Private Health Insurance Legislation Amendment Rules (No. 2) 2026

Administered by Department of Health, Disability and Ageing

Legislation au F2026L00167 Not in force Legislative Instrument

Legislation content

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

Overview

The Private Health Insurance Legislation Amendment Rules (No. 2) 2026 were issued under the authority of the Minister for Health and Ageing, as per Subsection 333-20(1) of the Private Health Insurance Act 2007. These Amendment Rules are designed to address a typographical error identified in the previous Private Health Insurance Legislation Amendment Rules (No. 1) 2026, specifically concerning the omission of certain items from the Support list under Schedule 1. The amendment rectifies this error by including specific Medicare Benefits Schedule (MBS) items in the Support treatment list, thus ensuring accurate and complete classification and categorisation of MBS items. This correction aims to maintain the integrity and effectiveness of the private health insurance system by providing a precise regulatory framework that aligns with the clinical categorisation of MBS items. The changes, effective from 1 March 2026, were developed following consultations with relevant stakeholders, including peak insurer and hospital representative associations, private health insurers, and private hospitals. The amendments do not substantively alter existing arrangements but ensure that the regulatory framework for private health insurance is accurate and comprehensive, facilitating better access to, and choice in, health care services. The policy objective is to uphold the right to health by improving the governing framework for private health insurance, ensuring better value for money for consumers, and enabling more informed purchasing decisions.

Scope and Application

The Private Health Insurance Legislation Amendment Rules (No. 2) 2026 apply to private health insurers, hospitals, and other entities involved in the provision of private health insurance services in Australia. These rules are designed to amend the Private Health Insurance (Complying Product) Rules 2015, rectifying an administrative error from the previous Amendment Rules (No. 1) 2026 by adding certain Medicare Benefits Schedule (MBS) items to the support treatment list. The rules aim to ensure that the classification and categorisation of MBS items within the private health insurance framework are accurate and reflect the correct clinical categories. The changes will be effective from 1 March 2026, and the amendments are limited to the correction of the administrative error without altering the substantive arrangements established under the Private Health Insurance Act 2007. The rules are made under the authority of the Minister for Health and Ageing and are consistent with the human rights to health by facilitating access to private health insurance benefits for health care services.

Key Provisions

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) to rectify an administrative error in the previous Amendment Rules. This change involves adding specific items to the Support treatment list in the MBS items section. The affected items are 81000, 81005, 81010, 82204, 82206, 93718, 93719, 93720, 93721, 93722, 93723, and 93724. These additions aim to correct a typing error identified in the Private Health Insurance Legislation Amendment Rules (No. 1) 2026, where certain items were omitted from the Support list. The clinical category or procedures type for these MBS items remain unchanged. The Amendment Rules impose obligations on the parties and entities governed by them, primarily through the rectification of an administrative error in the classification of MBS items. By including the missing items in the Support treatment list, the rules ensure that the classification of these items is consistent with the intended regulatory framework. This amendment facilitates the accurate application of private health insurance benefits for the specified treatments, thereby maintaining the integrity of the private health insurance system. The inclusion of these items is essential for insurers and providers to correctly classify and process claims for these treatments. Breaching the requirements set out in the Amendment Rules may not directly result in specific offences or penalties, as the changes are primarily administrative in nature. However, failure to comply with the updated classification rules could lead to incorrect billing or claims processing by private health insurers, which might result in financial discrepancies or disputes. The primary consequence of non-compliance would be the need to correct the administrative errors, which could involve audits, adjustments, and potential financial implications for both insurers and policyholders. While the Amendment Rules themselves do not specify penalties, the underlying regulations and compliance requirements of the Private Health Insurance Act 2007 could impose sanctions for non-compliance with the broader regulatory framework. The Amendment Rules aim to ensure that the classification of MBS items under the private health insurance framework is accurate and complete. By rectifying the administrative error from the previous Amendment Rules, the current legislative instrument ensures that the private health insurance system can effectively process claims for the specified treatments. This change is crucial for maintaining the integrity and functionality of the private health insurance classification system, thereby supporting the broader objectives of the Private Health Insurance Act 2007 in providing clear and consistent guidelines for private health insurance providers and consumers.

Legal classification tags

Area of Law
Private Health Insurance
Instrument
Regulation
Concepts
Definitions & Interpretation
Reporting & Disclosure Obligations
Regulatory Standards

Interactions

Authorises

All Versions

Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.