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.4)
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 Principal Rules) (as amended), 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 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 2010 (No.4) (the Amendment Rules) amends Schedule 5 of the Principal Rules.
The purpose of the amendments to Schedule 5 is to:
- ensure that 17 additional facilities are eligible for second tier default benefits;
- update the names of four hospitals;
- remove three facilities which have closed; and
- remove 18 facilities which have not reapplied for second tier default benefits.
These changes have decreased the table from 337 to 333 facilities.
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 2004.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
JULY 2010
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2010 (No.4)
1. Name of Rules
Rule 1 provides that the title of these Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No.4) (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 2010
Rule 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Benefit Requirements) Rules 2010 (the Principal Rules), which commenced on
29 January 2010 and were amended on 20 March 2010, 16 April 2010 and 1 July 2010.
Schedule – Amendments
Item 3 – Schedule 5, Clause 4
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 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 Principal Rules.
Item 3 provides that the table in Schedule 5, clause 4 of the Principal Rules is amended to insert 17 new facilities. The new facilities are:
| Name | Suburb | State |
| Chermside Dialysis Unit | CHERMSIDE | QLD |
| Diaverum Cannington Dialysis Clinic | CANNINGTON | WA |
| Diaverum Diamond Valley Dialysis Clinic | GREENSBOROUGH | VIC |
| Diaverum Stirling Dialysis Clinic | STIRLING | WA |
| Forest Hill Dialysis Clinic | FOREST HILL | VIC |
| Gosford Private Hospital | GOSFORD | NSW |
| Hartley Dialysis Clinic | BRIGHTON | SA |
| Lindfield Dialysis Clinic | LINDFIELD | NSW |
| Maitland Private Hospital | EAST MAITLAND | NSW |
| Malvern Dialysis Clinic | MALVERN | VIC |
| Modbury Dialysis Clinic | MODBURY | SA |
| Peninsula Endoscopy Centre | FRANKSTON | VIC |
| Reservoir Private Hospital | RESERVOIR | VIC |
| Southern Eye Centre, Day Surgery & Laser Clinic | FRANKSTON | VIC |
| Subiaco Private Hospital | SUBIACO | WA |
| The Glen Endoscopy Centre | GLEN WAVERLEY | VIC |
| Woodvale Private Hospital for Women | WOODVALE | WA |
Item 3 provides that the table in Schedule 5, clause 4 of the Principal Rules is amended to change the names of four facilities. The changes are:
From | Hervey Bay Surgical Centre | PIALBA | QLD |
To. | Hervey Bay Surgical Hospital | PIALBA | QLD |
From | Saint Frances Xavier Cabrini Hospital (Malvern) | MALVERN | VIC |
To | St Frances Xavier Cabrini Hospital - Malvern | MALVERN | VIC |
From | Saint Frances Xavier Cabrini Hospital (Prahran) | PRAHRAN EAST | VIC |
To | St Frances Xavier Cabrini Hospital - Prahran | PRAHRAN EAST | VIC |
From | St John of God Health Care (Ballarat) | BALLARAT | VIC |
To | St John of God Hospital, Ballarat | BALLARAT | VIC |
Item 3 provides that the table in Schedule 5, clause 4 of the Principal Rules deletes the following three hospitals as they have closed:
| Pioneer Valley Private Hospital | NORTH MACKAY | QLD |
| Logan Surgery Centre | LOGAN CENTRAL | QLD |
| Marie Stopes International – Caboolture | MORAYFIELD | QLD |
The following 18 facilities have been removed from Schedule 5, clause 4 of the Principal Rules as their eligibility for Second Tier expired on 30 June 2010.
| Name | Suburb | State |
| Bentleigh Surgicentre | BENTLEIGH | VIC |
| Calvary College Grove Rehabilitation Hospital | WALKERVILLE | SA |
| Calvary Health Care ACT | BRUCE | ACT |
| Calvary John James Hospital | DEAKIN | ACT |
| Calvary Wakefield Hospital | ADELAIDE | SA |
| Delmar Private Hospital | DEE WHY | NSW |
| Diagnostic Endoscopy Centre | DARLINGHURST | NSW |
| Healthwoods Specialist Centre | GRANVILLE | NSW |
| HOCA @ Mater | SOUTH BRISBANE | QLD |
| HOCA Chermside | CHERMSIDE | QLD |
| HOCA Gold Coast | SOUTHPORT | QLD |
| Inner West Endoscopy Centre | MARRICKVILLE | NSW |
| Melbourne Oral & Facial Surgery | MELBOURNE | VIC |
| Oral Surgery Day Centre | CHATSWOOD | NSW |
| South Western Day Surgical Centre | LIVERPOOL | NSW |
| Sydney IVF Canberra | DEAKIN | ACT |
| The Eye Institute | CHATSWOOD | NSW |
| The Wesley Clinic for Haemotology & Oncology | AUCHENFLOWER | QLD |
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
JULY 2010