Private Health Insurance (Prostheses) Amendment Rules 2019

Administered by Department of Health, Disability and Ageing

Legislation au F2019L00147 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

 

Private Health Insurance Act 2007

 

Private Health Insurance (Prostheses) Amendment Rules 2019

 

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.

 

In addition to the power to make this instrument under section 333-20 of the Act, subsection 33(3) of the Acts Interpretation Act 1901 provides that where an Act confers a power to make, grant or issue any instrument of a legislative or administrative character (including rules, regulations or by-laws), the power shall be construed as including a power exercisable in the like manner and subject to the like conditions (if any) to repeal, rescind, revoke, amend, or vary any such instrument.

 

The table in subsection 72-1(2) of Part 3-3 of the Act provides for benefit requirements that a complying health insurance policy that covers hospital treatment must meet. Under item 4 of that table there must be a benefit for the provision of a prosthesis, of a kind listed in 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 in other circumstances which may be set out in Private Health Insurance (Prostheses) Rules. The specified conditions are any that may be set out in Private Health Insurance (Prostheses) Rules.

 

If the complying health insurance policy also covers hospital-substitute treatment, under item 4 of the table in subsection 72-1(2) of Part 3-3 of the Act the same requirements apply.

 

The Private Health Insurance (Prostheses) Rules 2018 (No. 2) (Prostheses Rules) were created for the purposes of section 333-20 of the Act. Listed prostheses and their minimum benefits are set out in the Schedule to the Rules.  The list of prostheses in the Schedule is commonly referred to as the Prostheses List.

 

Purpose

The purpose of the Private Health Insurance (Prostheses) Amendment Rules 2019 (the Amending Rules) is to update the list of the kinds of prostheses in Part C of the Schedule to the Prostheses Rules.

 

The Schedule to the Prostheses Rules has three parts:

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

 

Rule 13 lists the kinds of prostheses that are in Part C of the Schedule. The list currently includes insulin infusion pumps, implantable cardiac event recorders and cardiac/remote monitoring systems.

 

The purpose of the Amending Rules is to add cardiac ablation catheters, mapping catheters for cardiac ablation or patches for cardiac ablation to this list.

 

Consultation

The Government made an agreement with the Medical Technology Association of Australia (MTAA) in October 2017 to promote the sustainability of privately insured healthcare and to support a viable, innovative and diverse medical technology sector in Australia. The agreement includes a commitment to review, through the Prostheses List Advisory Committee (PLAC), ways of listing new targeted medical devices on the Prostheses List that do not meet the current criteria for listing but are safe, clinically effective and cost effective, including, but not limited to, cardiac ablation catheters for atrial fibrillation.

 

The Minister for Health wrote to the Chair of the PLAC on 10 October 2017, asking to receive advice by 31 December 2018 regarding the inclusion of cardiac ablation catheters on the Prostheses List, including an assessment of comparative clinical and cost effectiveness.

 

The PLAC is the ministerially appointed committee made up of experts in the health sector and advisory members nominated by the major stakeholder organisations, representing the interests of private health insurers, private hospitals and day hospitals, medical device sponsors, clinicians and the Department of Veterans’ Affairs.

 

Following advice from the Medical Services Advisory Committee that cardiac ablation is a clinically effective and cost effective treatment for atrial fibrillation, the PLAC agreed in principle on 4 February 2019 to recommend that the Minister list cardiac ablation catheters, mapping catheters for cardiac ablation and patches for cardiac ablation on Part C of the Prostheses List.

 

Details of the Amending Instrument are set out in the Attachment.

The Amending Instrument commences the day after registration.

 

The Amending Instrument is a legislative instrument for the purposes of the Legislation Act 2003.


ATTACHMENT

 

Details of the Private Health Insurance (Prostheses) Amendment Rules 2019

 

Rule 1 – Name

 

Rule 1 provides for the Amending Rules to be referred to as the Private Health Insurance (Prostheses) Amendment Rules 2019.

 

Rule 2 – Commencement

 

Rule 2 provides that the Amending Rules commence the day after registration.

 

Rule 3 – Authority

 

Rule 3 provides that the Amending Rules is made under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.

 

Rule 4 – Schedules

 

Rule 4 provides that that each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

 

Schedule 1 – Amendments

 

Private Health Insurance (Prostheses) Rules 2018 (No. 2)

 

Item 1 – Rule 13

Item 1 repeals the current rule 13 and replaces it with the same text and additional paragraphs for cardiac ablation catheters, mapping catheters for cardiac ablation and patches for cardiac ablation.

 

This item enables the Minister to include prostheses falling with the description in paragraphs (iv) to (vi) of rule 13 in Part C of the Schedule. 

 

 


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 2019
 

This 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 instrument

The Private Health Insurance (Prostheses) Amendment Rules 2019 amend rule 13 of the Private Health Insurance (Prostheses) Rules 2018 (No. 2) to include additional kinds of prostheses that may be included in Part C of the Schedule to the Private Health Insurance (Prostheses) Rules 2018 (No. 2). The additional kinds of prostheses are cardiac ablation catheters, mapping catheters for cardiac ablation or patches for cardiac ablation. This will enable the Minister to include that kind of prosthesis in Part C of the Schedule if the Minister decides to grant an application for the listing of that kind of prosthesis, so an insured person with appropriate cover will receive a minimum benefit for the provision of the prosthesis (within the requirements of the legislation).

