PHI 64/18 Private Health Insurance (Reforms) Amendment Rules (No. 2) 2018

Page last updated: 30 October 2018

PHI 64/18 Private Health Insurance (Reforms) Amendment Rules (No. 2) 2018 (PDF 191 KB)

The Private Health Insurance (Reforms) Amendment Rules (No. 2) 2018 (the Amendment Rules No. 2) were made on 29 October 2018 and registered on the Federal Register of Legislation on 30 October 2018.

The Amendment Rules No. 2 incorporate new, or remove redundant, Medicare Benefit Schedule (MBS) item numbers from Schedules set out in the Private Health Insurance (Reforms) Amendment Rules 2018 that were made on 11 October 2018 (Principal Rules). The amendments are made to reflect changes to items on the MBS that take effect on 1 November 2018.

The Principal Rules insert new Schedules 5, 6 and 7 into the Complying Product Rules from 1 April 2019 to give effect to the product tier reforms, allocating MBS items to clinical categories or to the common or support treatments lists. The Amendment Rules No. 2 ensure that 1 November 2018 changes to the MBS are reflected in the allocation of MBS items for clinical categories and the common or support lists. Making these amendments to the Principal Rules ensures that the changes for product tiers and clinical categories that commence on 1 April 2019 reflect the updated MBS items.

The new or deleted MBS items only impact some items on the common and support treatment lists and some items mentioned for following clinical categories:

  • Back, neck and spine
  • Brain and nervous system
  • Skin
  • Sleep studies
  • Breast surgery (medically necessary)
  • Assisted reproductive technology
  • Eye (not cataract)
  • Kidney and bladder.
The 100 items added to the MBS are:
11505 11507 11508 12001 12002 12004 12005 12204 12205 12208 12254 12258 12261
12265 12268 12272 13260 30191 31003 31004 31005 36671 36672 36673 42505 42588
45060 45061 45062 45523 51011 51012 51013 51014 51015 51020 51021 51022 51023
51024 51025 51026 51031 51032 51033 51034 51035 51036 51041 51042 51043 51044
51045 51051 51052 51053 51054 51055 51056 51057 51058 51059 51061 51062 51063
51064 51065 51066 51071 51072 51073 51102 51103 51110 51111 51112 51113 51114
51115 51120 51130 51131 51140 51141 51145 51150 51160 51165 51170 51171 56620
56626 56660 56666 57522 57523 57537 57540 59302 59305

The 113 items deleted from the MBS are:
11222 11225 11509 13112 14053 14109 14112 21981 30185 30186 30195 30197 30203
30205 30213 30214 30308 30309 30313 30321 32501 36500 40300 40301 40303 40306
40309 40312 40315 40316 40318 40321 40324 40327 40330 40331 40332 40333 40334
40335 40336 40339 40342 40345 40348 40351 42783 42786 42789 42792 45020 45552
45555 45557 45559 45586 45638 45639 47681 47684 47687 47690 47693 47696 47699
47702 47703 47705 47708 47711 47714 47717 47720 47723 48600 48603 48606 48612
48613 48615 48618 48621 48624 48627 48630 48632 48636 48639 48640 48642 48645
48648 48651 48654 48657 48660 48663 48666 48669 48672 48675 48678 48681 48684
48687 48690 48691 48692 48693 48694 53600 60100 60101

An excel spreadsheet setting out the new items and their allocation to specific categories or lists will be made available shortly.

Five MBS items that were added to the MBS on 1 November 2018 have not been allocated to the categories or a list because they are not provided in hospitals (371, 372, 2729, 2731 and 13105).

The Amendment Rules No. 2 will commence on 1 November 2018 (to amend the Principal Rules). This ensures that the MBS items updated as at 1 November 2018 will be reflected in the allocation of MBS items to categories and lists that commence on 1 April 2019.

The Amendment Rules No. 2 and Explanatory Statement can be found by following the link to the Federal Register of Legislation.

If you have any questions regarding PHI Circular 64/18 please contact the Department of Health at PHI@health.gov.au.