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Rules/Other as made
This instrument amends the Private Health Insurance (Complying Product) Rules 2010 (No. 2) to remove references to the 30% rebate on private health insurance from the statement about a product subgroup of a complying product.
Administered by: Health
Made 30 Jan 2014
Registered 31 Jan 2014
Tabled HR 11 Feb 2014
Tabled Senate 11 Feb 2014
Date of repeal 08 Feb 2014
Repealed by Division 1 of Part 5A of the Legislative Instruments Act 2003

 

Private Health Insurance (Complying Product) Amendment Rules 2014 (No. 1)

 

I, SHANE PORTER, delegate of the Minister for Health, make these Rules under item 3 of the table in section 333-20 of the Private Health Insurance Act 2007.

 

 

 

 

Shane Porter

Assistant Secretary

Private Health Insurance Branch

Department of Health

30 January 2014

 

 

 



Part 1        Preliminary

 

1.               Name of Rules

 

These Rules are the Private Health Insurance (Complying Product) Amendment Rules 2014 (No. 1).

 

2.               Commencement

 

These Rules commence on 7 February 2014.

 

3.               Amendment of the Private Health Insurance (Complying Product) Rules 2010 (No. 2)

The Schedule to these Rules amends the Private Health Insurance (Complying Product) Rules 2010 (No. 2) as amended.


Schedule – Amendments

 

[1] - Schedule 1 – Standard information statements: hospital treatment

 

Omit Schedule 1 and substitute:

 

Schedule 1 – Standard information statements: hospital treatment

 

Form of statement

 

Note: The next page of these rules appears without page number, header or footer. 

This is to allow the form to be shown in its actual size as an A4 page.

 


Private Health Insurance Standard Information Statement – Hospital Policy

This Statement provides basic information for the purposes of comparison only. For full explanation of this hospital policy please contact the health insurer on <phone number> or visit <website URL>.

Health insurer:

<Health Insurer name>
(This insurer has membership restrictions)

Who is covered:

<Type of cover>

Product name:

<Product name>

Monthly premium:  #

$<xx.yy> (before any rebate or loading)

Available for:

Residents of <State/Territory>
Employees/Members of <Company/Organisation name>
Closed to new members

(must be purchased with certain general treatment policies)

Medicare Levy Surcharge:

<NOT> Exempt

Available From:

<dd mmm yyyy>

# You may be entitled to an Australian Government rebate on this premium. Your premium may include a Lifetime Health Cover loading and/or an insurer discount depending on your individual circumstances.  Check with your insurer for more details.

What’s covered if i have to go to hospital?

ü    <Insert appropriate text>

What services are not covered at all?
(Exclusions)

û     <Insert list of exclusions>   OR   No exclusions

What services are only covered to a limited extent?
(Restrictions, Benefit Limitation Periods)

You are not fully covered for:   OR   No restrictions  

·                     <Insert list of restrictions>

You are not fully covered for the time period listed after the services for:   OR   No benefit limitation periods

·                     <Insert list of BLP items + limitation periods>

How long are the waiting periods for new and upgrading members?

·                     <Insert list of waiting periods>

Will i have to pay anything if i go to hospital?
(Excesses, Co-payments, Medical/Hospital gaps)

Excess: <insert appropriate phrase>

Extra costs per day (co-payments): <Insert appropriate phrase(s)>   OR   No co-payments

Doctors’ and hospital bills: <X> out of 10 medical services paid for by this health insurer in <State/Territory> have no out-of-pocket expenses.     plus (optionally)    This insurer also has arrangements that may mean lower out-of-pocket expenses on doctors’ bills.    OR    Gap cover benefits are not available under this policy.

You may have to pay additional costs depending on the doctors chosen, the treatment you are having and the hospital you go to.

Before you go to hospital, you should ask your doctor, hospital and health insurer about any out-of-pocket costs that may apply to you.

What other features does this policy have?





 

 



Schedule – Amendments

 

[2]- Schedule 2 – Standard information statements: general treatment

 

Omit Schedule 2 and substitute:

 

Schedule 2 – Standard information statements: general treatment

 

Form of statement

 

Note: The next page of these rules appears without page number, header or footer. 

This is to allow the form to be shown in its actual size as an A4 page.

 

 

 


Private Health Insurance Standard Information Statement – General Treatment Policy

This Statement provides basic information for the purposes of comparison only. For full explanation of this general treatment policy please contacts the health insurer on <phone number> or visit <website URL>.

