Printable version of 40/11 (PDF 26 KB)
22 June 2011
Benefits Payable for Podiatric Surgery Performed in Hospitals and by Accredited Podiatrists
The purpose of this circular is to clarify that benefits payable for podiatric surgery performed in a hospital, including the professional fees of accredited podiatrists, should be paid under a private health insurance policy which covers hospital treatment, not general treatment.
This circular replaces circulars 42/04 and 42/05, which stated that if a private health insurer offered benefits for accredited podiatrists’ surgical fees they should do so from their ancillary tables. Those circulars were based on previous legislation.
Benefits for podiatric surgery performed in a hospital
In accordance with section 121-5 of the Private Health Insurance Act 200
7 (the PHI Act), podiatric surgery provided at a hospital, or provided, or arranged, with the direct involvement of a hospital is ‘hospital treatment’. Benefits paid for hospital treatment must only be paid under hospital treatment policies.
If insurers offer benefits for podiatric surgery performed in a hospital, the PHI Act and associated Rules set the minimum benefits that they must provide. The Private Health Insurance (Benefit Requirements) Rules
set the minimum benefit that insurers must pay per night towards hospital accommodation. The Private Health Insurance (Complying Product) Rules
also provide that insurers must cover the provision of a prosthesis that is associated with the surgery and is listed in the Private Health Insurance (Prostheses) Rules
For further information about this circular, please contact Mr Stephen Lewis on (02) 6289 8283.
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 2011 Private Health Insurance (PHI) Circulars
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