Private Health Insurance (Benefit Requirements) Rules 2007 (No. 2)
I, PENNY SHAKESPEARE, delegate of the Minister for Health and Ageing, make these Rules under item 3A of the table in section 333-20 of the Private Health Insurance Act 2007.
Dated 25 June 2007
____________________________________
Penny Shakespeare
Assistant Secretary
Private Health Insurance Branch
Acute Care Division
Department of Health and Ageing
Part 1 Preliminary
1. Name of Rules
2. Commencement
3. Definitions
Part 2 Minimum benefit requirements
4. Psychiatric care, rehabilitation and palliative care
5. Other hospital treatments
Schedule 1―Overnight accommodation: private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania
Schedule 2―Overnight accommodation: shared ward accommodation at public hospitals in the ACT, NSW, Northern Territory, Queensland, South Australia and Western Australia
Schedule 3―Same-day accommodation: hospitals in all States/Territories
Schedule 4―Nursing-home type patient accommodation: hospitals in all States/Territories
Schedule 5―Second-tier default benefits
Schedule 6―Outreach services
These Rules are the Private Health Insurance (Benefit Requirements) Rules 2007 (No. 02).
(1) These Rules commence on 1 July 2007.
(2) These rules revoke the Private Health Insurance (Benefit Requirements) Rules 2007, as amended.
In these Rules:
Act means the Private Health Insurance Act 2007.
ACT means the Australian Capital Territory.
certified Type B procedure means a Type B procedure certified in accordance with clause 10 of Schedule 1.
certified overnight Type C procedure means a Type C procedure certified in accordance with clause 11 of Schedule 1.
certified Type C procedure means a Type C procedure certified in accordance with clause 7 of Schedule 3.
continuous period of hospitalisation, for the purpose of counting days of hospital treatment, includes any two periods during which a patient was, or is, receiving hospital treatment as a patient at a hospital, whether or not the same hospital, where the periods are separated from each other by a period of not more than 7 days during which the patient was not receiving hospital treatment as a patient at any hospital.
diagnostic imaging services table means the table prescribed under subsection 4AA (1) of the Health Insurance Act 1973.
fee in the MBS means the Schedule fee as defined in subsection 8 (1A) of the Health Insurance Act 1973.
general medical services table means the table prescribed under subsection 4 (1) of the Health Insurance Act 1973.
insurer means a private health insurer.
item has the same meaning as in subsection 3 (1) of the Health Insurance Act 1973.
MBS comprises the:
(a) general medical services table;
(b) diagnostic imaging services table; and
(c) pathology services table.
NSW means the State of New South Wales.
nursing-home type patient has the same meaning as in subsection 3 (1) of the Health Insurance Act 1973.
Note: Item 19 of Schedule 2 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 also deals with nursing-home type patients.
outreach service means a service referred to in subsection 16 (1) of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007, unless subsection 16 (2) of that Act applies to the particular service.
pathology services table means the table prescribed under subsection 4A (1) of the Health Insurance Act 1973.
policy means a complying health insurance policy.
private hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a private hospital.
Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.
professional service has the same meaning as in subsection 3 (1) of the Health Insurance Act 1973.
public hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a public hospital.
Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.
Type A procedure means:
(a) a procedure specified in clauses 3 to 9 of Schedule 1; or
(b) a certified Type B procedure; or
(c) a certified overnight Type C procedure.
Type B procedure means:
(a) a procedure specified in clauses 3 to 7 of Schedule 3 other than a certified Type B procedure; or
(b) a certified Type C procedure.
Type C procedure means a procedure specified in clause 8 of Schedule 3 other than a certified Type C procedure.
Part 2 Minimum benefit requirements
Note: Item 1 in the table in subsection 72-1 (2) of the Act requires that each policy that covers hospital treatment must cover any part of hospital treatment that is psychiatric care, rehabilitation or palliative care if the treatment is provided in a hospital and no medicare benefit is payable for that part of the treatment.
(2) Despite subrule (1), the minimum benefit for the treatment may be reduced by the amount of any co-payment or excess that is required to be paid under the insured person's policy in respect of that treatment.
(1) For item 5 in the table in subsection 72-1 (2) of the Act, for a policy that covers any type of hospital treatment provided in a hospital, other than treatment referred to in rule 4, the minimum benefit for that treatment is the amount set out, or worked out using the method for working out the minimum benefit, for that treatment in Schedules 1, 2, 3, 4, 5, or 6 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.
(2) Despite subrule (1), the minimum benefit for the treatment may be reduced by the amount of any co-payment or excess that is required to be paid under the insured person's policy in respect of that treatment.
Schedule 1―Overnight accommodation: private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania
Part 1―General
For rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is:
(a) provided to a patient who is not a nursing-home type patient; and
(b) provided to a patient:
(i) at a private hospital; or
(ii) as shared ward accommodation at a public hospital in Victoria or Tasmania; and
Note: The definition of hospital treatment in section 121-5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121-5 (1) (c) of the Act.
(c) provided for the purpose of permitting the provision to the patient of hospital treatment that is:
(i) a Type A procedure; and
(ii) for a period that includes part of an overnight stay.
Note: A Type A procedure is defined to include a certified Type B procedure and a certified overnight Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.
(2) When counting the days referred to in the tables in this Schedule to determine the minimum benefit in respect of any particular patient, days forming part of a continuous period of hospitalisation are to be counted.
Table 1―Accommodation at private hospitals in all States/Territories
Class of patient | Minimum benefit payable per night |
Advanced surgical patient |
|
- first 14 days | $333 |
- over 14 days | $231 |
Surgical patient or obstetric patient |
|
- first 14 days | $308 |
- over 14 days | $231 |
Psychiatric patient |
|
- first 42 days | $308 |
- 43 – 65 days | $268 |
- over 65 days | $231 |
Rehabilitation patient |
|
- first 49 days | $308 |
- 50 - 65 days | $268 |
- over 65 days | $231 |
Other patients |
|
- first 14 days | $268 |
- over 14 days | $231 |
Table 2― Victoria: shared ward accommodation at a public hospital
Class of patient | Minimum benefit payable per night |
Advanced surgical patient |
|
- first 14 days | $333 |
- over 14 days | $231 |
Surgical patient or obstetric patient |
|
- first 14 days | $308 |
- over 14 days | $231 |
Psychiatric |
|
- first 42 days | $308 |
- 43 – 65 days | $268 |
- over 65 days | $231 |
Rehabilitation patient |
|
- first 49 days | $308 |
- 50 – 65 days | $268 |
- over 65 days | $231 |
Other patients |
|
- first 14 days | $268 |
- over 14 days | $231 |
Table 3―Tasmania: shared ward accommodation at a public hospital
Class of patient | Minimum benefit payable per night |
Advanced surgical patient |
|
- first 14 days | $333 |
- over 14 days | $231 |
Surgical patient or obstetric patient |
|
- first 14 days | $308 |
- over 14 days | $231 |
Psychiatric patient |
|
- first 42 days | $308 |
- 43 – 65 days | $268 |
- over 65 days | $231 |
Rehabilitation patient |
|
- first 49 days | $308 |
- 50 – 65 days | $268 |
- over 65 days | $231 |
Other patients |
|
- first 14 days | $268 |
- over 14 days | $231 |
Part 2 Type A procedures
3. Interpretation
A Type A procedure is a procedure specified in this Part provided to a patient in one of the categories of patients in clauses 4 to 9.
(1) In this Schedule, advanced surgical patient has the meaning given by this clause.
(2) A patient is taken to be an advanced surgical patient upon admission to a hospital:
(c) if the advanced surgery is rendered to a patient during an admission, from the day the advanced surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).
Note: The effect of the reference in subclause (2) (a) to a professional service, being a service for which a medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.
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5. Obstetric patient
(1) In this Schedule, obstetric patient has the meaning given by this clause.
