Federal Register of Legislation - Australian Government

Primary content

Rules/Other as made
This instrument amends the Private Health Insurance (Benefit Requirement) Rules 2011 to update the minimum benefits for Nursing-Home Type Patients at public hospitals in the Australian Capital Territory.
Administered by: Health
Registered 20 Sep 2016
Tabling HistoryDate
Tabled HR10-Oct-2016
Tabled Senate10-Oct-2016
Date of repeal 21 Sep 2016
Repealed by Division 1 of Part 3 of Chapter 3 of the Legislation Act 2003

EXPLANATORY STATEMENT

 

Issued by the Authority of the Minister for Health

 

Private Health Insurance Act 2007

 

Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No.6)

 

Authority

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) Amendment Rules 2016 (No. 6) (the Amendment Rules) amends the schedule of the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on 1 November 2011.

 

Purpose

Schedule A of the Amendment Rules amends Schedule 4 of the Principal Rules.  The purpose of the amendments to Schedule 4 of the Principal Rules is to change the minimum benefits payable by private health insurers per night for nursing-home type patients (NHTP) at public hospitals in the Australian Capital Territory and at private hospitals nationally.

 

Background

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 Principal Rules set out the minimum levels of benefits which are payable for hospital treatment.  Namely, 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).

 

Schedule 1 categorises MBS item numbers into overnight patient classifications comprising ‘Advanced surgical patient’, ‘Obstetric patient’, ‘Surgical patient’, ‘Psychiatric patient’, ‘Rehabilitation patient’ and ‘Other patients’.  Schedule 3 sets out MBS items for the same day hospital accommodation benefits which are payable for privately insured patients in all states and territories.

 

The minimum benefits payable per night for hospital treatment provided to NHTP in Schedule 4 of the Principal Rules is subject to review and change twice annually, to reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance (Pension and Rental Assistance Rates).  The latest indexation of these rates takes effect on 20 September 2016.

 

Schedule 5 of the Principal Rules requires a private 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 private 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.

 

Details

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

 

Consultation

Schedule A of the Amendment Rules - Item 1

On 29 August 2016, States and Territories were asked whether they would be increasing the NHTP contribution and accommodation rates in their jurisdiction in line with increases in the Pension and Rental Assistance Rates. New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia have advised that they will increase the NHTP accommodation rates in their public hospitals from 20 September 2016.  The Australian Capital Territory and the Northern Territory have advised that they are not increasing their NHTP contribution and accommodation rates at this time.

 

The Amendment Rules commence on 20 September 2016.

 

The Amendment Rules are a legislative instrument for the purposes of the

Legislation Act 2003.

 


ATTACHMENT

 

DETAILS OF THE PRIVATE HEALTH INSURANCE (BENEFIT REQUIREMENTS) AMENDMENT RULES 2016 (No. 6)

 

Section 1    Name of Rules

 

Section 1 provides that the title of the Rules is the Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 6) (the Amendment Rules).

 

Section 2    Commencement

 

Section 2 provides that the Amendment Rules are to commence on 20 September 2016

 

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

 

Section 3 provides that Schedule A to the Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011 (the Principal Rules) which commenced on
1 November 2011.

 

Schedule A – Amendment

 

Item 1 – Schedule 4, Clause 6 Minimum benefit, Table 1

 

Item 1 of the schedule to the Amendment Rules amends the minimum benefit payable per night for nursing-home type patients in public hospitals in the following territory: in clause 6, Table 1:

 

·       Australian Capital Territory $119.55

 

 

 


 

Text Box: Statement of Compatibility with Human Rights
Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011

Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 6) 
This Legislative Instrument is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
Overview of the Legislative Instrument

The Private Health Insurance (Benefit Requirements) Amendment Rules 2016 (No. 6) amend 
Schedule 4 of the Private Health Insurance (Benefit Requirements) Rules 2011 to update the minimum benefits for Nursing-Home Type Patients at public hospitals in the Australian Capital Territory.

Human rights implications
This legislative instrument engages Articles 2 and 12 of the International Covenant on Economic, Social and Cultural Rights by assisting with the progressive realisation by all appropriate means of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 

Private health insurance regulation assists with the advancement of these human rights by improving the governing framework for private health insurance in the interests of consumers.  Private health insurance regulation aims to encourage insurers and providers of private health goods and services to provide better value for money to consumers, to improve information provided to consumers of private health services to allow consumers to make more informed choices when purchasing services and requires insurers not to differentiate the premiums they charge according to individual health characteristics such as poor health.  

Conclusion
This legislative instrument is compatible with human rights because it advances the protection of human rights.

Tracey Duffy
Assistant Secretary
Private Health Insurance Branch
Medical Benefits Division
Department of Health