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.9)
Authority
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) Amendment Rules 2011 (No.9) (the Amendment Rules) amend Schedule 5 of the Private Health Insurance (Benefit Requirements) Rules 2010 (the Principal Rules).
Purpose
The purpose of the amendment is to update the table at Clause 4 of Schedule 5 of the Principal Rules to:
- remove one facility which closed on 30 August 2011; and
- change the name of one facility to reflect its current name.
These changes have reduced the number of listed facilities from 364 to 363.
Background
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 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).
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.
Details
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.
The Amendment Rules commence the day after registration.
The Amendment Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Authority: Section 333-20 of the
Private Health Insurance Act 2007
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2011 (No.9)
Schedule – Amendments
Item 1 – Schedule 5, Clause 4 Facilities, Table
Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to remove the following facility which closed on 30 August 2011:
Name | Address |
Montserrat Day Hospitals (Spring Hill) | Level 2, 35 Astor Terrace, BRISBANE QLD 4000 |
Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to reflect a change in the name of the following facility:
Previous Name | Current Name |
North Brisbane Cancer Centre | HOCA Chermside |
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
SEPTEMBER 2011