(2) A patient shall be taken to be an obstetric patient during an admission to a hospital from and including:
(a) whichever is the earlier of:
(ii) the day on which the patient commences labour leading to delivery in that hospital; or
(iii) the day on which a professional service with the item number 16515, 16518, 16519, 16522 (excluding caesarean) or 16525 is rendered to the patient in that hospital; or
(b) if the circumstances in paragraph (a) do not apply, the day before a professional service with the item number 16520 and 16522 (including caesarean) is rendered to the patient at that hospital, unless the particular obstetric procedure to be rendered is recognised as requiring a longer pre-operative period.
(3) In this clause, the item numbers specified are the item numbers in the general medical services table.
6. Surgical patient
(1) In this Schedule, surgical patient has the meaning given by this clause.
(2) A patient shall be taken to be a surgical patient upon admission to a hospital from and including:
(b) if a longer pre-operative period is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or
(c) if the surgery is rendered to a patient during an admission, from the day the surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).
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7. Psychiatric patient
In this Schedule, a psychiatric patient is deemed to be a patient in a hospital who, subject to approval by the insurer, is admitted for the purposes of undertaking a specific psychiatric treatment program.
Note: If a patient is receiving psychiatric treatment that is not under a specific psychiatric treatment program, the patient is taken to be in the category of 'other patient'.
8. Rehabilitation patient
In this Schedule, a rehabilitation patient is deemed to be a patient in a hospital who, subject to approval by the insurer, is admitted for the purposes of undertaking a specific rehabilitation treatment program.
Note: If a patient is receiving rehabilitation treatment that is not under a specific rehabilitation treatment program, the patient is taken to be in the category of 'other patient'.
(1) In this Schedule, other patient is deemed to be a patient at a hospital who is receiving any treatment that involves part of an overnight stay, but who is not:
(a) an advanced surgical patient;
(b) a surgical patient;
(c) an obstetric patient;
(d) a psychiatric patient; or
(e) a rehabilitation patient.
Note: A patient receiving hospital treatment that is palliative care as described in item 1 of the table in subsection 72-1 (2) of the Act is deemed to be in the category of 'other patient'.
Part 3 Certified Type B procedures and certified overnight Type C procedures
10. Certified Type B procedures
(1) Minimum benefits for overnight accommodation are payable for patients receiving a Type B procedure only if certification under subclause (2) is provided.
(2) Certification must be provided as follows:
(a) the practitioner providing the Type B procedure; or
(b) a professional employed by a hospital who is involved in the provision of the procedure provided by that hospital,
must certify in writing that:
(c) because of the medical condition of the patient specified in the certificate; or
(d) because of the special circumstances specified in the certificate,
it would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that includes part of an overnight stay.
11. Certified overnight Type C procedures
(1) Minimum benefits for overnight accommodation are payable for patients receiving a certified Type C procedure only if:
(a) certification has first been provided for the Type C procedure in accordance with clause 7 of Schedule 3; and
(b) certification under subclause (2) is also provided.
(2) Certification must be provided as follows the practitioner providing the certified Type C procedure must certify in writing that:
(a) because of the medical condition of the patient specified in the certificate; or
(b) because of the special circumstances specified in the certificate,
it would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that includes part of an overnight stay.
For rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is provided:
(a) to a patient who is not a nursing-home type patient; and
(b) as shared ward accommodation at a public hospital in the ACT, NSW, Northern Territory, Queensland, South Australia or Western Australia; and
Note: The definition of hospital treatment in section 121-5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121-5 (1) (c) of the Act.
(c) for the purpose of permitting the provision to the patient of hospital treatment that is:
(i) a Type A procedure; and
(ii) for a period that includes part of an overnight stay.
Note: A Type A procedure is defined to include a certified Type B procedure and a certified overnight Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.
2. Minimum benefit
Table
State/Territory | Minimum benefit payable per night |
ACT | $275 |
NSW | $275 |
Northern Territory | $269 |
Queensland | $278 |
South Australia | $275 |
Western Australia | $275 |
Schedule 3―Same-day accommodation: hospitals in all States/Territories
Part 1―General
For rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is provided for the purpose of permitting the provision to the patient of hospital treatment that:
(a) is a Type B procedure; and
(b) is provided to a patient at a hospital; and
(c) does not include part of an overnight stay at a hospital.
Note 1: A Type B procedure includes a certified Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.
Note 2: The definition of hospital treatment in section 121-5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121-5 (1) (c) of the Act.
2. Minimum benefit
(1) The minimum benefit for hospital treatment provided in the circumstances specified in this Schedule is the amount set out in Table 1 or 2 in this clause for that hospital treatment.
(2) The references to Bands in the tables are references as follows:
(a) Band 1 means Band 1 treatment;
(b) Band 2 means Band 2 treatment;
(c) Band 3 means Band 3 treatment;
(d) Band 4 means Band 4 treatment,
as those bands are described in Part 2 of this Schedule.
Table 1
Public hospitals | Band 1 | Band 2 | Band 3 | Band 4 |
|
|
|
|
|
NSW | $199 | $223 | $246 | $275 |
ACT | $200 | $224 | $246 | $275 |
Northern Territory | $195 | $222 | $258 | $269 |
Queensland | $203 | $227 | $249.50 | $278 |
South Australia | $200 | $227 | $250 | $275 |
Tasmania | $193 | $230 | $267 | $308 |
Victoria | $195 | $231 | $268 | $308 |
Western Australia | $218 | $218 | $218 | $218 |
Table 2
Private hospitals | $173 | $217 | $264 | $308 |
Part 2―Type B procedures
3. Interpretation
A Type B procedure is a procedure specified as a Band 1, 2, 3 and 4 as described in this Part.
Note: These procedures normally require hospital treatment that does not include part of an overnight stay.
4. Band 1
(1) Hospital treatment that involves a professional service of the type identified by the MBS item number specified in this subclause is Band 1 treatment for the purposes of the tables in clause 2 of this Schedule:
(a) category 3―therapeutic procedures, being the items below in the general medical services table:
T1: Miscellaneous Therapeutic Procedures:
13100 13103 13703 13706 13915 13918 13921 13927 13930
T8: Surgical Operations:
30210 30473 30475 30476 30478 30679 32075 32078 32081 32084 32087 32090 32095 35500 35539 35545 35703 37011 39000 39100 41604 41647 41674 41680 42575 45027 50658; and
(b) category 5―diagnostic imaging services, being the items below in the diagnostic imaging services table:
I1: Ultrasound:
55118 55600 55603; and
(2) Other hospital treatment requiring day admission to a hospital that is not Band 2, 3 or 4 treatment is Band 1 treatment for the purposes of the tables in clause 2 of this Schedule.
5. Non-band specific Type B day procedures
(1) Hospital treatment that involves a professional service of the type identified by the MBS item number specified in this clause is a non-band specific Type B day procedure.
