PHI 52/20 Second-tier update arrangements due to suspended accreditation assessments

Private health insurance announcement.

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

This circular is to advise all hospitals that the second-tier default benefit eligibility process administered by the Department of Health is continuing during the response phase of the COVID-19 pandemic.

Accreditation certificates: As per the announcement from the Australian Commission on Safety and Quality in Health Care (ACSQHC), the accreditation status of health services organisations will be maintained during the response phase of the COVID-19 pandemic.  See further information and exceptions to these arrangements.

If the hospital has not undergone an accreditation assessment at the time the application for second-tier eligibility is due, it must supply the following information with the application to support the accreditation status:

  • the most recent accreditation certificate to the National Safety and Quality Health Service (NSQHS) Standards
  • if the accreditation is to the first edition of the NSQHS Standards, then the hospital must also provide an Informed Financial Consent (IFC) and internal procedures as per Advisory 18/10
  • written confirmation from the accrediting agency to advise the hospital’s accreditation status has been extended/maintained

All other requirements for second-tier eligibility must also be provided. See more details, including guidelines, hospital second-tier category and application forms.

If the hospital is then assessed as eligible for second-tier default benefits, the second-tier expiry date will be set to 60 days after the maintained accreditation was expected to expire (usually 3 years). Once the accreditation is assessed and the certificate is issued, the hospital must immediately submit it to the Department at If the accreditation expiry date is later than the date the department had calculated (due to delays in accreditation assessments), a new second-tier expiry date will be set to 60 days after that date. No application or fee is required for this process.

If the hospital is not accredited following the resumption of assessments, it must immediately inform the department.