PHI 45/17 Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No.7) Private Health Insurance (Complying Product) Amendment Rules 2017 (No.3)

Page last updated: 20 September 2017

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The Private Health Insurance (Benefit Requirements) Amendment Rules 2017 (No. 7) (the Benefit Requirements Amendment Rules) amend the Private Health Insurance (Benefit Requirements) Rules 2011 and the Private Health Insurance (Complying Product) Amendment Rules 2017 (No.3) amend the Private Health Insurance (Complying Product) Rules 2015 and were registered with the Federal Register of Legislation (FRL) and commence on 20 September 2017.

Benefit Requirements Amendment Rules

Medicare Benefit Schedule (MBS) item changes – Schedule 3

The Benefit Requirements Amendment Rules amend Schedule 3 of the Principal Rules to add one new MBS item 73343 to Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 6 – Pathology services, P7. Details of the amendment are set out in the Benefit Requirements Amendment Rules, which are available on the FRL website.

Nursing Home Type Patients – Schedule 4

State/Territory Minimum benefit per night
Queensland From $121.00 to $125.00
Tasmania From $141.10 to $142.05
Victoria From $130.00 to $134.00

Nursing-Home Type Patient minimum benefits have been updated to reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance. The amendments increase the minimum benefits payable for privately insured nursing home type patients at public hospitals in Queensland, Tasmania and Victoria. The changes are as follows: The existing rates for other states and territories remain in force as follows:

State/Territory Minimum benefit per night
New South Wales $121.80
Northern Territory $90.69
South Australia $118.00
Australian Capital Territory $121.95
Western Australia $138.10

The minimum benefit for nursing home type patient accommodation in private hospitals in all states and territories has reduced from $52.30 to $51.90.

Second Tier Default Benefits – Schedule 5

The Benefit Requirements Amendment Rules amend Schedule 5 of the Principal Rules to insert a reference to the new list of Second-tier eligible facilities compiled by the Second Tier Advisory Committee at Schedule 5, Second-tier default benefits, Clause 4 - Facilities, subclause (1). Further information about this is available in PHI Circular 44/17.

Complying product amendment rules

Nursing-Home Type Patient contribution rates have been updated to reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance. The amendments update the patient contribution rate for nursing home type patients in Queensland, New South Wales, South Australia, Tasmania, Victoria, and Western Australia and increased the private hospitals nationally to $59.20.

State/Territory Contribution Rate
Queensland  
New South Wales  
South Australia  
Tasmania from $58.80 to $59.20
Victoria  
Western Australia  
Private hospitals nationally  

The existing rate for the Australian Capital Territory and the Northern Territory remains in force and is as follows:

State/Territory Contribution Rate
Australian Capital Territory $58.80
Northern Territory $57.85