PHI 40/15

This circular issued by the Private Health Insurance Branch contains information about the Private Health Insurance (Benefit Requirements) Amendment Rules 2015 (No. 2) and the Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 2)

Page last updated: 26 June 2015

Printable version of 40/15 (PDF 168 KB)

26 June 2015

Private Health Insurance (Benefit Requirements) Amendment Rules 2015 (No. 2) and the Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 2)

The Private Health Insurance (Benefit Requirements) Amendment Rules 2015 (No. 2) (the Benefit Requirements Amendment Rules) were registered with the Federal Register of Legislative Instruments (FRLI) and commence on 1 July 2015 (FRLI No: F2015L00926).

The Benefit Requirements Amendment Rules amend the Private Health Insurance (Benefit Requirements) Rules 2011.

Overnight accommodation benefits and same day accommodation benefits at private hospitals and public hospitals

Increases to overnight accommodation benefits and same day accommodation benefits at private hospitals and public hospitals have been made to reflect the March 2014 to March 2015 Consumer Price Index (CPI) increase of 1.3%.

The Benefit Requirements Amendment Rules update the minimum benefit payable per night for patients in private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania, providing that the patient is not classified as a nursing-home type patient. The following rates will apply:

Advanced surgical patient


- first 14 days $410
- over 14 days $285

Surgical patient or obstetric patient


- first 14 days $381
- over 14 days $285

Psychiatric patient


- first 42 days $381
- 43 – 65 days $330
- over 65 days $285


Rehabilitation patient


- first 49 days $381
- 50 – 65 days $330
- over 65 days $285

Other patients


- first 14 days $330
- over 14 days $285

An amendment has been made to the minimum benefit payable per night for patients in shared ward accommodation at public hospitals in the Australian Capital Territory (ACT), New South Wales (NSW), Northern Territory, Queensland, South Australia and Western Australia, providing that the patient is not classified as a nursing-home type patient. The new rates are as follows:
  • ACT $339;
  • NSW $339;
  • Northern Territory $339;
  • Queensland $346;
  • South Australia $339;
  • Western Australia $339.
New rates for minimum benefit for same-day accommodation in public hospitals and in private hospitals are implemented in each State and Territory and are as follows:
Public hospitals
Band 1

Band 2

Band 3

Band 4

NSW

$246

$275

$302

$339

ACT

$246

$275

$302

$339

Northern Territory

$246

$281

$326

$339

Queensland

$251

$282

$310

$346

South Australia

$246

$281

$310

$339

Tasmania

$239

$284

$329

$381

Victoria

$241

$285

$331

$381

Western Australia

$279

$279

$279

$279

Nursing-home type patients – Schedule 4

Increases were made to the minimum benefits for Nursing-Home Type Patients (NHTP) in public hospitals in South Australia, the ACT and Western Australia to reflect the twice annual pension increase which occurred 20 March 2015. The following new rates will apply:
State/TerritoryMinimum benefit per night
South Australia$115.00
ACT$117.65
Western Australia$138.10
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryMinimum benefit per night
New South Wales$117.30
Northern Territory$86.10
Queensland$113.00
Tasmania$136.55
Victoria$122.60

Second Tier Default Benefits – Schedule 5

The purpose of the amendments to Schedule 5 was to insert a reference to the new list of Second-tier eligible facilities compiled by the Second Tier Advisory Committee. Further information about this is available in PHI Circular 39/15.

Medicare Benefit Schedule (MBS) item numbers – Schedule 3

The Benefit Requirements Amendment Rules amend MBS items in Schedule 3 of the Private Health Insurance (Benefit Requirements) 2011. The changes are necessary to maintain consistency between the MBS item codes listed in the Principal Rules and the MBS from 1 July 2015.

Item 1 - Schedule 3, Part 3 Type C procedures, Clause 9 Interpretation, Category 3 Therapeutic Procedures, T11

Item 1 amends Schedule 3, Part 3 Type C procedures, Clause 9 Interpretation, Category 3 Therapeutic Procedures, T11 of the Principal Rules by deleting four MBS item numbers (18352, 18364, 18371 and 18373) and inserting four new MBS item numbers (18353, 18365, 18369 and 18374) into Type C procedures, Clause 9 Interpretation, Category 3 Therapeutic Procedures, T11. The introduction of the new items has resulted in the redundancy and subsequent deletion of items 18352, 18364, 18371 and 18373.

The four new items were listed in the in the Health Insurance (IncobotulinumtoxinA) Determination 2015 in April 2015 and are being transferred into the General Medical Services Table from 1 July 2015.

Details of the amendments are set out in the Benefit Requirements Amendment Rules, which are available on the ComLaw website.

Changes to the Private Health Insurance (Complying Product) Rules 2010 (No. 2)

The Private Health Insurance (Complying Product) Amendment Rules 2015 (No. 2)

(Complying Product Amendment Rules) were registered with the FRLI (FRLI No: F2015L00325) and commence on 1 July 2015.

These Rules amended the Private Health Insurance (Complying Product) Rules 2010 (No. 2).

The amendments update the patient contribution rates for nursing-home type patients in the Australian Capital Territory to $56.90.
State/TerritoryContribution Rates
Australian Capital Territoryfrom $55.80 to $56.90
The existing rates for other states and territories remain in force and are as follows:
State/TerritoryContribution Rates
New South Wales$56.90
Northern Territory$56.90
Queensland $56.90
Tasmania$56.90
Victoria $56.90
Western Australia$56.90
Private hospitals nationally$56.90
Details of the amendment is set out in the Complying Product Amendment Rules, which are available on the ComLaw website.