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. 8)
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.
Purpose
The Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 8) (the Amendment Rules) make an amendment to Schedule 1 of the Principal Rules to insert Medical Benefits Schedule (MBS) item 42731 in Part 2 Type A procedures, Clause 4 Advanced surgical patient, subclause (3).
In the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 7) which took effect on 1 November 2012, MBS item 42731 was removed from Schedule 1, Part 2. It has subsequently been brought to the Department of Health and Ageing’s attention that this item was inadvertently deleted.
The Amendment Rules have been made to remedy this inadvertent deletion. This amendment ensures that the minimum benefit requirements continue to apply to item 42731 where applicable. The Department has not been advised that anybody has been disadvantaged by the deletion of item 42731. Additionally, the Department does not expect any disadvantage to be suffered by patients due to the very short period of time between deleting item 42731 and the commencement of the Amendment Rules. Furthermore, the vast majority of benefits relating to episodes of private hospital treatment (98.1% in 2010-11) are paid under negotiated contacts between insurers and private hospitals which are outside the minimum benefit requirements under the Principal Rules. It is noted that the inadvertent removal of this item did not prevent insurers from continuing to cover this item under their insurance policies and paying benefits for patient treatment with respect to this item.
Background
The Private Health Insurance (Benefit Requirements) Rules 2011 (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 1 categorises MBS item numbers into overnight patient classifications comprising ‘Advanced surgical patient’, ‘Obstetric patient’, ‘Surgical patient’, ‘Psychiatric patient’, ‘Rehabilitation patient’ and ‘Other patients’.
Consultation
No consultation was undertaken with respect to this amendment as it relates only to an inadvertent deletion.
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
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
NOVEMBER 2012