Private Health Insurance (Prostheses) Amendment Rules 2007 (No. 2)

EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Private Health Insurance Act 2007

Private Health Insurance (Prostheses) Amendment Rules 2007 (No.2)

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Prostheses) Rules, providing for matters required or permitted by Part 3-3 of the Act, or necessary or convenient in order to carry out or give effect to Part 3-3 of the Act.

Item 4 of the table in subsection 72-1(2) of Part 3-3 of the Act provides for requirements that a complying health insurance policy that covers hospital treatment must meet.  There must be a minimum benefit for the provision of a prosthesis of a kind listed in the Private Health Insurance (Prostheses) Rules.

Item 4 of the table provides that in order for a private health insurer to be required to pay the minimum benefit, a Medicare benefit must be payable in respect of the professional service associated with the provision of the listed prosthesis.

If the complying health insurance policy also covers hospital-substitute treatment, the same requirements apply.

The Private Health Insurance (Prostheses) Rules 2007 (No.4) (the Rules) commence on 15 December 2007.

The Private Health Insurance (Prostheses) Amendment Rules 2007 (No.2) (the Amendment Rules) commence on 15 December 2007 and amend the Schedule to the Rules.

The Schedule to the Rules has two parts:

• Part A – Prostheses; and
• Part B – Human Tissue List.

The Amendment Rules update Part A of the Schedule to the Rules by:

• changing the minimum benefit and/or maximum benefit of thirteen (13) items; and
• deleting five (5) items, billing codes DV003, DV013, DV014, DV015 and DV016.

CONSULTATION

The Amendment Rules have been made having regard to recommendations made by the Prostheses and Devices Committee (PDC), a ministerially appointed committee comprised of nominees from private health insurers, hospitals, clinicians, prostheses and devices suppliers, and consumer representatives. 

In making their recommendations, the PDC were advised by Clinical Advisory Groups, other clinical experts, and benefits negotiators, all appointed by the PDC.

Details of the Amendment Rules are set out in Attachment.

The Amendment Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

                                                                                                                                                                     ATTACHMENT

DETAILS OF THE PRIVATE HEALTH INSURANCE (PROSTHESES) AMENDMENT RULES 2007 (No.2)

1.  Name of Rules

Rule 1 provides that the title of the Rules is the Private Health Insurance (Prostheses) Amendment Rules 2007(No.2).

2.  Commencement

Rule 2 provides for the Rules to commence on 15 December 2007.

3.  Amendment of the Schedule to the Private Health Insurance (Prostheses) Rules 2007 (No.4)

Rule 3 provides for the amendments to the Schedule to the Private Health Insurance (Prostheses) Rules 2007(No.4).

The amendments include:

• The deletion of billing codes DV003, DV013, DV014, DV015 and DV016; and

• Changes to the minimum and/or maximum benefits for the thirteen items listed in the table below.  A notation has also been included for billing code OH260.