13110 13212 13215 13292 13750 13755 13757 13948 14218 15338 15513 15539 16512 16603 16618 18216 18230 18242 18274 18276 18280 18284 18286 18290 18294 18296 18298 30041 30042 30045 30055 30081 30084 30087 30094 30096 30099 30102 30103 30104 30106 30107 30187 30189 30190 30223 30225 30262 30269 30281 30282 30283 30390 30391 30409 30484 30493 30653 30656 30659 30660 31225 31230 31235 31240 31255 31256 31257 31258 31260 31261 31262 31263 31265 31266 31267 31268 31270 31271 31272 31273 31275 31276 31277 31278 31280 31281 31282 31283 31285 31286 31287 31288 31290 31291 31292 31293 31295 31300 31305 31310 31315 31320 31325 31330 31335 31340 31345 31346 31350 31355 31441 31456 31458 31530 31551 31557 31560 31563 31566 32093 32094 32145 32147 32150 32153 32156 32168 32171 32177 32180 32504 34109 34130 34500 34503 34506 34524 34539 35324 35507 35508 35509 35512 35513 35516 35517 35520 35523 35526 35527 35542 35557 35569 35572 35611 35615 35616 35617 35618 35622 35623 35626 35627 35630 35633 35637 35639 35640 35643 35644 35645 35646 35647 35648 35687 35688 36812 36815 36818 36821 36824 36827 36830 36833 36836 36860 37219 37315 37318 37321 37354 37369 37435 37622 37623 37803 37806 37809 37812 37815 37854 38285 38286 39013 39118 39135 39140 39331 41503 41506 41509 41626 41629 41632 41644 41650 41653 41665 41668 41677 41695 41701 41716 41761 41764 41800 41801 41816 41819 41822 41825 41831 41849 41852 41855 41858 41861 41864 41886 41889 41892 41898 42503 42572 42573 42584 42593 42610 42611 42673 42680 42683 42686 42689 42692 42812 42818 42833 42845 42869 43942 43948 44102 44105 44136 44338 45019 45020 45030 45033 45039 45200 45224 45239 45506 45515 45626 45665 45668 45823 46327 46330 46336 46363 46366 46369 46396 46420 46423 46438 46441 46450 46486 46489 46494 46495 46501 46510 46525 47738 47906 47915 47918 47927 47972 48600 48603 48945 49218 49557 49700 49800 49803 49806 49809 50100 50115 51902 52015 52025 52042 52045 52057 52058 52061 52062 52064 52072 52073 52075 52081 52084 52087 52097 52099 52102 52144 52180 52300 52303 52321 52826 53003 53006 53009 53054 53056 53058 53060 53062 53064 53070 53206 53215 53218 53225 53410 53459 58939 59903 59912 59925 59970 59971 59972 59973 59974 60000 60003 60006 60009 60012 60015 60018 60021 60024 60027 60030 60033 60036 60039 60042 60045 60048 60051 60054 60057 60060 60063 60066 60069 60072 60075 60078
(2) A non-band specific Type B day procedure is Band 2, 3 or 4 treatment depending on anaesthetic type and, where applicable, theatre time as specified in clause 6 of this Schedule.
(3) If a non-band specific Type B day procedure does not involve anaesthetic or theatre times, the minimum benefit is the benefit for Band 1 treatment.
6. Other bands
In this Schedule:
Band 2 treatment means procedures, other than those that are Band 1 treatment, carried out under local anaesthetic with no sedation.
Band 3 treatment means procedures, other than those that are Band 1 treatment, carried out under:
(a) general anaesthesia; or
(b) regional anaesthesia; or
(c) intravenous sedation,
where the theatre time, being the actual time in theatre, is less than one hour.
Band 4 treatment means procedures, other than those that are Band 1 treatment, carried out under:
(a) general anaesthesia; or
(b) regional anaesthesia; or
(c) intravenous sedation,
where the theatre time, being the actual time in theatre, is one hour or more.
Note: Type C procedures are procedures that do not normally require hospital treatment.
(1) Benefits for day-only accommodation are payable for patients receiving a Type C procedure only if certification under subclause (2) is provided.
(2) Certification must be provided as follows the medical practitioner providing the professional service must certify in writing that:
(a) because of the medical condition of the patient specified in the certificate; or
(b) because of the special circumstances specified in the certificate,
it would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that does not include part of an overnight stay.
Part 3―Type C procedures
8. Interpretation
A Type C procedure is a procedure specified in this clause by reference to MBS items.
Note: These procedures normally do not require hospital treatment.
Items in the general medical services table
The following items are items in the general medical services table.
A1:
1 2 3 4 13 19 20 23 24 25 33 35 36 37 38 40 43 44 47 48 50 51 601 602
A2:
52 53 54 57 58 59 60 65 81 83 84 86 87 89 90 91 92 93 95 96 97 98 697 698
A3:
104 105 106 107 108 109
A4:
110 116 119 122 128 131
A5:
160 161 162 163 164
A6:
170 171 172
A7:
173 193 195 197 199
A8:
291 293 296 297 299 300 302 304 306 308 310 312 314 316 318 319 320 322 324 326 328 330 332 334 336 338 342 344 346 348 350 352 353 355 356 357 358 364 366 367 369 370
A9:
10801 10802 10803 10804 10805 10806 10807 10808 10809 10816
A12:
385 386 387 388
A13:
410 411 412 413 414 415 416 417
A14:
700 702 704 708 706 710 712 714 716 717
A15:
721 723 725 727 729 731 734 736 738 740 742 744 759 762 765 768 771 773 775 778 779 820 822 823 825 826 828 855 857 858
A16:
444 445 446 447 448 449
A17:
900 903
A18:
2497 2501 2503 2504 2506 2507 2509 2517 2518 2521 2522 2525 2526 2546 2547 2552 2553 2558 2559
A19:
2598 2600 2603 2606 2610 2613 2616 2620 2622 2624 2630 2631 2633 2635 2664 2666 2668 2673 2675 2677
A20:
2710 2712 2713 2721 2723 2725 2727
A21:
501 503 507 511 515 519 520 530 532 534 536
A22:
5000 5003 5007 5010 5020 5023 5026 5028 5040 5043 5046 5049 5060 5063 5064 5067
A23:
5200 5203 5207 5208 5220 5223 5227 5228 5240 5243 5247 5248 5260 5263 5265 5267
A24
2801 2806 2814 2824 2832 2840 2946 2949 2954 2958 2972 2974 3005 3010 3014 3018 3023 3028 3032 3040 3044 3051 3055 3062
A25:
5906 5908 5910 5912
A26:
6007 6009 6011 6013 6015
A27:
4001
M2:
10993 10994 10995 10996 10998 10999
M5
10988 10989
D1:
11000 11003 11006 11009 11012 11015 11018 11024 11027 11200 11203 11204 11205 11210 11211 11212 11215 11218 11221 11222 11224 11225 11235 11237 11240 11241 11242 11243 11300 11306 11309 11312 11315 11318 11321 11324 11327 11332 11333 11336 11339 11500 11503 11506 11509 11512 11602 11604 11605 11610 11611 11612 11614 11615 11700 11701 11702 11708 11709 11710 11711 11712 11713 11715 11718 11721 11722 11724 11727 11800 11810 11820 11830 11833 11900 11903 11906 11909 11912 11915 11917 11919 11921 12000 12003 12012 12015 12018 12021 12200 12201 12306 12309 12312 12315 12318 12321
D2:
12500 12503 12506 12509 12512 12515 12518 12521 12524 12527 12530 12533
T1:
13104 13200 13203 13206 13209 13221 12323 13290 13312 13709 13760 13839 13842 13939 13942 13945 14050 14053 14100 14106 14109 14112 14115 14118 14124 14200 14203 14206 14209 14215 14221 14227 14245
T2:
15000 15003 15006 15009 15012 15100 15103 15106 15109 15112 15115 15211 15214 15215 15218 15221 15224 15227 15230 15233 15236 15239 15242 15245 15248 15251 15254 15257 15260 15263 15266 15269 15272 15500 15503 15506 15509 15512 15515 15518 15521 15524 15527 15530 15533 15550 15553 15556 15559 15562
T3:
16003 16006 16009 16012 16015 16018
T4:
16400 16500 16514 16600
T6:
17610 17615 17620 17625 17640 17645 17650 17655 17680 17690
T7:
18213 18350 18351 18352 18354 18356 18358 18360 18362 18364 18366 18368 18370 18371 18372 18373
T8:
30003 30006 30026 30032 30038 30061 30062 30064 30071 30097 30185 30186 30192 30195 30196 30202 30203 30205 30207 30213 30214 30216 30219 30628 31200 31205 31210 31215 31220 32072 32115 32132 32135 32142 32500 32501 35502 35503 35554 35608 35614 35620 36800 37041 37218 37300 37303 37415 38800 39115 40862 41500 41659 41662 41698 41704 41755 41828 41846 42587 42614 42615 42617 42620 42644 42650 42667 42668 42676 42677 42744 42782 42783 42785 42786 42788 42789 42791 42792 42794 42797 42806 42807 42808 42809 42811 45021 45025 45026 45546 45799 45801 45805 45807 45829 45847 45851 47471 47735 47904 47912 47916 47924 50124 50125
O1:
51700 51703
O3:
52034 52036 52039 52055 52056 52133
O7:
53000 53004 53052
O9:
53458
O10:
53600
Items in the diagnostic imaging services table
The following items are items in the diagnostic imaging services table.
