Document ID: chunk:federal_register_of_legislation:F2024C01114:clause:7_29:p2
Version: federal_register_of_legislation:F2024C01114
Segment Type: clause
Provision Reference: sch 7 cl 29 (pt 2/7)
Character Range: 42125–44947

relating to a treatment referred to in subrule (2) or paragraph (a).

Interpretation
 (5) For paragraph (2) (a), the scope of cover of a particular clinical category includes, but is not limited to:
 (a) all hospital treatments involving the provision of an MBS item listed in Schedule 5 against that clinical category; and
 (b) all hospital treatments:
 (i) that are provided in relation to a treatment of a kind referred to in paragraph (2) (a) or (5) (a); and
 (ii) involving the provision of an MBS item listed in:
 (A) the common treatments list in Schedule 6; or
 (B) the support treatments list in Schedule 7.
 (6) Paragraph (5) (b) does not apply in relation to the clinical category "Podiatric surgery (provided by a registered podiatric surgeon)".
 (7) For subparagraph (2) (b) (i), a hospital treatment is an associated treatment for complications if it is:
 (a) provided during an episode in which hospital treatment of a kind described in paragraph (2) (a) is being provided; and
 (b) provided for a complication that arises during that episode.
 (8) For subparagraph (2) (b) (ii), a hospital treatment is an associated unplanned treatment if it is:
 (a) provided during an episode in which hospital treatment of a kind described in paragraph (2) (a) is being provided; and
 (b) an unplanned treatment that:
 (i) is provided as part of planned surgery performed during that episode; and
 (ii) is, in the view of the medical practitioner who provides the unplanned treatment, medically necessary and urgent.

11G. Provision of restricted and unrestricted cover

Gold policies
 (1) A gold policy must provide unrestricted cover for all hospital treatments in all clinical categories.

Silver policies and bronze policies
 (2) A silver policy or a bronze policy:
 (a) must provide restricted cover or unrestricted cover for all hospital treatments in the following clinical categories:
 (i) rehabilitation;
 (ii) hospital psychiatric services;
 (iii) palliative care; and
 (b) must provide unrestricted cover for all hospital treatments in:
 (i) the other clinical categories that a silver policy or a bronze policy, as appropriate, is required to cover; and
 (ii) any other clinical categories that the policy covers.

Basic policies
 (3) A basic policy must provide restricted cover or unrestricted cover for all hospital treatments in:
 (a) all of the clinical categories that a basic policy is required to cover; and
 (b) any other clinical categories that the policy covers.

11H. Naming of insurance policies that cover hospital treatment
 (1) For paragraph 63‑10 (g) of the Act, this rule applies to an insurance policy that covers hospital treatment (whether or not the policy also covers general treatment).
 (2) The policy must include a name that contains the policy's product tier.
 (3) If the policy