EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health and Ageing
Private Health Insurance Act 2007
Private Health Insurance (Complying Product) Amendment Rules 2008 (No.1)
Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Complying Product) Rules providing for matters required or permitted by Chapter 3 of the Act to be provided; or necessary or convenient to be provided in order to carry out or give effect to the Act.
The Private Health Insurance (Complying Product) Amendment Rules 2008 (No.1) (the Amendment Rules) commence on 1 May 2008, or if registered after that date, on the day following their registration on the Federal Register of Legislative Instruments. The Amendment Rules amend the Private Health Insurance (Complying Product) Rules 2008 (No. 1) (the Rules), which commenced on 20 March 2008.
Division 93 of the Act sets out the requirement for all private health insurers to provide standard information statements (SISs). A SIS provides key information about complying health insurance products, including restrictions and exclusions, and is in the form set out in the Rules.
The Amendment Rules make technical amendments to the Schedules to the Rules, which relate to SISs. The technical amendments have been made to resolve the confusion of long-term members of private health insurers about hospital waiting periods, to assist insurers to comply with the Act’s requirements for SIS page length and to rectify errors with dental item numbers and descriptions used on SISs to give examples of dental benefits.
Consultation
The dental item amendments have been discussed with the Australian Dental Association (ADA) and with the Consumer Website Reference Group, convened by the Private Health Insurance Ombudsman (PHIO). This Group was established to discuss operational aspects of the Private Health Insurance Ombudsman’s consumer website, www.privatehealth.gov.au, and consists of members from several insurers, the Australian Health Insurance Association, the Health Insurance Restricted Membership Association Australia and consumer representatives.
The Department invited private health insurance stakeholders to comment on the proposed amendments via an electronic bulletin distributed by PHIO.
All parties consulted were supportive of the changes.
The Department consulted the Office of Best Practice Regulation (OBPR) on the requirement to prepare a Regulation Impact Statement (RIS). OBPR confirmed that the amendments have a nil/low impact on businesses and the economy, therefore a RIS was not required. (Reference No. 9584).
The Act does not specify any conditions that need to be met before the power to make the Amendment Rules may be exercised.
Details of the amendments to the Rules are set out in the Attachment. The Amendment Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
APRIL 2008
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLYING PRODUCT) AMENDMENT RULES 2008 (No.1)
1. Name of Rules
Rule 1 provides that the title of the Amendment Rules is the Private Health Insurance (Complying Product) Amendment Rules 2008 (No.1).
2. Commencement
Rule 2 provides that the Amendment Rules are to commence on 1 May 2008, or if registered after that date, on the day following their registration on the Federal Register of Legislative Instruments (FRLI).
3. Amendments
Rule 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Complying Product) Rules 2008 (No.1).
Schedule 1 – Amendments
[1] Schedule 1 - Standard information statements: hospital treatment
This schedule provides for the form of statements for policies which cover hospital treatment only as set out in Part 3, Rule 14 of the Rules
Schedule 1 has been amended to modify that part of the SIS relating to waiting periods. The field labelled 'How long will I have to wait until I can claim?' is now labelled 'How long are the waiting periods for new and upgrading members?’
[2] Schedule 2 – Standard information statements: general treatment
This schedule provides for the form of statements for policies which cover general treatment only as set out in Part 3, Rule 15 of the Rules
Schedule 2 has been amended to modify the SIS disclaimer about premiums for policies which cover general treatment only. The reference to Lifetime Health Cover (LHC) has been removed.
Schedule 2 has also been amended so that in the Services field of the SIS ‘Non-PBS pharmaceuticals' sits between 'Optical' and 'Physiotherapy'.
The Examples of Maximum Benefits field of the SIS has also been amended. ‘Provisional bridge’, ‘Root canal therapy (one canal including preparation & filling)’, ‘Removal of old root canal filling’, ‘Emergency root canal’ and ‘Tooth extraction’ have been deleted from the field. ‘Filling of one root canal’ and ‘Surgical tooth extraction’ have been added to the field.
[3] Schedule 3 – Standard information statements: combined products
This schedule provides for the form of statements for policies which cover both hospital treatment and general treatment as set out in Part 3, Rule 16 of the Rules
Schedule 3 has been amended to modify that part of the SIS relating to waiting periods. The field labelled 'How long will I have to wait until I can claim?' is now labelled 'How long are the waiting periods for new and upgrading members?
Schedule 3 has been amended so that in the Services field of the SIS ‘Non-PBS pharmaceuticals' sits between 'Optical' and 'Physiotherapy'.
The Examples of Maximum Benefits field of the SIS has also been amended. ‘Provisional bridge’, ‘Root canal therapy (one canal including preparation & filling)’, ‘Removal of old root canal filling’, ‘Emergency root canal’ and ‘Tooth extraction’ have been deleted from the field. ‘Filling of one root canal’ and ‘Surgical tooth extraction’ have been added to the field.
[4] Schedule 4 – Standard information statements: permitted content
This schedule provides for the permitted content for all statements as set out in Part 3 of the Rules.
Schedule 4 Part 2 – hospital treatment has been amended so that the field labelled 'How long will I have to wait until I can claim?' is now labelled 'How long are the waiting periods for new and upgrading members?'.
Schedule 4, Part 3 – general treatment has been amended so that ‘Non-PBS pharmaceuticals' sits between 'Optical' and 'Physiotherapy' in the permitted content of the ‘Benefit limits (per 12 month)’ field.
Schedule 4, Part 3 – general treatment has been amended to change the descriptions ‘Root canal therapy (one canal including preparation and filling) – 417’ to ‘Filling of one root canal – 417’ and ‘Tooth extraction – 322’ to ‘Surgical tooth extraction – 322’ in the ‘Examples of Maximum Benefits’ field. The descriptions ‘Removal of old root canal – 421’, ‘Emergency root canal – 438’ and ‘Provisional bridge – 632’ have been deleted from that field. The sentence ‘If tooth extraction is covered under general dental instead of major dental, this example can be moved to the general dental box’ has been amended to read ‘If surgical tooth extraction is covered under general dental instead of major dental, this example can be moved to the general dental box’ in that field.