PHI 16/13

This circular issued by the Private Health Insurance Branch contains information about Nursing-Home Type Patient Contribution Rates and Minimum Benefits as at 20 March 2013 and new MBS item numbers

Page last updated: 22 March 2013

Printable version of 16/13 (PDF 133 KB)

22 March 2013

Nursing-Home Type Patient Contribution Rates and Minimum Benefits as at 20 March 2013 and new MBS item numbers

The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 1) (the Complying Product Amendment Rules) and the Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 1) (the Benefit Requirements Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) and commence on 20 March 2013 (FRLI No: F2013L00496 and F2013L00497 respectively).

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

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, Queensland, South Australia, Tasmania and Victoria to $53.55 and at private hospitals nationally to $53.55.
State/TerritoryContribution Rates
New South Walesfrom $52.05 to $53.55
Queenslandfrom $52.05 to $53.55
South Australiafrom $52.05 to $53.55
Tasmaniafrom $52.05 to $53.55
Victoriafrom $52.05 to $53.55
Private hospitals nationallyfrom $52.05 to $53.55
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryContribution Rates
Australian Capital Territory$50.95
Northern Territory$52.05
Western Australia$52.05

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 New South Wales, Tasmania, Queensland and Victoria and decrease the minimum benefits payable at private hospitals nationally. The changes are as follows:
State/TerritoryMinimum benefit per night
Tasmaniafrom $124.90 to $128.50
New South Walesfrom $109.10 to $111.70
Queenslandfrom $102.00 to $105.50
Private hospitals nationallyfrom $59.05 to $57.55
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryMinimum benefit per night
Victoria$113.70
South Australia$108.00
Australian Capital Territory$107.40
Western Australia$116.05
Northern Territory$77.47
Medicare Benefit Schedule (MBS) item numbers – Schedules 1 and 3

The Amendment Rules amend MBS items in Schedule 1 and 3 of the Private Health Insurance (Benefit Requirements) 2011. The changes are necessary to maintain consistency between the MBS item codes listed in the Principal Rules and the MBS from 1 March 2013.

Item 1 - Schedule 1, Part 2 Type A procedures, Clause 6 Surgical Patient, subclause (3)

Patients are taken to be surgical type overnight patients, for the purposes of minimum private health insurer benefits, if they meet the criteria of Schedule 1, Part 2, subclause 6(2) and are receiving the items listed in subclause 6(3), within the fee range of $254.00 to $852.95. Subclause 6(3) of the Principal Rules sets out the MBS item numbers for the purposes of this clause of the Principal Rules, but indicates that a listing in subclause 6(3) only applies where an item has a fee in the MBS within the specified range.

Item 1 amends Schedule 1, Part 2 Type A procedures, Clause 6 Surgical Patient, subclause (3) by inserting two MBS item numbers (32023 and 37245) into Schedule 1 of the Principal Rules to reflect that they should be classified as overnight hospital procedures. Item 32023 relates to an endoscopic insertion of stent/s for large bowel obstruction, stricture or stenosis, including colonoscopy. Item 37245 relates to a prostate endoscopic enucleation using high powered Holmium.

Item 2 – Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 2 Diagnostic Procedures & Investigations, D1

Item 2 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 2 Diagnostic Procedures & Investigations, D1 of the Principal Rules by inserting 1 MBS item (11244). Item 11244 relates to a diagnostic B-scan of orbital contents. It is recognised that this item may be performed, in rare cases, in isolation in hospital if determined by the treating medical practitioner.

Second-Tier Default Benefits – Schedule 5

The purpose of the amendments to Schedule 5 was to update the list of second-tier eligible facilities. Further information regarding the amendments to second-tier default benefits will be provided in a separate PHI circular.

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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