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.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), 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 2011 (No.7) (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 14 additional facilities that are eligible for second tier default benefits;
- change an address of one facility; and
- correct the listed order of two facilities.
These changes have increased the table of listed facilities from 347 to 361.
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
SEPTEMBER 2011
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2011 (No.7)
1. Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2011 (No.7) (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 Principal Rules which commenced on 29 January 2010.
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 14 new facilities:
Name | Address |
Castle Hill Hospital | 72-74 Cecil Avenue, CASTLE HILL NSW 2154 |
Dandenong Eye Clinic & Day Surgery Centre | 1-3 Falkiner Crescent, DANDENONG VIC 3175 |
Double Bay Day Surgery, The | 20 Manning Road, DOUBLE BAY NSW 2028 |
Frankston Private Day Surgery | Lot T5, Levels 1 and 2, 24-28 Frankston Flinders Road, FRANKSTON VIC 3199 |
HOCA @ Mater | 293 Vulture Street, SOUTH BRISBANE QLD 4101 |
HOCA @ Wesley | 1st Floor, Wesley Medical Centre, 40 Chasley Street, AUCHENFLOWER QLD 4066 |
HOCA Gold Coast | Level 9, Premion Place, 39 White Street, SOUTHPORT QLD 4215 |
Mogo Day Surgery | 2-4 Charles Street, MOGO NSW 2536 |
North Brisbane Cancer Centre | Chermside Medical Centre, 930-956 Gympie Road, CHERMSIDE QLD 4032 |
Queensland Eye Hospital | 55 Little Edward Street, SPRING HILL QLD 4004 |
Sydney IVF Day Surgery | Level 4, 321 Kent Street, SYDNEY NSW 2000 |
Sydney IVF Liverpool | 173-175 Bigge Street, LIVERPOOL NSW 2170 |
Tarietta Day Surgery | 73 Kooyong Road, CAULFIELD NORTH VIC 3161 |
Western Hospital | 168 Cudmore Terrace, HENLEY BEACH SA 5022 |
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 | Diaverum Diamond Valley Dialysis Clinic | 25 Grimshaw Street, GREENSBOROUGH VIC 3088 |
To | Diaverum Diamond Valley Dialysis Clinic | 15 Grimshaw Street, GREENSBOROUGH VIC 3088 |
Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to correct the listed order of the following facilities:
From: | The CAPS Clinic | 7 Phipps Close, DEAKIN ACT 2600 |
| The Cairns Clinic | 253 Sheridan Street, NORTH CAIRNS QLD 4870 |
To: | The Cairns Clinic | 253 Sheridan Street, NORTH CAIRNS QLD 4870 |
| The CAPS Clinic | 7 Phipps Close, DEAKIN ACT 2600 |
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
SEPTEMBER 2011