Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 1)

EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Private Health Insurance Act 2007

Private Health Insurance (Prostheses) Amendment Rules 2011 (No.1)

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 benefit for the provision of a prosthesis, of a kind listed in the Private Health Insurance (Prostheses) Rules (i.e. a listed prosthesis), in specified circumstances and under any specified conditions. The specified circumstances are that the listed prosthesis is provided in circumstances in which a Medicare benefit is payable or those other circumstances which are set out in the Private Health Insurance (Prostheses) Rules. The specified conditions are those set out in the Private Health Insurance (Prostheses) Rules, currently in relation to insulin infusion pumps and billing code SO041 (Osmed Sphere / Hemisphere tissue expander).  

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

The Private Health Insurance (Prostheses) Rules 2011 (No. 1) (the Principal Rules) commence on 21 February 2011.

The Schedule to the Principal Rules has three parts:

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

The Private Health Insurance (Prostheses) Amendment Rules 2011 (No.1) (the Amendment Rules) commence on 21 February 2011 and amend the Schedule to the Principal Rules.

The Amendment Rules update Part A of the Schedule to the Principal Rules by reinstating an item, billing code BB274 that was incorrectly removed when the Principal Rules were made.

CONSULTATION

The Sponsor of the kind of prosthesis affected by this amendment was consulted and had no objection to the amendment.

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

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

ATTACHMENT

DETAILS OF THE PRIVATE HEALTH INSURANCE (PROSTHESES) AMENDMENT RULES 2011 (No. 1)

1.  Name of Rules

Rule 1 provides that the title of the Rules is the Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 1).

2.  Commencement

Rule 2 provides for the Rules to commence on 21 February 2011.

3.  Amendment of the Schedule to the Private Health Insurance (Prostheses) Rules 2011 (No. 1)

Rule 3 provides for an amendment to the Schedule to the Private Health Insurance (Prostheses) Rules 2011 (No. 1).

The amendment reinstates an item, Billing Code BB274, which was incorrectly removed when the Principal Rules were made, as outlined in the table below: