PHI 07/13

This circular issued by the Private Health Insurance Branch contains information about Second-Tier Default benefits

Page last updated: 25 January 2013

Printable version of 07/13 (PDF 96 KB)

25 January 2013

Second-Tier Default benefits Process Changes and Information on the February 2013 Second Tier Advisory Committee Meeting

The purpose of this circular is to advise industry of minor administrative changes to the second tier default benefits arrangements. These changes are a consequence of the Private Health Insurance (Benefit Requirements) Amendment Rules 2012 (No. 10) (the Benefit Requirements Amendment Rules) which were registered on the Federal Register of Legislative Instruments (FRLI) on 2 January 2013 and commenced on 3 January 2013 (FRLI number F2013L00003).

It is also noted that the Private Health Insurance (Accreditation) Amendment Rules 2012 (No. 2) were registered on the Federal Register of Legislative Instruments (FRLI) on 2 January 2013 and commenced on 3 January 2013 (FRLI number F2013L00004).

Changes to the Second-tier process

In the interests of administrative simplicity, the list of second-tier eligible facilities will no longer be included in the Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Requirements Rules). Rather, the full second-tier eligible hospital list will be published via private health insurance circular after each Second Tier Advisory Committee (STAC) meeting, listing all STAC approved second-tier eligible facilities. The current STAC approved list of second-tier facilities is at Attachment A. Inclusion on this list establishes second-tier eligibility under the Benefit Requirements Rules.

All applications for second-tier eligibility should now be sent directly to the STAC secretariat.

For clarity, the Benefit Requirements Amendment Rules provide the eligibility criteria (reflecting existing criteria in the Administrative Arrangements for the Second Tier Default Benefits for Overnight and Day Only Treatment) that the STAC must consider for second-tier eligibility. These relate to providing evidence of being a private hospital, Informed Financial Consent, simplified billing, and Hospital Casemix Protocol data, as well as accreditation to the level of the National Standards or the interim level.

Hospitals currently eligible for second-tier benefits that are on the STAC-approved list at Attachment A are not immediately impacted. These facilities that hold the accreditation certificate that was used for their second-tier eligibility continue to be able to use that accreditation for the purposes of re-applying for second-tier eligibility until that accreditation expires. When existing accreditation expires, the hospital would be required to meeting the National Standards, subject to the implementation timelines specified by the Australian Commission on Safety and Quality in Healthcare. Details of these timelines are available at the Australian Commission on Safety and Quality in Health Care Website.

The new Administrative Arrangements for the Second Tier Default Benefits for Overnight and Day Only Treatment are at Attachment B.

Next Second Tier Advisory Committee Meeting

The next STAC meeting will be held on Friday, 22 February 2013.

The closing date for applications is Friday, 15 February 2013.

Please note that applicants are required to submit nine stapled copies of their application and at least an original plus one covering letter to:

Second Tier Advisory Committee Secretariat
Australian Private Hospitals Association
PO Box 7426
Canberra BC ACT 2610

Information which must be included in applications is outlined in the Sample application 2012 (updated) located on the Australian Private Hospitals Association Website.

A list of facilities whose second-tier eligibility expires on 30 June 2013 is at Attachment C.

For further information please email Info.

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 2013 Private Health Insurance (PHI) Circulars.

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