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.7)
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.7) (the Amendment Rules) amends Schedule 5 of the Principal Rules.
The purpose of the amendments to Schedule 5 is to:
- remove Item Numbers from the table in Clause 4;
- ensure that 11 additional facilities are eligible for second tier default benefits;
- update the names of 31 hospitals; and
- remove one facility which has merged with another.
These changes have increased the table from 333 to 343 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
OCTOBER 2010
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2010 (No.7)
1. Name of Rules
Rule 1 provides that the title of these Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No.7) (the Amendment Rules).
2. Commencement
Rule 2 provides that the Amendment Rules commence on the day after registration on the Federal Register of Legislative Instruments.
3. Amendment of the 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, 8 July 2010 and 20 August 2010.
Schedule – Amendments
Item 1 – 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 1 replaces the table at clause 4 of Schedule 5 with a table that does not include item numbers.
Item 1 provides that the table at clause 4 of Schedule 5 of the Principal Rules is amended to insert 11 new facilities. The new facilities are:
| Name | Suburb | State |
| Bunbury Day Surgery | BUNBURY | WA |
| Calvary College Grove Rehabilitation Hospital | WALKERVILLE | SA |
| Calvary John James Hospital | DEAKIN | ACT |
| Macquarie University Hospital | MACQUARIE PARK | NSW |
| Mercy Hospital Mount Lawley | MOUNT LAWLEY | WA |
| Nephrocare Bondi Dialysis Clinic | BONDI JUNCTION | NSW |
| Northern Endoscopy Centre | SALISBURY SOUTH | SA |
| Oral Surgery Day Centre | CHATSWOOD | NSW |
| Perth Day Surgery Centre | LEEDERVILLE | WA |
| Sydney IVF Canberra | DEAKIN | ACT |
| Vision Eye Institute | CHATSWOOD | NSW |
Item 1 provides that the table at clause 4 of Schedule 5 of the Principal Rules is amended to correctly reflect the names of 31 facilities. The changes are:
From | Adelaide Community Healthcare Alliance Inc – Ashford Campus | ASHFORD | SA |
To | Ashford Community Hospital | ASHFORD | SA |
From | Adelaide Community Healthcare Alliance Inc – Flinders Private Hospital Campus | BEDFORD | SA |
To | Flinders Private Hospital | BEDFORD | SA |
From | Adelaide Community Healthcare Alliance Inc – The Memorial Hospital Campus | ADELAIDE | SA |
To | Memorial Hospital | ADELAIDE | SA |
From | Calvary Hospital (Lenah Valley Campus) | LENAH VALLEY | TAS |
To | Calvary Health Care Tasmania (Hobart) | LENAH VALLEY | TAS |
From | Calvary Private Hospital (Riverina) | WAGGA WAGGA | NSW |
To | Calvary Private Hospital Wagga Wagga | WAGGA WAGGA | NSW |
From | Cliveden Hill Private Hospital | MELBOURNE EAST | VIC |
To | Epworth Cliveden | MELBOURNE EAST | VIC |
From | Coffs Harbour Day Surgery Centre | COFFS HARBOUR | NSW |
To | Coffs Harbour Day Surgical Centre | COFFS HARBOUR | NSW |
From | Dalcross Private Hospital | KILLARA | NSW |
To | Dalcross Adventist Hospital | KILLARA | NSW |
From | Dandenong Eye Clinic & Day Surgery Centre | DANDENONG | VIC |
To | Dandenong Eye Clinic | DANDENONG | VIC |
From | Elsternwick Private Hospital | ELSTERNWICK | VIC |
To | Cabrini Health Elsternwick Rehabilitation Service | ELSTERNWICK | VIC |
From | Frances Perry Private Hospital | CARLTON | VIC |
To | Frances Perry House | CARLTON | VIC |
From | Joondalup Private Hospital | JOONDALUP | WA |
To | Joondalup Health Campus | JOONDALUP | WA |
From | Marie Stopes International – Westmead | WESTMEAD | NSW |
To | Westmed Centre | WESTMEAD | NSW |
From | Mater Misericordiae Day Unit (Mackay) | MACKAY | QLD |
To | Mater Misericordiae Day Unit | MACKAY | QLD |
From | Minchinbury Community Private Hospital | MOUNT DRUITT | NSW |
To | Minchinbury Community Hospital | MOUNT DRUITT | NSW |
From | Mount Olivet Hospital | KANGAROO POINT | QLD |
To | St Vincent’s Hospital Brisbane | KANGAROO POINT | QLD |
From | New Farm Private Hospital | NEW FARM | QLD |
To | New Farm Clinic | NEW FARM | QLD |
From | Niola Private Hospital | WEST LEEDERVILLE | WA |
To | Abbotsford Private Hospital | WEST LEEDERVILLE | WA |
From | Noosa Private Hospital | NOOSAVILLE | QLD |
To | Noosa Hospital | NOOSAVILLE | QLD |
From | Northside Clinic Private Hospital | GREENWICH | NSW |
To | Northside Clinic | GREENWICH | NSW |
From | Ophthalmic Surgery Centre | CHATSWOOD | NSW |
To | Ophthalmic Surgery Centre (North Shore) | CHATSWOOD | NSW |
From | Peninsula Private Hospital (Frankston) | FRANKSTON | VIC |
To | Peninsula Private Hospital | FRANKSTON | VIC |
From | Peninsula Private Hospital (Kippa-Ring) | KIPPA-RING | QLD |
To | Peninsula Private Hospital | KIPPA-RING | QLD |
From | Southern Respiratory & Sleep Disorders Centre | CARINGBAH | NSW |
To | Southern Respiratory and Sleep Disorders Centre | CARINGBAH | NSW |
From | St John of God Health Care Nepean Rehabilitation Hospital | FRANKSTON | VIC |
To | St John of God Nepean Rehabilitation Hospital | FRANKSTON | VIC |
From | St John of God Health Care (Warrnambool) | WARRNAMBOOL | VIC |
To | St John of God Hospital (Warrnambool) | WARRNAMBOOL | VIC |
From | St Vincent’s & Mercy Private Hospital, Mercy Campus | MELBOURNE EAST | VIC |
To | Mercy Private Hospital | MELBOURNE EAST | VIC |
From | St Vincent’s Hospital | FITZROY | VIC |
To | St Vincent’s Private Hospital | FITZROY | VIC |
From | St Vincent’s Private Hospital (Bathurst) | BATHURST | NSW |
To | Bathurst Private Hospital | BATHURST | NSW |
From | Sydney Adventist Private Hospital | WAHROONGA | NSW |
To | Sydney Adventist Hospital | WAHROONGA | NSW |
From | Westmead Rehabilitation Centre | MERRYLANDS | NSW |
To | Westmead Rehabilitation Hospital | MERRYLANDS | NSW |
Item 1 also provides that the table at clause 4 of Schedule 5 of the Principal Rules deletes the following hospital, following its merger with St John of God Hospital, Murdoch.
| St John of God Murdoch Community Hospice | MURDOCH | WA |
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
OCTOBER 2010