Human rights implications

This instrument engages articles 9 and 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the rights to health and social security.

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 ICESCR. Whilst the UN Committee on Economic Social and Cultural Rights 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.

Analysis

This instrument enables the Minister to include additional items in Part C of the Schedule if the Minister decides to do so. The addition of these items will ensure that an insured person with appropriate cover will receive a minimum benefit for the provision of the prosthesis (if other requirements are met). The addition of new items will increase the amount of choice an insured person has in relation to the type of prostheses for which they must receive a minimum private health insurance benefit. This will impact positively on the right to health of insured persons.

Conclusion

The instrument is compatible with human rights because it enables advances in the protection of human rights.

Julianne Quaine

Assistant Secretary

Office of Health Technology Assessment

Technology Assessment and Access Division

Department of Health

Overview

The Private Health Insurance (Prostheses) Amendment Rules 2019 were introduced to update the list of prostheses covered by the Private Health Insurance Act 2007. This amendment was enacted by the Minister for Health in accordance with section 333-20 of the Act, allowing for the creation of rules to address matters required or permitted by Part 3-3 of the Act. The objective of these rules is to ensure that complying health insurance policies meet the necessary benefit requirements, including the provision of prostheses under specified conditions. The Amending Rules aim to update the Prostheses List by adding cardiac ablation catheters, mapping catheters for cardiac ablation, and patches for cardiac ablation to Part C of the Schedule, thereby enhancing the range of prostheses that can be covered by private health insurance policies. This update was driven by consultations with the Prostheses List Advisory Committee and recommendations based on clinical and cost-effectiveness assessments. The Amending Rules were developed in consultation with the Medical Technology Association of Australia and following advice from the Medical Services Advisory Committee, which confirmed the clinical and cost-effectiveness of cardiac ablation as a treatment for atrial fibrillation. The Prostheses List Advisory Committee, composed of health sector experts and representatives from stakeholder organisations, reviewed the proposal and recommended the inclusion of the specified prostheses. The Minister for Health subsequently agreed to these recommendations, leading to the creation of the Amending Rules. These rules are compatible with human rights, particularly the right to health and social security as outlined in the International Covenant on Economic, Social and Cultural Rights, by enhancing access to necessary medical devices and promoting equality of opportunity for people to achieve the highest attainable level of health.

Scope and Application

The Private Health Insurance (Prostheses) Amendment Rules 2019 amends the existing Private Health Insurance (Prostheses) Rules 2018 to update the list of prostheses covered by private health insurance policies in Australia. This amendment applies to private health insurers, policyholders, and medical technology providers within the Australian jurisdiction. The rules are made under section 333-20 of the Private Health Insurance Act 2007, which allows the Minister to make rules necessary or convenient to carry out or give effect to Part 3-3 of the Act. The Amending Rules specifically update Part C of the Prostheses List by adding cardiac ablation catheters, mapping catheters for cardiac ablation, and patches for cardiac ablation. These amendments ensure that insured persons with appropriate health insurance coverage receive minimum benefits for the provision of these prostheses, thereby enhancing their right to health and social security as recognised in the International Covenant on Economic, Social and Cultural Rights. The Amending Rules are compatible with human rights, as they expand the range of prostheses covered, thereby improving access to necessary medical treatments and supporting the right to health.

Key Provisions

The Private Health Insurance (Prostheses) Amendment Rules 2019 primarily update the Prostheses List by adding specific types of medical devices to Part C of the Schedule, which includes other prostheses not listed in Parts A and B. Rule 13 of the Prostheses Rules is amended to include cardiac ablation catheters, mapping catheters for cardiac ablation, and patches for cardiac ablation. These amendments allow the Minister to include these prostheses in Part C of the Schedule, thus enabling insured persons with appropriate cover to receive a minimum benefit for these prostheses. The Amending Rules impose specific obligations on the Minister and relevant stakeholders. The Minister is required to consider the inclusion of the specified prostheses in the Prostheses List based on their clinical and cost effectiveness, as recommended by the Prostheses List Advisory Committee (PLAC). The PLAC, comprising experts and stakeholders, provides advice on the suitability of these devices for inclusion. Once the Minister decides to include these prostheses in the Prostheses List, private health insurers must comply with the new requirements by offering minimum benefits for these prostheses to insured persons. There are no explicit offences, penalties, or civil/criminal consequences stated for breaches of the Private Health Insurance (Prostheses) Amendment Rules 2019. However, non-compliance with the amended rules could potentially lead to regulatory actions under the broader Private Health Insurance Act 2007. Insurers failing to adhere to the new benefit requirements could face penalties, including fines or other enforcement measures prescribed by the Act. These actions are intended to ensure that insured persons receive the minimum benefits mandated by the legislation.

Legal classification tags

Area of Law
Health Law
Insurance Law
Instrument
Regulation
Concepts
Regulatory Standards
Reporting & Disclosure Obligations
Enforcement Powers

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.