EXPLANATORY STATEMENT
Issued by the Authority of the Minister for Health
Private Health Insurance Act 2007
Private Health Insurance (Complying Product) Amendment Rules 2014 (No. 5)
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 2014 (No. 5) (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 (NHTP) at public hospitals in the Australian Capital Territory (ACT).
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 the ACT. 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 took effect on 20 March 2014.
Details
Details of the Amendment Rules are set out in the Attachment.
Consultation
On 7 March 2014, states and territories were asked whether they would be increasing the NHTP contribution and minimum benefit rates in their jurisdiction in line with increases in the Pension and Rental Assistance Rates. New South Wales, South Australia, Tasmania, Queensland, Northern Territory and Western Australia advised that they would be increasing the NHTP contribution rates in their public hospitals from 20 March 2014. The
Australian Capital Territory advised that it was not increasing its NHTP contribution and rates at that time. However ACT provided advice on 6 June 2014 that they will increase the NHTP contribution rate in public hospitals from 1 July 2014.
The Amendment Rules commence on 1 July 2014 or, if registered after 1 July 2014, 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
MEDICAL BENEFITS DIVISION
DEPARTMENT OF HEALTH
JUNE 2014
ATTACHMENT
DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLYING PRODUCT) AMENDMENT RULES 2014 (No. 5)
Section 1 Name of Rules
Section 1 provides that the title of the Rules is the Private Health Insurance (Complying Product) Amendment Rules 2014 (No. 5) (the Amendment Rules).
Section 2 Commencement
Section 2 provides that the Amendment Rules are to commence on 1 July 2014, or if registered after 1 July 2014, the day after registration.
Section 3 Authority
Section 3 provides that the Amendment Rules are made under item 3 of the table in section
333-20 of the Private Health Insurance Act 2007.
Section 4 Schedule
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
Schedule
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 – Amendment
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)(i) of the Principal Rules by increasing the NHTP contribution at public hospitals:
- Australian Capital Territory $53.55 to $55.80;
Overview
The Private Health Insurance (Complying Product) Amendment Rules 2014 (No. 5) were enacted to address the need for updating patient contribution rates for nursing-home type patients (NHTP) at public hospitals in the Australian Capital Territory (ACT) in line with recent increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates). These amendments were made under Section 333-20 of the Private Health Insurance Act 2007 by the Minister for Health, and their policy objective was to ensure that the contributions reflect the updated rates. The Amendment Rules were issued following consultations with the states and territories, with the ACT deciding to increase its NHTP contribution rates effective from 1 July 2014. The Amendment Rules themselves commenced on 1 July 2014, or the day after registration if enacted after this date.
The changes made by the Amendment Rules involve minor adjustments to Paragraph 8A(3)(a) of the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which set the patient contributions for NHTPs at public hospitals. Specifically, the Amendment Rules increase the NHTP contribution rate at public hospitals in the ACT from $53.55 to $55.80 per night, aligning it with the new Pension and Rental Assistance Rates. This legislative update ensures that the contributions for private health insurance remain consistent with the latest policy adjustments in pension and rental assistance rates, thereby maintaining the integrity and fairness of the private health insurance scheme.
Scope and Application
The Private Health Insurance (Complying Product) Amendment Rules 2014 (No. 5) pertains to the amendment of Rule 8A of the Private Health Insurance (Complying Product) Rules 2010 (No. 2), which set the patient contribution for privately insured nursing-home type patients (NHTP) at public hospitals. These rules apply to private health insurers, patients, and hospitals within the Australian Capital Territory (ACT). The primary objective is to adjust the patient contribution payable per night for NHTPs in public hospitals in the ACT, reflecting increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates) effective from 20 March 2014. The amendment to Rule 8A specifically modifies the contribution rate for NHTPs, ensuring alignment with the updated rates. These rules are made under Section 333-20 of the Private Health Insurance Act 2007 and are to commence on 1 July 2014, or the day after registration if enacted after that date.
Key Provisions
The main operative sections of the Private Health Insurance (Complying Product) Amendment Rules 2014 (No. 5) pertain to amendments of the Private Health Insurance (Complying Product) Rules 2010 (No. 2). Specifically, Rule 8A of the Principal Rules, which deals with the patient contribution for privately insured nursing-home type patients (NHTP) at public hospitals, is amended. The key change involves altering the patient contribution payable per night for NHTPs at public hospitals in the Australian Capital Territory (ACT) (Item 1, Schedule). This amendment adjusts the contribution amount to reflect increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates), effective from 1 July 2014.
The obligations imposed by the Amendment Rules primarily affect private health insurers. These insurers must now comply with the updated patient contribution rates set out in the amended Rule 8A. This requirement ensures that the benefits they pay for each day of NHTP hospital treatment at public hospitals are consistent with the new contribution rates. Additionally, insurers must ensure their policies and billing practices reflect these changes to avoid discrepancies or non-compliance.
In terms of consequences for non-compliance, the Amendment Rules do not explicitly state offences, penalties, or civil/criminal consequences for breach. However, given that these rules are made under the authority of the Private Health Insurance Act 2007, any failure to comply with the amended patient contribution rates could potentially lead to enforcement actions by the relevant authorities. Such actions may include fines, corrective measures, or other regulatory actions aimed at ensuring compliance with the Act and its rules. The specific penalties would depend on the nature and severity of the breach, as well as any additional provisions outlined in the Private Health Insurance Act 2007.