Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 3)

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 2010 (No. 3)

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 2010 (the Rules), which commenced on 29 January 2010, 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. These are 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 2010 (No. 3) (the Amendment Rules) amend Schedules 1, 2, 3 and 4 of the Rules. 

Schedule 1 sets out minimum benefit levels in regard to overnight accommodation at private hospitals in all States and Territories and overnight shared accommodation at public hospitals in Victoria and Tasmania.  Schedule 2 sets out minimum benefit levels in regard to overnight shared accommodation at public hospitals in the remaining States and Territories.  Schedule 3 sets out minimum benefit levels in regard to same day accommodation for private hospitals and public hospitals in all States and Territories.  These accommodation components are subject to annual review and are amended with reference to Consumer Price Index (CPI) movements from March to March each year (with the exception of Queensland public hospitals). The Queensland public hospital increase is based on the December to December Brisbane CPI.

In the year from March 2009 to March 2010, there was an increase of 2.9% in the CPI. The Rules make changes to the minimum benefit levels in Schedule 1, 2 and 3 to reflect these increases in the CPI.

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 to reflect the indexation applied to Adult Pension Basic Rate and the maximum daily rate of rental assistance that came into effect from 20 March 2010. 

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

Consultation

Changes made to Schedules 1, 2, and 3 of the Rules reflect the increase in minimum benefits due to the CPI change from March 2009 to March 2010.  The increases to the minimum benefits in public hospitals were made with the agreement of the relevant State/Territory health authority. 

ACT Health (Australian Capital Territory), SA Health (South Australia) and the Department of Health and Families (Northern Territory) were consulted with respect to increasing the minimum benefit for their jurisdiction in the circumstances described in Schedule 4 of the Rules.  No objections were made.

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

JUNE 2010

ATTACHMENT

DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2010 (No. 3)

1. Name of Rules

Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 3) (the Amendment Rules).

2. Commencement

Rule 2 provides that the Amendment Rules are to commence on 1 July 2010 or, if registered on a later date, the day after registration.

3.              Amendment of Private Health Insurance (Benefit Requirements) Rules 2010

Rule 3 provides that the Schedule to the Amendment Rules amends the Rules which commenced on 29 January 2010.

Schedule – Amendments

Item 1 – Schedule 1, Subclause 2(2) Minimum benefit, Table 1

Schedule 1 of the Rules sets out the minimum benefit payable per night for patients in private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania, providing that the patient is not classified as a nursing-home type patient.

Item 1 of the Schedule to the Amendment Rules increases the minimum benefit per night for private hospitals in all States/Territories in subclause 2(2), Table 1:

Advanced surgical patient

- first 14 days  From: $356 to $366

- over 14 days  From: $247 to $254

Surgical patient or obstetric patient

- first 14 days  From: $329 to $339

- over 14 days  From: $247 to $254

Psychiatric patient

- first 42 days  From: $329 to $339

- 43 – 65 days  From: $286 to $294

- over 65 days  From: $247 to $254

Rehabilitation patient

- first 49 days  From: $329 to $339

- 50 – 65 days  From: $286 to $294

- over 65 days  From: $247 to $254

Other patients

- first 14 days  From: $286 to $294

- over 14 days  From: $247 to $254

Item 2 – Schedule 1, Subclause 2(2) Minimum benefit, Table 2

Schedule 1 of the Rules sets out the minimum benefit payable per night for patients in private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania, providing that the patient is not classified as a nursing-home type patient.

Item 2 of the Schedule to the Amendment Rules increases the minimum benefit per night for shared ward accommodation at Victorian public hospitals in subclause 2(2), Table 2:

Advanced surgical patient

- first 14 days  From: $356 to $366

- over 14 days  From: $247 to $254

Surgical patient or obstetric patient

- first 14 days  From: $329 to $339

- over 14 days  From: $247 to $254

Psychiatric patient

- first 42 days  From: $329 to $339

- 43 – 65 days  From: $286 to $294

- over 65 days  From: $247 to $254

Rehabilitation patient

- first 49 days  From: $329 to $339

- 50 – 65 days  From: $286 to $294

- over 65 days  From: $247 to $254

Other patients

- first 14 days  From: $286 to $294

- over 14 days  From: $247 to $254

Item 3 – Schedule 1, Subclause 2(2) Minimum benefit, Table 3

Schedule 1 of the Rules sets out the minimum benefit payable per night for patients in private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania, providing that the patient is not classified as a nursing-home type patient.

Item 3 of the Schedule to the Amendment Rules increases the minimum benefit per night for shared ward accommodation at Tasmanian public hospitals in subclause 2(2), Table 3:

Advanced surgical patient

- first 14 days  From: $356 to $366

- over 14 days  From: $247 to $254

Surgical patient or obstetric patient

- first 14 days  From: $329 to $339

- over 14 days  From: $247 to $254

Psychiatric patient

- first 42 days  From: $329 to $339

- 43 – 65 days  From: $286 to $294

- over 65 days  From: $247 to $254

Rehabilitation patient

- first 49 days  From: $329 to $339

- 50 – 65 days  From: $286 to $294

- over 65 days  From: $247 to $254

Other patients

- first 14 days  From: $286 to $294

- over 14 days  From: $247 to $254

Item 4 – Schedule 2, Clause 2 Minimum benefit, Table

Schedule 2 of the Rules sets out the minimum benefit payable per night for patients in shared ward accommodation at public hospitals in the ACT, NSW, Northern Territory, Queensland, South Australia and Western Australia, providing that the patient is not classified as a nursing-home type patient.

Item 4 of the Schedule to the Amendment Rules increases the minimum benefit per night for shared ward accommodation at ACT, NSW, Northern Territory and South Australian public hospitals in clause 2, Table:

• ACT   From: $294 to $303;
• NSW   From: $294 to $303;
• Northern Territory From: $294 to $303; and
• South Australia  From: $294 to $303.

Item 5 – Schedule 3, Subclause 2(2) Minimum benefit, Table 1

Schedule 3 of the Rules set out the minimum benefit payable for same-day accommodation patients in all the State/Territory hospitals, providing that:

1. hospital treatment is classified as a type B procedure; and
2. the patient is not classified as a nursing-home type patient.

Item 5 of the Schedule to the Amendment Rules increases the minimum benefit for same-day accommodation in public hospitals in NSW, ACT, Northern Territory, South Australia, Tasmania and Victoria in subclause 2(2), Table 1:

Item 6 – Schedule 3, Subclause 2(2) Minimum benefit, Table 2

Schedule 3 of the Rules set out the minimum benefit payable for same-day accommodation patients in all private hospitals in the States andTerritories, providing that the:

1. hospital treatment is classified as a type B procedure; and
2. the patient is not classified as a nursing-home type patient.

Item 6 of the Schedule to the Amendment Rules increases the minimum benefit per night for same-day accommodation in all State/Territory private hospitals in subclause 2(2), Table 2:

Item 7 – Schedule 4, Clause 6 Minimum benefit, Table 1

Schedule 4 of the Rules sets out the minimum benefit payable per night for patients that are classified as nursing-home type patients in hospitals. 

Item 7 of the Schedule to the Amendment Rules increases the minimum benefit per night for public hospitals in the following State and Territories in clause 6, Table 1:

• Northern Territory From: $67.72 to $70.47
• South Australia  From: $100.00 to $103.00
• ACT    From: $96.40 to $99.80

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

JUNE 2010