Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 9)

Administered by Department of Health, Disability and Ageing

Legislation au F2017L01527 Rules Not in force Legislative Instrument

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EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance Act 2007

 

Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (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 2017 (No. 9) (the Amendment Rules) consist of amendments which amend Schedule 3 of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on
1 November 2011.

 

Purpose

The purpose of the amendments to Schedule 3 of the Principal Rules is to insert seven new Medicare Benefits Schedule (MBS) item numbers and to remove five MBS item numbers.   The Amendment Rules reflect the items for cervical screening as part of the implementation of the National Cervical Screening Program (NCSP).

 

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 1 categorises MBS item numbers into overnight patient classifications comprising ‘Advanced surgical patient’, ‘Obstetric patient’, ‘Surgical patient’, ‘Psychiatric patient’, ‘Rehabilitation patient’ and ‘Other patients’.  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.

 

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.

 

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

In accordance with changes to the Health Insurance Legislation Amendment (2017 Measures No. 3) Regulation 2017, seven new MBS item numbers have been added and five MBS item numbers have been removed. Clinical advice was sought from within the Department regarding this amendment.

 

The Regulations implement new items for cervical screening as part of the implementation of the National Cervical Screening Program (NCSP) as agreed by Government in the 2015-16 Budget following recommendations of the Medical Services Advisory Committee (MSAC).

 

The Department of Health has consulted widely on the renewal of the National Cervical Screening Program (the renewal). Key consultation partners include states and territories, healthcare providers, pathologists, colposcopists and consumers. The renewal is supported by the Royal Australian College of General Practitioners, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal College of Pathologists of Australasia, the Australian Society of Gynaecologic Oncologists and the Australian Society for Colposcopy and Cervical Pathology.

 

The Amendment Rules commence on 1 December 2017.

 

The Amendment Rules are a legislative instrument for the purposes of the Legislation Act 2003.


Attachment

 
DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2017 (No. 9)

 

Section 1 Name of Rules

 

Section 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No.9) (the Amendment Rules).

 

Section 2 Commencement

 

Section 2 provides that the Amendment Rules are to commence on 1 December 2017.

 

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. 

 

Schedule – Amendments

 

Item 1 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology services, P3

 

Item 1 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology services, P3 of the Principal Rules by removing two MBS item numbers (69418 and 69419).

 

Item 2 - Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology services, P6

 

Item 2 amends Schedule 3, Part 3 – Type C Procedures, Clause 8 Interpretation, Category 6 – Pathology services, P6 of the Principal Rules by removing three MBS item numbers (73053, 73055 and 73057) and inserting seven new MBS item numbers (73070, 73071, 73072, 73073,        73074, 73075,  and 73076).

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

Overview

The Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 9) were enacted to amend the Private Health Insurance (Benefit Requirements) Rules 2011, which establish the minimum benefits that private health insurers must cover for various hospital treatments. This amendment was introduced to address the need to update the Medicare Benefits Schedule (MBS) items to align with the implementation of the National Cervical Screening Program (NCSP). The rules were enacted by the Minister for Health under the authority of section 333-20 of the Private Health Insurance Act 2007. The policy objective is to ensure that the benefits provided under private health insurance reflect current clinical practices and recommendations, particularly in the area of cervical screening, thereby enhancing the effectiveness of the NCSP. The Amendment Rules, which commenced on 1 December 2017, reflect the changes in MBS items for cervical screening, removing five and adding seven new item numbers. This update was based on recommendations from the Medical Services Advisory Committee (MSAC) and was supported by extensive consultation with key stakeholders including states and territories, healthcare providers, and professional medical colleges. By incorporating these changes, the rules aim to improve the coverage and accessibility of cervical screening services under private health insurance, ensuring they meet contemporary medical standards and public health objectives.

Scope and Application

The Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 9) applies to health insurers under the Private Health Insurance Act 2007, which governs the operation of private health insurance in Australia. These rules are amendments to the Private Health Insurance (Benefit Requirements) Rules 2011, which outline the minimum benefits that must be provided by health insurers for various types of hospital treatment. The Amendment Rules pertain specifically to the Medicare Benefits Schedule (MBS) item numbers associated with same day hospital accommodation benefits, which are payable for privately insured patients in all states and territories of Australia. The Amendment Rules introduce seven new MBS item numbers and remove five existing ones, reflecting updates as part of the implementation of the National Cervical Screening Program (NCSP). These amendments are designed to ensure that the MBS continues to meet the needs of the Australian public in terms of accessible and updated healthcare services. The Amendment Rules commenced on 1 December 2017 and are made under the authority of the Minister for Health, with the intent to facilitate the implementation of the NCSP as agreed by the government.

Key Provisions

The main operative sections of the Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 9) (the Amendment Rules) pertain to changes in the Medicare Benefits Schedule (MBS) item numbers for same day hospital accommodation benefits. These changes are detailed in Schedule 3 of the Amendment Rules, which amends the Principal Rules that commenced on 1 November 2011. Specifically, the Amendment Rules involve the removal of five MBS item numbers and the addition of seven new MBS item numbers (Section 4). These amendments are intended to align with the implementation of the National Cervical Screening Program (NCSP), as recommended by the Medical Services Advisory Committee (MSAC) and agreed by the government. The obligations and requirements imposed by the Amendment Rules primarily concern health insurers. They must ensure that the new MBS item numbers for cervical screening are included in their benefit packages, while removing the outdated MBS item numbers from their offerings. This update ensures that health insurers comply with the latest medical recommendations and government policy regarding cervical screening. The rules also require health insurers to review their existing contracts and agreements to ensure they reflect these changes and provide the correct level of benefits as per the new MBS item numbers. Failure to comply with the Amendment Rules can result in significant consequences for health insurers. While specific penalties are not outlined in the Explanatory Statement, non-compliance with rules governing private health insurance can lead to enforcement actions under the Private Health Insurance Act 2007. This may include financial penalties, corrective orders, or even the potential for legal proceedings if the non-compliance is found to be egregious or repeated. Health insurers must therefore ensure they are fully compliant with the Amendment Rules to avoid these repercussions and maintain their licensing and operational status. In summary, the Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 9) amend Schedule 3 of the Principal Rules to update the MBS item numbers for cervical screening. Health insurers are obligated to implement these changes in their benefit packages by the commencement date of 1 December 2017. Non-compliance could result in penalties or other enforcement actions, making it crucial for insurers to adhere to the new requirements set forth by the Amendment Rules.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.