I1:
55028 55029 55030 55031 55032 55033 55036 55037 55038 55039 55044 55045 55048 55049 55054 55070 55073 55076 55079, 55113 55114 55115 55116 55117 55238 55244 55246 55248 55252 55274 55276 55278 55280 55282 55284 55292 55294 55296 55700 55703 55704 55705 55706 55707 55708 55709 55712 55715 55718 55721 55723 55725 55729 55731 55733 55736 55739 55812 55814 55816 55818 55820 55822 55824 55826 55828 55830 55832 55834 55836 55838 55840 55842 55844 55846 55852 55854
I2:
56001 56007 56010 56013 56016 56022 56028 56030 56036 56041 56047 56050 56053 56056 56062 56068 56070 56076 56101 56107 56141 56147 56220 56221 56223 56224 56225 56226 56227 56228 56229 56230 56231 56232 56233 56234 56235 56236 56237 56238 56239 56240 56259 56301 56307 56341 56347 56401 56407 56409 56412 56441 56447 56449 56501 56507 56541 56547 56549 56551 56619 56625 56659 56665 56801 56807 56841 56847 57001 57007 57041 57047 57201 57247 57341 57345 57350 57355
I3:
57506 57509 57512 57515 57518 57521 57524 57527 57700 57703 57706 57709 57712 57715 57721 57901 57902 57903 57906 57909 57912 57915 57918 57921 57924 57927 57930 57933 57939 57942 57945 57960, 57963 57966 57969 58100 58103 58106 58108 58109 58112 58115 58300 58306 58500 58503 58506 58509 58521 58524 58527 58700 58706 58715 58718 58721 58900 58903 58909 58912 58915 58916 58921 58924 58927 58933 58936 59103 59300 59303 59306 59309 59312 59314 59318 59503 59700 59703 59712 59715 59718 59724 59733 59736 59739 59751 59754 59760 59763 60100 60500 60503 60918 60927
I4:
61302 61303 61306 61307 61310 61313 61314 61316 61317 61320 61328 61340 61348 61352 61353 61356 61360 61361 61364 61368 61372 61373 61376 61381 61383 61384 61386 61387 61389 61390 61393 61397 61401 61402 61405 61409 61413 61417 61421 61425 61426 61429 61430 61433 61434 61437 61438 61441 61442 61445 61446 61449 61450 61453 61454 61457 61458 61462 61465 61469 61473 61480 61484 61485 61495 61499 61505
I5:
63001 63004 63007 63010 63040 63043 63046 63049 63052 63055 63058 63061 63064
63067 63070 63073 63101 63111 63114 63125 63128 63131 63151 63154 63161 63164 63167 63170 63173 63176 63179 63182 63185 63201 63204 63219 63222 63225 63228 63231 63234 63237 63240 63243 63271 63274 63277 63280 63301 63304 63307 63322 63325 63328 63331 63334 63337 63340 63361 63385 63388 63391 63401 63404 63416 63425 63428 63440 63443 63446 63461 63470 63473 63491 63494 63497
Items in the pathology services table
The following items are items in the pathology services table.
P1:
65060 65066 65070 65072 65075 65078 65081 65084 65087 65090 65093 65096 65099 65102 65105 65108 65111 65114 65117 65120 65123 65126 65129 65132 65133 65134 65135 65136 65137 65139 65140 65142 65144 65147 65150 65153 65156 65159 65162 65165 65171
P2:
66500 66503 66506 66509 66512 66515 66518 66519 66536 66539 66542 66545 66548 66551 66554 66557 66560 66563 66566 66569 66572 66575 66578 66581
66584 66587 66590 66593 66596 66599 66602 66605 66608 66623 66626 66629 66632 66635 66638 66641 66644 66647 66650 66653 66655 66656 66659 66662 66665 66667 66669 66670 66671 66672 66673 66674 66677 66680 66683 66686 66695 66698 66701 66704 66707 66710 66711 66712 66713 66716 66719 66722 66725 66728 66731 66734 66737 66743 66749 66750 66751 66752 66755 66758 66761 66764 66767 66770 66773 66776 66779 66782 66785 66788 66791 66800 66803 66806 66809 66812 66815 66818
P3:
69300 69303 69306 69309 69312 69318 69321 69324 69327 69330 69333 69336 69339 69345 69354 69357 69360 69363 69364 69365 69367 69384 69387 69390 69393 69396 69399 69402 69405 69408 69411 69413 69442 69443 69445 69471 69472 69474 69475 69478 69481 69484
P4:
71057 71058 71059 71060 71062 71064 71066 71068 71069 71071 71072 71073 71074 71075 71077 71079 71081 71083 71085 71087 71089 71091 71093 71095 71097 71099 71101 71103 71106 71109 71113 71115 71117 71119 71121 71123 71125 71127 71129 71131 71133 71134 71135 71137 71139 71141 71143 71145 71146 71147 71149 71151 71153 71155 71157 71159 71163 71164
P5:
72813 72816 72817 72818 72823, 72824, 72825, 72826, 72830, 72836, 72844, 72846, 72847 72848 72851 72852 72855 72856 72857
P6:
73043 73045 73047 73049 73051 73053 73055 73057 73059 73060 73061
P7:
73287 73289 73300 73305 73308 73311 73314 73317 73320
P8:
73521 73523 73525 73527 73529
P9:
73801 73802 73803 73804 73805 73806 73807 73808 73809 73810 73811
P10:
73901 73903 73905 73907 73909 73910 73912 73913 73915
P11:
73921
Category 8 – services provided by nurses, allied and dental health professionals
The following items are items in the general medical services table.
M6:
80000 80005 80010 80015 80020
M7:
80100 80105 80110 80115 80120 80125 80130 80135 80140 80145 80150 80155 80160 80165 80170
M8:
81000 81005 81010.
M9
81100 81105 81110 81115 81120 81125
Schedule 4―Nursing-home type patient accommodation: hospitals in all States/Territories
(1) For rule 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is provided:
(a) to a nursing-home type patient; and
(b) at a hospital.
Note: The definition of hospital treatment in section 121-5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121-5 (1) (c) of the Act.
2. Minimum benefit
The minimum benefit for hospital treatment provided in the circumstances described in this Schedule is the amount set out in Table 1 or 2 of this Schedule for that hospital treatment.
Table 1
Public hospital: State/Territory | Minimum benefit per night |
NSW | $95.30 |
Northern Territory | $56.85 |
Queensland | $88.50 |
South Australia | $93.50 |
Tasmania | $91.68 |
Victoria | $92.15 |
ACT | $89.35 |
Western Australia | $97.80 |
Private hospitals | $72.90 |
Schedule 5―Second-tier default benefits
(1) In this Schedule:
facility means a private hospital specified in clause 4 of this Schedule.
negotiated agreement means an agreement entered into between a hospital and an insurer, that includes provisions to the effect that, except to the extent (if any) provided in the agreement, the hospital agrees to accept payment by the insurer in satisfaction of any amount that would, apart from the agreement, be owed to the hospital, in relation to an episode of hospital treatment, by an insured person under a policy.
(2) In this Schedule, except in subclause (4) of this clause, the ACT is taken to be part of NSW and the Northern Territory is taken to be part of the State of South Australia.
(a) private hospitals which provide psychiatric care for at least 50% of the episodes of hospital treatment;
(b) private hospitals which provide rehabilitation care for at least 50% of the episodes of hospital treatment;
(c) private hospitals which do not fall into categories (a) or (b), with up to and including 50 licensed beds;
(d) private hospitals which do not fall into categories (a) or (b) with more than 50 licensed beds and up to and including 100 licensed beds;
(e) private hospitals which do not fall into categories (a) or (b), with more than 100 licensed beds, without an accident and emergency unit or a specialised cardiac care unit;
(f) private hospitals which do not fall into categories (a) or (b), with more than 100 licensed beds, with either (or both) an accident and emergency unit or a specialised cardiac care unit;
(g) private hospitals which only provide hospital treatment which does not include any part of an overnight stay.
2. Circumstances
For rules 4 and 5 of Part 2 of these Rules, the circumstances for hospital treatment to which this Schedule applies are that the treatment is provided to a patient who is not a nursing-home type patient and the treatment is provided at a facility.
