Prostheses List Benefit Reductions

Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 4) and Private Health Insurance (Prostheses) Amendment Rules 2017 (No.1)

Page last updated: 09 February 2017

Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 4)

The delegate of the Minister for Health has made the Private Health Insurance (Prostheses) Amendment Rules 2016 (No. 4) (the Amendment Rules) to revise the benefits of 2,439 prostheses on Part A of the Private Health Insurance (Prostheses) Rules 2016 (No. 4) (the Prostheses List).



The Amendment Rules will change the Prostheses List by reducing the minimum benefits payable for devices in the following categories or assessment bodies:
  • 01.01 - Anterior Chamber Intraocular Lenses, benefits reduced by 10%
  • 01.02 - Posterior Chamber Intraocular Lenses, benefits reduced by 10%
  • 08 - Cardiac, benefits reduced by 10%
  • 11 - Hip, benefits reduced by 7.5%
  • 12 - Knee, benefits reduced by 7.5%
These benefit reductions will commence on 20 February 2017.

Private Health Insurance (Prostheses) Amendment Rules 2017 (No. 1)

The Department has identified that, due to an internal systems issue, details relating to 391 billing codes are incorrect. The errors relate to hip, knee, cardiac and intra-ocular lens devices.

To correct these errors, the Private Health Insurance (Prostheses) Amendment Rules 2017 (No. 1) will commence on 20 February 2017.

This amendment does not change the reduced benefits or effective date of these reductions.

Changes

PDF version: Benefits Reduction (effective 20 February 2017) Part A - Change Details (PDF 1076 KB)
including Amendment No. 4 - Published 8 September 2016 and Amendment No 1 - Published 30 January 2017

Excel version: Benefits Reduction (effective 20 February 2017) Part A - Change Details (Excel 244 KB)
including Amendment No. 4 - Published 8 September 2016 and Amendment No 1 - Published 30 January 2017

Prostheses List - Part A

PDF version: Benefits Reduction (effective 20 February 2017) Part A (PDF 5135 KB)
Excel version: Benefits Reduction (effective 20 February 2017) Part A (Excel 3687 KB)

Prostheses List Database

MS Access version: Prostheses List - including Amendment No. 4 - Published 8 September 2016 and Amendment No 1 (Access 7.3 MB)
Published 30 January 2017