PHI 17/12

This circular issued by the Private Health Insurance Branch contains information about the Private Health Insurance Amendment Rules

Page last updated: 19 April 2013

Printable version of 17/12 (PDF 23 KB)

21 March 2012

Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 1) and Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 1)

The Private Health Insurance (Complying Product) Amendment Rules 2012 (No. 1) (the Complying Product Amendment Rules) and the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 1)(the Benefit Requirements Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) and commenced on 20 March 2012 (FRLI No: F2012L00599 and F2012L00604 respectively).

The Rules amend the Private Health Insurance (Complying Product) Rules 2010 (No. 2) and the Private Health Insurance (Benefit Requirements) Rules 2011 (Benefit Requirements Rules).

The 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 rates for nursing-home type patients in New South Wales (NSW), Northern Territory (NT), Queensland (QLD), South Australia (SA), Tasmania (TAS), and at private hospitals nationally from $50.55 to $50.95.

The existing rates for Western Australia (WA), Australian Capital Territory (ACT) and Victoria (VIC) remain in force.

The Complying Product Amendment Rules can be viewed on the ComLaw website.

The Benefit Requirements Amendment Rules

Nursing-Home Type Patients - Schedule 4

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 NSW, NT, TAS, and decreases the minimum benefits payable at private hospitals nationally. The changes are as follows:
Public hospital: State/TerritoryMinimum benefit per night
New South Walesfrom $104.90 to $109.10
Northern Territoryfrom $75.23 to $75.83
Tasmaniafrom $121.30 to $122.25
Private hospitalsfrom $60.55 to $60.15
The existing rates for WA, ACT, VIC, QLD and SA remain in force.

MBS Item Number Updates - Schedules 1 & 3

Amendments have been made to Schedules 1 and 3 to add, remove and reclassify MBS item numbers in the Benefit Requirements Rules.

To reflect the changes in the MBS commencing 1 March 2012, MBS item numbers 42738 and 42739 have been added to the Rules in Schedule 3. A further eight MBS item numbers (13924, 13933, 13936, 32215, 32217, 36658, 36660 and 36662) were added to Schedules 1 and 3 as these item numbers were inadvertently excluded from the Rules in the past.

Six MBS item numbers (10993, 10994, 10995, 10996, 10998 and 10999) have been removed from Schedule 3 as these items were removed from the MBS from 31 December 2011.

Six MBS item numbers from Schedule 3 have been reclassified. MBS item numbers 36663, 36664 and 36666 were reclassified from Type B to Type A procedures and MBS item numbers 36665, 36667 and 36668 were reclassified from Type C to Type B procedures.

Second Tier Default Benefits – Schedule 5

The purpose of the amendments to Schedule 5 was to add six facilities that are eligible for second tier default benefits. Further information regarding the amendments to second tier default benefits will be provided in a separate PHI circular to be issued by the Department shortly.

The Benefit Requirements Amendment Rules can be viewed on the ComLaw website.

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 2012 Private Health Insurance (PHI) Circulars.

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