EXPLANATORY STATEMENT

Issued by the Authority of the Minister for Health and Ageing

Private Health Insurance Act 2007

Private Health Insurance (Prostheses) Amendment Rules 2012 (No.1)

Authority

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.

Purpose

The purpose of the Amendment Rules is to amend Part A of the Schedule to the Private Health Insurance (Prostheses) Rules 2012 (No. 1) (Principal Rules) by:

•     inserting items that were incorrectly removed when the Principal Rules were made; and

•making revisions to the listings of various items.  These revisions were inadvertently not made when the Principal Rules were drafted.  These revisions include the deletion of the listing of certain items or parts of items, the movement of the listing of certain items to new grouping schemes and the correction of typographical errors.

Background

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.

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

The Principal Rules commenced on 3 March 2012.

The Schedule to the Principal Rules has three parts:

•Part A – Prostheses; and

•Part B – Human Tissue List;

•Part C – Other Prostheses.

Consultation

In accordance with section 17 of the Legislative Instruments Act 2003, the Department consulted with the Sponsors of each prosthesis affected by these amendments have been consulted. There are no objections to the amendments. The Department has received a standing Regulatory Impact Statement (RIS) exemption from the Department of Finance and Deregulation (DoFD).

Details

The Schedule to the Amendment Rules amends the Schedule – Part A – Prostheses List – February 2012, to the Principle Rules. Details of the Amendment Rules are set out in the Attachment to this explanatory statement.

The Amendment Rules commence on 9 April 2012 and amend the Schedule to the Principal Rules and 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 2012 (No.1)

1.  Name of Rules

Rule 1 provides that the title of the Rules is the Private Health Insurance (Prostheses) Amendment Rules 2012 (No. 1).

2.  Commencement

Rule 2 provides for the Rules to commence on 9 April 2012.

3.  Amendment of the Schedule to the Private Health Insurance (Prostheses)  Rules 2012 (No. 1)

Schedule – Amendments

Item 1- Schedule – Part A – Prostheses List – February 2012

Rule 3 provides for the amendments to the Schedule to the Private Health Insurance (Prostheses) Rules 2012 (No. 1). The following amendments have been made due to administrative/drafting errors made in the Private Health Insurance (Prostheses) Rules 2012 (No. 1) on 3 March 2012.

The reasons for the items listed in the Schedule to the Amendment Rules are provided below.

Items 1.1 – 1.3 amend the Principle Rules to correctly list billing code DY550 as FI061. This error occurred due to the transfer application not being processed by the Department of Health and Ageing (the Department).

Items 1.4 – 1.6 fixes the billing code DY020 to be listed in the correct group with the amended minimum benefit amount. This occurred due to a drafting error by the Department.

Items 1.7, 1.8, 1.39 and item 1.40 fixes the details for billing code DP868 to be listed in the correct group, sub group and suffix with the amended benefit amount. This occurred due to a drafting error by the Department.

Items 1.9 – 1.11 fixes the correct grouping and minimum benefit amount for billing code DY400 which occurred due to a drafting error by the Department.

Items 1.12 – 1.16 and item 1.56 amend the Principle Rules by deleting billing codes SN032, SN146, SN708, SN709 and SN437. These billing codes were incorrectly listed due to the deletion applications not being processed by the Department.

Items 1.17 – 1.52 fixes the incorrect suffix listing and minimum benefit amounts for billing codes SK538, SK539, SK540, SK541, SK542, SK543, SN801, JJ712, DE370, EO074, EO073 and EO072 which occurred due to a drafting error made by the Department.

Items 1.53 – 1.55 amends the Principle Rules by reinstating billing code DY538 which was incorrectly deleted from the schedule due to a drafting error made by the Department.

STATEMENT OF COMPATIBILITY FOR A BILL OR LEGISLATIVE INSTRUMENT THAT DOES NOT RAISE ANY HUMAN RIGHTS ISSUES