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 2009 (No. 5)
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 2009 (No. 2) (the Rules) (as amended), which commenced on 30 July 2009, provide for the minimum benefit requirements for psychiatric, rehabilitation and palliative care and other hospital treatment. Schedules 1 to 5 of 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 2009 (No. 5) (the Amendment Rules) amend Schedule 4 and 5 of the Rules.
The purpose of the amendments to Schedule 4 of the Rules is to reflect the changes in the minimum benefits for hospital treatment for patients who are classified as “nursing-home type patients” at public hospitals in certain States/Territories and at private hospitals nationally to reflect the indexation applied to Adult Pension Basic Rate and the maximum daily rate of rental assistance that will be effective from 20 September 2009.
The purpose of the amendments to Schedule 5 of the Rules is to ensure that 17 new facilities are eligible for second tier default benefits. The insertion of 17 facilities into the table at clause 4 of Schedule 5 of the Rules increases the table from 287 facilities to 304 facilities.
Details of the Amendment Rules are set out in the Attachment.
Consultation
Department of Health and Families (NT), Queensland Health (QLD), Department of Health (SA), Department of Health and Human Services (TAS), Department of Health (VIC) and Department of Health (WA) were consulted with respect to increasing the minimum benefit for their jurisdictions in the circumstances described in Schedule 4 of the Rules. No objections were made.
Consultation for changes to Schedule 5 of the Rules occurred with industry through the Second Tier Advisory Committee, which includes equal representation from both the private hospital and private health insurance sectors.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
SEPTEMBER 2009
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2009 (No. 5)
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2009 (No. 5) (the Amendment Rules).
2. Commencement
Rule 2 provides that the Amendment Rules are to commence on 20 September 2009 or, if registered on a later date, the day after registration.
3. Amendment of Private Health Insurance (Benefit Requirements) Rules 2009 (No. 2)
Rule 3 provides that the Schedule to the Amendment Rules amends the Rules which commenced on 30 July 2009 and which were amended on 28 August 2009.
Schedule – Amendments
Item 1 – Schedule 4, Clause 6 Minimum benefit, Table 1
Schedule 4 of the Rules set out the minimum benefit payable per night for patients that are classified as Nursing Home Type Patients in hospitals.
Item 3 of the Schedule to the Amendment Rules increases the minimum benefit per night for public hospitals in the following States and Territories in clause 6, Table 1:
- Northern Territory From: $60.72 to $67.72
- Queensland From: $92.00 to $96.00
- South Australia From: $97.50 to $100.00
- Tasmania From: $99.25 to $109.20
- Victoria From: $99.15 to $101.65 and
- Western Australia From: $99.30 to $101.65
Item 4 – Schedule 4, Clause 6 Minimum benefit, Table 2
Schedule 4 of the Rules set out the minimum benefit payable per night for patients that are classified as Nursing Home Type Patients in hospitals.
Item 4 of the Schedule to the Amendment Rules decreases the minimum benefit per night for private hospitals in clause 6, Table 2:
- Private hospitals From: $69.75 to $65.60.
Item 5 – Schedule 5, Clause 4 Facilities, Table
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 if the health insurer does not have a negotiated agreement with the hospital. 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 5 of the Schedule to the Amendment Rules amends clause 4 of Schedule 5 of the Rules to specify that 17 new facilities are entitled to second tier default benefits.
The new facilities are:
1. | Adelaide Day Surgery | 18 North Terrace, ADELAIDE SA 5000 | ||
2. | Bankstown Primary Health Care Day Surgery | 67 Rickard Road, BANKSTOWN NSW 2200 | ||
3. | Bondi Junction Private Hospital | Level 1, 21 Spring Street, BONDI JUNCTION NSW 2022 | ||
4. | Eastern Suburbs Private Hospital | 8 Chapel Street, RANDWICK NSW 2031 | ||
5. | Harley Place Day Surgery | Suite 605, Harley Place, 251 Oxford Street, BONDI JUNCTION NSW 2022 | ||
6. | Holy Spirit Northside | 627 Rode Road, CHERMSIDE QLD 4032 | ||
7. | Hopewell Hospice | 11 Dunkirk Close, ARUNDEL QLD 4214 | ||
8. | Manly Waters Private Hospital | 17 Cove Avenue, MANLY NSW 2095 | ||
9. | Marie Stopes International - Canberra | Level 1, Cnr Moore & Alinga Streets, CANBERRA CITY ACT 2601 | ||
10. | Marie Stopes International – Westmead | 27 Railway Parade, WESTMEAD NSW 2145 | ||
11. | Minchinbury Community Private Hospital | Rupertswood Road, MOUNT DRUITT NSW 2770 | ||
12. | Oxford Day Surgery & Dermatology | 416-418 Oxford Street, MOUNT HAWTHORN WA 6016 | ||
13. | Pennant Hills Day Endoscopy Centre | 10 Ramsay Road, PENNANT HILLS NSW 2120 | ||
14. | Southern Respiratory & Sleep Disorders Centre | Level 2, Sutherland Hospital, The Kingsway, CARINGBAH NSW 2229 | ||
15. | Sydney Day Surgery | 213-219 Darlinghurst Road, DARLINGHURST NSW 2010 | ||
16. | Western Plains Day Surgery | 62 Windsor Parade, DUBBO NSW 2830 | ||
17. | Western Private Hospital | 1-9 Marion Street, FOOTSCRAY VIC 3011 | ||
As a result of these insertions, the table has increased from 287 facilities to 304 facilities.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
SEPTEMBER 2009