Private health insurance resources
PHI 62/23 attachments – 2024 private health insurance premium application form and templates
These attachments to PHI circular 62/23 are the 2024 private health insurance premium application form and templates.
Modernising and Improving Private Health Insurance – Prescribed List
This paper provides updated data for the General Miscellaneous (GM) category of the Prescribed List, and quantifies the revised approach to data collection and analysis.
List of declared hospitals
The Minister for Health and Aged Care must declare a facility to be a hospital under section 121–5(6) of the Private Health Insurance Act 2007. View the current list of declared hospitals.
NTREAP Meeting Outcomes – 2 August 2023
Natural Therapies Review Expert Advisory Panel (NTREAP) meeting outcomes for 2 August 2023 meeting.
Cost Recovery Implementation Statement – Administration of the Prescribed List of Benefits for Medical Devices and Human Tissue Products – 1 July 2023
This cost recovery implementation statement describes how the Department of Health and Aged Care recovers the costs of administering the Prescribed List of Benefits for Medical Devices and Human Tissue Products.
Stakeholder Feedback Report – Consultation Paper 5 Bundling of Benefits for General Use Items
This report provides an analysis of stakeholder feedback received in response to the Prostheses List Reform Consultation Paper 6a – Listing Criteria.
Stakeholder Feedback Report - Prostheses List Reforms Consultation Paper 6(b) Proposed Cost Recovery Arrangements
This report provides an analysis of stakeholder feedback received in response to the Prostheses List Reform Consultation Paper 6b Cost Recovery Arrangements.
Stakeholder Feedback Report – Consultation Paper 6(a) Proposed Listing Criteria
This report provides an analysis of stakeholder feedback received in response to the Prostheses List Reform Consultation Paper 6a - Listing Criteria.
Private Health Insurance classification of MBS items 1 July 2023
This spreadsheet classifies MBS items by private health insurance clinical category or procedure type and includes MBS items effective 1 July 2023.
Private health insurance clinical category definitions 1 July 2023
Standard clinical category definitions for private health insurance hospital policies, released on 21 June 2023 and effective at 1 July 2023.
CIRG outcome note – 17 March 2023
The outcomes of the Clinical Implementation Reference Group (CIRG) Meeting 9.
NTREAP Meeting Outcomes – 19 May 2023
The Natural Therapies Review Expert Advisory Panel (NTREAP) met on 19 May 2023 for its 7th meeting. This document provides a record of the meeting.
Private hospital second-tier category list
Private health insurers use this list to calculate the second-tier default benefits payable to individual hospitals. This list is updated every year to be correct as of 1 August.
Submissions analysis on the Prostheses List Compliance Strategy
The below report provides analysis of stakeholder feedback to the proposed Prostheses List Compliance Strategy. The submission period for responses was between 14 September and 21 October 2022.
Prostheses List Compliance Strategy – Safeguarding the Prostheses List
The below document outlines Prostheses List compliance obligations for relevant stakeholders and the Australian Government.
Prostheses List cardiac implantable electronic devices (CIEDs) benefit reductions from 1 July 2023
The below data documents detail cardiac implantable electronic devices (CIEDs) that will have their Prostheses List (PL) benefits reduced by 40% of the gap on 1 July 2023.
Supplementary advice on bundling arrangements for General Use Items on the Prostheses List
This report details supplementary advice on bundling arrangements for General Use Items on the Prostheses List.
CIRG outcome note – 28 October 2022
The outcomes of the Clinical Implementation Reference Group (CIRG) Meeting 8.
Private health insurance clinical category definitions 1 March 2023
Standard clinical category definitions for private health insurance hospital policies, as of 23 February 2023 and effective 1 March 2023.
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Changes to the Prostheses List timeframes (2023/24)
This webinar recording provides an overview of the timing and impact of bypassing the March 2024 update and information on the Prostheses List reforms planned for 2023.
Options for a reformed Prostheses List pre-listing assessment framework and governance structure
This report provides a framework and proposes options for governance that would align the Prostheses List processes with those of other health technology assessment processes within the Government. It was developed by Adelaide Health Technology Assessment, under the Prostheses List Reform program.
Review of the Prostheses List advisory committee and associated subcommittees
This review provides options and recommendations for the future governance of the Prostheses List. It was developed by Ernst & Young under the Department’s Prostheses List Reform program.
Prostheses List Reforms – Pre-listing Assessment framework and Governance structure
This report outlines the pre-listing assessment framework and governance structure for the Prostheses List. It also addresses Ernst & Young, and Adelaide Health Technology Assessment options and recommendations.
Private Health Insurance classification of MBS items 1 March 2023
This spreadsheet classifies MBS items by private health insurance clinical category and procedure type and includes MBS items commencing 1 March 2023.
Outcomes of the hospital treatment certification and dual listed MBS items meeting – September 2022
This fact sheet provides our position on the hospital treatment certification.
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