Note: The definition of hospital treatment in section 121-5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121-5 (1) (c) of the Act.
3. Minimum benefit
(1) Despite anything in Schedules 1, 2, 3 or 6, but subject to subclause (2) of this clause, the minimum benefit for an episode of hospital treatment at a facility that does not have a negotiated agreement with the insurer, is the amount specified in this Schedule (the second tier default benefit).
(3) If a hospital ceases to be a facility for the purposes of this Schedule, the minimum benefit in relation to an episode of hospital treatment for an insured person who was an admitted patient at the facility or booked for hospital treatment at the facility (as opposed to merely being on the facility’s waiting list) before the day that the hospital ceased to be a facility is the minimum benefit that would have applied if the hospital continued to be a facility at the time the treatment was provided.
(4) Subject to subclauses (2) and (8), the minimum benefit payable by an insurer for an episode of hospital treatment between 1 September of a particular year (the first year) and 31 August of the next year is an amount no less than 85% of the average charge for the equivalent episode of hospital treatment, under that insurer's negotiated agreements in force on 1 August of the first year with all such comparable private hospitals in the State in which the facility is located.
(5) The formula for calculating the average charge for the equivalent episode of hospital treatment by an insurer in each State is as follows:
i = group of the insurer's negotiated agreements in force on 1 August of the first year with comparable private hospitals in the State;
n= the number of the insurer's negotiated agreements in force on 1 August of the first year with comparable private hospitals in the State;
Rji = charge for episode of hospital treatment type j in the negotiated agreement i
Rj = average charge for episode of hospital treatment type j.
(6) In subclause (4), each episode of hospital treatment must be identified using the patient classification system and payment structure in the majority of the relevant insurer's negotiated agreements in force on 1 August of the first year with all comparable private hospitals in the State in which the facility is located.
(a) the charge will include the sum of the amount payable by the insurer under that insurer's negotiated agreement and any excess or co‑payment amounts payable by members, in accordance with the insurer's rules; and
Note: Policy holders’ financial obligations under such levels of cover will still apply.
(b) must not include any charges:
(i) referred to in the insurer's negotiated agreements for prostheses; and
(ii) that are minimum benefits for prosthesis as specified for the purpose of item 4 of the table in subsection 72-1 (2) of the Act, and
(iii) referred to in the insurer's negotiated agreements for hospital treatment provided to nursing-home type patients.
(8) Subject to subclause (2), if an insurer has less than 5 negotiated agreements in force on 1 August of the first year with a particular category of comparable private hospitals in a State, then all of that insurer's negotiated agreements with all classes of private hospitals in that State are to be used to calculate the minimum benefit.
4. Facilities
The hospitals specified in the table below are facilities for the purpose of this Schedule.
Table
Item | Facility Name | Address |
1 | (Alpha) Westmead Private Hospital | Cnr of Mons and Darcy Roads, WESTMEAD NSW 2145 |
2 | Aesthetic Day Surgery | 14 Kensington Street, KOGARAH NSW 2217 |
3 | Adelaide Community Healthcare Alliance Inc – Ashford Campus | 55 Anzac Highway, ASHFORD SA 5035 |
4 | Adelaide Community Healthcare Alliance Inc – Flinders Private Hospital Campus | Flinders Drive, BEDFORD SA 5042 |
5 | Adelaide Community Healthcare Alliance Inc – The Memorial Hospital Campus | Sir Edwin Smith Avenue, NORTH ADELAIDE SA 5006 |
6 | Adelaide Eye & Laser Centre | 215 Greenhill Road, EASTWOOD SA 5063 |
7 | Albury-Wodonga Private Hospital | 1125 Pemberton Street, ALBURY NSW 2640 |
8 | Allamanda Private Hospital | 21 Spendelove Avenue, SOUTHPORT QLD 4215 |
9 | Allamanda Surgicentre | 103 Nerang Street, SOUTHPORT QLD 4215 |
10 | Armidale Private Hospital | Rusden St, ARMIDALE NSW 2350 |
11 | Attadale Private Hospital | 21 Hislop Road, ATTADALE WA 6156 |
12 | Ballina Day Surgery | 46 Tamar Street, BALLINA NSW 2478 |
13 | Bankstown Primary Health Care Day Surgery | 67 Rickard Road, BANKSTOWN NSW 2200 |
14 | Baringa Private Hospital | Mackay Road, COFFS HARBOUR NSW 2450 |
15 | Bethesda Hospital | 25 Queenslea Drive, CLAREMONT WA 6010 |
16 | Beleura Private Hospital | 925 Nepean Highway, MORNINGTON VIC 3931 |
17 | Bellbird Private Hospital | 198 Canterbury Road, BLACKBURN VIC 3130 |
18 | Berkeley Vale Private Hospital | 8 Lorraine Avenue, BERKELEY VALE NSW 2261 |
19 | Bondi Junction Private Hospital | 21 Spring St, BONDI JUNCTION NSW 2022 |
20 | Brisbane Private Hospital | 259 Wickham Terrace, BRISBANE QLD 4000 |
21 | Brisbane Waters Private Hospital | 21 Vidler Avenue, WOY WOY NSW 2256 |
22 | Broadmeadow Day Surgery | 1st Floor (Suite 1), 18 Lambton Road, BROADMEADOW NSW 2292 |
23 | Buderim Gastroenterology Centre (Maroochydore) | Suite 5, 102 Wises Road, MAROOCHYDORE QLD 4558 |
24 | Caboolture Private Hospital | McKean Street, CABOOLTURE QLD 4510 |
25 | Cabrini Brighton | 243 New Street, BRIGHTON VIC 3186 |
26 | Cairns Private Hospital | 1 Upward Street, CAIRNS QLD 4870 |
27 | Caloundra Private Hospital | 96 Beerburrum Street, CALOUNDRA QLD 4551 |
28 | Calvary Central Districts Hospital | 25- 37 Jarvis Road, ELIZABETH VALE SA 5112 |
29 | Calvary Day Procedure Centre | 329, 331, 333 Edward Street, WAGGA WAGGA NSW 2650 |
30 | Calvary Health Care ACT | Calvary Public and Private Hospital, Haydon Drive, BRUCE ACT 2617 |
31 | Calvary Health Care Sydney – Hurstville Community | 37 Gloucester Road, HURSTVILLE NSW 2220 |
32 | Calvary Hospital Adelaide | 89 Strangways Terrace, NORTH ADELAIDE SA 5006 |
33 | Calvary Private Hospital (Riverina) | Hardy Ave, WAGGA WAGGA NSW 2650 |
34 | Campbelltown Private Hospital | 42 Parkside Crescent, CAMPBELLTOWN NSW 2560 |
