Under the Private Health Insurance Act 2007, private health insurers must pay benefits for a range of prostheses. Prostheses covered by this act are those that:
- you receive as part of an episode of hospital treatment or hospital substitute treatment
- you have private health insurance cover
- a Medicare benefit is payable for the service.
For regular updates to industry about private health insurance, please see the Private Health Insurance circulars.
The Medical Technology Association of Australia (MTAA) agreement is a commitment by the Government and the MTAA to improve access to breakthrough medical technology and affordability of medical devices for privately insured Australians.
Please see the Agreement between the Government and the MTAA.
Private Health Insurance – Cover for Prostheses
If you are having surgery to implant or apply a prosthesis, your private health insurer must pay a benefit for it if:
- you have the correct cover for the treatment
- the product is on the Prostheses List.
The Prostheses List includes over 10,000 surgically implanted prostheses, human tissue items and other medical devices. It also shows the minimum benefits that private health insurers must pay for each prosthesis.
Private Health Insurance – Cover for Prostheses has further details about how prostheses are covered by private health insurance.
The Prostheses List
The Prostheses List is the list of surgically implanted prostheses, human tissue items and other medical devices for which private health insurers must pay benefits when:
- the patient has the correct health insurance cover
- the patient receives them as part of hospital treatment or hospital substitute treatment, and
- there is a Medicare benefit payable for the professional service.
The Prostheses List is for Private Health Insurers, prostheses device manufacturers and other sponsors. You can get further details about the list and download it at The Prostheses List.
Prostheses List Advisory Committee (PLAC) and Sub-Committees
Prostheses List Advisory Committee (PLAC) and other specialist committees maintain the Prostheses List. The committees are responsible for reforming the prostheses listing arrangements which helps to make private health insurance more affordable. The committees are:
- The Prostheses List Advisory Committee (PLAC)
- Prostheses Clinical Advisory Groups (CAGs)
- The Panels of Clinical Experts, and
- The Health Economics Sub-Committee (HESC).
You can get more details about the governance structures around the Prostheses List, their Terms of Reference and legal basis.
Prostheses List Management System (PLMS)
The Prostheses List Management System allows prostheses device sponsors and suppliers to create, edit and monitor applications for prostheses listings. Please see the User support - Quick Reference Guides to help access the PLMS System.
Cost Recovery Implementation Statement (CRIS) – Administration of the Prostheses List (1 July 2017 to 30 June 2018)
Administration of the prostheses listing is fully cost recovered by application fees paid to list prostheses on the Prostheses List. The Cost Recovery Implementation Statement – Administration of the Prostheses List sets out the current cost recovery arrangements:
PDF version: Cost Recovery Implementation Statement – Administration of the Prostheses List (1 July 2017 to 30 June 2018) (PDF 228 KB)
Word version: Cost Recovery Implementation Statement – Administration of the Prostheses List (1 July 2017 to 30 June 2018) (Word 120 KB)
Meetings, Events, Calendars and Consultations
- Calendars of upcoming meetings and events related to the Prostheses List.
- upcoming consultations and records of past consultations.