As per the Government-MTAA agreement, the final round of benefit reductions payable by private health insurers for devices on the Prostheses List will take effect 1 February 2020. The reduction is calculated on the basis of the Prostheses List benefit on 31 January 2020. The following groups are exempt: 03.01.01, 08.17.01, 08.18.01 and 08.18.02.
The table shows the reduction percentages that apply.
Benefit reductions effective 1 February 2020
Ophthalmic
–5%
Except groups
Foldable
–8.5%
Viscoelastic
–10%
Ears nose throat
–5%
Except groups (cochlear implants, speech processors, sound processor accessory kits, implantable bone conduction hearing system)
–
General miscellaneous
–5%
Except groups (infusion pumps, balloon based; sponges; pliable patches, internal adhesives, ligating devices; staples and tackers)
–7%
Neurosurgical
–5%
Urogenital
–
Specialist ortho
–
Except groups (screws; surgical accessories; bone cement)
–3%
Plastic and reconstructive
–
Cardiac
–7.5%
Except group (cardiac defect occluders)
–10%
Cardiothoracic
–
Vascular
–5%
Except assessment bodies (vascular patches; arterial closure devices; long term vascular access devices);
and groups (occlusion devices particle; coil, peripheral; polymer; delivery device for occlusion media)
–10%
Hip
–4.5%
Knee
–2.5%
Spinal
–3.75%
Additional information on the benefit reductions can be found at:
- Private health insurance reforms: Prostheses List benefit reductions
- Agreement between the Government and the Medical Technology Association of Australia (MTAA)
Draft Prostheses List available to sponsors via PLMS
18 November 2019
Deadline for feedback
25 November 2019
February 2020 Prostheses List published
2 December 2019
February 2020 Prostheses List effective
1 February 2020