35 | Canada Bay Private Hospital | 55-57 Burwood Road, CONCORD NSW 2137 |
36 | Capital Day Surgery Centre | Calvary Clinic, Mary Potter Circuit, BRUCE ACT 2617 |
37 | Caringbah Day Surgery | 42 President Avenue, CARINGBAH NSW 2229 |
38 | Castle Hill Hospital | 72-74 Cecil Avenue, CASTLE HILL NSW 2154 |
39 | Castlecrag Private Hospital | 150 Edinburgh Road, CASTLECRAG NSW 2068 |
40 | Chasely Day Surgery | Wesley Medical Centre, 40 Chasely Street, AUCHENFLOWER QLD 4066 |
41 | Chesterville Day Hospital | 26-28 Chesterville Road, CHELTENHAM VIC 3192 |
42 | Cliveden Hill Private Hospital | 29 Simpson Street, EAST MELBOURNE VIC 3002 |
43 | Coffs Harbour Day Surgery Centre | 69 Albany Street, COFFS HARBOUR NSW 2450 |
44 | Colin Street Day Surgery | 51 Colin Street, WEST PERTH WA 6005 |
45 | Como Private Hospital | 152 Como Parade West, PARKDALE VIC 3194 |
46 | Coolenberg Clinic | 60 Lake Rd, PORT MACQUARIE NSW 2444 |
47 | Cotham Private Hospital | 209 Cotham Road, KEW VIC 3101 |
48 | Dalcross Private Hospital | 28 Stanhope Road, KILLARA NSW 2071 |
49 | Dandenong Eye Clinic & Day Surgery Centre | 1-3 Falkiner Crescent, DANDENONG VIC 3175 |
50 | Darwin Private Hospital | Rocklands Drive, TIWI NT 0810 |
51 | Delmar Private Hospital | 58 Quirk Street, DEE WHY NSW 2099 |
52 | Donvale Rehabilitation Hospital | 1119-1121 Doncaster Road, DONVALE VIC 3111 |
53 | Dorset Rehabilitation Hospital | 146 Derby Street, PASCOE VALE VIC 3044 |
54 | Dudley Private Hospital | 261 March Street, ORANGE NSW 2800 |
55 | Eastern Suburbs Private Hospital | 8 Chapel Street, RANDWICK NSW 2031 |
56 | Epworth Eastern Hospital | 1 Arnold Street, BOX HILL VIC 3128 |
57 | Epworth Freemasons | 166 Clarendon Street & 320 Victoria Parade, EAST MELBOURNE VIC 3002 |
58 | Epworth Hospital | 89 Bridge Road, RICHMOND VIC 3121 |
59 | Epworth Rehabilitation Brighton | 85-91 Wilson Street, BRIGHTON VIC 3186 |
60 | Epworth Rehabilitation Camberwell | 888 Toorak Road, CAMBERWELL VIC 3184 |
61 | Essendon Day Procedure Centre | Level 2, 665 Mount Alexander Road, MOONEE PONDS VIC 3039 |
62 | Essendon Private Hospital | 35 Rosehill Road, ESSENDON WEST VIC 3040 |
63 | Eye-Tech Day Surgeries | Level 3, St Andrew's Place, North Street, SPRING HILL QLD 4000 |
64 | Eye-Tech Day Surgeries Southside | 22-26 Sanders Street, UPPER MOUNT GRAVATT QLD 4122 |
65 | Figtree Private Hospital | 1 Suttor Place, FIGTREE NSW 2525 |
66 | Frances Perry Private Hospital | 285 Cardigan Street, CARLTON 3053 |
67 | Frankston Private Day Surgery | 24-28 Frankston-Flinders Road, FRANKSTON VIC 3199 |
68 | Friendly Society Private Hospital | 19-23 Bingera Street, BUNDABERG QLD 4670 |
69 | Fullarton Private Hospital | 293-295 Fullarton Road, PARKSIDE SA 5063 |
70 | Geelong Private Hospital | Cnr Ryrie & Bellarine Streets, GEELONG VIC 3220 |
71 | GI Clinic, Perth | Units 9 & 10, 16 Hulme Court, MYAREE WA 6154 |
72 | Glenferrie Private Hospital | 25 Linda Crescent, HAWTHORN VIC 3122 |
73 | Glengarry Private Hospital | 53 Arnisdale Road, DUNCRAIG WA 6023 |
74 | Greenslopes Private Hospital | Newdegate Street, GREENSLOPES QLD 4120 |
75 | Griffith Rehabilitation Hospital | 13 Dunrobin Road, HOVE SA 5045 |
76 | Griffiths Road Day Surgery | 182 Christo Road, WARATAH NSW 2298 |
77 | Harley Place Day Surgery | Suite 605, 251 Oxford Street, BONDI JUNCTION NSW 2022 |
78 | Hastings Day Surgery | Cnr Parker & Savoy Streets, PORT MACQUARIE NSW 2444 |
79 | Hawkesbury District Health Service | Cnr Macquarie and Day Streets, WINDSOR NSW 2756 |
80 | Healthwoods Specialist Centre
| 53 Cowper Street, GRANVILLE NSW 2142 |
81 | Hervey Bay Surgical Centre | Cnr O’Rourke Street & Boat Harbour Drive, PIALBA QLD 4655 |
82 | Hillcrest-Rockhampton Private Hospital | 4 Talford Street, ROCKHAMPTON QLD 4700 |
83 | Hills Private Hospital | 499 Windsor Road, BAULKHAM HILLS NSW 2153 |
84 | Hobart Private Hospital | Argyle Street, HOBART TAS 7000 |
85 | Hollywood Private Hospital | Monash Avenue, NEDLANDS WA 6009 |
86 | Holroyd Private Hospital | 123-129 Chetwynd Road, GUILDFORD NSW 2161 |
87 | Holy Spirit Northside | 627 Rode Road, CHERMSIDE QLD 4032 |
88 | Hopetoun Rehabilitation Hospital | 2-6 Hopetoun Street, ELSTERNWICK VIC 3185 |
89 | Hopewell Hospice | 11 Dunkirk Close, ARUNDEL QLD 4214 |
90 | Hunters Hill Private Hospital | 9 Mount Street, HUNTERS HILL NSW 2110 |
91 | Inner West Endoscopy Centre | 311 Marrickville Road, MARRICKVILLE NSW 2204 |
92 | Ivanhoe Private Rehabilitation Hospital | 134-142 Ford Street, IVANHOE VIC 3079 |
93 | John Fawkner Private Hospital | 275 Moreland Road, COBURG VIC 3058 |
94 | John Flynn-Gold Coast Private Hospital | 42 Inland Drive, TUGUN QLD 4224 |
95 | Joondalup Private Hospital | Cnr Grand Boulevard and Shenton Avenue, JOONDALUP WA 6027 |
96 | Kahlyn Private Hospital | 40 Briant Road, MAGILL SA 5072 |
97 | Kareena Private Hospital | 86 Kareena Road, CARINGBAH NSW 2229 |
98 | Kawana Private Hospital | Suite 14, Level 1, Innovation Parkway, BIRTINYA QLD 4575 |
99 | Knox Private Hospital | 262 Mountain Highway, WANTIRNA VIC 3152 |
100 | Lady Davidson Private Hospital | Bobbin Head Road, TURRAMURRA NSW 2074 |
101 | Lake Macquarie Private Hospital | 3 Sydney Street, GATESHEAD NSW 2290 |
102 | Lawrence Hargrave Private Hospital | 72 Phillip Street, THIRROUL NSW 2515 |
103 | Linacre Private Hospital | 12 Linacre Road, HAMPTON VIC 3188 |
104 | Liverpool Day Surgery | 105-119 Longstaff Avenue, MOOREBANK NSW 2170 |
105 | Logan Endoscopy Services | Unit 2/32 76 Beaudesert Road, BROWN PLAINS QLD 4118 |
106 | Logan Surgery Centre | Unit 12, 13-21 Mayes Avenue, LOGAN CENTRAL QLD 4114 |
107 | Macarthur Private Hospital | 92-96 Dumaresq Street, CAMPBELLTOWN NSW 2560 |
108 | Maitland Private Hospital | 173 Chisholm Road, EAST MAITLAND NSW 2323 |
109 | Manly Waters Private Hospital | 17 Cove Avenue, MANLY NSW 2095 |
110 | Manningham Day Procedure Centre | Level 3, 200 High Street, LOWER TEMPLESTOWE VIC 3107 |
111 | Maryvale Private Hospital | McDonald Street, MORWELL VIC 3840 |
112 | Masada Private Hospital | 26 Balaclava Road, EAST ST KILDA VIC 3183 |
113 | Mater Hospital Yeppoon | 55 Cliff Street, YEPPOON QLD 4703 |
114 | Mater Misericordiae Day Unit (Mackay) | 1 Wellington Street, MACKAY QLD 4740 |
