Private health insurance clinical category definitions 1 Nov 2021

Standard clinical category definitions for private health insurance hospital policies, effective 1 November 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 is derived from the MBS XML Data file ‘MBS XML 211101’ released on 22 September 2021, and includes 1 November 2021 changes to the MBS General Medical Services Table, Diagnostic Imaging Services Table and the Pathology Services Table.

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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