EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, Paragraph (bj)
(HIB 05/2005)
Paragraph (bj) of Schedule 1 to the National Health Act 1953 (“the Act”) provides that the Minister may determine the minimum levels of benefit payable by a registered health benefits organization for an episode of hospital treatment provided to contributors, other than in emergencies, in a hospital or day hospital facility with which the organization does not have a hospital purchaser-provider agreement which covers such treatment. These benefits are known in the industry as “default benefits”.
The current determination was made on 30 June 1999 and is comprised of eight schedules setting out the minimum levels of benefit which are payable for a range of hospital treatment. These include benefits for overnight accommodation and day accommodation.
This determination amends the determination made on 30 June 1999 by omitting Schedule 4 (Nursing Home Type Patient Accommodation) and substituting a new Schedule 4. The new schedule reflects changes in benefits payable for overnight accommodation to the Nursing Home Type Patients (NHTPs) in private and public hospitals.
The charge for providing hospital treatment to NHTPs in private hospitals has been capped at $111.10 per day. The default benefit for NHTPs in private hospitals is set by subtracting the amount of the patient contribution from the capped amount. The patient contribution, which is not insurable, is calculated by reference to pension rates and set by the Minister’s Determination under subsection 3(1) of the Health Insurance Act 1973. The default benefit payable to NHTPs in private hospitals is modified each time that a change to the pension rate leads to a change to the amount of the patient contribution.
Consultation
Default benefits for NHTPs in public hospitals in all States and Territories are set in accordance with the daily bed rate for NHTPs calculated by each State and Territory minus the patient contribution as set by the Minister’s Determination under subsection 3(1) of the Health Insurance Act 1973. All States and Territories decide whether to adjust the daily bed rate for NHTPs each time there is a change to the standard pension rate. The Minister amends the default benefit payable for NHTPs in each State and Territory every time a particular State or Territory notifies the Commonwealth that it has modified its daily bed rate for NHTPs.
This determination adjusts the default benefit payable to NHTPs in private hospitals in all States/Territories and public hospitals within Northern Territory to take into account a recent change to the amount of the patient contribution.
This determination does not affect the default benefit payable in public hospitals in New South Wales, Queensland, South Australia, Tasmania, Victoria, Western Australia or the Australian Capital Territory.
This determination commences on 1 April 2005. 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
March 2005