PHI 58/23 Private Health Insurance Legislation Amendment Rules (No. 7) 2023

The Amendment Rules were registered on the Federal Register of Legislation on 18 September 2023 and commenced 20 September 2023. Advance email notification was provided to the sector on 15 September 2023.

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

The Private Health Insurance Legislation Amendment Rules (No. 7) 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 18 September 2023 and commenced 20 September 2023. Advance email notification was provided to the sector on 15 September 2023.

The Amendment Rules amend the Benefit Requirements Rules to:

  • index the monetary qualifiers from 1 November 2023 for Medicare Benefits Schedule (MBS) items to be included in Type A procedure patient classifications for “advanced surgical patient” and “surgical patient”. The increases are in line with supplementary indexation of MBS fees of 0.5 per cent from 1 November 2023;
  • remove MBS items 30473, 30478, 41647 and 45027 inadvertently retained in those listed as Band 1 Type B procedures; and
  • update the minimum benefits payable by private health insurers per night for nursing-home type patients (NHTP) at private hospitals nationally and at public hospitals except for the Australian Capital Territory (ACT), South Australia and Victoria as outlined below.

The Amendment Rules amend the Complying Product Rules to increase the daily patient contribution payable by NHTPs for accommodation in private hospitals nationally and public hospitals in all state and territory jurisdictions except for the ACT.

Nursing‑Home Type Patient (NHTP) accommodation indexation, 20 September 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 September 2023 are set out in Table 1, below:

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

Public hospital: State/Territory

Daily patient contribution rate payable by a NHTP

Australian Capital Territory

$70.55 (no change)

New South Wales

$74.20

Northern Territory

$74.20

Queensland

$74.20

South Australia

$74.20

Tasmania

$74.20

Victoria

$74.20

Western Australia

$74.20

Private Hospitals all States and Territories

$74.20

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 2023 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

$142.45 (no change)

New South Wales

$165.60

Northern Territory

$147.19

Queensland

$145.80

South Australia

$141.00 (no change)

Tasmania

$178.10

Victoria

$140.00 (no change)

Western Australia

$148.40

Private Hospitals all States and Territories

$36.90

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. 7) 2023’.

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