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. 5)
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. 5) (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 of the Principal 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 minor changes to paragraph 8A(3)(a) of the Principal Rules by increasing the amount for the NHTP contribution at public hospitals in Western Australia.
Consultation
The Western Australian Department of Health was consulted with regard to increasing the NHTP contribution in that jurisdiction. No objections were made.
The Amendment Rules commence on 1 November 2010 or, if registered after 1 November 2010, the day after registration.
The Amendment Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLYING PRODUCT) AMENDMENT RULES 2010 (No. 5)
- Name of Rules
Rule 1 provides that the title of the Rules is the Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 5) (the Amendment Rules).
2. Commencement
Rule 2 provides that the Amendment Rules are to commence on 1 November 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)(viii) of the Principal Rules by increasing the NHTP contribution at public hospitals in Western Australia from $47.35 to $48.35. This increase reflects the indexation applied to the Adult Pension Basic Rate and the maximum daily rate of rental assistance that commenced on 20 September 2010.
PRIVATE HEALTH INSURANCE BRANCH
DEPARTMENT OF HEALTH AND AGEING
OCTOBER 2010
Overview
The Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 5) were enacted to amend the Private Health Insurance (Complying Product) Rules 2010, which were themselves introduced under the Private Health Insurance Act 2007. The overarching aim of these legislative amendments is to adjust the patient contribution for privately insured nursing-home type patients (NHTP) receiving hospital treatment at public hospitals in Western Australia. This adjustment was necessary to align the patient contribution with the indexation applied to the Adult Pension Basic Rate and the maximum daily rate of rental assistance, which commenced on 20 September 2010. The rules were developed under the authority of the Minister for Health and Ageing, ensuring that they are consistent with the objectives of the Act. The rules were subject to consultation with the Western Australian Department of Health, which did not raise any objections, and they commenced on 1 November 2010 or the day after registration if enacted later.
Scope and Application
The Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 5) apply to private health insurers and their policies that provide hospital cover in Australia. These rules are made under section 333-20 of the Private Health Insurance Act 2007, and they specifically amend the patient contribution for privately insured nursing-home type patients (NHTP) at public hospitals in Western Australia. The amendment increases the patient contribution amount for NHTPs in public hospitals in Western Australia from $47.35 to $48.35, reflecting the indexation applied to the Adult Pension Basic Rate and the maximum daily rate of rental assistance. These rules apply across Australia but focus on adjusting the contribution rates for NHTPs in Western Australia. The amendment rules commenced on 1 November 2010, or if registered later, the day after registration. These Amendment Rules are subordinate instruments extending the provisions of the main Act by adjusting the specific contribution amount for NHTPs in Western Australia.
Key Provisions
The Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 5) (Amendment Rules) amend the Private Health Insurance (Complying Product) Rules 2010 (Principal Rules) to modify the patient contribution for privately insured nursing-home type patients (NHTP) at public hospitals in Western Australia. Specifically, Rule 3 of the Amendment Rules, through its Schedule, increases the NHTP contribution at public hospitals in Western Australia from $47.35 to $48.35 per day, as stated in Item 1 of the Schedule which amends subparagraph 8A(3)(a)(viii) of the Principal Rules. This adjustment follows the indexation applied to the Adult Pension Basic Rate and the maximum daily rate of rental assistance, effective from 20 September 2010.
The obligations imposed by the Amendment Rules primarily concern private health insurers who must now adhere to the revised patient contribution amount for NHTPs at public hospitals in Western Australia. Insurers are required to ensure that the daily benefit paid for NHTP hospital treatment is restricted to the hospital’s charge less the updated patient contribution amount of $48.35 per day. This change necessitates updates to their billing and reimbursement processes to align with the new legislative requirement. Additionally, hospitals in Western Australia must accurately record and report the NHTP contributions to comply with the rules.
Failure to comply with the provisions set out in the Amendment Rules may result in civil or criminal consequences, although specific penalties are not detailed in the Explanatory Statement. Generally, under the Private Health Insurance Act 2007, non-compliance with the rules regarding patient contributions can lead to financial penalties, corrective actions, or other enforcement measures as deemed appropriate by the relevant authorities. The precise penalties for breach are usually outlined in the Act or subsequent regulations but are not specified in this particular amendment.
The Amendment Rules, being legislative instruments under the Legislative Instruments Act 2003, are designed to ensure that the changes to the patient contribution for NHTPs are implemented effectively and in accordance with the legislative framework. By adjusting the NHTP contribution in Western Australia, the Amendment Rules aim to maintain equitable and updated financial arrangements for privately insured patients receiving treatment in public hospitals.