EXPLANATORY STATEMENT
Private Health Insurance Act 2007
Private Health Insurance (Prostheses) Amendment Rules 2013 (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 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.
Listed prostheses are currently set out in the Schedule to the Private Health Insurance (Prostheses) Rules 2012 (No. 2) (the Principal Rules). The Principal Rules currently include the following 10 prostheses (the VAIOS System):
- VAIOS Humeral Head (Billing Code OH 386)
- VAIOS Reverse Humeral Insert (Billing Code OH390)
- VAIOS Humeral Neck (Billing Code OH387)
- VAIOS Humeral Stem (Billing Code OH388)
- VAIOS Cemented Glenoid (Billing Code OH385)
- VAIOS Glenoid Metal Back (Billing Code OH383)
- VAIOS Humeral Metal Back Reverse (Billing Code OH389)
- VAIOS Glenoid Insert (Billing Code OH384)
- VAIOS Glenoid Dome (Billing Code OH391)
- VAIOS Locking screw (Billing Code OH392)
The Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 1) (the Amending Rules) were made on 8 February 2013 and commence on 5 March 2013. The Amending Rules will replace the current Schedule to the Principal Rules with a new Schedule of listed prostheses. The VAIOS System is not listed in the Amending Rules.
The purpose of the Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 2) is to maintain the listing of the VAIOS System, as required by an interim Court order.
The 10 components of the VAIOS System will be listed with their current billing codes, product details and minimum benefits.
These Rules will commence immediately after the commencement of the Amending Rules on 5 March 2013.
Consultation
No consultation has been taken in connection with these Rules. They have been made in response to an interim Court order and it would therefore be inappropriate to undertake consultation about them.
The Rules are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 2)
This 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 Legislative Instrument
Item 4 of the table in subsection 72-1(2) of the Private Health Insurance Act 2007 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 in specified circumstances and under any specified conditions. The specified circumstances are that the prosthesis is provided in circumstances where a Medicare benefit is payable or any other circumstance set out in those Rules.
If the complying health insurance policy covers hospital-substitute treatment, the same requirements apply.
Listed prostheses are currently set out in the Schedule to the Private Health Insurance (Prostheses) Rules 2012 (No. 2) (the Principal Rules). The Schedule currently includes the following 10 prostheses (the VAIOS prostheses): VAIOS Humeral Head; VAIOS Reverse Humeral Insert; VAIOS Humeral Neck; VAIOS Humeral Stem; VAIOS Cemented Glenoid; VAIOS Glenoid Metal Back; VAIOS Humeral Metal Back Reverse; VAIOS Glenoid Insert; VAIOS Glenoid Dome; and VAIOS Locking screw.
A new Schedule to the Principal Rules is to be substituted by the Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 1) (the Amending Rules), made on 8 February 2013 and commencing on 5 March 2013. The VAIOS prostheses are not included in the Amending Rules.
The Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 2) (the Rules) will amend the Schedule to the Principal Rules from 5 March 2013 to maintain the listing of the VAIOS prostheses, as required by an interim Court order.
Human rights implications
These Rules are being made to give effect to an interim order of the Federal Court to maintain the listing of the VAIOS prostheses pending further proceedings. However, the maintenance of the listing of the VAIOS prostheses does not have any negative impact on human rights. In particular, it does not limit the rights to health or social security and the requirement for the payment of insurance benefits for the VAIOS prostheses is not restricted on the basis of sex, age, race etc.
Doug Fawns
Assistant Secretary
Medical Benefits Division
Department of Health and Ageing