PHI 71/18 Private Health Insurance (Reforms) Amendment Rules (No.3) 2018

Page last updated: 20 December 2018

PHI 71/18 Private Health Insurance (Reforms) Amendment Rules (No.3) 2018 (PDF 57 KB)

The Private Health Insurance (Reforms) Amendment Rules (No.3) 2018 (the Amendment Rules No.3) were made on 18 December 2018 and registered on the Federal Register of Legislation on 19 December 2018.

The Amendment Rules No.3 incorporate new Medicare Benefit Schedule (MBS) item numbers for the clinical categories arrangements that are set out in the Private Health Insurance (Reforms) Amendment Rules 2018 (the Principal Rules), which commence on 1 April 2019. These amendments ensure consistency between the clinical categories arrangements and the MBS as at 1 January 2019.

The Principal Rules introduce product tiers and clinical categories, along with the common treatments list and the support treatments list, for the administration of hospital treatments required to be covered by insurers. These Amendment Rules No. 3 add two MBS item numbers to the support treatments list to ensure it reflects the MBS as at 1 January 2019. These items apply to individual pathology tests that are required for assessment of a patient’s eligibility to access certain cancer-related pharmaceuticals under the Pharmaceutical Benefits Scheme. MBS item 72814 was added to the MBS on 1 November 2018. Details about that item and its intended placement in the support treatments list were notified to insurers by email on 2 November 2018. MBS item 73344 is being added to the MBS on 1 January 2019. Visit the Federal Register of Legislation website for details of the item. (www.legislation.gov.au/Details/F2018L01776)

In addition, these Amendment Rules No. 3 make minor technical amendments to improve the Amendment Rules. The effect of these amendments will be to:

  • provide for insurers to give insured persons a more precise description of the length of time remaining until they reach 10 continuous years of cover and their Lifetime Health Cover loading is removed. The explanatory statement for this change includes an explanation about information that can be provided to insured persons (see link below); and
  • ensure that a hospital will be included in the second-tier eligible hospitals class for a period ending 60 calendar days after the date on which its accreditation against the National Safety and Quality Health Service Standards is due to expire (rather than ceasing on the day the accreditation is due to expire).

The amendments regarding information on the Lifetime Health Cover loading and inclusion of the additional MBS item numbers commence on 1 January 2019, in advance of the commencement of the relevant reforms on 1 April 2019. The amendment to the second tier default benefits provisions commences on 31 December 2018, so this technical change is incorporated before commencement of the second-tier reforms on 1 January 2019.

The Amendment Rules No. 3 and Explanatory Statement can be found by visiting the Federal Register of Legislation website.

If you have any questions regarding PHI Circular 71/18 please contact the Department of Health at PHI@health.gov.au.