Health insurer:

<Health Insurer name>
(This insurer has membership restrictions)

Who is covered:

<Type of cover>

Product name:

<Product name>

Monthly premium: #

$<xx.yy> (before any rebate or loading)

Available for:

Residents of <State/Territory>
Employees/Members of <Company/Organisation name>
Closed to new members

(must be purchased with certain hospital policies)

Medicare Levy Surcharge:

NOT Exempt

Available From:

<dd mmm yyyy>

# You may be entitled to an Australian Government rebate on this premium.  Your premium may include an insurer discount. Check with your insurer for more details.

Preferred service provider arrangements: By using this health insurer’s “preferred providers” you will have lower out-of-pocket costs on <list of services>and have access to more “no gap” services. A list of preferred providers is available from the health insurer.   OR   Insurer’s own wording

 

Services

Cover

Waiting period
(months)

Benefit limits
(per 12 months)

Examples of maximum benefits

Dental

 

 

 

Periodic oral examination –           $<xx.yy> OR
                                         <xx>% of charge

Scale & clean – $ OR % as above
Fluoride treatment – $ OR %

·                         General dental

·                         Major dental

 

 

 

Surgical tooth extraction – $ OR %
Full crown veneered – $ OR %

·                         Endodontic

 

 

 

Filling of one root canal - $ OR %

·                         Orthodontic

 

 

 

Braces for upper & lower teeth, including removal plus fitting of retainer – $ OR %

Optical (eg prescribed spectacles/ contact lenses)

 

 

 

Single vision lenses & frames – $ OR %
Multi-focal lenses & frames –
$ OR %

Non PBS pharmaceuticals

 

 

 

Per eligible prescription item - $ OR %

Physiotherapy

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Chiropractic

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Podiatry

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Psychology

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Acupuncture

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Naturopathy

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Remedial massage

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Hearing aids

 

 

 

Per hearing aid – $ OR %

Blood glucose monitors

 

 

 

Per monitor – $ OR %

Ambulance

 

 

 

<Insert appropriate phrase>

¬ <Special features of the product>

Other features:




Schedule – Amendments

 

[3]- Schedule 3 – Standard information statements: combined products

 

Omit Schedule 3 and substitute:

 

Schedule 3 – Standard information statements: combined products

 

Form of statement

 

Note: The next page of these rules appears without page number, header or footer. 

This is to allow the form to be shown in its actual size as an A4 page.

 

 


 

Private Health Insurance Standard Information Statement – Combined Policy              

This Statement provides basic information for the purposes of comparison only. For full explanation of this combined hospital and general treatment policy please contact the health insurer on <phone number> or visit <website URL>.

Health insurer:

<Health Insurer name>
(This insurer has membership restrictions)

Who is covered:

<Type of cover>

Product name:

<Product name>

Monthly premium:  #

:

$<xx.yy> (before any

 rebate or loading)

Available for:

Residents of <State/Territory>
Employees/Members of <Company/Organisation name>
Closed to new members

Medicare Levy Surcharge:

<NOT> Exempt

Available From:

<dd mmm yyyy>

# You may be entitled to an Australian Government rebate on this premium.  Your premium may include a Lifetime Health cover loading and/or an insurer discount depending on your individual circumstances.  Check with your insurer for more details.

Hospital Component

The following applies to the hospital component for the <Product name> policy from <Health Insurer name>.

What’s covered if i have to go to hospital?

ü <Insert appropriate text>

What services are not covered at all?
(Exclusions)

û <Insert list of exclusions>    OR    No exclusions

What services are only covered to a limited extent?
(Restrictions, Benefit Limitation Periods)

You are not fully covered for:    OR    No restrictions

·     <Insert list of restrictions>

You are not fully covered for the time period listed after the services for:    OR    No benefit limitation periods

·     <Insert list of BLP items + limitation periods>

How long are the waiting periods for new and upgrading members?

·     <Insert list of waiting periods>

Will i have to pay anything if i go to hospital?
(Excesses, Co-payments, Medical/Hospital gaps)

Excess: <insert appropriate phrase>  OR    No excess

Extra costs per day (co-payments): <Insert appropriate phrase(s)>   OR    No co-payments

Doctors’ and hospital bills: <X> out of 10 medical services paid for by this health insurer in <State/Territory> have no out-of-pocket expenses.    plus (optionally)    This insurer also has arrangements that may mean lower out-of-pocket expenses on doctors’ bills.    OR    Gap cover benefits are not available under this policy.