115 | Mater Misericordiae Hospital Bundaberg | 313 Bourbong Street, BUNDABERG QLD 4670 |
116 | Mater Misericordiae Hospital Gladstone | Rossella Street, GLADSTONE QLD 4680 |
117 | Mater Misericordiae Hospital Mackay | 76 Willetts Road, NORTH MACKAY QLD 4740 |
118 | Mater Misericordiae Hospital Rockhampton | cnr Ward & Jessie Streets, ROCKHAMPTON QLD 4700 |
119 | Mater Misericordiae Private Hospital
| 35 Rocklands Road, CROWS NEST NSW 2065 |
120 | Mater Misericordiae Private Hospital (South Brisbane) | 301 Vulture Street, SOUTH BRISBANE QLD 4101 |
121 | Mater Misericordiae Private Hospital Townsville | 21 Fulham Road, PIMLICO QLD 4810 |
122 | Mater Misericordiae Women’s & Children’s Private Health Service (Children’s Campus) | Cnr Raymond Terrace & Stanley Street, SOUTH BRISBANE QLD 4101 |
123 | Mater Misericordiae Women’s & Children’s Private Health Service (Women’s Campus) | Raymond Terrace, SOUTH BRISBANE QLD 4101 |
124 | Mater Private Hospital Redland | Weippin Street, CLEVELAND QLD 4163 |
125 | Mayo Private Hospital | Lot 1, Potoroo Drive, Kolodong, VIA TAREE NSW 2430 |
126 | Melbourne Oral & Facial Surgery | Level 12, 63 Exhibition Street, Scala House, MELBOURNE VIC 3000 |
127 | Metropolitan Rehabilitation Hospital | 275 Addison Road, PETERSHAM NSW 2049 |
128 | Mitcham Private Hospital | 27 Doncaster East Road, MITCHAM VIC 3132 |
129 | Montserrat Day Hospital (Gaythorne) | 383 – 391 Samford Road, GAYTHORNE QLD 4051 |
130 | Montserrat Day Hospital (Indooroopilly) | 12 Riverview Terrace, INDOOROOPILLY QLD 4068 |
131 | Montserrat Day Hospital (Spring Hill) | Level 2, 35 Astor Terrace, BRISBANE QLD 4000 |
132 | Mosman Private Hospital | 1 Ellamatta Avenue, MOSMAN NSW 2088 |
133 | Mount Hospital | 150 Mounts Bay Road, PERTH WA 6000 |
134 | Mount Olivet Hospital | 411 Main Street, KANGAROO POINT QLD 4169 |
135 | Mt Lawley Private Hospital | 14 Alvan Street, MOUNT LAWLEY WA 6050 |
136 | Mt Wilga Private Hospital | 2 Manor Road, HORNSBY NSW 2077 |
137 | Murdoch Surgicentre | 100 Murdoch Drive, MURDOCH WA 6150 |
138 | Murray Valley Private Hospital | Nordsvan Drive, WODONGA VIC 3690 |
139 | Nambour Selangor Private Hospital | 62 Netherton Street, NAMBOUR QLD 4560 |
140 | National Capital Private Hospital | Gilmore Crescent & Hospital Road, GARRAN ACT 2605 |
141 | Nepean Private Hospital | Barber Avenue, PENRITH NSW 2750 |
142 | New Farm Private Hospital | 22 Sargent Street, NEW FARM QLD 4005 |
143 | Newcastle Private Hospital | 2 Lookout Road, NEW LAMBTON NSW 2305 |
144 | Noosa Private Hospital | 111 Goodchap Street, NOOSAVILLE QLD 4566 |
145 | North Eastern Private Hospital | 580 Lower North East Road, CAMPBELLTOWN SA 5074 |
146 | North Shore Private Hospital | Westbourne Street, ST LEONARDS NSW 2065 |
147 | North West Brisbane Private Hospital | 137 Flockton Street, EVERTON PARK QLD 4053 |
148 | Northpark Private Hospital | Greenhills Road, BUNDOORA VIC 3083 |
149 | Northside Clinic Private Hospital | 2 Greenwich Road, GREENWICH NSW 2065 |
150 | Northside Cremorne Clinic | 3 Harrison Street, CREMORNE NSW 2090 |
151 | Northside West Clinic | 23-27 Lytton Street, WENTWORTHVILLE NSW 2145 |
152 | Nowra Private Hospital | Weeroona Place, NOWRA NSW 2541 |
153 | Olympia Private Rehabilitation Hospital | 12 Francis Grove, THORNBURY VIC 3071 |
154 | Ophthalmic Surgery Centre | Suite 6, 12-14 Malvern Avenue, CHATSWOOD NSW 2067 |
155 | Orange Day Surgery Centre | 60 McNamara Street, ORANGE NSW 2800 |
156 | Pacific Day Surgery | 38 Misterton Street, FORTITUDE VALLEY QLD 4006 |
157 | Pacific Private Hospital | 119-123 Nerang Street, SOUTHPORT QLD 4215 |
158 | Parkwynd Private Hospital | 137 East Terrace, ADELAIDE SA 5000 |
159 | Pendlebury Clinic Private Hospital | Suite 3, 52 Pendlebury Road, CARDIFF NSW 2285 |
160 | Peninsula Private Hospital (Frankston) | Cnr Cranbourne & McClelland Drive, FRANKSTON VIC 3199 |
161 | Peninsula Private Hospital (Kippa-Ring) | Cnr George and Florence Streets, KIPPA-RING QLD 4020 |
162 | Perfect Vision Eye Surgery | Suite 3, 25 –29 Hunter Street, HORNSBY NSW 2077 |
163 | Perth Clinic | 29 Havelock St, WEST PERTH WA 6005 |
164 | Pindara Day Procedure Centre | 13 Carrara Street, BENOWA QLD 4217 |
165 | Pindara Gold Coast Private Hospital | Allchurch Avenue, BENOWA QLD 4217 |
166 | Pine Rivers Private Hospital | Dixon Street, STRATHPINE QLD 4500 |
167 | Poplars Private Hospital | 66 Norfolk Road, EPPING NSW 2121 |
168 | Port Macquarie Private Hospital | Lake Road, PORT MACQUARIE NSW 2444 |
169 | Prince of Wales Private Hospital | Levels 5-7, Ambulatory Care Services Centre Building, Prince of Wales Campus, Barker Street, RANDWICK NSW 2031 |
170 | Randwick Day Surgery | 2 Eurimble Avenue, RANDWICK NSW 2031 |
171 | Ringwood Private Hospital | 36 Mount Dandenong Road, EAST RINGWOOD VIC 3134 |
172 | Rivercity Private Hospital | 401 Milton Road, AUCHENFLOWER QLD 4066 |
173 | Roderick Street Day Surgery | 23 Roderick Street, IPSWICH QLD 4305 |
174 | Rosebud SurgiCentre | 1537 Point Nepean Road, ROSEBUD WEST VIC 3940 |
175 | Saint Frances Xavier Cabrini Hospital (Malvern) | 181-183 Wattletree Road, MALVERN VIC 3144 |
176 | Saint Frances Xavier Cabrini Hospital (Prahran) | 646 High Street, PRAHRAN EAST VIC 3181 |
177 | Shepparton Private Hospital | Fitzgerald Street, SHEPPARTON VIC 3630 |
178 | Short Street Day Surgery | 2 Short Street, SOUTHPORT QLD 4215 |
179 | Solander Day Surgery | 182 Grafton St, CAIRNS QLD 4870 |
180 | South Coast Digestive Diseases Centre | 86 Ashmore Road, BUNDALL QLD 4217 |
181 | South Pacific Private Hospital | 18 Beach Street, CURL CURL NSW 2096 |
182 | South Perth Hospital | 76 South Terrace, COMO WA 6152 |
183 | South Western Day Surgery Centre | 20-22 Bigge Street, LIVERPOOL NSW 2170 |
184 | Southern Highlands Private Hospital | 99 Bowral Street, BOWRAL NSW 2576 |
185 | Spendelove House Private Hospital | 24 Spendelove Avenue, SOUTHPORT QLD 4215 |
186 | Sportsmed.SA Hospital | 32 Payneham Road, STEPNEY SA 5069 |
187 | St Andrew’s Ipswich Private Hospital | Cnr Roderick and Pring Streets, IPSWICH QLD 4305 |
188 | St Andrew’s Toowoomba Hospital | 280 North Street, TOOWOOMBA QLD 4350 |
189 | St George Private Hospital | 1 South Street, KOGARAH NSW 2217 |
