Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 3)

Administered by Department of Health, Disability and Ageing

Legislation au F2015L01449 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 2015 (No. 3)

 

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 2015 (No. 3) (the Amendment Rules) amend Rule 8A of the Private Health Insurance (Complying Product) Rules 2015 (the Principal Rules) which commenced on 1 July 2015.

 

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 each State and Territory.

 

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 each State and Territory. 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 September 2015.

 

Details

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

 

Consultation

On 27 August 2015, 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. Queensland, New South Wales, Tasmania, Victoria, South Australia, Western Australia and the Northern Territory have advised that they will increase the NHTP contribution rates in their public hospitals from 20 September 2015.

 

On 27 August 2015 the Australian Government Department of Health (the Department) advised States and Territories of its intention to increase minimum private health insurance benefits for private hospital accommodation as a consequence of CPI movements for the period September 2014-September 2015.

 

The Amendment Rules commence on 20 September 2015.

 

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

SEPTEMBER 2015


ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (COMPLYING PRODUCT) AMENDMENT RULES 2015 (No. 3)

 

Section 1 Name of Rules

Section 1 provides that the title of the Rules is the Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 3) (the Amendment Rules).

Section 2 Commencement

Section 2 provides that the Amendment Rules are to commence on 20 September 2015.

Section 3 Amendment of Private Health Insurance (Complying Product) Rules 2015

Section 3 provides that the Schedule to the Amendment Rules amends the Private Health Insurance (Complying Product) Rules 2015 (the Principal Rules) which commenced on 1 July 2015.

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 in each State and Territory.

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Overview

The Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 3) were enacted to align the patient contribution payable per night for nursing-home type patients at public hospitals with increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance. This amendment was necessitated by the adjustments to these rates, which took effect on 20 September 2015. The rules were made under the authority of Section 333-20 of the Private Health Insurance Act 2007 and aim to ensure that private health insurance benefits for hospital treatment remain equitable and reflective of current economic conditions. Following consultation with the States and Territories, it was determined that the contribution rates would be updated to match the new rates, thereby maintaining the integrity of the benefits provided to policyholders.

Scope and Application

The Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 3) amends Rule 8A of the Private Health Insurance (Complying Product) Rules 2015, which set the patient contribution for privately insured nursing-home type patients (NHTP) receiving treatment at public hospitals. This amendment applies to all states and territories within Australia and is aimed at aligning the patient contribution rates with the increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates), effective from 20 September 2015. The rules are a legislative instrument under the Legislative Instruments Act 2003 and are authorised by Section 333-20 of the Private Health Insurance Act 2007. The amendment follows consultation with the states and territories, which have confirmed their intention to increase the NHTP contribution rates in line with the aforementioned increases. The Amendment Rules ensure that private health insurers adjust their benefits accordingly to reflect these changes.

Key Provisions

The Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 3) primarily address the patient contribution payable per night for nursing-home type patients (NHTP) in public hospitals across each state and territory (Rule 3). These amendments, which took effect on 20 September 2015, were made in response to increases in the Adult Pension Basic Rate and the Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates). The purpose of these changes is to align the patient contributions with the updated rates, ensuring they reflect the most recent economic adjustments. These rules impose obligations on private health insurers to adjust their benefit payments for NHTPs in public hospitals. Specifically, they require insurers to limit the amount of benefit they pay for each day of NHTP hospital treatment to the hospital’s charge minus the patient contribution amount, as amended by the new rules (Rule 8A(3)(a)). This ensures that the patient contributions are consistent with the updated rates, providing a clear and regulated framework for what privately insured patients must contribute. Breach of these rules could have significant consequences. While the explanatory statement does not explicitly detail the penalties for non-compliance, the Private Health Insurance Act 2007 generally provides for penalties in the event of non-compliance with the rules. Such penalties could include fines or other enforcement actions. For instance, under section 178 of the Act, a person who contravenes any provision of the rules may be liable for a civil penalty of up to $22,200 for a corporation and $4,440 for an individual, reflecting the seriousness of ensuring accurate and timely contributions for NHTPs.

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