EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 3)
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 2012 (No. 3) (the Amendment Rules) amends Schedules 3 of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.
Purpose
The Amendment Rules amends Schedule 3 of the Principal Rules to reclassify Medicare Benefit Schedule (MBS) item number 42738, an ophthalmology item, in Schedule 3, Part 2 which is currently listed in Part 3 of Schedule 3 of the Principal Rules.
In Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No.1) MBS item 42738 was moved from Schedule 3, Part 2 to Schedule 3, Part 3. It has subsequently been brought to the Department of Health and Ageing’s attention that moving MBS item 42738 from Part 2 to Part 3 may inadvertently, and negatively, affect patients. The Department has decided to move MBS item 42738 back into Part 2, the case before Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No.1), and will conduct further consultation on the most appropriate location for MBS item number 42738 in the Principal Rules.
Background
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 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 3 sets out MBS item numbers for the same day hospital accommodation benefits which are payable for privately insured patients in all states and territories. Schedule 3, Part 2, lists MBS items that normally require hospital treatment that does not include part of an overnight stay. Schedule 3, Part 3 lists MBS items numbers that normally do not require hospital treatment.
Private health insurers are required to pay a minimum same-day accommodation benefit, in respect of treatment covered under a private health insurance policy, for MBS items listed Schedule 3, Part 2 of the Principal Rules. Insurers are only required to pay and accommodation benefit for MBS items listed in Schedule 3, Part 3 of the Principal Rules, in circumstances where a medical practitioner certifies that because of a medical condition of a patient, or because of special circumstances, it would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at a hospital.
Details
Details of the Amendment Rules are set out in the Attachment.
Consultation
The Department of Health and Ageing has consulted with medical specialists regarding this amendment. The Amendment Rules are a result of these consultations. The Department intends to consult further with medical practitioners, private health insurers and patients on the appropriate location of MBS item number 42738 in the Principal Rules.
The Amendment Rules commence on 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 2012 (No. 3)
1. Name of Rules
Section 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 3) (the Amendment Rules).
2. Commencement
Section 2 provides that the Amendment Rules are to commence on the day after registration.
3. Amendment of Private Health Insurance (Benefit Requirements) Rules 2011
Section 3 provides that the Schedule to the Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.
Schedule Amendments
Item 1 – Schedule 3, Part 3, Subclause 8, Category 3 (T8)
Item 1 of the Schedule to the Amendment Rules deletes MBS item 42738 from Schedule 3, Part 3.
Item 2 – Schedule 3, Part 2, Subclause 5(1)
Item 2 of the Schedule to the Amendment Rules inserts MBS item 42738 in Schedule 3, Part 2 after item number 42692.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
APRIL 2012
This material is provided to persons who have a role in Commonwealth legislation, policy and programs as general guidance only and is not to be relied upon as legal advice. Commonwealth agencies subject to the Legal Services Directions 2005 requiring legal advice in relation to matters raised in connection with this template must seek that advice in accordance with the Directions.