Issued by the Authority of the Minister for Health and Ageing
Private Health Insurance Act 2007
Private Health Insurance Legislation Amendment Rules (No. 2) 2026
Authority
Subsection 333-20(1) of the Private Health Insurance Act 2007 (the Act) authorises the Minister to, by legislative instrument, make specified Private Health Insurance Rules providing for matters required or permitted by the corresponding Chapter, Part, or section to be provided; or necessary or convenient to be provided in order to carry out or give effect to that Chapter, Part or section.
The Private Health Insurance Legislation Amendment Rules (No. 2 2026) (the Amendment Rules) amends the:
- Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules).
Subsection 33(3) of the Acts Interpretation Act 1901 provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.
Purpose
The Amendment Rules make consequential amendments to the Complying Products Rules 2015 to implement changes to the private health insurance (PHI) clinical category classification of items of the Medicare Benefits Schedule (MBS) to rectify a typing error in the previous Amendment Rules.
An error was identified in the Private Health Insurance Legislation Amendment Rules (No. 1) 2026 had missing items in the Support list under Schedule 1 – Amendment Clinical categories, Common treatments and Support treatments.
Changes to the clinical categorisation of MBS items are achieved by adding the following items to the support treatment list:
- 81000, 81005, 81010, 82204, 82206, 93718, 93719, 93720, 93721, 93722, 93723, 93724
There are no changes to the clinical category or procedures type for these MBS items. This amendment is to rectify an administrative error.
The private health insurance classification and categorisation changes commencing
1 March 2026 are detailed in the Attachment to this Explanatory Statement. Further PHI clinical category and procedure type information, including the announcement of changes through PHI ‘Circulars’ and the ‘Private Health Insurance Classification of MBS items’ technical document (PHI technical document) can be viewed on the Department’s website (www.health.gov.au).
Consultation
Private Health Insurance Rules classifications for MBS items
Medical officers within the department provide expert clinical advice to assist in determining the appropriate PHI clinical category and procedure type for accommodation benefits for MBS items in private health insurance rules.
The department’s weekly email to private health sector stakeholders, including peak insurer and hospital representative associations, private health insurers and private hospitals, includes information on the anticipated changes to MBS items and consultation processes.
Feedback received from stakeholders was considered when determining the final amendments.
The Amendment Rules
The consequential amendments in these Amendment Rules are administrative in nature and do not substantively alter existing arrangements established under the Act.
Details
Details of the Amendment Rules are set out in Attachment A. The Amendment Rules are a legislative instrument for the purposes of the Legislation Act 2003.
Attachment A
Details of the Private Health Insurance Legislation Amendment Rules (No.2) 2026
Section 1 – Name
Section 1 provides that the name of the instrument is the Private Health Insurance Legislation Amendment Rules (No. 2) 2026 (the Amendment Rules).
Section 2 – Commencement
Section 2 provides that the instrument commences on 1 March 2026.
Section 3 – Authority
Section 3 provides that the Amendment Rules are made under subsection 333-20(1) of the Private Health Insurance Act 2007.
Section 4 – Schedules
Section 4 provides that each instrument that is specified in a Schedule to the instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to the instrument has effect according to its terms.
All Schedule changes commence 1 March 2026.
Schedule 1—Amendments— Support treatments
Private Health Insurance (Complying Product) Rules 2015 (Complying Product Rules)
Schedule 1 of the Amendment Rules repeals the existing MBS items in the Support treatments table of MBS items in the Complying Product Rules, and substitutes an amended table.
Items have been added to the table to rectify an administrative error in the previous Private Health Insurance Legislation Amendment Rules (No. 1) 2026.
The following items to the Support treatment list:
- 81000, 81005, 81010, 82204, 82206, 93718, 93719, 93720, 93721, 93722, 93723, 93724
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Private Health Insurance Legislation Amendment Rules (No. 2) 2026
This disallowable legislative instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the disallowable legislative instrument
The purpose of the Private Health Insurance Legislation Amendment Rules (No. 2) 2026 (the Amendment Rules) is to amend the following instruments:
- Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules).
The Amendment Rules make consequential amendments to the:
- Complying Product Rules to rectify an administrative error by listing 12 items to the Support treatment list
Human rights implications
The Amendment Rules engage the right to health by facilitating the payment of private health insurance benefits for health care services, encouraging access to, and choice in, health care services. Under Article 12 of the International Covenant on Economic, Social and Cultural Rights, specifically the right to health, the Amendment Rules assist with the progressive realisation by all appropriate means of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
Private health insurance regulation assists with the advancement of these human rights by improving the governing framework for private health insurance in the interests of consumers. Private health insurance regulation aims to encourage insurers and providers of private health goods and services to provide better value for money to consumers, and to improve information provided to consumers of private health services to allow consumers to make more informed choices when purchasing services. Private health insurance regulation also requires that insurers do not differentiate the premiums they charge according to individual health characteristics such as poor health.
The amendments relating to omission or insertion of MBS items in the Benefit Requirements Rules and the Complying Product Rules, and under definitions of hospital treatment are because of the changes to the MBS that take effect on 1 March 2026.
Consultation
Private Health Insurance Rules classifications for MBS items
Medical officers within the department provide expert clinical advice to assist in determining the appropriate PHI clinical category and procedure type for accommodation benefits for MBS items in private health insurance rules.
The department’s weekly email to private health sector stakeholders, including peak insurer and hospital representative associations, private health insurers and private hospitals, includes information on the anticipated changes to MBS items and consultation processes.
Feedback received from stakeholders was considered when determining the final amendments.
Conclusion
This disallowable legislative instrument only engages human rights to the extent that it maintains current arrangements with respect to the regulation of private health insurance. Therefore, this instrument is compatible with human rights because these changes continue to ensure that existing arrangements advancing the protection of human rights are maintained.
Paul McBride
Assistant Secretary
Private Health Strategy Branch
Portfolio Strategy Division
Systems Strategy Group
Department of Health, Disability and Ageing