PHI 79/10

This circular issued by the Private Health Insurance Branch contains information on Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (NO. 7A) and Private Health Insurance (Complying Product) Amendment Rules 2010 (NO. 5)

Page last updated: 14 February 2013

Printable version of 79/10 (PDF 33 KB)

17 November 2010

Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (NO. 7A) and Private Health Insurance (Complying Product) Amendment Rules 2010 (NO. 5)

The Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 7A) (the Benefit Requirements Amendment Rules) and the Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 5) (the Complying Product Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) on 29 October 2010 and took effect on 1 November 2010 (FRLI No: F2010L02894 and FRLI No: F2010L02893 respectively).

These Rules amended the Private Health Insurance (Benefit Requirements) Rules 2010 (the Benefit Requirements Rules) and the Private Health Insurance (Complying Product) Rules 2010 (the Complying Product Rules).

The Benefit Requirements Amendment Rules

Amendments have been made to Schedules 1 and 3 of the Benefit Requirements Rules to reflect changes in Medicare Benefits Schedule (MBS) items that commenced on 1 November 2010.

Amendments made to the Benefit Requirements Rules include:
  1. A definition of a ‘participating midwife’ in Part 1, clause 4 (Preliminary) for the purposes of Schedule 1, Part 2, clause 5. This is defined in the Health Insurance Act as a midwife who has been approved by the Minister, or otherwise an eligible midwife, who renders a service in collaboration with one or more medical practitioners of a kind specified in the Health Insurance Amendment Regulations 2010 (No.1). An eligible midwife is one who meets the Nursing and Midwifery Board of Australia’s registration standard and has been endorsed by the Australian Health Practitioners Regulation Agency.
  2. The specified amount for advanced surgical patient has been increased from greater than $806.13 to greater than $820.64, and the specified range for surgical patient has been increased from the previous range of $240.05 to $806.13, to a new range of $244.37 to $820.64 respectively (Schedule 1). This reflects an increase of 1.8 % which has been applied as a result of indexation.
  3. MBS item numbers 444, 445, 446, 447, 448, 449 and 10997 have been deleted from Schedules 1 and 3.
  4. MBS item number 13218 has been re-categorised from an advanced surgical patient to a surgical patient (Schedule 1).
  5. MBS item numbers 16406, 16527, 16528, 82120, 82125, 82100, 82105, 82110, 82115, 82130, 82135, 82140 have been added to Schedules 1 and 3. A new category of professional services provided to a patient by a participating midwife with the MBS item numbers 82120 and 82125 has also been created.
As of the date of this Circular, two participating midwives have been issued with provider numbers. Provider numbers will be notified to insurers directly by Medicare Australia.

Details of the amendments are set out in the Private Health Insurance (Benefit Requirements) Amendment Rules 2010 (No. 7A), which is available on the ComLaw website.

The Complying Product Amendment Rules

Amendments have been made to Part 2, Rule 8A (3)(a)(viii) which specifies the contribution for Nursing-Home Type Patients (NHTP). The Complying Product Amendment Rules increase the amount of the NHTP contribution payable by privately insured patients at public hospitals in Western Australia from $47.35 to $48.35.

Details of the amendments are set out in the Private Health Insurance (Complying Product) Amendment Rules 2010 (No. 5), which is 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 2012 Private Health Insurance (PHI) Circulars.

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