Private health insurance clinical category definitions 1 July 2021

Standard clinical category definitions for private health insurance hospital policies, effective 1 July 2021.


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 reflects the MBS as of 1 July 2021 (derived from the 18 June 2021 MBS XML file, with additional items from the MBS XML files published on 16 and 21 June 2021).

*Item 48939 is listed in the Bone, joint and muscle clinical category but should be in the Joint reconstructions category.

Amendments will be made to the next version of the document. Please refer to the Private Health Insurance Legislation Amendment Rules (No. 4) 2021 for correct categorisations.

For older versions of this publication, visit the National Library's web archive.

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