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 2009
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, or necessary or convenient in order to carry out or give effect to the Act.
The Private Health Insurance (Complying Product) Amendment Rules 2009 (the Amendment Rules) amend the Private Health Insurance (Complying Product) Rules 2008 (No.2) (the Rules) (as amended) which commenced on 1 July 2008
The purpose of Rule 8A of the Rules is to enforce the patient contribution for privately insured nursing-home type patients (NHTP) by restricting the amount of benefit that private health insurers pay for each day of NHTP hospital treatment at a hospital. The amount of benefit is restricted to the hospital’s charge less the patient contribution amount.
The Amendment Rules make a minor change to paragraph 8A(3)(c) of the Rules by amending the amount for the NHTP patient contribution at public hospitals in Western Australia from $39.70 to $40.80.
Details of the amendment to the Rules are set out in the Attachment.
Consultation
The Western Australian Department of Health was consulted with regard to increasing the NHTP patient contribution for its jurisdiction.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
FEBRUARY 2009
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLYING PRODUCT) AMENDMENT RULES 2009
- Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Complying Product) Amendment Rules 2009 (the Amendment Rules).
2. Commencement
Rule 2 provides that the Amendment Rules are to commence on the day after registration on the Federal Register of Legislative Instruments.
3. Amendment of Private Health Insurance (Complying Product) Rules 2008 (No.2)
Rule 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Complying Product) Rules 2008 (No.2) which commenced on 1 July 2008, and were subsequently amended on 20 September 2008, 9 December 2008 and 1 January 2009.
Schedule – Amendments
Item 1 – Part 2, Paragraph 8A(3)(c)
Paragraph 8A(3)(c) of the Rules provides the patient contribution for privately insured Nursing-home type patients (NHTP) at a public hospital. The purpose of Rule 8A of the Rules is to enforce the patient contribution for NTHP by restricting the amount of benefit that private health insurers pay for each day of NHTP hospital treatment at a hospital. The amount of benefit is restricted to the hospital’s charge less the patient contribution amount.
Item 1 of the Schedule of the Amendment Rules amends subparagraph 8A(3)(c)(viii), Part 2 of the Rules by increasing the NHTP patient contribution at a public hospital in Western Australia from $39.70 to $40.80. This increase reflects the indexation to Adult Pension Basic Rate and the maximum daily rate of rental assistance that commenced on 20 September 2008. The increase also brings public hospitals in Western Australia in line with public hospitals in Northern Territory, South Australia, Victoria, Tasmania and Queensland.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
FEBRUARY 2009
Overview
The Private Health Insurance (Complying Product) Amendment Rules 2009 were introduced to amend the Private Health Insurance (Complying Product) Rules 2008 (No.2), which commenced on 1 July 2008. These amendments were made under the authority of the Minister for Health and Ageing, pursuant to Section 333-20 of the Private Health Insurance Act 2007. The primary objective of these rules is to adjust the patient contribution for privately insured nursing-home type patients (NHTP) at public hospitals in Western Australia, ensuring consistency with other states and territories, and reflecting changes in the Adult Pension Basic Rate and the maximum daily rate of rental assistance. This amendment was developed following consultation with the Western Australian Department of Health.
The key change introduced by the Amendment Rules is an increase in the NHTP patient contribution at public hospitals in Western Australia from $39.70 to $40.80, effective from the day of registration on the Federal Register of Legislative Instruments. This adjustment aligns Western Australian public hospitals with those in other jurisdictions and addresses the need to enforce patient contributions accurately while keeping pace with relevant economic indices.
Scope and Application
The Private Health Insurance (Complying Product) Amendment Rules 2009, made under the authority of the Private Health Insurance Act 2007, pertain to the patient contributions for privately insured nursing-home type patients receiving treatment in public hospitals. These rules apply to private health insurers and affect the manner in which they calculate benefits for hospital treatments of nursing-home type patients. The Amendment Rules specifically target the patient contribution for these patients in public hospitals in Western Australia, adjusting it from $39.70 to $40.80. This adjustment aligns the contribution with the indexation to the Adult Pension Basic Rate and the maximum daily rate of rental assistance, which took effect on 20 September 2008. These rules are part of the broader regulatory framework designed to ensure consistency and fairness in patient contributions across different states and territories within Australia. The amendment was made following consultation with the Western Australian Department of Health, ensuring that the changes reflect current social and economic conditions accurately.
Key Provisions
The main operative sections of the Private Health Insurance (Complying Product) Amendment Rules 2009 are Rule 3 and Item 1 of the Schedule, which amend the Private Health Insurance (Complying Product) Rules 2008 (No.2). Specifically, Rule 3 details the amendment to the existing Rules, while Item 1 of the Schedule specifies the increase in the patient contribution for privately insured nursing-home type patients (NHTP) at public hospitals in Western Australia from $39.70 to $40.80. This amendment is intended to ensure consistency across different states and territories and to reflect the recent changes to the Adult Pension Basic Rate and the maximum daily rate of rental assistance.
The Amendment Rules impose certain obligations and requirements on private health insurers. They must adhere to the new patient contribution amount specified for NHTP in Western Australia, which means that the benefit payable for each day of hospital treatment for these patients must be adjusted to the hospital’s charge less the increased patient contribution amount of $40.80. This adjustment is necessary to comply with the regulatory framework established under Chapter 3 of the Private Health Insurance Act 2007 and to ensure that the patient contribution is enforced appropriately.
Failure to comply with the requirements set out in the Amendment Rules may result in civil or criminal consequences. While the specific penalties are not detailed in the Explanatory Statement, breaches of the Private Health Insurance Act 2007 and its subsidiary legislation could potentially incur fines and other sanctions. The exact penalties would be determined based on the nature and severity of the breach, as well as any applicable provisions within the Act and related regulations. Insurers are expected to take all necessary steps to ensure compliance to avoid any legal repercussions.