PHI 24/23 Private Health Insurance Legislation Amendment Rules (No. 2) 2023

Private health insurance clinical category and procedure type updates following Medicare Benefits Schedule (MBS) item changes from 1 March 2023.

Date published:
PHI circular type:
PHI announcement
Audience:
Health sector

Nursing‑Home Type Patient (NHTP) accommodation indexation, 20 March 2023.

The Private Health Insurance Legislation Amendment Rules (No. 2) 2023 (the Amendment Rules) amend the Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Requirements Rules) and the Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules).

The Amendment Rules were registered on the Federal Register of Legislation on 17 March 2023 and commenced 20 March 2023. Advance email notification was provided to the sector on 10 March 2023.

NHTP contributions and minimum insurer benefits are indexed by the Commonwealth twice annually, on 20 March and 20 September. Jurisdictions are consulted on changes to rates in public hospitals. Some jurisdictions apply changes from 1 July, annually.

Patient contribution

The Private Health Insurance (Complying Product) Rules 2015 (Part 2 – 8A(3) Benefit requirement – nursing-home type patients) establish the statutory minimum daily patient contribution rate payable by a NHTP in hospitals. Daily patient contribution rates from 20 March 2023 are set out in Table 1, below:

Table 1. Daily patient contribution rate payable by NHTP at hospitals from: 20 March 2023

Public hospital: State/Territory

Daily patient contribution rate payable by a NHTP

Australian Capital Territory

$65.40 (no change)

New South Wales

$70.55

Northern Territory

$70.55

Queensland

$70.55

South Australia

$70.55

Tasmania

$70.54 (seventy dollars and fifty-four cents)

Victoria

$70.55

Western Australia

$70.55

 

 

Private Hospitals all States and Territories

$70.55

Minimum benefit payable by private health insurers for NHTP

The Private Health Insurance (Benefit Requirements) Rules 2011 (Schedule 4 – Nursing-home type patient accommodation: hospitals in all States/Territories, Part 6) establish the minimum benefit payable per night by private health insurers for NHTP in hospitals. Benefits from 20 September 2022 are set out in Table 2, below:

Table 2. Minimum benefit payable per night by private health insurers for NHTP from:

20 March 2023

Public hospital: State/Territory

Minimum NHTP benefit payable by insurer per night  

Australian Capital Territory

$137.30 (no change)

New South Wales

$160.20

Northern Territory

$140.05 (no change)

Queensland

$141.00 (no change)

South Australia

$132.00 (no change)

Tasmania

$169.31

Victoria

$140.00 (no change)

Western Australia

$144.75

 

 

Private Hospitals all States and Territories

$40.55

Further details on the amendments are included in the Explanatory Statement accompanying the Amendment Rules available on the Federal Register of Legislation at www.legislation.gov.au by searching ‘Private Health Insurance Legislation Amendment Rules (No. 2) 2023’.

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