PHI 15/14

This circular issued by the Private Health Insurance Branch contains information about Nursing-Home Type Patient Contribution Rates and Minimum Benefits as at 20 March 2014

Page last updated: 19 March 2014

Printable version of 15/14 (PDF 343 KB)

19 March 2014

Nursing-Home Type Patient Contribution Rates and Minimum Benefits as at 20 March 2014

The Private Health Insurance (Complying Product) Amendment Rules 2014 (No.2) (‘the Complying Product Amendment Rules’) and the Private Health Insurance (Benefit Requirements) Amendment Rules 2014 (No. 1) (‘the Benefit Requirements Amendment Rules’) were registered with the Federal Register of Legislative Instruments (FRLI) and commence on 20 March 2014 (FRLI No: F2014L00311 and F2014L00309 respectively).

The Rules amend the Private Health Insurance (Complying Product) Rules 2010 (No. 2) and the Private Health Insurance (Benefit Requirements) Rules 2011.

The Complying Product Amendment Rules

Nursing-home type patient contribution rates have been updated to reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance.

The amendments update the patient contribution rates for nursing-home type patients in Queensland, New South Wales, South Australia, Northern Territory, Tasmania, and Western Australia; and increased the private hospitals nationally.
State/TerritoryContribution Rates
Queenslandfrom $54.75 to $55.80
New South Walesfrom $54.75 to $55.80
Northern Territory from $52.05 to $55.80
South Australiafrom $54.75 to $55.80
Tasmaniafrom $54.75 to $55.80
Western Australiafrom $54.75 to $55.80
Private hospitals nationallyfrom $54.75 to $55.80
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryContribution Rates
Australian Capital Territory$53.55
Victoria$54.75

The Benefit Requirements Amendment Rules

Nursing-Home Type Patients - Schedule 4

Nursing-home type patient minimum benefits have been updated to reflect the indexation applied to the Adult Pension Basic Rate and Maximum Daily Rate of Rental Assistance.

The amendments increase the minimum benefits payable for privately insured nursing-home type patients at public hospitals in New South Wales, Tasmania and Northern Territory, and decrease the minimum benefits payable at private hospitals nationally. The changes are as follows:
State/TerritoryMinimum benefit per night
New South Walesfrom $111.70 to $114.05
Tasmaniafrom $131.40 to $133.90
Northern TerritoryFrom $77.47 to $83.10
Private hospitals nationallyfrom $56.35 to $55.30
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryMinimum benefit per night
South Australia$111.00
ACT$111.20
Western Australia$125.45
Victoria$118.00
Queensland$109.00

Medicare Benefit Schedule (MBS) item number – Schedule 3

The Benefit Requirements Amendment Rules insert one new MBS item in Schedule 3 of the Private Health Insurance (Benefit Requirements) 2011.

Item 1 - Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 3 – Therapeutic procedures, T11

Item 1 amends Schedule 3, Part 3 Type C procedures, Clause 8 Interpretation, Category 3 Therapeutic procedures, T11 of the Principal Rules by inserting 1 MBS item (18377). This MBS item relates to therapeutic procedures which are not usually performed in hospital. However, it is recognised that this item may be performed, in rare cases, in isolation in hospital if determined by the treating medical practitioner.

MBS item 18377 commenced on 1 March 2014 under a remake of the Health Insurance (General Medical Services Table) Regulations. MBS item 18377 is a new item to make benefits available for the treatment of chronic migraine with the injection of botulinum toxin type A for patients 18 years or older who have experienced an inadequate response to at least 3 prophylactic migraine medications before commencement, and the requirements relating to botulinum toxin type A under the Pharmaceutical Benefits Scheme are complied with.

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 2014 Private Health Insurance (PHI) Circulars.

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