PHI 43/10

This circular issued by the Private Health Insurance Branch contains information regarding Private Health Insurance (Benefits Requirements) amendment rules 2010 (No.4)

Page last updated: 07 February 2013

Printable version of PHI 43/10 (PDF 72 KB)

Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No.4) – Changes to Second Tier Eligible Hospitals

Please note that the Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No.4) (the Rules) have been registered with the Federal Register of Legislative Instruments (FRLI) and take effect on 8 July 2010 (FRLI No: F2010L01949). The changes to the Rules relate to Schedule 5 – Second Tier Default Benefits and are outlined below:

New Hospitals Added to Schedule 5

The following hospitals have been added to Schedule 5 of the Rules. These hospitals will be eligible for Second Tier Default Benefits from 8 July 2010 until 30 June 2012.
Hospital NameSuburbState
Chermside Dialysis UnitChermsideQLD
Diaverum Cannington Dialysis ClinicCanningtonWA
Diaverum Diamond Valley Dialysis ClinicGreensboroughVIC
Diaverum Stirling Dialysis ClinicStirlingWA
Forest Hill Dialysis ClinicForest HillVIC
Gosford Private HospitalGosfordNSW
Hartley Dialysis ClinicBrightonSA
Lindfield Dialysis ClinicLindfieldNSW
Maitland Private HospitalMaitlandNSW
Malvern Dialysis ClinicMalvernVIC
Modbury Dialysis ClinicModburySA
Peninsula Endoscopy CentreFrankstonVIC
Reservoir Private HospitalReservoirVIC
Southern Eye Centre, Day Surgery & Laser ClinicFrankstonVIC
Subiaco Private HospitalSubiacoWA
The Glen Endoscopy CentreGlen WaverleyVIC
Woodvale Private Hospital for WomenWoodvaleWA
40 other hospitals, which are already listed in Schedule 5 of the Rules, were confirmed by the Second Tier Advisory Committee as continuing to be eligible for Second Tier Default Benefits until 30 June 2012. These hospitals are:
Hospital NameSuburbState
Bega Valley Private HospitalBegaNSW
Buderim Gastroenterology Centre (Maroochydore)MaroochydoreQLD
Cabrini BrightonBrightonVIC
Colin Street Day SurgeryWest PerthWA
Dalcross Private HospitalKillaraNSW
Eye-Tech Day SurgeriesSpring HillQLD
Eye-Tech Day Surgeries SouthsideUpper Mount GravattQLD
Forster Private HospitalForsterNSW
Gympie Private HospitalGympieQLD
Hervey Bay Surgical HospitalPialbaQLD
Holroyd Private HospitalGuildfordNSW
Kawana Private HospitalBirthinyaQLD
Kingaroy Private HospitalKingaroyQLD
Malvern Private HospitalMalvern EastVIC
Mater Misericordiae Day UnitMackayQLD
Mater Misericordiae Hospital BundabergBundabergQLD
Mater Misericordiae Hospital GladstoneGladstoneQLD
Mater Misericordiae Hospital MackayMackayQLD
Mater Misericordiae Hospital RockhamptonRockhamptonQLD
Mater Misericordiae Hospital YeppoonYeppoonQLD
Mater SydneyNorth SydneyNSW
Murdoch SurgicentreMurdochWA
Niola Private HospitalWest LeedervilleWA
Pendlebury Clinic Private HospitalCardiffNSW
Rosebud SurgiCentreRosebud WestVIC
Sentiens ClinicWest PerthWA
South Terrace Urology Day SurgeryAdelaideSA
St Frances Xavier Cabrini Hospital - MalvernMalvernVIC
St Frances Xavier Cabrini Hospital - PrahranPrahranVIC
St John of God Hospital, BallaratBallaratVIC
St John of God Hospital GeelongGeelongVIC
St Vincent's Private Hospital (Darlinghurst)DarlinghurstNSW
Stirling District HospitalStirlingWA
Sydney Haematology & Oncology ClinicsHornsbyNSW
Terrace West Endoscopy CentreIpswichQLD
The Hornsby Sleep Disorder and Diagnostic CentreWaitaraNSW
The Marian CentreWembleyWA
The Melbourne Eastern Private HospitalBoroniaVIC
The Sydney Private HospitalAshfieldNSW
Westmead Rehabilitation HospitalMerrylandsNSW

