PHI 35/13

This circular issued by the Private Health Insurance Branch contains information about Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No.2) and Private Health Insurance (Complying Product) Amendment Rules 2013 (No.2)

Page last updated: 03 July 2013

Printable version of 35/13 (PDF 121 KB)

28 June 2013

Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No.2) and Private Health Insurance (Complying Product) Amendment Rules 2013 (No.2)

Changes to the Private Health Insurance (Benefit Requirements) Rules 2011

The Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 2) (the Benefit Requirements Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) and commence on 1 July 2013 (FRLI No: F2013L01190).

These Benefit Requirements Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011.

Overnight accommodation benefits and same day accommodation benefits at private hospitals and public hospitals

Increases to overnight accommodation benefits and same day accommodation benefits at private hospitals and public hospitals have been made to reflect the March 2012 to March 2013 Consumer Price Index (CPI) increase.

The Benefit Requirements Amendment Rules update the minimum benefit payable per night for patients in private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania, providing that the patient is not classified as a nursing-home type patient. The following rates will apply:

Advanced surgical patient

- first 14 days $394
- over 14 days $273

Surgical patient or obstetric patient

- first 14 days $365
- over 14 days $273

Psychiatric patient

- first 42 days $365
- 43 – 65 days $317
- over 65 days $273

Rehabilitation patient

- first 49 days $365
- 50 – 65 days $317
- over 65 days $273

Other patients

- first 14 days $317
- over 14 days $273

An amendment has been made to the minimum benefit payable per night for patients in shared ward accommodation at public hospitals in the Australian Capital Territory (ACT), New South Wales (NSW), Northern Territory, Queensland, South Australia and Western Australia, providing that the patient is not classified as a nursing-home type patient. The new rates are as follows:
  • ACT $326;
  • NSW $326;
  • Northern Territory $318;
  • Queensland $331;
  • South Australia $326;
  • Western Australia $326.
New rates for minimum benefit for same-day accommodation in public hospitals and in private hospitals are implemented in each State and Territory and are as follows:
Public hospitalsBand 1Band 2Band 3Band 4
NSW$236$263$290$326
ACT$236$263$290$326
Northern Territory$230$262$305$318
Queensland$241$270$297$331
South Australia$236$269$297$326
Tasmania$229$272$316$365
Victoria$231$273$318$365
Western Australia$267$267$267$267
Band 1Band 2Band 3Band 4
Private Hospitals$204$257$313$365

Nursing-home type patients – Schedule 4

Increases were made to the minimum benefits for Nursing-Home Type Patients (NHTP) in public hospitals in the ACT to reflect the twice annual pension increase which occurred 20 March 2013. The following new rates will apply:
State/TerritoryMinimum benefit per night
Australian Capital Territory$111.20
South Australia$111.00
Western Australia$125.45
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryMinimum benefit per night
New South Wales$111.70
Northern Territory$77.47
Queensland$105.50
Tasmania$128.50
Victoria$113.70

Second Tier Default Benefits – Schedule 5

The purpose of the amendments to Schedule 5 was to insert a reference to the new list of Second-tier eligible facilities compiled by the Second Tier Advisory Committee. Further information about this is available in PHI Circular 36/13.

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 May 2013 and 1 July 2013.

Item 1 - Schedule 1, Part 2 Type A procedures, Subclause 4(3) Advanced surgical patient

Item 1 amends Schedule 1, Part 2 Type A procedures, Subclause 4(3) Advanced Surgical Patient, by removing one MBS item number (30512) from Schedule 1 of the Principal Rules as this item has been removed from the MBS. Item 30512 relates to morbid obesity, gastric bypass for, by any method including anastomosis.

Item 2 - Schedule 1, Part 2 Type A procedures, Subclause 6(3) Surgical patient

Item 2 amends Schedule 1, Part 2 Type A procedures, Clause 6 Surgical Patient, subclause (3) by removing one MBS item numbers (30511) as this item has been removed from the MBS. Item 30511 relates to a morbid obesity, gastric reduction or gastroplasty for, by any method.

Item 3 – Schedule 3, Part 3 Type C procedures, Clause 8, Category 3 Therapeutic Procedures, T8

Item 3 amends Schedule 3, Part 3 Type C procedures, Clause, Category 3 Therapeutic Procedures, T8 of the Principal Rules by inserting two MBS item numbers (32523 and 32526).

Details of the amendments are set out in the Benefit Requirements Amendment Rules, which are available on the ComLaw website.

Changes to the Private Health Insurance (Complying Product) Rules 2010 (No. 2)

The Private Health Insurance (Complying Product) Amendment Rules 2013 (No. 2) (Complying Product Amendment Rules) were registered with the FRLI (FRLI No: F2013L01189) and commence on 1 July 2013.

These Rules amended the Private Health Insurance (Complying Product) Rules 2010 (No. 2).

The amendments update the patient contribution rates for nursing-home type patients in Western Australia, and the Australian Capital Territory to $53.55.
State/TerritoryContribution Rates
Western Australiafrom $52.05 to $53.55
Australian Capital Territoryfrom $50.95 to $53.55
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryContribution Rates
New South Wales$53.55
Northern Territory$52.05
Queensland $53.55
Tasmania$53.55
Victoria $53.55
Private hospitals nationally$53.55
Details of the amendment is set out in the Complying Product Amendment Rules, which are available 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 2013 Private Health Insurance (PHI) Circulars.

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