Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No. 2)

EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Private Health Insurance Act 2007

Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No. 2)

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Benefit Requirements) Rules providing for matters required or permitted by Part 3-3 of the Act, or necessary or convenient to be provided in order to carry out or give effect to Part 3-3 of the Act.

The Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2), which commenced on 1 July 2008 (the Rules), provide for the minimum benefit requirements for psychiatric, rehabilitation and palliative care and other hospital treatment. Schedules 1 to 5 to the Rules set out the minimum levels of benefit which are payable for hospital treatment. Namely, benefits for overnight accommodation (Schedules 1 and 2), same day accommodation (Schedule 3), nursing-home type patients (Schedule 4) and second tier default benefits (Schedule 5).

The Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No. 2) (the Amending Rules) amend Schedules 1, 3 and 5 of the Rules.

The purpose of these amendments is to reflect changes in the minimum benefits payable for overnight shared accommodation at public hospital in Victoria and to ensure that a new facility is eligible for second tier default benefits. In order to carry out this purpose, it is necessary for minimum benefit rates for Victoria in clause 2, Table 2 of Schedule 1 and clause 2, Table 1 of Schedule 3 to be amended, and for the new facility to be inserted into the table at clause 4 of Schedule 5 of the Rules.

Details of the Amending Rules are set out in the Attachment.

Consultation

The amendments made to Schedule 1 and 3 were made with the agreement of Victoria Health Department.

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.

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

JULY 2008

ATTACHMENT

DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2008 (No. 2)

1. Name of Rules

Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2008 (No. 2) (the Amending Rules).

2. Commencement

Rule 2 provides that the Amending Rules are to commence on the day after registration.

3.              Amendment of Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2)

Rule 3 provides that the Schedule to the Amending Rules amends the Private Health Insurance (Benefit Requirements) Rules 2008 (No. 2) which commenced on 1 July 2008 (the Rules).

Schedule – Amendments

Item 1 – Schedule 1, Clause 2

Schedule 1 of the Rules sets out minimum benefit levels in regard to overnight accommodation in private hospitals in all States/ Territories and shared ward accommodation at public hospitals in Victoria and Tasmania. These accommodation components are regularly subject to review and amendment. The Amending Rules increase Victoria’s minimum benefits payable per night by $1 from $279 to $280 in the following categories:

• Psychiatric: 43 – 65 days;
• Rehabilitation: 50 – 65 days;
• Other patients: first 14 days.

 No other changes have been made to Table 2 in clause 2 of Schedule 1 of the Rules.

Item 2 – Schedule 3, Clause 2

Schedule 3 of the Rules sets out minimum benefit levels in regard to same-day accommodation for hospitals in all States/ Territories. These accommodation components are regularly subject to review and amendment. The Amending Rules increase Victoria’s minimum benefits payable for hospital treatment with respect to public hospitals that are classified as Band 3 by $1 from $279 to $280.

No other changes have been made to Table 1 in clause 2 of Schedule 3 of the Rules.

Item 3 – Schedule 5, Clause 4

Schedule 5 of the Rules requires a health insurer to pay second tier default benefits for most episodes of hospital treatment provided in private hospital facilities that are specified in Schedule 5 with which the health insurer does not have a negotiated agreement. 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 and 3 of the Rules.

Item 1 of the Schedule to the Amending Rules amends clause 4 of Schedule 5 of the Rules to specify a new facility that is entitled to second tier default benefits.

The new facility is:

As a result of this insertion, the table has increased from 279 listed facilities to 280 listed facilities. No change has been made to the previously listed facilities.

The Amending Rules commence on the day after registration on the Federal Register of Legislative Instruments. 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

JULY 2008