PHI 59/13

This circular issued by the Private Health Insurance Branch contains information about amendment to the Private Health Insurance (Benefit Requirements) Rules 2011

Page last updated: 01 October 2013

Printable version of 59/13 (PDF 111 KB)

1 October 2013

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

The Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 5) (the Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) and commenced on 1 October 2013 (FRLI Number: F2013L01753).

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

Medicare Benefit Schedule (MBS) item number – Schedule 3

The Amendment Rules insert a new MBS item in Schedule 3 of the Private Health Insurance (Benefit Requirements) 2011.

Item 1 - Part 2 - Type B procedures, Clause 5 - Non-band specific Type B day procedures, subclause (1)
Item 1 amends Schedule 3, Part 1, clause 5 by inserting one new MBS item 18375 into Schedule 3 of the Principal Rules to reflect that they should be classified as same day procedures.

MBS item 18375 commenced on 1 October 2013 under the Health Insurance (Botulinum Toxin for Urinary Incontinence due to Neurogenic Detrusor Overactivity)Determination 2013 made under section 3C of the Health Insurance Act 1973. MBS item 18375 is a new item for injection of botulinum toxin to treat urinary incontinence caused by neurogenic detrusor overactivity. The intention is that this item be moved into the Health Insurance (General Medical Services Table) Regulations at the next available opportunity.

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.

Item 1 – Schedule 5, Clause 4 - Facilities, subclause (1)

Item 1 of Schedule B to the Amendment Rules updates the reference to the latest Second Tier Advisory Committee-approved list. A hospital is a facility for the purposes of this Schedule if it is included in the list of second-tier eligible facilities approved by the Second Tier Advisory Committee existing at the time that the Private Health Insurance (Benefit Requirements) Amendment Rules 2013 (No. 5) commence.
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