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 2010 (No. 4)
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 2010 (No. 4) (the Amendment Rules) amend the Private Health Insurance (Complying Product) Rules 2010 (the Principal Rules) which commenced on 30 January 2010.
The purpose of Rule 8A 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 minor changes to paragraph 8A(3)(a) of the Principal Rules by amending the amounts for the NHTP contribution at public hospitals in NSW, Queensland, South Australia, Tasmania and Victoria.
The Amendment Rules also amend the NHTP contribution at private hospitals provided for in paragraph 8A(3)(b) of the Principal Rules.
Consultation
The NSW Department of Health (NSW), Queensland Health (QLD), Department of Health (SA), Department of Health and Human Services (TAS) and the Department of Human Services (VIC) were consulted with regard to increasing the NHTP contribution for their jurisdictions. No objections were made.
No specific consultation was undertaken in relation to the amendment to paragraph 8A(3)(b) of the Principal Rules regarding private hospitals because the changes were machinery in nature and did not substantially alter existing arrangements.
The Amendment Rules commence on 20 September 2010 or, if registered after
20 September 2010, 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
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLYING PRODUCT) AMENDMENT RULES 2010 (No. 4)
- Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 4) (the Amendment Rules).
2. Commencement
Rule 2 provides that the Amendment Rules are to commence on 20 September 2010, or if registered on a later date, the day after registration.
3. Amendment of Private Health Insurance (Complying Product) Rules 2010
Rule 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Complying Product) Rules 2010 (the Principal Rules) which commenced on 30 January 2010.
Schedule – Amendments
Item 1 – Part 2, Paragraph 8A(3)(a)
Paragraph 8A(3)(a) of the Principal Rules provides the patient contribution for privately insured NHTPs at a public hospital.
Item 1 of the Schedule of the Amendment Rules amends Part 2 subparagraph 8A(3)(a)(ii) of the Principal Rules by increasing the NHTP contribution at public hospitals in New South Wales from $47.35 to $48.35. Item 1 further amends Part 2 subparagraph 8A(3)(a)(iv) to subparagraph 8A(3)(a)(vii) of the Principal Rules by increasing the NHTP contribution at public hospitals in Queensland, South Australia, Tasmania and Victoria from $47.35 to $48.35. This increase reflects the indexation applied to Adult Pension Basic Rate and the maximum daily rate of rental assistance that will commence on 20 September 2010.
Item 2 – Part 2, Paragraph 8A(3)(b)
Paragraph 8A(3)(b) of the Principal Rules provides the patient contribution for privately insured NHTPs at private hospitals.
Item 2 of the Schedule of the Amendment Rules amends Part 2 subparagraph 8A(3)(b) of the Principal Rules by increasing the NHTP contribution at private hospitals from $47.35 to $48.35. This increase reflects the indexation applied to Adult Pension Basic Rate and the maximum daily rate of rental assistance that will commence on 20 September 2010.
Overview
The Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 4) were introduced to amend the Private Health Insurance (Complying Product) Rules 2010, which commenced on 30 January 2010, under the authority of Section 333-20 of the Private Health Insurance Act 2007. This amendment was enacted by the Parliament of Australia and aims to address the gap in enforcing patient contributions for privately insured nursing-home type patients (NHTP) by regulating the amount of benefit that private health insurers can pay for each day of NHTP hospital treatment at a hospital. The policy objective is to restrict the amount of benefit to the hospital’s charge less the patient contribution amount. The Amendment Rules specifically increase the NHTP contribution at public and private hospitals in various states, reflecting the indexation applied to the Adult Pension Basic Rate and the maximum daily rate of rental assistance, effective from 20 September 2010. Consultations were held with relevant health departments in NSW, Queensland, South Australia, Tasmania, and Victoria, which did not object to the changes.
Scope and Application
The Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 4) amends the Private Health Insurance (Complying Product) Rules 2010, which are made under section 333-20 of the Private Health Insurance Act 2007. The amendment rules apply to private health insurers and are designed to adjust the patient contribution for nursing-home type patients (NHTP) receiving treatment in public and private hospitals within specified jurisdictions. The amendment rules specifically target the patient contribution amounts for NHTPs in New South Wales, Queensland, South Australia, Tasmania, and Victoria, reflecting the indexation applied to the Adult Pension Basic Rate and the maximum daily rate of rental assistance, effective from 20 September 2010. These changes are made to ensure that the patient contribution remains aligned with broader economic adjustments. The amendment rules do not extend beyond these jurisdictions and do not introduce any new exemptions or thresholds; they merely update existing financial parameters.
Key Provisions
The Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 4) (Amendment Rules) amend the Private Health Insurance (Complying Product) Rules 2010 (Principal Rules), which commenced on 30 January 2010, by making minor adjustments to the patient contribution amounts for nursing-home type patients (NHTP) at both public and private hospitals. These amendments are captured in Rule 8A of the Principal Rules, which is intended to enforce the patient contribution for privately insured NHTPs by restricting the amount of benefit that private health insurers pay for each day of NHTP hospital treatment at a hospital (s. 333-20). Specifically, Rule 8A(3)(a) addresses the NHTP contribution at public hospitals, while Rule 8A(3)(b) addresses the NHTP contribution at private hospitals.
The Amendment Rules impose specific obligations on private health insurers to adjust their payment policies to align with the updated patient contribution amounts. Insurers must ensure that the amount of benefit they pay for each day of NHTP hospital treatment at a public hospital in New South Wales, Queensland, South Australia, Tasmania, and Victoria is limited to the hospital’s charge less the new patient contribution amount of $48.35, as detailed in the amended paragraph 8A(3)(a). Similarly, for private hospitals, the patient contribution is set at $48.35, as per the amended paragraph 8A(3)(b). These changes ensure that the patient contributions reflect the indexation applied to the Adult Pension Basic Rate and the maximum daily rate of rental assistance, which are set to commence on 20 September 2010.
Failure to comply with the updated patient contribution amounts as stipulated by the Amendment Rules may result in legal consequences for private health insurers. Although the explanatory statement does not explicitly detail the penalties for non-compliance, breaches of the Private Health Insurance Act 2007 or its associated rules could potentially lead to civil or criminal sanctions, depending on the severity and intent of the breach. Penalties under the Act could include fines and other sanctions as prescribed by the legislation. Insurers are thus required to ensure their practices are in strict adherence to these updated rules to avoid any potential repercussions.