EXPLANATORY STATEMENT
Issued by Authority of the Minister for Health and Ageing
National Health Act 1953
Determination under Schedule 1, paragraph (bj)
(HIB 10/2005)
Schedule 1, paragraph (bj) of 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 (RHBO) for an episode of 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 which covers such treatment. These benefits are known in the industry as “default benefits”.
The current Determination made on 30 June 1999 comprises eight schedules setting out the minimum levels of benefit which are payable for a range of hospital treatment. These include benefits for overnight accommodation, day accommodation, prostheses and second tier default benefits.
Schedule 5 (Benefits Payable in Respect of Prostheses and Human Tissues) of the current Determination has two parts:
- Part A – Prostheses; and
- Part B – Human Tissues.
Schedule 5 prescribes the prostheses and human tissues that RHBOs must fully fund for their members who have taken out a policy under which benefits are payable for the items.
For prostheses the benefit payable is the charge for the item negotiated between the RHBO and one only of the manufacturer, supplier or hospital (or their agent).
For human tissues the benefit payable is set by the Minister with reference to applications from suppliers.
This determination amends the determination made on 30 June 1999 by omitting Schedule 5 (Benefits Payable in Respect of Prostheses and Human Tissues) and substituting a new Schedule 5.
The Department of Health and Ageing assesses applications from manufacturers and suppliers to include items in Schedule 5 in February and August of each year.
In assessing the applications for listing on the Schedule in February 2005, some errors were made in entering information about products, and some products were inadvertently omitted from the Schedule.
This determination substitutes the Schedule 5 of February 2004 for a Schedule that incorporates the correction of these errors and omissions.
The new Schedule 5 modifies the previous Schedule by:
- adding a number of new items; and
- amending the details of items already on the Schedule to correct errors.
CONSULTATION
This determination has been made having regard to advice provided by the Prostheses and Devices Committee (PDC), a ministerially appointed committee comprised of members from the major stakeholder groups – the Australian Health Insurance Association, the Australian Private Hospitals’ Association, Catholic Health Australia, the Australian Medical Association, the Consumers’ Health Forum, the Medical Industry Association of Australia and the Commonwealth Department of Veterans’ Affairs.
The PDC considered the applications for listing of new products that were omitted from the determination made in February 2005.
Corrections to details of products already listed have been made in consultation with the suppliers of the products.
The determination takes effect on 27 May 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
MAY 2005