Private Health Insurance (Benefit Requirements) Amendment Rules 2009 (No. 6)

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. 6)

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 Principal 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 Principal 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. 6) (the Amendment Rules) amend Schedule 5 of the Principal Rules. The purpose of the amendment is to ensure that 12 additional facilities and one facility which changed its name are eligible for second tier default benefits. The insertion of 12 additional facilities into the table at clause 4, Schedule 5 of the Principal Rules increases the table from 304 facilities to 316 facilities. The Amendment Rules also re-number some facilities to ensure that the table is in alphabetical order.

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

Consultation

Consultation for changes to Schedule 5 occurred with industry through the Second Tier Advisory Committee (STAC), which includes equal representation from both the private hospital and private health insurance sectors. Facilities wishing to be considered for inclusion in Schedule 5 are individually assessed by the STAC which then makes a recommendation to the Minister as to whether or not the hospital meets the eligibility criteria.  This arrangement was negotiated with the private health industry and has been in place since Second Tier was introduced.

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

OCTOBER 2009

ATTACHMENT

DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2009 (No. 6)

1. Name of Rules

Rule 1 provides that the title of these Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2009 (No. 6) (the Amendment Rules).

2. Commencement

Rule 2 provides that the Amendment Rules commence on the day after registration.

3.              Amendment of Private Health Insurance (Benefit Requirements) Rules 2009 (No. 2)

Rule 3 provides that the table in clause 4, Schedule 5 of the Private Health Insurance (Benefit Requirements) Rules 2009 (No. 2) (the Principal Rules) is amended to specify that 12 new facilities are entitled to second tier default benefits.

Schedule 5 of the Principal 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 Principal Rules. 

The new facilities are:

Rule 3 of the Amendment Rules also changes the name of the following facility:

Rule 3 of the Amendment Rules also changes the order of the listed facilities in the table at clause 4 of schedule 5 of the Principal Rules to correct an error in the alphabetical order. The re-numbered facilities are:

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

OCTOBER 2009