Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 3)

Administered by Department of Health, Disability and Ageing

Legislation au F2016L01596 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Private Health Insurance Act 2007

 

Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 3)

 

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 2016 (No. 3) (the Amendment Rules) amend the Private Health Insurance (Prostheses) Rules 2016 (No. 4) (the Principal Rules) to correct minor 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 Principal 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 Principal 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:

  • change the listing details of 13 billing codes on Part B to reflect the correct benefit of the prostheses; and
  • correct the benefit recorded in error for a billing code in Part A, and insert the correct benefit.

The Amendment Rules commence on the day after registration.

Consultation

In accordance with section 17 of the Legislation Act 2003, the Department consulted with the sponsors 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 Legislation 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 2016 (No. 3)

 

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 2016 (No. 3) (the Rules) amend the Private Health Insurance (Prostheses) Rules 2016 (No. 4) (the Principal Rules) to correct minor 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 Principal 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 Principal 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 Amendment Rules amend the Principal Rules by:

  • change the listing details of 13 billing codes on Part B to reflect the correct benefit of the prostheses; and
  • correct the benefit recorded in error for a billing code in Part A, and insert the correct benefit.

 

Human rights implications

The Amendment 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 Amendment Rules correct the names of 2 prostheses and correct the minimum benefit for 1 prosthesis.  Each of these changes has a beneficial impact on the right to health in Australia, ensuring that minimum benefits, or higher minimum benefits, are required to be paid for the provision of these prostheses under private health insurance policies covering hospital treatment, where relevant conditions are met.   

 

The amendments made by the Amendment Rules do not reduce the minimum benefit payable for any listed prosthesis.

 

Conclusion

The Amendment Rules are compatible with human rights because they advance the protection of human rights, specifically the right to health.

 

Tracey Duffy

Assistant Secretary

Private Health Insurance Branch

Medical Benefits Division

Department of Health

 

Overview

The Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 3) were enacted to correct minor drafting errors in the Private Health Insurance (Prostheses) Rules 2016 (No. 4), which are subordinate legislation under the Private Health Insurance Act 2007. This Act was enacted by the Commonwealth Parliament to regulate the private health insurance industry in Australia, aiming to ensure that health insurance policies provide adequate coverage for essential health services, including prostheses. The Amendment Rules specifically address inaccuracies in the listing details and benefits of certain prostheses, ensuring that policyholders receive the correct benefits for listed prostheses under their private health insurance policies. The Department of Health consulted with the relevant stakeholders before proposing these amendments, receiving no objections and confirming their compatibility with human rights, particularly the right to health as recognised under the International Covenant on Economic, Social and Cultural Rights. The rules are designed to maintain the integrity and effectiveness of health insurance coverage, ensuring that individuals have access to necessary prostheses without undue financial burden, thereby supporting the broader policy objective of the Private Health Insurance Act to provide equitable access to health services.

Scope and Application

The Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 3) serve to correct minor drafting errors in the Private Health Insurance (Prostheses) Rules 2016 (No. 4). These amendment rules apply to complying health insurance policies that cover hospital treatment and hospital-substitute treatment, ensuring that there is a benefit for the provision of listed prostheses under specific circumstances. The rules are designed to ensure that the minimum benefits for prostheses are accurately recorded and paid out, thus enhancing the right to health under the International Covenant on Economic, Social and Cultural Rights. The amendment rules primarily affect entities such as private health insurers and policyholders by correcting the benefits for 13 billing codes of prostheses and rectifying an error in the benefit for one specific billing code. The rules apply nationally across Australia and do not exclude any particular persons or entities from their scope. The amendment rules are subordinate instruments made under the authority of the Private Health Insurance Act 2007, which provides a framework for regulating private health insurance in Australia. There are no stated exclusions or exemptions in these rules, and they are compatible with human rights as they uphold the right to health by ensuring that minimum benefits are correctly stipulated for prostheses.

Key Provisions

The Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 3) primarily amend the Private Health Insurance (Prostheses) Rules 2016 (No. 4) to correct minor drafting errors. Specifically, they adjust the listing details of 13 billing codes on Part B to accurately reflect the correct benefit of the prostheses and correct the benefit recorded in error for a billing code on Part A, inserting the correct benefit. These amendments are made pursuant to section 333-20 of the Private Health Insurance Act 2007, which empowers the Minister to make rules regarding prostheses as necessary or convenient for implementing Part 3-3 of the Act. Under the Private Health Insurance Act 2007, complying health insurance policies that cover hospital treatment must include a benefit for the provision of a listed prosthesis, in specified circumstances such as when a Medicare benefit is payable or under other conditions outlined in the Principal Rules. If a policy also covers hospital-substitute treatment, similar requirements apply. The Amendment Rules ensure that the benefits listed in the Principal Rules are accurate and reflect the correct benefits for each prosthesis, thereby upholding the standards set by the Act. This correction is crucial for maintaining the integrity of health insurance policies and ensuring that policyholders receive the benefits they are entitled to under their contracts. The Amendment Rules impose specific obligations on private health insurers to ensure compliance with the corrected benefits listed in the Principal Rules. Insurers must update their policies to reflect these amendments, ensuring that the benefits for listed prostheses are accurately represented. This requirement is essential to avoid discrepancies in the benefits provided to policyholders and to maintain the trust and reliability of private health insurance offerings. In terms of consequences for non-compliance, while the Amendment Rules themselves do not specify particular offences, penalties, or criminal consequences, failure to comply with the requirements of the Private Health Insurance Act 2007 can result in significant repercussions. Non-compliance with the Act may lead to civil penalties, including fines, and potential criminal charges for serious breaches. These penalties are intended to enforce adherence to the regulatory standards and protect the interests of policyholders.

Legal classification tags

Area of Law
Health Law
Insurance Law
Instrument
Regulation
Concepts
Definitions & Interpretation
Reporting & Disclosure Obligations
Compliance Obligations

Interactions

Authorises

All Versions

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.