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

Administered by Department of Health, Disability and Ageing

Legislation au F2010L01646 Rules Not in force Legislative Instrument

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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:

 

Public hospitals

Band 1

Band 2

Band 3

Band 4

 

 

 

 

 

NSW

From: $213 to $219

From: $238 to $245

From: $263 to $270

From: $294 to $303

ACT

From: $213 to $219

From: $239 to $246

From: $262 to $270

From: $294 to $303

Northern Territory

From: $213 to $219

From: $243 to $250

From: $282 to $290

From: $294 to $303

South Australia

From: $213 to $219

From: $243 to $250

From: $268 to $276

From: $294 to $303

Tasmania

From: $206 to $212

From: $246 to $253

From: $285 to $293

From: $329 to $339

Victoria

From: $208 to $214

From: $247 to $254

From: $287 to $295

From: $329 to $339

 

 

 

 

 

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:

 

Private hospitals

Band 1

Band 2

Band 3

Band 4

 

 

 

 

 

 

From: $185 to $190

From: $232 to $239

From: $282 to $290

From: $329 to $339

 

 

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

Overview

The Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 3) were enacted to amend the Private Health Insurance (Benefit Requirements) Rules 2010 and address the need to update minimum benefit levels for various types of hospital treatment in response to inflation. These rules were introduced by the Minister for Health and Ageing under the authority granted by the Private Health Insurance Act 2007. The policy objective is to ensure that private health insurance policies provide adequate and updated benefits that reflect the changing costs of healthcare services. The rules were developed following consultations with relevant State/Territory health authorities and indexation adjustments were made in line with the Consumer Price Index movements from March 2009 to March 2010, as well as changes to the Adult Pension Basic Rate and the maximum daily rate of rental assistance. These amendments aim to ensure that insured patients receive the necessary hospital benefits that are proportionate to the actual costs of providing healthcare services.

Scope and Application

The Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 3) apply to all private health insurers operating in Australia and their members, focusing on the minimum benefit requirements for various hospital treatments. These rules are designed to ensure that private health insurance policies provide adequate coverage for specified medical procedures, including psychiatric, rehabilitation, and palliative care, as well as other hospital treatments. The amendment rules specifically address the minimum benefit levels for overnight and same-day accommodation in both public and private hospitals across all states and territories, as well as for patients classified as nursing-home type patients in public hospitals. The adjustments to these minimum benefits are indexed to the Consumer Price Index, with some variations for Queensland public hospitals, and are updated annually. The rules do not exempt any particular entity or individual from these requirements and apply uniformly across the Commonwealth. Subordinate instruments may further specify or modify these requirements as needed, ensuring that the benefits remain aligned with inflation and other relevant economic factors.

Key Provisions

The Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 3) (Amendment Rules) are an amendment to the existing Private Health Insurance (Benefit Requirements) Rules 2010, which outline the minimum benefit requirements for various types of hospital treatment under the Private Health Insurance Act 2007. These amendments, which came into effect on 1 July 2010, adjust the minimum benefit levels payable for overnight and same-day hospital accommodation, as well as for nursing-home type patients, in line with the Consumer Price Index (CPI) movements from March 2009 to March 2010. Specifically, the amendments increase the minimum benefits for overnight and same-day accommodation in both public and private hospitals across all states and territories, and for nursing-home type patients in public hospitals in certain states and territories. The Amendment Rules impose obligations on private health insurers to ensure that they comply with the updated minimum benefit requirements as outlined in Schedules 1 to 4. This includes providing the specified minimum levels of benefit for overnight and same-day accommodation in both public and private hospitals, as well as for nursing-home type patients in public hospitals. These requirements are intended to ensure that consumers have access to a minimum standard of care and coverage under their private health insurance policies. Insurers must also ensure that they communicate these updated benefit levels to their policyholders in a clear and transparent manner. Breaches of the minimum benefit requirements set out in the Amendment Rules may result in enforcement actions by the Australian Prudential Regulation Authority (APRA) or the Australian Competition and Consumer Commission (ACCC). These could include financial penalties, corrective notices, or other enforcement actions. The severity of the penalties will depend on the nature and extent of the breach, as well as any previous history of non-compliance. In the case of ongoing or repeated breaches, the authorities may also consider more severe penalties, including the possibility of revoking the insurer's registration or imposing other restrictions on their operations. Consumers who believe that their insurer has not complied with the minimum benefit requirements may also be able to lodge a complaint with the Private Health Insurance Ombudsman.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.