EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (bj)
(HIB 04/2006)
Schedule 1, paragraph (bj) of the National Health Act 1953 (“the Act”) provides that the Minister may determine the minimum benefit levels payable by registered health benefits organisations for hospital treatment provided, other than in emergencies, in a hospital or day hospital facility with which the organisation does not have a hospital purchaser-provider agreement covering such treatment. These benefits are known in the industry as “default benefits”.
The current Determination dated 24 June 2005 (HIB 11/2005) (as amended), is comprised of seven schedules setting out the minimum benefit levels payable for a range of hospital treatment. These include benefits for overnight accommodation, and day accommodation.
This Determination amends the Determination dated 24 June 2005 (as amended) by omitting Schedule 3 and substituting a new Schedule 3 (HIB 04/2006).
Schedule 3 sets the default benefits payable for same day accommodation in hospitals and day hospital facilities in all States and Territories by specifying the default benefits that are payable in relation to Medicare Benefits Schedule (MBS) item numbers.
The new Schedule 3 has been amended to reflect changes to the Northern Territory level of benefits payable for same day accommodation in hospitals and day hospital facilities.
The changes are necessary because Schedule 3 links the default benefits that are payable to the types of professional services rendered to admitted hospital patients. The types of professional services rendered are identified by reference to MBS item numbers and fees.
CONSULTATION
The changes that vary the Schedule 3 level of benefit applying to the Northern Territory are of a machinery nature and do not substantially alter existing arrangements.
The Determination was made on 2 February 2006 and takes effect on the day following registration on the Federal Register of Legislative Instruments. The Determination and this explanatory statement have been lodged for registration on the Federal Register of Legislative Instruments.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
FEBRUARY 2006