EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Benefit Requirements) Amendment Rules 2014 (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 2014 (No. 3) (the Amendment Rules) consist of two Schedules (A and B), which amend Schedules 1 and 5 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
The purpose of Schedule A to the Amendment Rules is to amend Schedule 1 of the Principal Rules to remove a Medicare Benefits Schedule (MBS) item number that was intended to be removed by the Private Health Insurance (Benefit Requirements) Amendment Rules 2014 (No. 2), but was not due to a misdescribed amendment.
Schedule B of the Amendment Rules
The purpose of the amendments provided in Schedule B is to update the reference to the latest Second Tier Advisory Committee-approved list. The list of facilities eligible for second tier default benefits is the list existing at the time of this amendment and is published on the Department of Health’s website at http://www.health.gov.au/.
Background
The Private Health Insurance (Benefit Requirements) Amendment Rules 2014 (No. 2) commenced on 1 July 2014, as part of those rules it was intended that MBS item 42737 be removed from the Principal Rules. The amendment however was misdescribed, listing item 42737 under Clause 4 Advanced surgical patient, subclause (3) of Part 2 Type A procedures, instead of Part 2 Type A procedures Clause 6 Surgical procedures, subclause (3).
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.
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 (the Committee), which includes equal representation from both private hospital and private health insurance sectors. The Committee considered the application of the North Lakes Day Hospital facility in an out-of-session meeting as their application was misplaced due to an administrative error.
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
MEDICAL BENEFITS DIVISION
DEPARTMENT OF HEALTH
JULY 2014
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2014 (No. 3)
Section 1 Name of Rules
Section 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2014 (No. 3) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on the day after registration.
Section 3 Authority
Section 3 provides that the Amendment Rules are made under item 3A of the table in section 333-20 of the Private Health Insurance Act 2007.
Section 4 Schedule
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
Schedules A and B
Schedules A and B provide that the Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on
1 November 2011.
Schedule A – Amendments
Item 1 – Schedule 1, Part 2, Type A procedures, Subclause 6(3) Surgical patient
Item 1 amends Schedule 1, Part 2 Type A procedures, Clause 6 Surgical Patient, subclause (3) by removing MBS item number 42737.
Schedule B – Amendments
Item 1 – Schedule 5, Clause 4 Facilities, Paragraph (1)
Item 1 of Schedule C to the Amendment Rules updates the reference to the latest Second Tier Advisory Committee-approved list. The list of facilities eligible for second tier default benefits is the list existing at the time of this amendment and is published on the Department of Health’s website at http://www.health.gov.au/