Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 1)

Administered by Department of Health, Disability and Ageing

Legislation au F2014L00172 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Private Health Insurance Act 2007

 

Private Health Insurance (Prostheses) Amendment Rules 2014 (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.

The Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 1) (the Amendment Rules) amend the Private Health Insurance (Prostheses) Rules 2014 (No.1) (the Principal Rules) to correct drafting errors in the Principal Rules.

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 Principal Rules. 

The Amendment Rules will vary the Principal Rules as follows:

  • deleting 12 products, BX296, BX297, BX298, BX299, BX300, BX301, BX302, BX303, BX304, BX305, BX306, BX307 and OE029, due to an administrative error;
  • removing two (2) products from Part A and inserting them in Part C, BT153 and MI141; and
  • adding three (3) new products to Part A, TO149, SO049 and SO050.

The Amendment Rules commence 28 February 2014.  

 

Consultation

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

The Amendment 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 2014 (No. 1)

 

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

The Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 1) (the Rules) amend the Private Health Insurance (Prostheses) Rules 2014 (No. 1) (the Principal Rules) to correct drafting errors in the Principal Rules.

 

Item 4 of the table in subsection 72-1(2) of Part 3-3 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 (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, identified by billing code, are currently set out in the Schedule to the Principal Rules. 

 

The Rules amend the Principal Rules by:

  • deleting 12 products, BX296, BX297, BX298, BX299, BX300, BX301, BX302, BX303, BX304, BX305, BX306, BX307 and OE029, due to an administrative error;
  • removing two (2) products from Part A and inserting them in Part C, BT153 and MI141; and
  • adding three (3) new products to Part A, TO149, SO049 and SO050.

 

Human rights implications

The Rules engage the following human rights:

 

Right to Health

 

The right to health – the right to the enjoyment of the highest attainable standard of physical and mental health – is contained in article 12(1) of the International Covenant on Economic Social and Cultural Rights (ICESCR).  Whilst the UN Committee on Economic Social and Cultural Rights (the Committee) has stated that the right to health is not to be understood as a right to be healthy, it does entail a right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health.

 

The Rules remove entries for 12 prostheses at the request of the sponsors of these prostheses. These prostheses are currently part of a grouping and benefit review and were incorrectly listed.

 

Generally the prostheses removed from the Rules have been replaced by newer models due to upgraded technologies or advancements in surgical procedures. 

 

Conclusion

The Rules are compatible with human rights because they advance the protection of human rights, specifically the right to health [and, to the extent that right is limited the limitation is reasonable, necessary and proportionate]

 

Shane Porter

Assistant Secretary

Medical Benefits Division

Department of Health

 

Overview

The Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 1) were enacted to amend the Private Health Insurance (Prostheses) Rules 2014 (No. 1) and correct drafting errors identified in the principal rules. These amendment rules were introduced under Section 333-20 of the Private Health Insurance Act 2007, which empowers the Minister to make rules providing for matters required or permitted by Part 3-3 of the Act, or necessary or convenient to carry out or give effect to Part 3-3 of the Act. The purpose of these rules is to ensure that the listed prostheses comply with the specified requirements under the Act. The Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 1) were enacted by the Parliament of Australia and aim to ensure that health insurance policies meet the necessary requirements for providing prostheses in specified circumstances. The amendment rules were introduced to address the drafting errors in the principal rules and ensure the correct prostheses are listed, ultimately contributing to the protection of the right to health as recognised in international human rights instruments.

Scope and Application

The Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 1) apply to entities and individuals involved in the private health insurance industry, particularly those providing health insurance policies that cover hospital treatment. These Rules amend the Private Health Insurance (Prostheses) Rules 2014 (No.1) to correct drafting errors and ensure compliance with the Private Health Insurance Act 2007. The amendment affects the classification and listing of prostheses that must be covered under complying health insurance policies. The Rules operate nationally, impacting all jurisdictions within Australia where the Private Health Insurance Act 2007 applies. The amendment does not introduce new exclusions or exemptions; instead, it rectifies previous errors by deleting incorrectly listed prostheses, reclassifying certain products, and adding new ones. The legislative changes are effective from 28 February 2014, and further adjustments can be made through subordinate instruments as necessary.

Key Provisions

The Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 1) amend the Private Health Insurance (Prostheses) Rules 2014 (No. 1) to correct drafting errors in the Principal Rules. These amendments ensure that the listed prostheses are accurately reflected and that there are no administrative errors in the prostheses that qualify for benefits under the Act. Section 72-1(2) of Part 3-3 of the Act requires that a complying health insurance policy that covers hospital treatment must include a benefit for the provision of a prosthesis, listed in the Prostheses Rules, under specified circumstances. The Amendment Rules correct errors by removing twelve products due to an administrative error, reclassifying two products, and adding three new products to the list. The Amendment Rules impose specific obligations on the parties governed by them. Insurers must ensure that their health insurance policies comply with the amended list of prostheses, providing benefits for the listed prostheses under the specified conditions. This includes ensuring that the prostheses are correctly classified and that the benefits align with the rules as amended. Additionally, the Department of Health, as the governing body, must maintain an updated and accurate list of prostheses that qualify for benefits, ensuring that the list is reflective of current technologies and medical practices. There are no specific offences or penalties outlined in the Amendment Rules themselves. However, non-compliance with the Private Health Insurance Act 2007 or the amended Prostheses Rules could lead to civil or criminal consequences. The Act provides for various penalties, including fines, for breaches related to health insurance policies. The maximum penalties can be significant, depending on the nature and severity of the breach. The Act also allows for the recovery of benefits paid out in error, which could result in financial liabilities for insurers found to be non-compliant. Furthermore, ongoing non-compliance could lead to regulatory action against the insurer, potentially impacting their ability to operate in the Australian market. The compatibility of the Amendment Rules with human rights is addressed through the Statement of Compatibility with Human Rights. The Rules are designed to enhance the right to health by ensuring that the list of prostheses is accurate and up-to-date, thereby providing equality of opportunity for people to access necessary medical treatments. By removing outdated or incorrectly listed prostheses, the Rules support the right to health as recognised under international human rights law. The changes are reasonable, necessary, and proportionate, as they aim to correct administrative errors and ensure that the benefits provided are aligned with current medical standards.

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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.