Private Health Insurance (Prostheses) Amendment Rules (No. 3) 2019

Administered by Department of Health, Disability and Ageing

Legislation au F2019L00219 Rules Not in force Legislative Instrument

Legislation content

EXPLANATORY STATEMENT

Private Health Insurance Act 2007

 

Private Health Insurance (Prostheses) Amendment Rules (No. 3) 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 2019 (No. 1) (Prostheses Rules) 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.

 

Purpose

The purpose of the Private Health Insurance (Prostheses) Amendment Rules (No. 3) 2019 (the Amending Rules) is to correct errors in the listing and the minimum benefit for one prosthesis in Part C of Schedule 1 to the Prostheses Rules.

The errors were contained in the Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019 that implement the listing of this prosthesis on the Prostheses List, among other amendments to the Prostheses Rules.

 

Consultation

The sponsor of the prosthesis affected was consulted on this correction.

 

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

 

The Amending Instrument commences immediately following the commencement of the Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019.

 

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 (No. 3) 2019

 

Section 1 - Name

 

Section 1 provides for the Amending Rules to be referred to as the Private Health Insurance (Prostheses) Amendment Rules (No. 3) 2019.

 

Section 2 - Commencement

 

Section 2 provides that the Amending Rules commences immediately after the commencement of the Private Health Insurance (Prostheses) Rules (No. 2) 2019. The Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019  commence immediately after the commencement of the Private Health Insurance (Prostheses) Rules 2019 (No. 1) on 1 March 2019.

 

Section 3 - Authority

 

Section 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.

 

Section 4 - Schedules

 

Section 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 2019 (No. 1)

 

Item 1 – Schedule 1, Part C, Billing Code BS359

 

Item 1 repeals the listing of this prosthesis under the incorrect subheading in Part C of Schedule 1 to the Prostheses Rules.

 

Item 2 – Schedule 1, Part C, Billing Code BS359

 

Item 2 inserts the listing of this prosthesis under the correct subheading and lists the correct minimum benefit in Part C of Schedule 1 to the Prostheses Rules.

 


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. 3) 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 purpose of the Private Health Insurance (Prostheses) Amendment Rules (No. 3) 2019 (the Amending Rules) is to correct errors in the listing and the minimum benefit for one prosthesis in Part C of Schedule 1 to the Private Health Insurance (Prostheses) Rules 2019 (No. 1) (the Prostheses Rules).

The errors were contained in the Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019 that implement the listing of this prosthesis on the Prostheses List, among other amendments to the Prostheses Rules.

Human rights implications

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

Analysis

This instrument will ensure that the appropriate private health insurance benefit is paid in respect of this prosthesis on the Prostheses List. 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 (No. 3) 2019 were enacted to amend the Private Health Insurance (Prostheses) Rules 2019 and address errors in the listing and the minimum benefit for one prosthesis in Part C of Schedule 1 to the Prostheses Rules. The Private Health Insurance Act 2007 established a framework for regulating private health insurance in Australia, including the requirement for health insurance policies to cover certain prostheses under specific conditions. This amendment was made under the authority of section 333-20 of the Act, which empowers the Minister to make rules necessary for carrying out or giving effect to Part 3-3 of the Act. The Amending Rules were developed following consultation with the sponsor of the affected prosthesis and are compatible with human rights as they support the right to health by ensuring appropriate private health insurance benefits are paid for listed prostheses. The Private Health Insurance (Prostheses) Amendment Rules (No. 3) 2019 were enacted by the Parliament of Australia to address errors in the listing and the minimum benefit for a prosthesis in the Prostheses Rules. The Amending Rules correct the errors found in the Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019 and ensure that the appropriate private health insurance benefit is paid for the affected prosthesis, thereby supporting the right to health of insured persons. The policy objective is to maintain the integrity of the Prostheses List and ensure that the right to health is upheld by providing equality of opportunity for people to enjoy the highest attainable level of health through the provision of necessary prostheses.

Scope and Application

The Private Health Insurance (Prostheses) Amendment Rules (No. 3) 2019 apply to the rules governing the provision of prostheses under private health insurance policies in Australia. These rules are necessary to ensure that the benefits of private health insurance are appropriately applied to the provision of listed prostheses, in circumstances where a Medicare benefit is payable or in other specified conditions. The rules are designed to correct errors in the listing and the minimum benefit for one prosthesis that were identified in previous amendments. The rules are made under section 333-20 of the Private Health Insurance Act 2007, which provides for the making of rules regarding prostheses, and the instrument is a legislative one for the purposes of the Legislation Act 2003. The Amending Rules commence immediately following the commencement of the Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019, which in turn commence immediately after the commencement of the Private Health Insurance (Prostheses) Rules 2019 (No. 1) on 1 March 2019. The instrument has been found to be 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, specifically engaging article 12 of the International Covenant on Economic Social and Cultural Rights, which relates to the right to health. The rules will ensure that the appropriate private health insurance benefit is paid in respect of this prosthesis on the Prostheses List, which will impact positively on the right to health of insured persons.

Key Provisions

The Private Health Insurance (Prostheses) Amendment Rules (No. 3) 2019 (the Amending Rules) primarily address the correction of errors identified in the Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019. Specifically, Section 4 of the Amending Rules amends the listing and the minimum benefit for a particular prosthesis in Part C of Schedule 1 of the Private Health Insurance (Prostheses) Rules 2019 (No. 1) (the Prostheses Rules). This involves repealing the incorrect listing of the prosthesis under a wrong subheading and then inserting the correct listing under the appropriate subheading with the accurate minimum benefit details (Schedule 1, Item 1 and Item 2). The Amending Rules come into effect immediately following the commencement of the Private Health Insurance (Prostheses) Amendment Rules (No. 2) 2019, which in turn commence after the commencement of the Private Health Insurance (Prostheses) Rules 2019 (No. 1) on 1 March 2019 (Section 2). The Amending Rules impose specific obligations on private health insurance providers. They must ensure that the corrections made by the Rules are implemented in their policies to accurately list and benefit the specified prosthesis as per the Prostheses List. This includes updating their internal systems and policy documents to reflect the amendments. By doing so, they ensure compliance with the legislative requirements and avoid potential legal repercussions for non-compliance. Additionally, these Rules necessitate that the sponsor of the affected prosthesis was consulted prior to the amendment, highlighting the importance of stakeholder engagement in the regulatory process. Failure to comply with the requirements set out in the Amending Rules may lead to various legal consequences. While specific penalties are not detailed in the Explanatory Statement, non-compliance with legislative requirements in the private health insurance sector generally could result in financial penalties, enforcement actions, or even revocation of the insurer’s license to operate. The Act provides for enforcement mechanisms to ensure adherence to the rules, thus protecting the rights of insured individuals to receive the correct benefits as stipulated by law.

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Health Law
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Regulation
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Definitions & Interpretation
Repeal & Amendment
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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.