Private health insurance clinical category definitions 1 January 2022

Standard clinical category definitions for private health insurance hospital policies, effective 1 January 2022.


Clinical categories for private health insurance hospital product tier arrangements

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Definitions of the clinical categories for hospital treatment policies as found in the Private Health Insurance (Complying Product) Rules 2015.

The clinical categories include an indicative list of Medicare Benefit Schedule (MBS) items that should be covered. The list of items is derived from the MBS XML Data file ‘MBS‑XML‑220101’ released on 17 December 2021, and includes 1 January 2022 changes which include minor administrative changes, continued telehealth arrangements, indexation to the fixed Extended Medicare Safety Net cap, Bulk-billing incentive changes, new items to support the suitability assessment for COVID-19 vaccine, a new item for cardiac MRI and the extension of temporary items to support the Governments response to the COVID-19 pandemic. A number of changes to the MBS General Medical Services Table, Diagnostic Imaging Services Table and the Pathology Services Table will also be implemented.

The assignment of MBS items by clinical category reflects the PHI rules, accessible on the Federal Register of Legislation.

For other versions of this publication, review the Private health insurance clinical category and procedure type collection, or visit the National Library's web archive.

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