jewish Private Hospital | Woollahra | NSW |
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
FEBRUARY 2007