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 2011 (No.10)
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 2011 (the Principal Rules), which commenced on 1 November 2011, 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 2011 (No.10) (the Amendment Rules) amends Schedule 5 of the Principal Rules.
The purpose of the amendment is to update the table at Clause 4 of Schedule 5 of the Principal Rules to:
- add 13 additional facilities that are eligible for second tier default benefits;
- delete one facility that has closed; and
- change an address of one facility.
These changes have increased the table of listed facilities from 361 to 373.
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
DECEMBER 2011
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2011 (No.10)
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2011 (No.10) (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 2011
Rule 3 provides that the Schedule to the Amendment Rules amends the Principal Rules which commenced on 1 November 2011.
Schedule – Amendments
Item 1 – Schedule 5, Clause 4 Facilities, Table
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 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to insert the following 13 new facilities:
Name | Address |
Imaging@Olympic Park | AAMI Park, Suite 2, 60 Olympic Boulevard, MELBOURNE VIC 3000 |
Lambton Road Day Surgery | 163 Lambton Road, BROADMEADOW NSW 2292 |
Marie Stopes International Bowen Hills | 8 Campbell Street, BOWEN HILLS QLD 4006 |
Marie Stopes International - Canberra | Level 1 Moore & Alinga Streets, CANBERRA CITY ACT 2601 |
Marie Stopes International East St Kilda | 338 Dandenong Road, EAST ST KILDA VIC 3182 |
Marie Stopes International Midland Centre | 8 Sayer Street, MIDLAND WA 6056 |
Marie Stopes International Rockhampton | 123 Bolsover Street, ROCKHAMPTON QLD 4700 |
Marie Stopes International Salisbury | 11 Hayling Street, SALISBURY QLD 4107 |
Marie Stopes International Southport | 34 Cougal Street, SOUTHPORT QLD 4215 |
Marie Stopes International Townsville | 26 Mcilwraith Street, TOWNSVILLE QLD 4810 |
Skin and Cancer Foundation (Westmead) Day Procedure Centre | 7 Ashley Lane, WESTMEAD NSW 2145 |
Steele Street Clinic | 166 Steele Street, DEVONPORT TAS 7310 |
Westmed Centre | 27 Railway Parade, WESTMEAD NSW 2145 |
Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to change the address of the following facility:
From: | 0015930K: | South Pacific Private Hospital | 18 Beach Street, CURL CURL NSW 2096 |
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To: | 0015930K: | South Pacific Private Hospital | 24 Beach Street, CURL CURL NSW 2096 |
Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to delete the following facility which closed on 30 September 2011:
Terrace West Endoscopy Centre | 18 Limestone Street, IPSWICH QLD 4305 |
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
DECEMBER 2011