Under the Private Health Insurance Act 2007, private health insurers are required to pay benefits for a Prescribed List product when:
- the product is on the Prescribed List of medical devices and human tissue products
- the patient receives the product as part of hospital treatment or hospital substitute treatment
- the patient has appropriate health insurance to cover for the treatment
- a Medicare benefit is payable for a service associated with the use of the product.
If a product that is being subject to a post-listing review process meets the requirements above, insurers are still required to pay the associated benefits, until the outcome of the post-listing review is implemented. This includes benefits payable for urogynaecological mesh devices (mid-urethral slings); spinal cord stimulators; and surgical guides and biomodels.