190 | St Helens Private Hospital | 186 Macquarie Street, HOBART TAS 7000 |
191 | St John of God Health Care (Ballarat)
| 101 Drummond Street North, BALLARAT VIC 3350 |
192 | St John of God Health Care (Burwood) | 13 Grantham Street, BURWOOD NSW 2135 |
193 | St John of God Health Care (Warrnambool) | 136 Botanic Road, WARRNAMBOOL VIC 3280 |
194 | St John of God Health Care Berwick | Gibb Street, BERWICK VIC 3806 |
195 | St John of God Health Care Nepean Rehabilitation Hospital | 255 Cranbourne Road, FRANKSTON VIC 3199 |
196 | St John of God Hospital Bendigo | Lily Street, BENDIGO VIC 3552 |
197 | St John of God Hospital Bunbury | Cnr Robertson Drive & Bussell Highway, BUNBURY WA 6230 |
198 | St John of God Hospital Geelong | 80 Myers Street, GEELONG VIC 3220 |
199 | St John of God Hospital Geraldton | 12 Hermitage Street, GERALDTON WA 6530 |
200 | St John of God Hospital Murdoch | 100 Murdoch Drive, MURDOCH WA 6150 |
201 | St John of God Hospital (Richmond) | 177 Grose Vale Road, NORTH RICHMOND NSW 2754 |
202 | St John of God Hospital, Subiaco | 12 Salvado Road, SUBIACO WA 6008 |
203 | St John of God Pinelodge Clinic | 1480 Heatherton Road, DANDENONG VIC 3175 |
204 | St Luke’s Hospital | 18 Roslyn Street, POTTS POINT NSW 2011 |
205 | St Vincent’s & Mercy Private Hospital, Mercy Campus | 159 Grey Street, MELBOURNE EAST VIC 3002 |
206 | St Vincent’s Hospital (Toowoomba) | Scott Street, TOOWOOMBA QLD 4350 |
207 | St Vincent’s Private Hospital (Bathurst) | Gorman’s Hill Road, BATHURST NSW 2795 |
208 | St Vincent’s Private Hospital (Fitzroy) | 59 Victoria Parade, FITZROY VIC 3065 |
209 | Stirling District Hospital | 20 Milan Terrace, STIRLING SA 5152 |
210 | Strathfield Private Hospital | 3 Everton Road, STRATHFIELD NSW 2135 |
211 | Sunnybank Private Hospital | 245 McCullough Street, SUNNYBANK QLD 4109 |
212 | Sydney Adventist Private Hospital | 185 Fox Valley Road, WAHROONGA NSW 2076 |
213 | Sydney Day Surgery | 213-219 Darlinghurst Road, DARLINGHURST NSW 2010 |
214 | Sydney Haematology and Oncology Clinics | Unit 13/49 Palmerston Road, HORNSBY NSW 2077 |
215 | Sydney IVF – Liverpool | 173-175 Bigge Street, LIVERPOOL NSW 2170 |
216 | Sydney IVF Day Surgery | Level 4, 321 Kent Street, SYDNEY NSW 2000 |
217 | Sydney Oculoplastic Surgery | 229 Macquarie St, SYDNEY NSW 2000 |
218 | Sydney Retina Clinic & Day Surgery | Level 13, 187 Macquarie Street, SYDNEY NSW 2000 |
219 | Sydney Southwest Private Hospital | 32-40 Bigge Street, LIVERPOOL NSW 2170 |
220 | Tamara Private Hospital | 2-6 Dean Street, TAMWORTH NSW 2340 |
221 | Terrace West Endoscopy Centre | 18 Limestone Street, IPSWICH QLD 4305 |
222 | The Adelaide Clinic | 33 Park Terrace, GILBERTON SA 5081 |
223 | The Albert Road Clinic | 31-33 Albert Road, SOUTH MELBOURNE VIC 3004 |
224 | The Avenue Private Hospital | 40 The Avenue, WINDSOR VIC 3181 |
225 | The Bays Hospital – Mornington | 262-268 Main Street, MORNINGTON VIC 3931 |
226 | The Burnside War Memorial Hospital | 120 Kensington Road, TOORAK GARDENS SA 5065 |
227 | The CAPS Clinic
| Strickland Crescent, DEAKIN ACT 2600 |
228 | The Double Bay Day Surgery | 20 Manning Road, DOUBLE BAY NSW 2028 |
229 | The Eye Institute | Level 4, 270 Victoria Avenue, CHATSWOOD NSW 2057 |
230 | The Geelong Clinic | 98 Townsend Road, ST ALBANS PARK VIC 3219 |
231 | The Hills Parenting Centre | 105 Showground Road, CASTLE HILL NSW 2154 |
232 | The Hornsby Sleep Disorder and Diagnostic Centre | 104 Balmoral Street, WAITARA NSW 2077 |
233 | The Marian Centre | 187 Cambridge Street, WEMBLEY WA 6014 |
234 | The Melbourne Clinic | 130 Church Street, RICHMOND VIC 3121 |
235 | The Melbourne Private Hospital | Royal Parade, PARKVILLE VIC 3050 |
236 | The San Day Surgery | 1a Northcote Road, HORNSBY NSW 2077 |
237 | The Sydney Clinic | 22-24 Murray Street, WAVERLEY NSW 2024 |
238 | The Sydney Private Hospital | 63 Victoria Street, ASHFIELD NSW 2131 |
239 | The Victoria Clinic | 324 Malvern Road, PRAHRAN VIC 3181 |
240 | Toowong Private Hospital | 496 Milton Rd, TOOWONG QLD 4066 |
241 | Toronto Private Hospital | Cary Street, TORONTO NSW 2283 |
242 | Townsville Day Surgery | 1 Martinez Avenue, West End, TOWNSVILLE QLD 4810 |
243 | Tweed Day Surgery | 38-44 Boyd Street, TWEED HEADS NSW 2485 |
244 | Vaucluse Private Hospital | 82 Moreland Road, BRUNSWICK VIC 3056 |
245 | Victorian Rehabilitation Centre | 499 Springvale Road, GLEN WAVERLY VIC 3150 |
246 | Vista Laser Eye Clinics NSW | 1 McClaren St, NORTH SYDNEY NSW 2060 |
247 | Wandene Private Hospital | 7 Blake Street, KOGARAH NSW 2217 |
248 | Wangaratta Private Hospital | 134-150 Templeton Street, WANGARATTA VIC 3677 |
249 | Warners Bay Private Hospital | Fairfax Road, WARNERS BAY NSW 2282 |
250 | Warringal Private Hospital | 216 Burgundy Street, HEIDELBERG VIC 3084 |
251 | Waverly Private Hospital | 343-357 Blackburn Road, MOUNT WAVERLY VIC 3149 |
252 | Wesley Private Hospital | 91 Milton Street, ASHFIELD NSW 2131 |
253 | West Lakes Day Surgery | 151 Brebner Drive, WEST LAKES SA 5021 |
254 | Western Plains Day Surgery | 62 Windsor Parade, DUBBO NSW 2830 |
255 | Western Private Hospital | Corner Eleanor and Marion Streets, FOOTSCRAY VIC 3011 |
256 | Westmead Rehabilitation Centre | 7 Coleman Street, MERRYLANDS NSW 2160 |
257 | Wolper Jewish Private Hospital | 8 Trelawney Street, WOOLLAHRA NSW 2025 |
This Schedule ceases to have effect at midnight on 30 June 2008.
Note: Section 16 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with outreach services. That section ceases to have effect on 1 July 2008.
2. Circumstances
For rules 4 and 5 of Part 2 of these Rules, the circumstance specified for hospital treatment to which this Schedule applies is that the treatment is an outreach service.
3. Minimum benefit
The minimum benefit for hospital treatment provided in the circumstances described in this Schedule is the amount set out in Table 1 or 2 of this clause for that hospital treatment.
Table 1
Public hospital: State/Territory | Minimum benefit payable per day |
NSW | $166 |
Victoria | $166 |
Queensland | $166 |
South Australia | $166 |
Western Australia | $166 |
Tasmania | $166 |
ACT | $166 |
Northern Territory | $157 |
Table 2
Private hospitals | $166 |
Note
1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See www.frli.gov.au
