Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2013L00496 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 (Complying Product) Amendment Rules 2013 (No. 1)

 

Authority

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 and/or section 188-1 of the Act, or necessary or convenient in order to carry out or give effect to Chapter 3 and/or section 188-1 of the Act.

 

The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1) (the Amendment Rules) amend Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2) (the Principal Rules) which commenced on 14 January 2011.

 

Purpose

The purpose of the amendments to Rule 8A is to change the patient contribution payable per night for nursing-home type patients (NHTPs) at public hospitals in some states and at private hospitals nationally. 

 

Background

Rule 8A of the Principal Rules sets 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.  The amount of benefit is restricted to the hospital’s charge less the patient contribution amount.

 

The Schedule to the Amendment Rules makes minor changes to Paragraph 8A(3)(a) of the Principal Rules by amending the NHTP contribution rate at public hospitals in New South Wales, Queensland, South Australia, Tasmania and Victoria.  The Amendment Rules also make changes to Paragraph 8A(3)(b) of the Principal Rules by amending the NHTP contribution rate at private hospitals nationally.  Changes to the NHTP contribution rate reflect increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates), which take effect on 20 March 2013.

 

Details

Details of the Amendment Rules are set out in the Attachment.

 

Consultation

On 25 February 2013, states and territories were asked whether they would be increasing the NHTP contribution and accommodation rates in their jurisdiction in line with increases in the Pension and Rental Assistance Rates.  New South Wales, Queensland, South Australia, Tasmania and Victoria advised that they will increase the NHTP contribution rates in their public hospitals from 20 March 2013.  The Australian Capital Territory advised that it is not increasing its NHTP contribution and accommodation rates at this time.  Western Australia has advised of their intention to increase NHTP contribution rates at a later date yet to be determined.  No advice has been received from the Northern Territory.

 

No specific consultation was undertaken in relation to the amendment to Paragraph 8A(3)(b) of the Principal Rules regarding private hospitals because the change was machinery in nature and linked to the twice annual Pension and Rental Assistance Rates increase.  The change does not substantially alter existing arrangements.

 

The Amendment Rules commence on 20 March 2013 or, if registered after 20 March 2013, 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

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

MARCH 2013


ATTACHMENT

 

Details of the Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1)

 

Section 1 Name of Rules

Section 1 provides that the title of the Rules is the Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1) (the Amendment Rules).

Section 2 Commencement

Section 2 provides that the Amendment Rules are to commence on 20 March 2013, or if registered on a later date, the day after registration.

Section 3 Amendment of Private Health Insurance (Complying Product) Rules 2010 (No. 2)

Section 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Complying Product) Rules 2010 (No. 2) (the Principal Rules) which commenced on 14 January 2011.

Schedule – Amendments

Item 1 – Part 2, Paragraph 8A(3)(a)

 

Paragraph 8A(3)(a) of the Principal Rules set out the patient contribution for privately insured NHTPs at public hospitals.

 

Item 1 of the Schedule of the Amendment Rules amends Part 2, Paragraph 8A(3)(a) of the Principal Rules by increasing the NHTP contribution at public hospitals:

 

  • New South Wales from $52.05 to $53.55;
  • Queensland from $52.05 to $53.55;
  • South Australia from $52.05 to $53.55;
  • Tasmania from $52.05 to $53.55; and
  • Victoria from $52.05 to $53.55.

 

Item 2 – Part 2, Paragraph 8A(3)(b)

 

Paragraph 8A(3)(b) of the Principal Rules set out the patient contribution for privately insured NHTPs at private hospitals.

 

Item 2 of the Schedule of the Amendment Rules amends Part 2, Paragraph 8A(3)(b) of the Principal Rules by increasing the NHTP contribution at private hospitals from $52.05 to $53.55.

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overview

The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1) were enacted to amend Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which commenced on 14 January 2011. This amendment was made under the authority of Section 333-20 of the Private Health Insurance Act 2007, which allows the Minister to make rules necessary to carry out or give effect to the Act. The primary purpose of these amendments was to adjust the patient contribution payable per night for nursing-home type patients (NHTPs) in public and private hospitals to reflect increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates) effective from 20 March 2013. The changes were made to ensure that the patient contribution rates remained consistent with the updated rates, thereby maintaining the integrity of the private health insurance scheme. States and territories were consulted regarding these amendments, with New South Wales, Queensland, South Australia, Tasmania, and Victoria agreeing to the rate increases, while the Australian Capital Territory and Northern Territory did not provide specific advice.

Scope and Application

The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1) apply to the regulation of private health insurance products within Australia, specifically targeting the patient contributions for nursing-home type patients (NHTPs) receiving treatment in public and private hospitals. These amendments are made under the authority of the Private Health Insurance Act 2007 and serve to modify Rule 8A of the Private Health Insurance (Complying Product) Rules 2010. The amendments adjust the patient contribution rates for NHTPs at public hospitals in New South Wales, Queensland, South Australia, Tasmania, and Victoria, and at private hospitals nationally, reflecting increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates). The changes came into effect on 20 March 2013, aligning with the updates to the Pension and Rental Assistance Rates. These rules do not apply to the Australian Capital Territory and Northern Territory as of the date of the amendment, although future adjustments may be considered.

Key Provisions

The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1) (Amendment Rules) amend Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2) (Principal Rules). These amendments adjust the patient contributions payable for nursing-home type patients (NHTPs) in both public and private hospitals, aligning with increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates). Specifically, Rule 8A(3)(a) of the Principal Rules, which governs the patient contribution for NHTPs at public hospitals, is amended for New South Wales, Queensland, South Australia, Tasmania, and Victoria, with the contribution rate increasing from $52.05 to $53.55 per night. Similarly, Rule 8A(3)(b) of the Principal Rules, concerning the patient contribution for NHTPs at private hospitals nationally, is also amended to increase the contribution rate from $52.05 to $53.55 per night. These changes are intended to reflect the recent increases in the relevant rates. The Amendment Rules impose specific obligations on private health insurers. They must now comply with the new patient contribution rates set out in the amended Rule 8A. This means that from 20 March 2013, private health insurers must adhere to the updated contribution rates for NHTPs at both public and private hospitals. This requirement ensures that the benefits paid by insurers are correctly calculated based on the new rates. The rules also necessitate that insurers update their systems and documentation to reflect these changes, ensuring that all claims and payments are processed accurately and in compliance with the new rates. Failure to comply with the new patient contribution rates set out in the Amendment Rules can lead to several consequences. While the Amendment Rules themselves do not explicitly detail penalties or sanctions for non-compliance, breaches of the Private Health Insurance Act 2007 (Act) may result in enforcement actions by the Australian Prudential Regulation Authority (APRA). Such actions could include fines, corrective actions, or other regulatory measures. Additionally, insurers may face legal challenges from policyholders who are overcharged or underpaid due to non-compliance with the new rates. It is important for insurers to ensure they are fully compliant to avoid potential financial and reputational risks.

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