PHI 42/24 Private Health Insurance Legislation Amendment Rules (No. 4) 2024

This circular provides information about hospital accommodation benefits, nursing home type patient contribution and the second-tier application fee from 1 July 2024.

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

The Private Health Insurance Legislation Amendment Rules (No. 4) 2024 (the Amendment Rules) amend the: 

The Amendment Rules were registered on the Federal Register of Legislation on 28 June 2024. Notification was also emailed t direct to the sector on 28 June 2024.

We administer private health insurance under the Private Health Insurance Act 2007 and associated rules.

The Amendment Rules amend the:

  • Benefit Rules to update the minimum benefits payable by private health insurers per night for overnight and same day accommodation for private patients in private hospitals and public hospitals nationally, and for nursing-home type patients (NHTPs) in public hospitals in the Australian Capital Territory (ACT) and South Australia (SA).
  • Complying Product Rules to increase the daily patient contribution payable by a NHTP in public hospitals in the ACT.
  • Business Rules to amend the fee for processing and assessment of applications by declared private hospitals for inclusion in the second-tier eligible hospitals class to $985.

Overnight and same day accommodation benefit indexation

Overnight and same-day minimum hospital treatment accommodation benefits payable by insurers for private patients are indexed annually effective 1 July. The indexation figure applied is the percentage change reported by the Australian Bureau of Statistics in the Consumer Price Index (CPI) weighted average of 8 capital cities for the 12 months to the March quarter; which for March 2024 is 3.6 per cent. Total fees and charges for privately insured patients in public hospitals are determined by the state or territory in which the patient is receiving public hospital treatment.

Overnight accommodation

The tables below provide the minimum benefits payable by insurers from 1 July 2024 for overnight accommodation as described in the Amendment Rules. These changes will be incorporated into updates to the Benefit Rules.

Overnight accommodation for private patients in private hospitals in all states/territories and shared ward accommodation for private patients in public hospitals in Victoria and Tasmania

Class of patientMinimum benefit payable per night
Advanced surgical patient 
first 14 days$527
over 14 days$367
Surgical patient or obstetric patient 
first 14 days$489
over 14 days$367
Psychiatric patient 
first 42 days$489
43 – 65 days$425
over 65 days$367
Rehabilitation patient 
first 49 days$489
50 – 65 days$425
over 65 days$367
Other patients 
first 14 days$425
over 14 days$367

Overnight shared ward accommodation for private patients at public hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia

Public hospitalsMinimum benefit payable per night
Australian Capital Territory$436
New South Wales$436
Northern Territory$436
Queensland$447
South Australia$436
Western Australia$436

Same day accommodation

The tables below provide the minimum benefits payable by insurers from 1 July 2024 for same day accommodation as described in the Amendment Rules. These changes will be incorporated into updates to the Benefit Rules.

Same day accommodation for private patients in hospitals in all states/territories

Public hospitalsBand 1Band 2Band 3Band 4
New South Wales$316$352$389$436
Australian Capital Territory$316$352$389$436
Northern Territory$316$363$418$436
Queensland$322$365$399$447
South Australia$316$363$398$436
Tasmania$307$366$422$489
Victoria$311$367$426$489
Western Australia$359$359$359$359
Private hospitalsBand 1Band 2Band 3Band 4
Private hospitals all states and territories$274$344$418$489

Nursing‑Home Type Patient (NHTP) accommodation indexation

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 the changes from July or September, annually.

The ACT will implement the 20 March 2024 indexation to the daily patient contribution rate payable by NHTP at hospitals in the ACT from 1 July 2024.

Patient contribution

The Complying Product Rules Part 2 – 8A(3) Benefit requirement – nursing-home type patients, establish the statutory minimum daily patient contribution rate payable by a NHTP in hospital.

The table below shows the daily patient contribution payable by a NHTP in hospital from 1 July 2024 described in the Amendment Rules and will be incorporated into the Complying Product Rules.

Minimum patient contribution for each day as a nursing-home type patient at a hospital

Public hospitalsMinimum patient contribution for each day a NHTP
Australian Capital Territory$75.55
New South Wales$75.55   NO CHANGE – amended March
Northern Territory$75.55   NO CHANGE – amended March
Queensland$75.55   NO CHANGE – amended March
South Australia$75.55   NO CHANGE – amended March
Tasmania$75.55   NO CHANGE – amended March
Victoria$75.55   NO CHANGE – amended March
Western Australia$75.55   NO CHANGE – amended March
Private hospitalsMinimum patient contribution for each day a NHTP
Private hospitals all states and territories$75.55   NO CHANGE – amended March

Minimum benefit payable by private health insurers for NHTP

The Benefits Rules 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.

Rates were updated from 20 March 2024 for private patients in private hospitals nationally, and for private patients in public hospitals in New South Wales, Tasmania and Western Australia. From 1 July 2024 updated rates will be implemented by the ACT and SA. Rates in Victoria, Queensland and the Northern Territory remain unchanged.

The table below shows the minimum benefit payable by insurers for NHTP from 1 July 2024 as described in the Amendment Rules and will be incorporated into the Benefits Rules.

Minimum benefit payable per night by insurers for nursing home type patient accommodation

Public hospitalsMinimum benefit per night
Australian Capital Territory$147.45
New South Wales$172.60   NO CHANGE – amended March
Northern Territory$147.19   NO CHANGE
Queensland$145.80   NO CHANGE
South Australia$146.00
Tasmania$181.30   NO CHANGE – amended March
Victoria$140.00   NO CHANGE
Western Australia$149.75   NO CHANGE – amended March
Private hospitalsMinimum benefit per night
Private hospitals all states and territories$35.55     NO CHANGE – amended March

Second-tier benefits eligibility application fee indexation

The activities and tasks that make up the assessment for second tier default benefits eligibility have been reviewed and updated. Government policy to index charges annually has resulted in an increase in the application fee of $40 to $985 from 1 July 2024.

Find out more in our Cost Recovery Implementation Statement (CRIS). The 2024–2025 CRIS will be available online from 1 July 2024.

More information

Further details on the amendments are included in the Explanatory Statement accompanying the Amendment Rules available on the Federal Register of Legislation website by searching ‘Private Health Insurance Legislation Amendment Rules (No. 4) 2024’ or unique ID F2024L00824.

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