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Rules/Other as made
These Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011 to update the table at Clause 4 of Schedule 5 to add 13 additional facilities that are eligible for second tier default benefits, delete one facility that has closed, and change an address of one facility.
Administered by: Health
Registered 19 Dec 2011
Tabling HistoryDate
Tabled HR07-Feb-2012
Tabled Senate07-Feb-2012
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014

EXPLANATORY STATEMENT

 

 

Issued by the Authority of the Minister for Health and Ageing

 

Private Health Insurance Act 2007

 

Private Health Insurance (Benefit Requirements) Amendment Rules 2011 (No.10)

 

Section 333-20 of the Private Health Insurance Act 2007 (the Act) provides that the Minister may make Private Health Insurance (Benefit Requirements) Rules providing for matters required or permitted by Part 3-3 of the Act, or necessary or convenient to be provided in order to carry out or give effect to Part 3-3 of the Act.

 

The Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules), which commenced on 1 November 2011, provide for the minimum benefit requirements for psychiatric, rehabilitation and palliative care and other hospital treatment. Schedules 1 to 5 of the Rules set out the minimum levels of benefit, which are payable for hospital treatment. These are benefits for overnight accommodation (Schedules 1 and 2), same day accommodation (Schedule 3), nursing-home type patients (Schedule 4) and second tier default benefits (Schedule 5).

 

The Private Health Insurance (Benefit Requirements) Amendment Rules 2011 (No.10) (the Amendment Rules) amends Schedule 5 of the Principal Rules.

 

The purpose of the amendment is to update the table at Clause 4 of Schedule 5 of the Principal Rules to:

·      add 13 additional facilities that are eligible for second tier default benefits;

·      delete one facility that has closed; and

·      change an address of one facility.

 

These changes have increased the table of listed facilities from 361 to 373.

 

Details of the Amendment Rules are set out in the Attachment.

 

Consultation

Consultation for changes to Schedule 5 occurred with industry through the Second Tier Advisory Committee (STAC), which includes equal representation from both the private hospital and private health insurance sectors.  Facilities wishing to be considered for inclusion in Schedule 5 are individually assessed by the STAC which then makes a recommendation to the Minister as to whether or not the hospital meets the eligibility criteria.  This arrangement was negotiated with the private health industry and has been in place since 2004.

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

DECEMBER 2011

ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2011 (No.10)

 

1.       Name of Rules

 

Rule 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2011 (No.10) (the Amendment Rules).

 

2.       Commencement

 

Rule 2 provides that the Amendment Rules commence on the day after registration.

 

3.       Amendment of Private Health Insurance (Benefit Requirements) Rules 2011

 

Rule 3 provides that the Schedule to the Amendment Rules amends the Principal Rules which commenced on 1 November 2011.

 

Schedule – Amendments

 

Item 1 – Schedule 5, Clause 4 Facilities, Table

 

Schedule 5 of the Principal Rules requires a health insurer to pay second tier default benefits for most episodes of hospital treatment provided in private hospital facilities that are specified in Schedule 5 if the health insurer does not have a negotiated agreement with the hospital.  Schedule 5 sets a higher minimum level of benefit (for overnight treatment and day only treatment provided in specified facilities) than the minimum benefit set for such treatment by Schedules 1, 2 and 3 of the Principal Rules.

 

Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to insert the following 13 new facilities:

 

Name

Address

Imaging@Olympic Park

AAMI Park, Suite 2, 60 Olympic Boulevard, MELBOURNE  VIC  3000

Lambton Road Day Surgery

163 Lambton Road, BROADMEADOW  NSW  2292

Marie Stopes International Bowen Hills

8 Campbell Street, BOWEN HILLS  QLD  4006

Marie Stopes International - Canberra

Level 1 Moore & Alinga Streets, CANBERRA CITY  ACT  2601

Marie Stopes International East St Kilda

338 Dandenong Road, EAST ST KILDA  VIC  3182

Marie Stopes International Midland Centre

8 Sayer Street, MIDLAND  WA  6056

Marie Stopes International Rockhampton

123 Bolsover Street, ROCKHAMPTON  QLD  4700

Marie Stopes International Salisbury

11 Hayling Street, SALISBURY  QLD  4107

Marie Stopes International Southport

34 Cougal Street, SOUTHPORT  QLD  4215

Marie Stopes International Townsville

26 Mcilwraith Street, TOWNSVILLE  QLD  4810


 

Skin and Cancer Foundation (Westmead) Day Procedure Centre

7 Ashley Lane, WESTMEAD  NSW  2145

Steele Street Clinic

166 Steele Street, DEVONPORT  TAS  7310

Westmed Centre

27 Railway Parade, WESTMEAD  NSW  2145

 

Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to change the address of the following facility:

 

From:

0015930K:

South Pacific Private Hospital

18 Beach Street, CURL CURL  NSW  2096

 

 

 

 

To:

0015930K:

South Pacific Private Hospital

24 Beach Street, CURL CURL  NSW  2096

 

Item 1 provides that the table in Schedule 5, Clause 4 of the Principal Rules is amended to delete the following facility which closed on 30 September 2011:

 

Terrace West Endoscopy Centre

18 Limestone Street, IPSWICH  QLD  4305

 

 

 

PRIVATE HEALTH INSURANCE BRANCH

DEPARTMENT OF HEALTH AND AGEING

DECEMBER 2011