PHI 40/18 Private Health Insurance (Prostheses) Amendment Rules 2018 No. 2 – Prostheses Benefit Reductions

Page last updated: 19 June 2018

PHI 40/18 Private Health Insurance (Prostheses) Amendment Rules 2018 No. 2 – Prostheses Benefit Reductions (PDF 99 KB)

The delegate of the Minister for Health has made the Private Health Insurance (Prostheses) Amendment Rules 2018 No. 2 (the Amendment Rules), to replace Part A and Part C of the Schedule to the Private Health Insurance (Prostheses) Rules 2017 No. 1. The Schedule is generally known as the February 2018 Prostheses List.

The Amendment Rules implement the final prostheses benefit reductions for 2018 as set out in the Government Agreement with the Medical Technology Association of Australia

From 1 February 2018 the benefits for prostheses were reduced by 80% of the agreed total reduction amount for each product group for 2018. On 1 August 2018 the benefits for prostheses will reduce by the remaining 20% of the agreed 2018 reduction amounts. The table below sets out the 2018 benefit reductions for prostheses and how they have been applied.

The Amendment Rules have been registered on the Federal Register of Legislation and come into effect on 1 August 2018.

Note: The Amendment Rules are not the regular Prostheses List – the August Prostheses List will be published in August 2018, and will incorporate the benefit reductions.

Information on the prostheses benefit reduction agreement, and copies of the updated Prostheses List are available on the Department of Health Prostheses List webpage.

Benefit Reductions
First Round of Benefit Reductions
(Phased Introduction)
Category
Assessment Body/Group
1 Feb 2018
(reduction compared to the August 2017 PL)
1 Aug 2018
(reduction compared to the February 2018 PL)
Total reductions in 2018
(compared to the August 2017 PL)
01Opthalmic01.02.02 - Foldable
6.8%
1.8240%
8.5%
01.03.01 - Viscoelastic
8.0%
2.1739%
10.0%
All other benefits
4.0%
1.0417%
5.0%
02Ear, Nose and Throat02.01.01 - Cochlear Implants
4.0%
1.0417%
5.0%
02.01.02 - Speech Processors
4.0%
1.0417%
5.0%
02.01.03 - Speech Processor Accessory Kit
4.0%
1.0417%
5.0%
02.01.04 - Implantable Bone Conduction Hearing System
4.0%
1.0417%
5.0%
02.01.05.05 - Active Middle Ear Implants
0.0%
0.0000%
0.0%
All other benefits
4.0%
1.0417%
5.0%
03General Miscellaneous03.01.01 - Hepatic, Yttrium 90, Standard Dose
0.0%
0.0000%
0.0%
03.02.02 - Infusion Pumps, Balloon Based
6.0%
1.5957%
7.5%
03.05.03 - Sponges
6.0%
1.5957%
7.5%
03.05.04 - Pliable Patches
6.0%
1.5957%
7.5%
03.08.02 - Internal Adhesives
6.0%
1.5957%
7.5%
03.08.03 - Ligating Devices
6.0%
1.5957%
7.5%
03.08.04 - Staples & Tackers
6.0%
1.5957%
7.5%
All other benefits
4.0%
1.0417%
5.0%
04NeurosurgicalAll benefits
4.0%
1.0417%
5.0%
05UrogenitalAll benefits
4.0%
1.0417%
5.0%
06Special Orthopaedic06.03.04 - Screws
8.0%
2.1739%
10.0%
06.03.05 - Surgical Accessories
8.0%
2.1739%
10.0%
06.03.14 - Bone Cement
8.0%
2.1739%
10.0%
All other benefits
4.0%
1.0417%
5.0%
07Plastic and ReconstructiveAll benefits
2.0%
0.5102%
2.5%
08Cardiac08.13.01 – Cardiac Defect Occluders
8.0%
2.1739%
10.0%
08.13.03 – Left Atrial Appendage Closure
0.0%
0.0000%
0.0%
08.17.01 – Transcatheter Aortic Valve Implantation
0.0%
0.0000%
0.0%
All other benefits
16.0%
4.7619%
20.0%
09CardiothoracicAll benefits
4.0%
1.0417%
5.0%
10Vascular10.04 - Vascular Patches
8.0%
2.1739%
10.0%
10.07 - Arterial Closure Devices
8.0%
2.1739%
10.0%
10.08.01 - Particle
8.0%
2.1739%
10.0%
10.08.02 - Coil, Peripheral
8.0%
2.1739%
10.0%
10.08.03 - Polymer
8.0%
2.1739%
10.0%
10.08.06 - Delivery Device For Occlusion Media
8.0%
2.1739%
10.0%
10.09 - Long Term Vascular Access Devices
8.0%
2.1739%
10.0%
All other benefits
4.0%
1.0417%
5.0%
11HipAll benefits
4.0%
1.0417%
5.0%
12KneeAll benefits
2.64%
0.6779%
3.3%
13SpinalAll benefits
3.0%
0.7732%
3.75%