Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022

Administered by Department of Health, Disability and Ageing

Legislation au F2022L00364 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

Private Health Insurance Act 2007

 

Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022

 

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.

 

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.

 

Subsection 72-10(6) of the Act provides that the Private Health Insurance (Prostheses) Rules may set out listing criteria that must be satisfied in order for an application for a prosthesis to be listed to be granted.

 

Background

 

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 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 in other circumstances which may be set out in the Private Health Insurance (Prostheses) Rules. The specified conditions are any that may be set out in the 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.

 

Purpose

 

The Private Health Insurance (Prostheses) Rules (Prostheses Rules) are made for the purposes of subsection 333-20(1) of the Act. Listed prostheses and their minimum benefits are set out in the Schedule to the Prostheses Rules. The list of prostheses in the Schedule is commonly referred to as the Prostheses List.

 

The purpose of the Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022 (the Amending Rules) is to remove the billing code MI485 from Part 1 – Prostheses List – Part A of the Schedule.

 

This billing code was listed incorrectly as a result of an administrative error.

 

Consultation

 

The Amending Rules have been made following consultation with the sponsor of the prosthesis affected.

 

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

 

The Prostheses Rules commence on the day following registration.

 

The Prostheses Rules are a legislative instrument for the purposes of the Legislation Act 2003.

ATTACHMENT 1

 

Provision by provision description of the Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022

 

Rule 1 Name

 

Rule 1 provides that the title of the Amending Rules is the Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022.

 

Rule 2 Commencement

 

Rule 2 provides that the Amending Rules commence on the day after the instrument is registered on the Federal Register of Legislation.

 

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 each instrument that is specified in Schedule 1 to the Amending Rules is amended or repealed as set out in the applicable items to the Schedule, and any other item in a Schedule to this instrument has effect according to its terms.

 

Schedules 1 – Amendments

 

Private health Insurance (Prostheses) Rules (No. 1) 2022

 

Item 1 removes one billing code for a prosthesis that was listed incorrectly as a result of an administrative error.


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 (No. 1) 2022
 

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 Legislative Instrument

The table in subsection 72-1(2) of Part 3-3 of the Private Health Insurance Act 2007 (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 Private Health Insurance (Prostheses) Rules (No. 1) 2022 were made 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.

The Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022 (the Amending Rules) amend the Private Health Insurance (Prostheses) Rules (No. 1) 2022 (the Prostheses Rules) by removing the billing code MI485 from Part 1 – Prostheses List – Part A of the Schedule.

 

Human rights implications

This instrument engages article 12 of the International Covenant on Economic Social and Cultural Rights (ICESCR), specifically the right to health.

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. In addition, the right to health must meet certain key requirements, including that health care must be scientifically and medically appropriate and of good quality.

Analysis

The removal of the billing code will ensure that an insured person has access to private health insurance benefits for prostheses that have been assessed as clinically and cost effective, but not those products that have been listed by an error. 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, in particular the right to health.

 

Elizabeth Flynn

Assistant Secretary

Prostheses List Reform Taskforce

Technology Assessment and Access Division

Health Resourcing Group

Department of Health

 

Overview

The Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022 were enacted to amend the Private Health Insurance (Prostheses) Rules (No. 1) 2022, made under section 333-20 of the Private Health Insurance Act 2007. This legislative instrument addresses an administrative error by removing the incorrectly listed billing code MI485 from the Prostheses List, ensuring that only clinically and cost-effective prostheses are covered by private health insurance policies. The Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022 were made following consultation with the sponsor of the affected prosthesis, and they were developed by the Australian Government's Department of Health to ensure the integrity and effectiveness of the Prostheses List. The policy objective is to maintain the quality and appropriateness of health care services provided under private health insurance, specifically concerning the provision of prostheses, thereby protecting and enhancing the right to health of insured persons.

Scope and Application

The Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022 apply to the listing criteria for prostheses under the Private Health Insurance Act 2007. This amendment is specifically targeted at correcting an administrative error by removing an incorrectly listed billing code from the Prostheses List. The Act itself applies to entities that provide private health insurance and individuals who hold such insurance in Australia, focusing on ensuring that the benefits provided under complying health insurance policies meet certain standards, particularly regarding prostheses. The rules are made under the authority granted by section 333-20 of the Act, which allows the Minister to establish rules concerning prostheses to ensure they are necessary or convenient for the operation of the Act. These rules have a national reach, affecting the entire Commonwealth of Australia. The rules do not introduce any new exclusions or thresholds but rather correct an existing error, ensuring that the listing of prostheses remains accurate and reliable for insured individuals. The scope of the rules can be extended or restricted through subordinate instruments, such as further amendments or specific regulations, which may be introduced to address additional changes or requirements in the future.

Key Provisions

The main operative sections of the Private Health Insurance (Prostheses) Amendment Rules (No. 1) 2022 concern the correction of an administrative error in the listing of a billing code for a prosthesis. Rule 1 provides the title of the Amending Rules, while Rule 2 specifies that the Amending Rules commence on the day after the instrument is registered on the Federal Register of Legislation. Rule 3 asserts the authority for making these rules under section 333-20 of the Private Health Insurance Act 2007. Finally, Rule 4 outlines that the Schedule to the Amending Rules amends the Private Health Insurance (Prostheses) Rules (No. 1) 2022 by removing an incorrectly listed billing code from the Prostheses List. The Schedule provides the specific amendments that remove billing code MI485 from Part 1 – Prostheses List – Part A. The Amending Rules impose obligations on parties by ensuring that only prostheses that meet certain criteria are listed in the Prostheses List, thereby aligning with the health benefit requirements set out in the Private Health Insurance Act 2007. The removal of the incorrectly listed billing code ensures that only clinically and cost-effective prostheses are eligible for private health insurance benefits. This maintains the integrity of the Prostheses List and ensures that insured persons have access to appropriate health care services. There are no specific offences, penalties, or civil or criminal consequences outlined for breach of the Amending Rules. However, the Amending Rules serve to correct an administrative error, thereby ensuring compliance with the Act's requirements. The removal of the billing code MI485 from the Prostheses List is intended to prevent insured persons from accessing benefits for prostheses that were listed erroneously, which could have resulted in financial implications for both the insured person and the health insurance provider. By ensuring the accuracy of the Prostheses List, the Amending Rules contribute to the effective operation of the private health insurance system in Australia.

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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.