Hospital Name Changes on Schedule 5

Please note that the following hospital names have been changed on Schedule 5 to reflect their current State/Territory hospital licences:
Previous NameNew NameSuburbState
Hervey Bay Surgical CentreHervey Bay Surgical HospitalPialbaQLD
Saint Frances Xavier Cabrini Hospital (Malvern)St Frances Xavier Cabrini Hospital – MalvernMalvernVIC
Saint Frances Xavier Cabrini Hospital (Prahran)St Frances Xavier Cabrini Hospital – PrahranPrahranVIC
St John of God Health Care (Ballarat)St John of God Hospital, BallaratBallaratVIC
The provider numbers have not changed and there has been no loss in eligibility for Second Tier Default Benefits for these hospitals.
The facilities listed below have closed and have been removed from Schedule 5.
Logan Surgery CentreLogan CentralQLD
Marie Stopes International – CabooltureMorayfieldQLD
Pioneer Valley Private HospitalNorth MackayQLD
Further to Private Health Insurance Circular PHI 11/10, the following hospitals did not reapply to the Second Tier Advisory Committee for consideration on 28 May 2010. They have been deleted from Schedule 5 as they are not eligible for Second Tier Default Benefits from 30 June 2010.
Bentleigh SurgicentreBentleighVIC
Calvary College Grove Rehabilitation HospitalWalkervilleSA
Calvary Health Care ACTBruceACT
Calvary John James HospitalDeakinACT
Calvary Wakefield HospitalAdelaideSA
Delmar Private HospitalDee WhyNSW
Diagnostic Endoscopy CentreDarlinghurstNSW
Healthwoods Specialist CentreGranvilleNSW
HOCA @ MaterSouth BrisbaneQLD
HOCA ChermsideChermsideQLD
HOCA Gold CoastSouthportQLD
Inner West Endoscopy CentreMarrickvilleNSW
Melbourne Oral & Facial SurgeryMelbourneVIC
Oral Surgery Day CentreChatswoodNSW
South Western Day Surgical CentreLiverpoolNSW
Sydney IVF CanberraDeakinACT
The Eye InstituteChatswoodNSW
The Wesley Clinic for Haematology & OncologyAuchenflowerQLD
The Rules are available on the ComLaw website.
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Next Second Tier Advisory Committee Meeting

The next Second Tier Advisory Committee meeting will be held on Friday 27 August 2010.

The closing date for applications is Friday 6 August 2010.

Please note that applicants are required to submit nine stapled copies of their application to

Second Tier Advisory Committee Secretariat
c/o Department of Health and Ageing
MDP 401
GPO Box 9848
Canberra ACT 2601

Information which must be included in applications is outlined in the Second Tier Default Benefit – Sample Application Guide 2010 located on the Australian Private Hospitals Association website. Select Advocacy; Resources; Second Tier Default Benefits - Sample Application Guide 2010.

Health Insurers' Second Tier Default Benefit Rates Annual Audit

Health insurers are reminded that annual lists of un-audited Second Tier Default Benefit rates, from 1 September 2010 to 30 August 2011, are due to the Department of Health and Ageing by 31 August 2010.

The audited rates, along with a statement from the auditor stating that the rates have been calculated in accordance with Schedule 5. are due to the Department and the Private Health Insurance Administration Council (PHIAC) by 30 September 2010.
In order to reduce the amount of paper used to meet this requirement, it is preferred that both the un-audited and the audited rates (along with the statement from the auditor), be emailed to Stephen Lewis.

If an electronic version is not available, a hardcopy of the second tier listing should be printed, double-sided if possible, and posted to:

Mr Stephen Lewis
Director, Legal Policy Section
Department of Health and Ageing
MDP 401
GPO Box 9848
Canberra ACT 2601

Please email only audited second tier listings to PHIAC or, if unable to email, post to:

Suite 16, 1st Floor
71 Leichhardt Street
Kingston ACT 2601

If you require further information please telephone: (02) 6289 9853/24 hr answering machine or email the enquiry to Private Health Insurance Branch

For more information visit 2010 Private Health Insurance (PHI) Circulars.

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