 You may have to pay additional costs depending on

  • the doctors chosen
  • the treatment you are having and
  • the hospital you go to.

Before you go to hospital, you should ask your doctor, hospital and health insurer about any out-of-pocket costs that may apply to you.

What other features does this hospital policy have?






 

 



General Treatment Component

The following applies to the general treatment component for the <Product name> policy from <Health Insurer name>.

Preferred service provider arrangements: By using this health insurer’s “preferred providers” you will have lower out of pocket
 costs on <list of services> and have access to more “no gap” services. A list of preferred providers is available from the health
insurer.    OR    Insurer’s own wording

 

Services

Cover

Waiting period
(months)

Benefit limits
(per 12 months)

Examples of maximum benefits

     Dental

 

 

 

Periodic oral examination –           $<xx.yy> OR
                                         xx% of charge

Scale & clean – $ OR % as above
Fluoride treatment – $ OR %

·                     General dental

·                     Major dental

 

 

 

Surgical tooth extraction – $ OR %
Full crown veneered – $ OR %

·                     Endodontic

 

 

 

Filling of one root canal -- $ OR %

·                     Orthodontic

 

 

 

Braces for upper & lower teeth, including removal plus
fitting of retainer – $ OR %

Optical (eg prescribed
spectacles/ contact lenses)

 

 

 

Single vision lenses & frames – $ OR %
Multi-focal lenses & frames –
$ OR %

Non PBS pharmaceuticals

 

 

 

Per eligible prescription item – $ OR %

Physiotherapy

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Chiropractic

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Podiatry

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Psychology

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Acupuncture

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Naturopathy

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Remedial massage

 

 

 

Initial visit – $ OR %
Subsequent visit – $ OR %

Hearing aids

 

 

 

Per hearing aid – $ OR %

Blood glucose monitors

 

 

 

Per monitor – $ OR %

Ambulance

 

 

 

<Insert appropriate phrase>

¬ <Special features of the product>



Other features:



 


Schedule – Amendments

 

[4] - Schedule 4 – Standard information statements: permitted content

 

Omit Part 1 of Schedule 4 and substitute:

 

Schedule 4 – Standard information statements: permitted content

 

Part 1 – all statements

Field

Description

Permitted content

Date of Issue:

Date on which the content of the SIS is updated.

dd [month in words] yyyy

Health Insurer:

Trading Name or Brand Name of the health insurer in the State the product is being sold.

[Health insurer trading name]

Restricted Membership insurers:

Disclaimer to be printed directly below the health insurer name if the product is offered by a restricted membership insurer.

(This insurer has membership restrictions)

Available for:

Name of the State/Territory in which the product subgroup is available for sale.

All States can only be used where every feature of the product subgroups are identical, including the premium.

One of:

·         NSW & ACT; OR

·         Northern Territory; OR

·         Queensland; OR

·         South Australia; OR

·         Tasmania; OR

·         Victoria; OR

·         Western Australia OR

·         All States

Corporate products:

One of the following statements to be printed directly below the State name if the product is a corporate product.

One of “employees” or “members” may be deleted or both can be used.

Employees/Members of [Company/Organisation name]

OR

Employees/Members of organisations with arrangements with this health insurer

Closed Products:

Statement to be printed directly below the State name (or below the corporate product statement if applicable) if the product is not currently available for purchase.

Closed to new members

Product Name:

Marketing name of the product.

[product name]

Who is covered:

Who is covered under this policy.

 

 

One of the following:

·         One adult; OR

·         Two adults; OR

·         Dependants only; OR

·         One adult & dependant(s); OR

·         Two adults & dependant(s); OR

·         Two adults & any dependant(s); OR

·         At least 3 adults & any dependants;

Monthly Premium:

Monthly premium.  Other discounts are not to be included here.

$[xx.yy amount of premium]

Available from:

Date from which the product becomes available for purchase.  Field only to appear/be completed if the statement is provided before the product is available.  The field is to be placed beneath the monthly premium field.

dd [month in words] yyyy

Medicare Levy Surcharge:

Indicates whether or not the policy will exempt the holder from the Medicare Levy Surcharge.  The field is to be placed beneath the monthly premium field.

Exempt OR

NOT exempt

<product code>

A unique identifying code for the standard information statement

A product code generated by the PrivateHealth.gov.au system.