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. 6)
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. 6) (the Amendment Rules) amend Schedule 4 of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.
Purpose
Schedule A of the Amendment Rules
Schedule A of the Amendment Rules amends Schedule 4 of the Principal Rules. The purpose of the amendments to Schedule 4 of the Principal Rules is to change the minimum benefits payable per night for nursing-home type patients (NHTPs) at public hospitals in some states and at private hospitals nationally.
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 A of the Amendment Rules
The minimum benefits payable per night for hospital treatment provided to NHTPs in Schedule 4 of the Principal Rules is subject to review and change twice annually, to reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates). The latest indexation of these takes effect on the day after registration.
Details
Details of the Amendment Rules are set out in the Attachment.
Consultation
Schedule A of the Amendment Rules
On 23 August 2012, states and territories were asked whether they would be increasing the NHTP contribution and accommodation rates in their jurisdiction in line with increases in the Pension and Rental Assistance Rates. Tasmania and Victoria requested an increase the NHTP accommodation rates in their public hospitals which was given effect in Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 5). The Australian Capital Territory, New South Wales, Queensland and South Australia advised that it will not increase its NHTP accommodation rates at this time. On 25 September 2012 the Northern Territory provided an increase request to the Department of Health and Ageing.
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. 6)
Section 1 Name of Rules
Section 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 6) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on the day after registration.
Section 3 Amendment of Private Health Insurance (Benefit Requirements) Rules 2011
Section 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.
Schedule A – Amendments
Item 1 – Schedule 4, Clause 6 Minimum benefit, Table 1
Item 1 of Schedule 4, Clause 6, Minimum benefit, Table 1, to the Amendment Rules increases the minimum benefit payable per night for nursing-home type patients in public hospitals in the following states in Clause 6, Table 1:
- Northern Territory from $75.83 to $77.47
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
OCTOBER 2012
Overview
The Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 6) were introduced to amend the minimum benefits payable per night for nursing-home type patients (NHTPs) in public hospitals in certain states and in private hospitals nationally. Enacted under Section 333-20 of the Private Health Insurance Act 2007 by the Minister for Health, these Amendment Rules aim to align the benefits with the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance. The rules were developed following consultations with states and territories, where Tasmania and Victoria requested an increase in NHTP accommodation rates in their public hospitals, effective from the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 5). In contrast, the Australian Capital Territory, New South Wales, Queensland, and South Australia did not request an increase at that time, while the Northern Territory submitted a request later on. These Amendment Rules are intended to ensure that private health insurance benefit requirements are kept up-to-date and reflective of the changes in relevant rates.
Scope and Application
The Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 6) amends the Private Health Insurance (Benefit Requirements) Rules 2011 to change the minimum benefits payable per night for nursing-home type patients (NHTPs) in public hospitals in some states and in private hospitals nationally. These amendments reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates). The Amendment Rules are applicable to private health insurance providers and policyholders across Australia, with specific adjustments for NHTPs in public hospitals in the Northern Territory, as well as for NHTPs in private hospitals nationwide. The amendments are designed to ensure that the minimum benefits provided under private health insurance policies are aligned with the current rates of pension and rental assistance, thereby providing adequate coverage for those in need of nursing home-type care. The Amendment Rules are a legislative instrument under the authority of Section 333-20 of the Private Health Insurance Act 2007 and will commence on the day after registration.
Key Provisions
The Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 6) (Amendment Rules) are a set of regulations that modify the Private Health Insurance (Benefit Requirements) Rules 2011 (Principal Rules). These Amendment Rules, detailed in Schedule A, primarily revise the minimum benefits payable per night for nursing-home type patients (NHTPs) in public hospitals and private hospitals across Australia. Specifically, the Amendment Rules adjust the rates based on the latest indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates). The changes are set to take effect from the day after registration.
Under the Private Health Insurance Act 2007, these Amendment Rules impose certain obligations on health insurers and providers. Health insurers are required to ensure that they offer policies that meet the updated minimum benefit requirements as specified in the Amendment Rules. Providers, particularly hospitals, must adhere to these new rates when treating NHTPs and billing health insurers accordingly. The rules are designed to ensure that patients receive adequate support and that there is consistency in the level of care across different states and territories.
Breaching the provisions of these Amendment Rules can have legal consequences. Health insurers found to be non-compliant with the updated minimum benefit requirements could face penalties, including fines. The exact penalty amounts are not specified in the explanatory statement, but under the broader framework of the Private Health Insurance Act 2007, penalties can be significant and are intended to enforce compliance with the Act’s provisions. Similarly, hospitals that do not adhere to the new rates may face scrutiny and potential fines, ensuring that they provide the required level of care as stipulated by the Amendment Rules.
In summary, the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 6) mandate specific changes to the minimum benefits for NHTPs in hospitals, reflecting updated indexation rates. These changes are binding on health insurers and providers, who must comply with the new rates to avoid potential penalties. The rules aim to standardise and enhance the quality of care provided to NHTPs, ensuring they receive adequate support through their private health insurance.